Hospitals ‘close to collapse’ amid scenes ‘from hell’ during pandemic – inquiry

Professor Kevin Fong – former national clinical adviser in emergency preparedness, resilience and response at NHS England – told the Covid inquiry he was on the scene of the Soho bombing in 1999 and worked in A&E during the July 7 London bombings “but nothing that I saw… was as bad as Covid was every single day” for the hospitals most badly hit during the pandemic.

One medic told him it was like a “terrorist attack” every day and staff did not know when the attacks would stop.

Speaking to the inquiry in central London, Prof Fong said: “The scale of death experienced by the intensive care teams during Covid was unlike anything they had ever seen before.

“They’re no strangers to death  – they are the intensive care unit. They look after some of the sickest patients in the hospital, but the scale of death was truly, truly astounding.

“I worked on a shift where we had six deaths in a single shift. Another hospital told us that they had 10 deaths on a shift, two of whom were their own staff.

“We had nurses talking about patients raining from the sky, where one of the nurses told me they just got tired of putting people in body bags.

“(One hospital) said that sometimes they were so overwhelmed that they were putting patients in body bags, lifting them from the bed, putting them on the floor, and putting another patient in that bed straight away because there wasn’t time.

“We went to another hospital where things got so bad, they were so short of resource, that they ran out of body bags, and they were instead issued with 9ft clear plastic sacks and cable ties.

“And those nurses talk about being really traumatised by that, because they had recurring nightmares about feeling like they were just throwing bodies away.

“These people are used to seeing death, but not on that scale, and not like that…

“It really was like nothing else I have ever seen.”

In one hospital, nurses took to wearing adult nappies because they were so stretched they could not take toilet breaks. Others went to Screw Fix to buy visors for their own protective equipment.

Prof Fong also told the inquiry he undertook an informal visit to one of the “hardest hit” intensive care units in the country.

“It was very memorable, I was greeted at the entrance by one of the intensive care registrars,” he said.

“I asked him immediately what things have been like. I’ll never forget his reply, he said: ‘It’s been like a terrorist attack every day since it started, and we don’t know when the attacks are going to stop’.”

Prof Fong said the experience for NHS staff on the front line in intensive care was “indescribable” and there were units where 70% of patients died.

He conducted around 40 visits of intensive care units on behalf of NHS England to offer peer support to doctors and nurses. He also wrote reports which were sent back to managers including England’s chief medical officer Prof Sir Chris Whitty.

During one visit in late December 2020, Prof Fong said he was at a hospital with a medium-sized unit.

“I’ll never forget it,” he said. “It was a scene from hell.

“This was a hospital in massive, massive trouble. We went to an intensive care unit…

“There were so few staff that some of the nurses had chosen to either use the patient commodes in the side rooms, and some of the nurses had chosen to wear adult diapers because there was literally no one to give them a toilet break and take over their nursing duties.

“The intensive care unit was full. Their overflow areas were full, their non-invasive ventilation unit, their respiratory unit was full.

“This was a hospital bursting at the seams. I then toured the hospital with the intensive care staff – a doctor who then looked after the unit and the rest of the hospital.

“I’ll never forget being in the stairwell with him, and he’s out of breath on the stairs because he has himself had Covid in the first wave and now is suffering the consequences of long Covid, but he’s still there.

“The referrals were coming up all the time, (but there were) no places to put patients in the intensive care unit…”

Prof Fong told how one patient died in an ambulance because they could not get into the hospital, while other patients could not be intubated as there was no room or staff and ICU was full.

“It’s genuinely the closest I’ve ever seen a hospital to a state of collapse in my entire career,” he said.

Earlier, Prof Fong told the inquiry that, in one unit, patients were “close enough to hold hands” when each bed in an intensive care unit should each be given a space “the size of a very large living room”.

The anaesthetist at University College London Hospitals NHS Foundation Trust, who was seconded to NHS England in March 2020, told the UK Covid-19 Public Inquiry that a colleague at a district general hospital contacted him in the early days of the crisis to tell him they were “overflowing with patients”.

He was told that the hospital was “running out of staff and running out of basic consumable items” including drugs and equipment.

On another occasion, an intensive care consultant told him about the difficult experiences his unit experienced in the first wave – including wearing gowns over underwear because of a lack of scrubs, and sleeping in cars.

“He talked about having to sleep in the boot of his Ford Galaxy when he was on duty for three months at the start of the pandemic,” Prof Fong said.

“They talked about running out of PPE. They talked about going to Screwfix to get visors.

“They talked about running out of theatre scrubs and having to go to the local private hospitals and beg them for their supply.

“And when they ran out of that, they talked about having to have one shift where they had no theatre scrubs and they went around in their underwear and gowns for the shift.”

Prof Fong added: “I went into another unit of similar size, where they talked about how on the television, what you saw was these big units who complained about being short of equipment, but were usually wearing PPE, and how they said that they were watching those programmes, and they were standing in their own units wearing cagoules and waterproof trousers that the chief exec had bought from an outdoor shop.

“And they were, they were angry, actually, that is all that people knew was, was this sight of well-resourced hospitals, when the truth in the smaller hospitals was just that.”

Several people in the public seating area at the inquiry wiped away tears during Prof Fong’s testimony.

Prof Fong added: “It’s easy for us to think that we knew what’s going on – this isn’t just a problem with the NHS, any large organisation suffers this problem, of ‘what you can measure most easily that’s seen at the top, between what is actually happening at the front line’.

“And I think that it was easy to convince ourselves that we knew what was happening.”

He broke down as he added: “But you don’t know unless you’re the people going into that shop floor. You don’t know if you’re the not the people who are putting on PPE before we got vaccinations available, wondering if it’s buttoned up OK.

“You don’t know unless (you are) the people are trying to find bodybags and putting people in plastic sacks.

“You don’t know, if you are not the people who held onto iPads while relatives were screaming down the phone.

“You don’t know if you haven’t sat in transfer vehicles next to a patient who’s dying of Covid, wondering if your PPE is buttoned up well enough that you might not do the same.

“It is impossible to know.

“Although this is not hard numerical data, the information is important. There is more to know than just what you can count.”