£160m new cancer centre becomes fourth NHS hospital building in London to fail post-Grenfell fire safety checks

NHS bosses today revealed that cladding on London’s newest hospital building failed fire safety checks ordered after the Grenfell Tower disaster.

The £160 million Guy’s Cancer Centre opened last September as part of a vision to develop world-class cancer care at Guy’s and St Thomas’ NHS trust.

Initial investigations raised no concerns but subsequent checks found that rain screen panels on the 14-storey tower were made of aluminium composite material.

Similar materials are thought to have contributed to the spread of the inferno at Grenfell Tower, in which at least 80 people died on June 14.

Work to replace the cladding, which covers about 15 per cent of the exterior, is due to begin within weeks. The building, which has fire detection systems and sprinklers, will remain open after a London Fire Brigade investigation enabled the Trust to declare the centre safe.

Trust chief executive Amanda Pritchard said: “We will carry out remedial work including the removal of cladding to ensure that we comply with the new Government advice, to reassure our patients and the public and to make sure that the cancer centre continues to reflect the highest safety standards.

This will be done as quickly as possible in a planned and measured way, with work likely to start this autumn. The safety of our patients, visitors and staff continues to be our highest priority.”

The cancer centre, beside Guy’s hospital in London Bridge, was designed by Roger Stirk Harbour + Partners and healthcare architects Stantec, and built by Laing O’Rourke.

It received more than £30 million in charity donations, including £2 million from the charity of broadcasters David and Jonathan Dimbleby. It includes a private 53-bed HCA hospital on its top four floors and a “hub” of 70 scientists from King’s College London.

Government guidance issued last week states that aluminium composite material presents a “significant fire hazard” on buildings higher than 18m.

HCA said: “We are reassured by London Fire Brigade’s advice, following a thorough inspection, that the hospital is safe. We welcome the action that Guy’s and St Thomas’ are taking to remove the small areas of cladding, to ensure that the building follows the latest government advice and has the highest safety standards.”

Last month checks ordered by NHS Improvement found combustible cladding at North Middlesex hospital, King’s College hospital and at the National Hospital for Neurology and Neurosurgery, part of University College London Hospitals. None of the cladding was found on inpatient facilities, NHS Improvement said. 

Last week John Radcliffe hospital in Oxford was forced to close its major trauma centre for a year after the discovery of cladding


Westway cycle superhighway abandoned as TfL suggests new route through Notting Hill and Holland Park


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Westway superhighway plan

Plans to build a cycle superhighway on the Westway flyover were today formally axed by Mayor Sadiq Khan.

The proposed extension of Boris Johnson’s flagship East-West superhighway would have used one lane of the elevated section of the A40 between Paddington and Acton to extend the so-called “Crossrail for bikes” west of Hyde Park.

Transport for London says it is now “assessing the feasibility” of an alternative route on Bayswater Road, Notting Hill Gate, Holland Park Avenue and Wood Lane.

Mr Khan’s decision to abandon the Westway was first rumoured last November but confirmed this afternoon as TfL published long-delayed results of a second public consultation.

Despite securing 69 per cent support in the 847 responses, TfL said there were difficulties accessing the route, potentially unpleasant cycling conditions and a high cost. The consultation was conducted between February and March 2016, towards the end of Mr Johnson’s second term as Mayor.

An initial TfL consultation, in January 2015, found 70 per cent support for building the superhighway on the Westway. See p163 of the PDF

TfL said any construction on the Westway would have been delayed with three years of structural repairs to the flyover that are due to start next year.

Leon Daniels, Managing Director of Surface Transport at TfL, said: “After careful consideration of feedback from the public and local boroughs we have decided not to pursue a cycle route over the Westway flyover. Instead we are exploring the feasibility of an alternative cycle route which would include Bayswater Road, Notting Hill Gate, Holland Park Avenue and Wood Lane.

“The Westway route fails to deliver benefits for pedestrians, it would have serious connectivity problems in terms of getting on and off the route, and the significant road refurbishment that we need to carry out along the route between 2018 and 2020 would seriously delay construction.

“The Mayor and TfL remain absolutely committed to delivering a high quality cycle route in this part of west London and making walking and cycling in London safer and easier.”

