Richard North, 27/04/2020  

I may have made some observations around this general issue before. So it may come as no surprise that I consider the news of the day (yesterday, actually) is that Birmingham's Nightingale hospital is "not being used at all" ten days after it was opened.

Nevertheless, it seems pointless pursuing this issue when the chief executive of University Hospitals Birmingham NHS Foundation Trust, Dr David Rosser, claims it is a "good thing" the hospital had not received patients. It shows, he says, that the NHS had "absorbed" the extra pressure.

This is a man who boasts a salary in the band £155-160,000 and, as a qualified doctor, has a CV as long as your arm. One wonders though what it is about obviously intelligent men (and women) that turns their brains to jelly when they achieve high executive office.

As it stands, an amoeba with learning difficulties could probably work out why the NHS hospital service isn't particularly stressed at the moment. In the first instance, it has turfed out at least 15,000 patients, many of them old and frail. A goodly number of whom have been placed in care homes – or death camps as they now tend to be called – where their residence all too often amounts to a death sentence.

Secondly, having turned hospitals into Covid-19 treatment centres, nobody in their right mind would want to go anywhere near them, unless at death's door, for fear of catching the disease. Thus, A&E departments are running on empty, with this April's numbers expected to be down by a million, compared with the same period last year.

On top of that, as many as 2,700 cancer patients each week are not being referred to hospitals for diagnosis – on the very sensible grounds that someone with such a condition cannot afford to take the risk of attending one of these modern-day temples of infection.

How many people with other conditions have been deterred from attending has not been spelt out, but if we're talking shed-loads, then the "shed" is probably bigger than the former Brabazon hanger in Bristol, assuming it hasn't been earmarked as a temporary mortuary.

And then we learn that more than two million so-called elective operations have been cancelled – including mine – leaving whole tranches of the NHS estate struggling to find anything to do with their time. This is especially true of labour-intensive organ transplants, which have fallen dramatically. Last spring more than 80 a week were carried out.

According to NHS England, postponing the planned operations, which typically cost £1 billion per month, has released 12,000 beds for Covid-19 patients. "We are probably only delivering around a third of our usual surgical activity and that's nearly all for emergency and very urgent surgery", says Derek Alderson, president of the Royal College of Surgeons in England.

Assuming, on the other hand, that Dr Rosser still has the intelligence he was born with, he must think us very stupid to believe his frankly moronic assertion that having empty Nightingale Hospitals is a "good thing".

From a confidential discussion with an intellectually challenged amoeba, I learnt that it would be a better thing for these Hospitals to take over the task of treating Covid-19 infected patients, allowing the rest of the NHS to get back to doing boring old things like treating all the other patients.

The more cynical of us, though, might even suspect that NHS politics are being played out on a grand scale. As long as the Covid-19 epidemic is up and running, hospital trusts have open access to the Treasury cheque book. This is the opportunity to buy up much needed kit, to refurbish and increase ICU provision and lay in all sorts of new goodies that previously have been denied.

With the clapometer off the scale, this also opens the way for health service staff to make a pitch for healthy pay increases – possibly the only way of injecting anything healthy into the service at the moment. But, having saved the prime minister's life in such a spectacular manner, how could he possibly say no?

One could almost imagine that, had SARS-Cov-2 not already existed, the NHS management might need to have invented it, thus lending fuel to the fire of another wild conspiracy theory.

It can now be revealed that senior NHS management paid laboratory technicians in Wuhan to release the virus into the wild, in anticipation that the resultant pandemic would help the NHS pay its bills – and afford the extravagant salaries for its senior executives.

It is also the case that the recruitment of retired doctors and nurses to treat Covid-19 patients was part of a conspiracy to reduce the demands on the NHS pension fund, again making more available for senior executives.

In saner times, one might have hoped that even the NHS medical collective could learn something from the experience of the Covid-19 pandemic. They could thus walk back from the failed experiment of providing all-purpose general hospitals to serve all needs, and provide dedicated isolation hospitals which can be used in emergencies and for routine admissions of winter flu sufferers.

Here I am reminded of a pre-war scheme where the Admiralty paid grants to trawler owners to build their ships to a higher specification than commercially necessary so that, in the event of war, they could be converted into warships. And very feisty craft they made (pictured).

Something of that system survived after the war, whence owners of roll-on roll-off ferries were paid to build them with specially strengthened decks, so that they could carry heavy military vehicles such as tanks, to aid our armed forces.

It would thus be an intelligent use of funds to design and build such facilities as leisure centres as dual-purpose buildings, which could easily and quickly be converted into temporary treatment centres when the need arises. This has to be cheaper than paying to convert existing NHS hospitals, and then having to pay to catch up on all the cancelled procedures – in this case estimated at around £3 billion.

What also probably hasn't been factored in is the cost of decontaminating those facilities which have been used for Covid-19 patients, and the additional costs of reconverting them back for their original uses. This might be especially expensive for operating theatres which have been converted into ICUs.

Such things, however, are probably not on the top of the list of Johnson's priorities as he is set to return to work this week. His main concern will be the lockdown, and how to lift restrictions without triggering a new surge of infection.

But, as I pointed out yesterday, since hospitals have become foci of infection, we can expect them to be continually re-seeding the communities they serve with new episodes of infection.

It should be recalled, though, that one of the six conditions set out by the WHO for releasing the lockdown was the minimisation of hotspot risks in vulnerable places such as nursing homes and, of course, hospitals. It is all very well Johnson tweaking the social distancing protocols, but before he can even think about a full lockdown release, he must address the hospital problem.

That said, the bigger problem might be to get political recognition that hospitals are a problem, if not the problem. As the NHS has been turned into a quasi-religious cult, it is going to be very hard to deal with the issue of how many people the service is killing.

Should he ever decide to address that problem, he might find that the Nightingale Hospitals are his lifeline. By transferring most of the Covid-19 patients to them, he can expedite the return of hospitals to their normal functions and limit their role as foci of infection.

But as long as we have the likes of David Rosser saying that keeping the Nightingales empty is a good thing, we have a near-insoluble problem. Removing the infection is the easy part. Dealing with NHS officials is altogether a different matter.

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