Health chiefs build makeshift critical care wards amid fears London could run out of intensive care beds in days

News comes as one London trust becomes epicentre of growing crisis, with 21 deaths since Friday

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Health chiefs are taking desperate action to build makeshift critical care wards, amid fears London could run out of intensive care beds in four days. 

The news came as one London trust became the epicentre of the growing crisis, with 21 deaths since Friday.

Medics said they were being forced to choose which patients to try and save as the Health Secretary announced plans to use London’s ExCeL conference centre as a field hospital, with 4,000 beds split into two giant wards. 

From next week, it will provide 500 beds equipped with ventilators and oxygen. 

In a call between health chiefs on Tuesday, one of NHS England's national directors said London would run out of intensive care beds in just four days without urgent action. 

Hospitals were told to attempt to expand the number of extra beds to cope with intensive care patients by thousands in a bid to cope with growing pressures. 

The worst-hit trust in the country is London North West University Healthcare NHS Trust, where 21 patients diagnosed with Covid-19 have died since Friday. 

The trust controls two major hospitals including Northwick Park in Harrow, which last week became the first in the country to declare a critical incident due to a surge in coronavirus patients. Nurses from the hospital are pictured below wearing plastic bags as protective wear.

Staff at the hospital told the Telegraph that a shortage of equipment and trained clinicians meant doctors were already having to ration care to those with the best survival chances.

Medical workers have built an extra six-bed intensive care ward in a nearby room after the hospital ran out of space.

"This Covid is really, really bad. We need help," said one senior nurse, who did not wish to be named. "We're already in an Italy situation, where the doctors are deciding who should be put on the ventilators and who should not. Most of the people who passed away have been elderly with various comorbidities [the presence of additional conditions], but we also have younger people struggling to breathe and they will sometimes get the ventilators first.

"We also don't have enough people who can operate the machines, and that is a real problem. Many of our colleagues are falling ill with flu-like symptoms, but they still come into work because otherwise who will look after the patients?

"The very old ones die even with the ventilator. Some of them are conscious, but others are so confused because of the lack of oxygen. All we can do is try and make them comfortable."

A spokesman for the trust denied that doctors were already running out of ventilators but confirmed that staff were rapidly working to increase the number of critical care beds, with others retraining to work in intensive care.

"Our doctors routinely have conversations with patients and their families, as well as with their colleagues, about what care should be given if a patient becomes seriously unwell while in hospital," a spokesman said. 

"This is a very sad but well-understood part of working in a hospital. It is important to know that the way in which our doctors and patients reach these decisions should remain the same for all patients, regardless of whether or not they have tested positive for Covid-19."

It comes as medics across the country were warned that intensive care standards will be dramatically lowered, with nurses told to care for six times as many patients as normal. The graphic above shows intensive care at normal standards.

Normally, the NHS sets a ratio of one nurse for every patient in critical care units, in order to ensure patients in life-threatening situations are constantly monitored. But hospitals are being told there should be a minimum of one nurse for every six patients as they attempt to cope with rising levels of demand. 

It comes as a survey of NHS chief executives across the country found one in three expected to run out of intensive care capacity by next week. 

Nicki Credland, chair of the British Association of Critical Care Nurses, said the profession had no choice but to "dilute" the standard of care to try to help more patients. 

She told Health Service Journal: "There will absolutely be a lot of concern about this in the profession, but it's the only option we've got available. We simply don't have the capacity to increase our staffing levels quickly enough.

"It will dilute the standard of care, but that's absolutely better than not having enough critical care staff."

The plans will also mean consultants have to oversee more patients, with a ratio of one senior doctor for 15 patients replaced with a 1: 30 rule.

Alison Pittard, dean of the Faculty of Intensive Care Medicine, said the changes are the "only safe way to do it". She added: "I welcome the guidance that's been agreed that will allow healthcare professionals to continue to deliver high-quality care in the safest possible way."

The poll of 34 trust chief executives by Health Service Journal found that 11 expected their trust to run out of intensive care capacity by next week, with warnings from eight such trusts expecting to exhaust their resources this week.

One said: "We are preserving ventilation capacity by ensuring that only those who may survive are considered."

Claire Murdoch, of NHS England, said: "This is exactly why the NHS is already increasing treatment capacity across all hospitals, while getting on with other options too, including new facilities and as landmark deal with private hospitals which has put 20,000 staff, 8,000 beds and 1,200 ventilators at our disposal."