The Treasury and No.10 refused a National Health Service request for 10,000 additional permanent beds in the summer of 2020 as the country prepared for the second wave of Covid-19, it has emerged.
NHS England chief executive Amanda Pritchard told the Covid Inquiry yesterday that the July 2020 decision had been "extremely disappointing" and that the health service would be in a "very different position" today if the request had been approved.
Pritchard, who was chief operating officer for NHS England and chief executive of NHS Improvement at the time, said the extra capacity would have given the health service "additional headroom" to treat thousands more patients – and would have made it "more resilient" going into the winter of 2020-21, when the second Covid wave struck.
She said the added capacity would also have allowed the NHS to recover more quickly from the backlog of non-urgent work that had begun to build up as a result of the initial wave of the novel virus.
The inquiry heard that the Treasury decision – made in conjunction with then-prime minister Boris Johnson's private office – reflected a desire for the NHS to make more use of the emergency Nightingale Hospitals that had been set up earlier in 2020 and anticipated the future impact of Covid vaccination.
Pritchard told yesterday's hearing that the last government's later support for the "urgent and emergency care recovery plan" had seen funding reprioritised to make an additional 4,000 beds available in the acute sector. But she said that decision was only taken in January last year.
Pritchard said the investment had "made a big difference" but had come "some considerable period" after the July 2020 request for extra permanent capacity.
Nightingale hospitals cost £358m and treated few patients
NHS evidence published yesterday by the inquiry showed a total of £358m was spent on delivering Nightingale hospitals, set up to offer additional capacity to cope with Covid cases in the early weeks of the pandemic.
However, the data also underscored that in most cases, the facilities were hardly used for their intended purpose.
Nightingale hospitals in London, Birmingham, Manchester, Harrogate and Bristol all became operational in April 2020, with sister facilities in Sunderland and Exeter going live in May and July respectively.
According to the NHS figures, the capital's Nightingale hospital – which was based at the repurposed ExCeL London events centre in Docklands – admitted just 57 patients during the first wave of the pandemic and was not used to tread Covid cases in the second wave. It became a vaccination centre from January 2021. The centre's setup, running and decommissioning cost a total of £132.4m.
Birmingham's Nightingale hospital, based at the National Exhibition Centre, never admitted any patients in either the first or second waves of the pandemic. Its setup, running and decommissioning cost a total of £50.4m.
The Nightingale hospitals at Harrogate, Bristol and Sunderland also never admitted any patients with Covid in either the first or second waves of the virus.
Manchester's Nightingale hospital admitted 84 patients with Covid in the first wave of the pandemic, and none in the second wave. From October 2020 to March 2021 it was used to provide NHS services to non-Covid patients.
Exeter's Nightingale hospital opened after the first wave of the pandemic, but took in 247 patients with Covid in the second wave as well as offering alternative NHS services such as CT scans. The site was subsequently purchased by the Royal Devon University Healthcare NHS Foundation Trust to provide a range of orthopaedic, ophthalmology, diagnostic and rheumatology services.
Counsel to the inquiry Jacqueline Carey KC asked Pritchard whether she thought the Nightingale hospitals had been a "useful resource", given their £358m cost.
"Yes is the simple answer," the NHS England chief executive replied. "When we were at the beginning of this process, making decisions about opening these unprecedented field hospitals – because that's what we're talking about – we went into this expecting to need them.
"We didn't have community prevalence data, we only had the data which was the rear-view mirror about patients who were in hospital at the time, so it was much more uncertain than it became later on, when we could predict much more accurately what was likely to happen."
Pritchard said that had the Nightingale hospitals had not been stood up in the spring of 2020, the Covid Inquiry would have been asking different questions if the NHS had been unable to treat many thousands of patients with the virus.
She said that the facilities had existed to provide "super-surge" capacity that would have been "field-hospital medicine" rather than critical care as it is conventionally understood.
"The alternative is that you do not treat people at all," she said.
Pritchard said that, in the case of the Birmingham Nightingale hospital, the capacity it offered had not been needed because the city's University Hospitals Trust stretched the capacity it could offer to the region, which had represented a "much better" model of care.
She added: "By the time we got to wave two, there was sufficient greater knowledge about the virus and how it worked to know that you would really not want to ventilate patients in a field hospital, you would absolutely want to keep them on a hospital site."
The inquiry continues.