Hospitals in Liverpool and the surrounding region are ‘dangerously close to being overwhelmed’ as a surge of coronavirus patients piles pressure on the creaking local NHS network.
That’s the warning from the Medical Director of Liverpool’s main NHS Trust, who spelt out in detail how serious the situation currently is.
Dr Tristan Cope was responding to an article by the editor of the Spectator magazine Frazer Nelson, who suggested that the debate over the current NHS situation in Liverpool was a ‘politicised’ one and who attempted to play down the severity of the crisis.
In his piece, Mr Nelson wrote: “Liverpool University Hospitals had 320 Covid patients earlier this week, vs 400 at the peak last time.
“But zoom out, and the situation is very different: there are about 350 Covid patients in hospitals across the entirety of South West and South East of England, for example. Should Liverpool get too busy, extra capacity will be added and patients routed to other hospitals: this is how the NHS works.
He added: “There are other hospitals within half an hour’s drive (in St Helens and Clatterbridge, for example) that can take on stroke and cancer patients. There are many ways of creating capacity in hospitals, and that's before you get to the Nightingale overflow units. Elective operations can be delayed - which of course creates problems down the line. But there are many ways to stop being overwhelmed.”
In a direct response, Dr Cope picked out a number of flaws in the argument and gave his own expert view on the situation in his hospitals.
In a lengthy twitter thread, he said: “Let’s analyse this piece in some detail, shall we?
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“Clatterbridge and St. Helens are cold sites, not suitable for acute patients.
“The Clatterbridge Cancer Centre has moved to Liverpool. It already treats cancer patients and will continue to do so.
“There are a number of other acute hospitals around Liverpool, but they too are struggling with demand. They don’t have capacity to take extra patients from Liverpool. Non-urgent elective surgery has already been stopped or reduced in many of these hospitals.
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“The focus will be on trying to maintain cancer and other urgent surgery as much as possible, but even that is under threat if hospital admissions in Merseyside and Cheshire continue at current rates.
“There have been far more ICU transfers over the last week than would be expected for even a bad winter. As pointed out, staffing is the main constraint, although some hospitals are also exceeding physical capacity and looking after ICU patients in operating theatres.
“As ICU capacity is expanded above normal “commissioned” or funded levels it is usually theatre staff who are redeployed to support this, so operating theatres have to be shut down. And sometimes the operating theatres have to be used as ICU areas.
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“Staff absence is currently around 12% due to a combination of usual sickness rates and covid-related absence (self-isolation etc). Covid-related absence is a greater proportion than non-covid sickness. Staff who have symptoms and test negative can return to work.
“Staff who test positive can return to work after 7 days. Staff who have to isolate due to contact rather than symptoms have to isolate for 14 days currently, regardless of whether they negative, but generally asymptomatic contacts aren’t being tested.”
Dr Cope said the situation in Liverpool is ‘more severe’ than the North West average, with more than 25% of inpatient beds in the city now occupied by covid patients.
That is in the setting of hospitals that had more than 90% bed occupancy with non-covid patients before this surge began.
He explained that Liverpool hospitals now have a bed occupancy of more than 95% with additional beds opened, but with fewer staff, adding: “There isn’t capacity in other surrounding hospitals to divert general emergency admissions, at least not for more than an hour or so at a time.”
Responding to Mr Nelson’s argument about capacity in hospitals on the South East or South West, Dr Cope said: “There is capacity in hospitals in other regions outside the NW, but not sure how that would help for emergency admissions? In the event of an emergency, please travel to the SE or SW of England, it’s only a 6 hour drive?
“Mutual aid is being applied across the region for critically ill patients when needed. If existing critical care capacity is exceeded capacity can be increased, but this would be at the cost of stopping other activity, such as cancer and urgent surgery.
“Transferring critically ill patients long distances between regions is a potential option in extreme circumstances, but very far from ideal as it takes a transfer team and ambulance out of action for many hours.”
Answering the key question posed in the article about Liverpool’s hospitals being overwhelmed, Dr Cope said: “Are hospitals at risk of being overwhelmed by the current surge in covid admissions?
“That depends on what you mean by overwhelmed. If you consider stopping all cancer and other urgent scheduled surgery again, having hospitals full, emergency departments full.
“Ambulances waiting outside emergency departments because the ED is full, and therefore ambulances not available to attend emergencies. If you consider that to be “overwhelmed”, then yes, hospitals are in danger of being overwhelmed if current admission rates continue.
“Not there yet, but dangerously close, at least in the Liverpool City Region and other parts of Merseyside and Cheshire”
Ending on a more positive note and urging local people to do the right thing, Dr Cope added: “There is some good news though. If people behave responsibly, follow the social distancing rules, wear facemasks in indoor public places, wash hands and don’t mix or socialise with others outside their home or bubble, then community infection rates and admissions will come down.”