However the decision was greeted with concern by some cyclists, many of whom accuse Mr Khan of failing to build on Mr Johnson’s legacy or meet an election pledge to make London a “byword for cycling” across the world.

The Westway option was only proposed by Mr Johnson and his cycling commissioner Andrew Gilligan because Kensington and Chelsea council refused to allow a superhighway on Kensington High Street. The Tory authority is responsible for much of the alternative route.

This was the reaction on Twitter:

Sean‏ @seanlondonandon: “Less direct, less road space and on RBKC roads an LA who refuse to allow protected bike lanes. This is yet more failing on cycling”

Liz Almond‏: “I don’t have any confidence that RBKC would allow TfL to build anything that would be worth the money.”

Josh Blacker‏: “Much better connectivity than Westway route – no side roads on elevated section to leave/join.”

Jon Stone‏: “Not necessarily a bad thing, because a street-level route could be more useful – but given TfL’s recent designs…”

The Westway plans involved the removal of one of the three eastbound lanes to create a bi-directional superhighway.

Motorists feared the loss of a lane would add to congestion experienced by drivers heading onto Marylebone Road. There were also concerns that cyclists would be riding alongside polluted area.

Caroline Russell, a Green Party member of the London Assembly, said: “The cancelled Westway route was a replacement for the cancelled CS10 to Park Royal. It wasn’t perfect taking people over the Westway on their bikes but would have provided  a safe east west route for people in west London. 

“TfL have put £750k into a study but it gives a project completion date of 2021. Is this simply some well-funded long grass?

“The Mayor must get on with this urgently. He must provide a decent east west route. People need properly connected networks if they are going to switch their daily journeys to bike. 

“If the Mayor is going to achieve his ambitious targets of getting people to change the way they travel he most provide people with safe, convenient and well connected networks of cycle routes that get people to work, to school to healthcare and the shops.”

‘Pre-hab’ is fab: Getting cancer patients fit before surgery leads to dramatic improvements in care


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A pioneering project that requires cancer patients to get fit and lose weight before surgery has delivered significant improvements in care.

Patients spend far less time recovering in hospital, are less prone to post-operative infections such as pneumonia and “get their life back” more quickly.

They are given FitBit-style devices to monitor their activity and advice on how to change their diet and lifestyle, including help to quit smoking. Surgery can be postponed if patients fail to respond.

The project at Imperial College Healthcare has won multiple awards and is set to be rolled out to other NHS trusts and a hospital in the Netherlands.

Its success comes at a time some health commissioners have considered restricting access to surgery for smokers and obese patients in a bid to ensure NHS cash is spent on the most deserving cases.

Venetia and Rashmi

Nurse specialist Venetia Wynter-Blyth with patient Rashmi Chauhan climbing Mt Snowdon

The PREPARE for Surgery project was set up by clinical nurse specialist Venetia Wynter-Blyth, a RCNi nurse of the year, for gastro-oesophagael cancer after a grant of almost £100,000 from Imperial Health Charity. It is due to expand to liver, pancreatic and lung cancers.

About 70 patients have completed the scheme, which aims to “train” patients for surgery that lasts 10 to 12 hours. Ms Wynter-Blyth said patients were required to sign up to four to six weeks of “pre-hab”. She said: “It’s non-negotiable. Whether they adhere to the programme is a different matter.

“We try to address some lifestyle changes people need to make. The point someone is told they have a deteriorating health condition such as cancer would ordinarily act as a barrier, but it can facilitate change. That is when your mortality is threatened.

“We are seeing people take responsibility. They are becoming more active. They recognise if they don’t do something it will preclude them from having surgery in the first place.”

Post-operative complications fell from 70 per cent to 30 per cent. Pneumonia rates halved to 29 per cent. Patients are discharged seven or eight days after surgery, down from 17 days. Imperial has saved about £300,000 as a result.

The PREPARE team at St Mary's hospital

The PREPARE team at St Mary’s hospital

Dr Helgi Johannsson, clinical director of theatres and anaesthesia at Imperial, said one patient who failed to follow the advice was refused surgery.

“He hadn’t stopped smoking, he looked dreadful, he really wasn’t motivated,” Dr Johannsson said. “I said to him: ‘Today is not the day for your operation.’ We sent him away for four weeks. He stopped smoking, he did exercises every day. He came back four weeks later looking like a different man and absolutely sailed through surgery.”

