Coronavirus: How Addenbrooke’s Hospital in Cambridge is battling back from Covid-19 - and preparing for a second wave
In the wake of the coronavirus pandemic, Paul Brackley talks to Cambridge University Hospitals chairman Mike More about waiting lists, surgery - and the dreaded second wave.
Addenbrooke’s Hospital staff are working hard to restore services for patients in the wake of the Covid-19 pandemic – but they have some significant challenges on their hands.
Dr Mike More, chairman of Cambridge University Hospitals, which runs Addenbrooke’s, said more operating theatres are now open, some screenings are taking place and outpatient activity is returning.
But he warned that some staff had “been to hell and back” while battling the worst of the outbreak and capacity has been hit by the coronavirus, with six times more patients waiting to be seen than before the pandemic.
“We were always very worried about the consequences for non-Covid patients, who were no longer in hospital, no longer being treated, were having delays or were not even presenting,” he told the Cambridge Independent.
“This has been a very profound worry for us all, clinically and organisationally. So we’ve always had planning in place from day one.
“There are constraints. We still have to maintain the difference between Covid and non-Covid provision for infection control, so that means we’ve got reduced capacity.
“We have 200 fewer beds available within the hospital for two reasons: one is the constraints around the use of facilities in order to prevent cross-infection, and the other is that clinicians have to wear PPE. There’s time involved in donning and doffing PPE at the end of the session, which has affected the number of patients we can deal with in an hour.
“At the moment we are operating about 80 per cent of our surgical theatre state now.
“All the emergency and urgent surgery is taking place and then we’ve got a very prioritised way of dealing with everything.
“We are adding in 20 beds to our critical care capacity, which is a flexible resource, which will help if we have later surges in the autumn.
“We’ve got something like 85 per cent of outpatients’ activity now back. A lot of that has been done by video conferencing and remote consultation, but that’s fine. We had lots of visitors from outpatients saying ‘we find it quite stressful coming into hospital’.”
More services are now returning.
“We are the first in the country to reintroduce bowel cancer screening and the first to run colonoscopies,” said Dr More. “We have been able to restart most of the services, but we still have waiting times.
“I’m particularly worried about diagnostic screening. We’ve still got a lot of delays there because of the physical capacity to do it.
“But we are looking at ways in which we can introduce more into community settings like Saffron Walden or Ely.
“So we are working very, very hard at it, but it’s not an overnight fix, and we still have the worry that we will always have that little bit less capacity while Covid is still here as a threat.”
With a backlog already, and reduced capacity, the scale of the challenge is significant.
“We have about 6,500 patients with surveillance overdue now – that’s about six times more than we had before Covid,” said Dr More.
“We reprioritise our waiting lists every week because it’s a dynamic thing. For some, waiting times will be longer than for others.
“For example, orthopaedic patients aren’t as urgent or as much of an emergency for some other conditions for surgery.
“That worries me a lot because I’m very conscious just because something isn’t an emergency or urgent, doesn’t mean that it’s not debilitating or very painful or meaning people are not able to work.”
The hospital trust aims to keep patients as up to date as they can through their GPs or via direct contact.
“I would say if a patient doesn’t feel that they have got enough communication please do let us know, do get in touch with the hospital. Our operation centre and contact centre are in touch with patients all of the time, but we are not going to give patients a date if we can’t be confident about it,” said Dr More.
There is some good news, however, on staffing.
Addenbrooke’s, which has had access to some pioneering Covid-19 testing machines, has not had a positive Covid-19 case among its staff since June.
“We’ve have had a much lower proportion of our staff falling ill than most hospitals,” notes Dr More.
“We have been able to bring in other staff as well – some retirees have come back and agency staff coming in.
“What I am worried about is that some of our staff have been to hell and back. It’s been very emotionally demanding and professionally demanding and people are very tired.
“If you are in critical care, on a hot day, and wearing a mask all of the time, and very heavy and hot PPE equipment in an already hot hospital, it’s tiring.
“We are seeing an increase in the number of cases of members of staff presenting with skin conditions because of the PPE. So we are very, very sensitive to the tiredness and the physicality of the work at the moment.
