Nurse chief warns of third wave and damage it could do to NHS

By Julia Gregory, local democracy reporter

A senior nurse HAS warned that hospitals are anticipating a third wave of covid.

Lead nurse for critical care Elaine Manderson said that Chelsea and Westminster Hospital is “anticipating that there will be a third wave. We have our plans in place.”

Her words echo a warning from the North West London Integrated Care System which is a collaboration of NHS, local authority, voluntary and community sector organisations. It cares for 2.4m people across eight  north west London boroughs.

It recently briefed Kensington and Chelsea council  that: “Rates of Covid-19 are rising rapidly again in North West London and we have to plan for a potential third wave of hospitalisations in late summer.”

Mrs Anderson stressed that people still need to follow precautions – mask wearing,  regular thorough hand washing and keeping a distance from others.

She’s been at the Chelsea and Westminster trust for 25 years and said caring for patients in the pandemic “has been a unique experience. I have never seen anything quite like it.”

“From an intensive care perspective we saw so many patients that we would not expect.”

She said covid had been “relentless.”

Whilst she is hoping that if a third wave of covid appears, it will be less severe, staff are taking time to reflect on the new Intensive Care Unit at the hospital.

Planned well before the pandemic the new unit – for adults and children – revolutionises what can be a terrifying and stressful place to stay.

“It’s just fortunate that we had these plans, and they were accelerated because of the pandemic,”  Mrs Manderson explained.

The  average length of stay is five days but it can be as long as six months.

It means that patients can enjoy the stunning views across London when they are well enough as the wards embrace the natural daylight to help with recovery.

“Traditionally ICUs are built with not an awful lot of natural light,” she said.

“But what we now know is  a lack of light can help  people develop delirium in intensive care.”

This matters because delirium can have long-term effects and patients can also have a higher risk of dying in hospital.

Studies show that 20 to 60 per cent of ICU patients can get delirium. Whilst it is early days the hospital will be monitoring the impact of the changes on their cases closely.

“One of the consequences of delirium is it can cause PTSD (post traumatic stress disorder), and patients can experience nightmares.”

Playwright Ray Connolly wrote Devoted, a  BBC Radio 4 play, starring Philip Jackson and Alison Steadman about his long spell in the ICU unit with covid. He was seriously ill in a coma  for 100 days and suffered two heart attacks, pneumonia and scarring of the lungs.

He explained: “Hallucinations are common in Covid patients and for months I travelled the world in my sleep, with trips to India, Italy, Norway, France and California.

The delusions were very clear in my mind. And I would later confidently tell doctors that I’d just been abroad – when, of course, I’d never left my bed.

And beds have been moved – instead of the traditional layout where they face inwards they now look sideways so patients can take in the view.

There’s also tailored lighting for each patient.

“We are trying to match the natural light and hope to see a reduction in delirium,” said Mrs Manderson.

Many patients find it difficult to sleep in hospital so the team turned their attention to that.

They have managed to reduce the background  noise from 80 decibels to 50 decibels – the “magic number for enabling people to sleep”.

They used noise reduction materials and changes to the roofs, like a music studio uses to cut out noise.

Excess noise can also make it feel frightening and stressful for patients and  visitors.

There are televisions at the end of each bed, which can be used to show videos sent in by family and friends and display photos – which proved such a boon during the pandemic when visitors were not allowed.

“People can be surrounded by images of their loved ones.”

Patients can also play relaxing music or videos featuring nature.

Other measures include double rooms, rather than open bays for four patients and better facilities for visiting families.

There’s a play room and improved waiting rooms and space for visitors to make a coffee or use a microwave.

There’s also space for visitors to lie down and have a rest during the long hours in hospital with a loved one.

Staff can also access sleep pods – flexible spaces where they can get forty winks undisturbed, take breaks or even study.

And once patients are well enough they can enjoy the indoor sky garden, which is planted with air purifying plants.

“It’s very green, very luscious,” said Mrs Manderson.

There are also sleep pods, equipped with ear phones there so people can relax with nature.

The changes have made a world of difference to the ICU unit.

“It feels a very calm space to walk into,” she said. “It’s not as noisy and people have got their space.

“From an infection point of view it feels much safer for our patients and staff.

“We have some remarkable views of West and North London and the West End as well. Looking north you can see the Wembley Arch, you can also see Stamford Bridge and the Royal Albert Hall and you can also look over Westminster.”