Open letter: our proposals and COVID-19

To the Editor of the Leicester Mercury

Dear Sir,

We are writing in response to the article published under the headline, ‘Campaigners Battle £450m Hospital Revamp Plans’ and particularly to set the record straight on the assertion that we have not considered COVID 19 when thinking about this investment in our local hospitals.

We recognise that the world has changed, for everyone, not just the NHS. One of the only certainties being that we will be living with increased uncertainty for a long time.

That being the case it is tempting  for organisations to shelve plans, put off decisions and hunker down, in the hope that the future becomes more certain or that someone comes along to tell them what to do.

We think that is the wrong approach especially now when we consider all that we have learnt in planning for, and dealing with, the impact of the first wave.

So, at the heart of the our clinical strategy (which drives the £450m reconfiguration plan) is the desire to focus emergency and specialist care at the Royal and the Glenfield hospitals and separate non-emergency care from emergency care so that when we are very busy those patients waiting for routine operations are not delayed or cancelled because we have had to prioritise an influx of emergency patients.

More recently, we have asked ‘Does this still make sense when we look at what the pandemic has taught us?’ The short answer is yes, and these are the reasons.

Intensive Care:

One of the biggest challenges we faced preparing for the first COVID peak was to create enough adult Intensive Care Unit (ICU) capacity. In steady state we have 50 ICU beds, the initial pandemic modelling suggested that we would require closer to 300 beds. Which was a daunting ask of our clinical teams. Nonetheless within a fortnight we had a plan to increase our capacity in line with the peak, largely as a result of converting every available space with the right oxygen supply into makeshift ICUs and by suspending children’s heart surgery so that we could convert children’s ICU, into adult ICU.

Thankfully, largely as a result of the success of lockdown halting the spread of the virus, the peak was not as pronounced as we had first expected and we had at the highest peak, 64 patients in intensive care.

In our reconfiguration plans we have said that we will create two ‘Super ICUs’ at the Royal and the Glenfield doubling our capacity to over 100 ICU beds. Had these been in place at the time of the pandemic our response would have been very different; we would have had enough ICU capacity with plenty to spare.

Children’s Heart Surgery:

As mentioned above, we knew that COVID would require us to care for very many more adult patients on ICU. Mercifully children were less affected by the virus. With limited ICU capacity we therefore took the difficult decision to halt children’s heart surgery in Leicester, transfer those children awaiting their operation to Birmingham Children’s Hospital and convert the Paediatric Intensive Care Unit at the Glenfield into an adult ICU. On balance we took the decision based on what would save the most lives, knowing that our children would still have their surgery albeit not in Leicester and as a consequence we could care for more of the terribly sick adults whose only hope was sedation and ventilation.

However in our reconfiguration plans we are going to create a standalone Children’s Hospital at the Royal; the first phase completes in spring 2021. Had the Children’s Hospital been built we would have been able to continue with heart surgery during COVID knowing that the children were safe in a standalone hospital with a totally separate ICU.

Cancer and Elective operations:

Locally and nationally patients who had been previously listed for operations and procedures were cancelled in very large numbers as hospitals made preparations for the pandemic. This affected all services and all types of patients even some with cancer. The only surgery we were able to continue was for those emergency cases that without an operation within 24-72 hours would have been likely to die. In terms of cancer cases where patients are often immuno-compromised there was the added concern about bringing them into a hospital with positive COVID patients and the impact that this could have if, in their already poorly state they picked up the virus.

In our reconfiguration plans we are going to build a standalone treatment centre at the Glenfield Hospital; this will be a brand new hospital next to the existing hospital. It fulfils our desire to separate emergency and elective procedures. Meaning that when we are busy with high numbers of emergencies, our elective patients still receive care. Had this been in place by the time of the pandemic we would have been able to maintain significant amount of our non-emergency work and create a ‘COVID clean’ site.

Impact on staff:

Even before the pandemic we regularly struggled to effectively staff our services. The fact that we have three separate hospitals with the duplication and triplication of services that entails means that we often have to spread our staff too thinly in order to cover clinical rotas. During the first peak of COVID we had 20% sickness across all staff groups meaning that 1 in 5 staff were either sick or self isolating. It is a testimony to all our staff that despite this we kept going but it is unsustainable in the long term.

Once reconfigured we will no longer have to run triplicate rotas for staff on three hospital sites. For example with two super ICUs rather than the current 3 smaller ones we would have been able to consolidate our staffing making it easier to cover absences when they occurred and perhaps even give staff the time to ‘decompress’ after repeat days of long and harrowing shifts.

Overall, it is clear to us that had the timing been different our hospitals would have been better able to cope with COVID 19 in their reconfigured state and our patients would have received a better, safer service.

Finally, we should make clear that we have no interest in the politics of all this but we do think that local people need the NHS now, more than ever, and as such the NHS has a duty to be the best it can be in a COVID endemic world. That is why we are recommending these plans to your readers… and we would encourage them to take part in the consultation to share their hopes and aspirations for their local NHS.

Yours sincerely,

Andrew Furlong, Medical Director and Children’s Orthopaedic Surgeon, UHL

Carolyn Fox, Chief Nurse, UHL

Professor Azhar Farooqi, OBE, GP and Clinical Chair, LLR CCGS

Professor Mayur Lakhani, CBE, GP and Clinical Chair, LLR CCG

Caroline Trevithick, Chief Nurse and Executive Director of Nursing, Quality and Performance, LLR CCGs