“Some of our teams in critical care didn’t leave the hospital for a fortnight – and that’s among the most emotionally challenging activities.
“But we have surveyed our staff and by and large I think they feel supported by the hospital.”
Weekend surgery and the use of private hospital facilities are helping to tackle the backlog of operations, which has 1,600 more people on it than it did pre-pandemic.
“We are running 30 theatre spaces now out of what was 37 pre-Covid and of those, six theatres are in The Nuffield and Spire.”
But how well could the hospital cope amid a second wave of the coronavirus – potentially coinciding with flu season?
“We have got much better at cohorting and remodelling within the hospital,” replies Dr More. “We have recognised the need to improve our critical care bed availability and we have got much better on PPE supplies. The uncertainty on PPE was always an enormous worry through March, April and May.
“Our testing capacity is also much better than what it was at the beginning of the pandemic, both for the staff and the community.
“Our modelling indicates that if we were to have further surges they wouldn’t themselves be any worse than we experienced in March and April and at that level we think we should be able to cope.
“Of course, there are uncertainties there. There is the possibility of it coinciding with flu and other respiratory conditions, and that is a much more damaging and difficult environment. At the moment, we are reasonably confident that if things don’t get worse than they were last spring, we should be able to cope.”
There is, however, a plan for additional surge capacity – a temporary facility on land near Addenbrooke’s where one of the new hospitals will be built.
“I don’t think that will be ready before the winter but I think we are getting close to persuading the government of the need for that in the Cambridge region.
“In the East of England we were one region that didn’t have any surge capacity provided but we are close to finalising discussions with the government.”
With further waves, the hospital trust would also have the benefit of experience and knowledge of the virus.
“I think we’ve got the decision-making process, we’ve got the people with experience and we’ve got a better understanding of what Covid is,” Dr More pointed out.
“It was a new disease. It had lots of surprising characteristics, such as in the way it impacted on some patients’ internal organs, which wasn’t anticipated.
“We’ve got the red and green areas, as we call them – those who are ready to deal with Covid patients, those that are separate. And I think that experience will take us a long way.”
Talk of a second wave in Europe may be premature, he suggested.
“I think the consensus view as to what is happening in Spain and Germany now is that it is not actually a second wave, but the first wave breaking through the sea wall. A second wave could be an entirely different phenomenon.
“I think it just goes to show that this thing has just not gone away. I think we’d all got into the hope that it was behind us.
“What we are seeing is it’s younger people who are getting out there and mixing a bit more. It’s understandable – I was young once – but I think we should get the message across to them that they do have a responsibility to everybody.”
There have been some changes to treatments, he added, but ventilator and oxygen capacity – which dominated much of the early healthcare discussions – was still important, he suggested.
“It’s still core for respiratory conditions. We have learnt that there are individual elements of treatment for individual patients that would be different now.
“Then again, we have had a good record. Our mortality rate was very low and our success rate was very high, relevant to most other hospitals.”
Today, the message to patients is not to be scared to go to hospital if it is important for them to do so.
Accident and emergency numbers, which fell significantly, are back up to about 70 per cent of pre-Covid levels, while emergency admissions are around 92 per cent of previous levels.
Dr More concluded: “If you have a serious condition, the hospital is a safe place to be. We’ve got social distancing within the hospital, we’ve got restrictions over visiting and the clinical staff have a very clear protocol with PPE and demarcating wards as Covid or non-Covid. We will keep it a safe place for you.”
Addenbrooke’s and Covid-19 in numbers
- 135 Covid-19 positive inpatients at the peak of the outbreak - there are now about 14, with none in critical care
- A&E numbers fell from 11,000 in March 2019 to 7,860 in March 2020
- 300-400 staff are tested each day for Covid-19 - 90 (3.4 per cent) have tested positive, but none since June
- The surgery waiting list has grown by about 1,600 during the outbreak
- 30 surgical theatres are operating, including six at the Nuffield and Spire Lea Hospitals. Before Covid-19, it had 37 theatres.
- The hospital has 200 fewer beds as a result of Covid-19 constraints, but is putting 20 more into critical care
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