The PREPARE team on top of Mt Snowdon

The PREPARE team on top of Mt Snowdon

One patient, Rashmi Chauhan, 61, marked the first anniversary of his operation for oesophageal cancer at St Mary’s hospital by climbing Mount Snowdon with the PREPARE team in June, helping to raise £10,000 for the project.

He had his oesophagus, or food pipe, removed and his stomach remodelled. “The operation is one of the hardest operations on the body,” he said. “I feel I’m fitter now than before the operation. I feel like I’ve had a new lease of life.

“It wasn’t put like I had to lose weight. I wasn’t negative – it was positive. It was: ‘Let’s see if you can do this.’ If my body is going to have 10 hours of surgery, the only way to make sure everything goes smoothly is to get as physically fit as you can.”

PREPARE stands for: Physical activity; Removal of bad habits; Eat well; Psychological wellbeing; Ask about medicines; Respiratory exercises; Enhanced recovery.

  • An edited version of this article appears in tonight’s Evening Standard

Anti-HIV drug PrEP available free on NHS in London from September



A drug that dramatically reduces the chance of contracting HIV is to be offered free on the NHS from next month, it was announced today.

Sexual health clinics in London will be among the first in the country to offer the treatment, known as PrEP or pre-exposure prophylaxis, from early September.

It will be offered to about 10,000 high-risk people across the country under a £10 million three-year trial. Previous trials have shown it cuts the risk of HIV from unprotected sex by 86 per cent. Experts believe its availability could effectively end the HIV epidemic in the UK.

Deborah Gold, chief executive at National AIDS Trust, said: “This is a pivotal moment in the fight against HIV. PrEP, if targeted properly at those in need and at risk, offers the possibility of transforming the English HIV epidemic.”

The trial, the largest of its kind in the world, comes after the Court of Appeal last year ruled that funding PrEP fell within NHS England’s remit. It had argued that providing the drug was the responsibility of local authorities.

People have been able to buy PrEP privately at a cost of about £400 a month. It is normally taken as a daily pill. The NHS in Scotland decided in April to make it freely available.

There are about 2,600 new diagnoses of HIV in London a year, but campaigners believe the capital could be on the verge of a big reduction due to the use of PrEP and early testing.

The trial – which will also be pioneered in Brighton, Manchester, Liverpool and Sheffield – will be extended countrwide by next April. It will gather evidence on the uptake and cost-effectiveness of the treatment. Women and transgender people will also be given access to the trial.

Simon Stevens, chief executive of NHS England, said: “This major new intervention should complement and supercharge the wide-ranging and increasingly successful effort to prevent HIV. It’s another milestone in more than three decade’s worth of progress in tackling one of humanity’s major health challenges.”

Ian Green, chief executive of Terrence Higgins Trust, said: “We’re pleased that NHS England has announced a start date for the much anticipated PrEP trial. This trial has been gaining momentum in England, and is vital as we work towards ending HIV transmission.

“The priority must now be to make sure that the trial is rolled out speedily across the country, and that no-one at risk of HIV is left behind. Now that the PrEP trial drug has been procured, we’re well on the way to protecting over 10,000 people at risk of HIV.”

Professor Brian Gazzard, chief investigator for the PrEP trial, said: “This.. could mean the difference between staying HIV negative or becoming HIV positive. The data and evidence we generate will not only be of international interest but more importantly will enable commissioners in England to plan for a PrEP programme that benefits individuals and the taxpayer.”


Doctors: don’t be afraid to douse acid attack victims with gallons of water


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A doctor working at the centre of London’s acid attack epidemic today urged bystanders to douse victims with gallons of water to help save them from horrific burns.

Dr Johann Grundlingh, a consultant emergency physician at Newham hospital and the Royal London, in Whitechapel, said first aiders may fear they were “water boarding” victims but pleaded with them to act decisively as they awaited medical help as “every second counts”.

Almost a third of the 454 attacks reported in London last year were in Newham, and Dr Grundlingh said he had treated about 20 victims across both hospitals.

He and colleague Jessie Payne, with Taj Hassan, president of the Royal College of Emergency Medicine, today published an article in the British Medical Journal suggesting that new laws be fast-tracked to make carrying acid a criminal offence.

It added: “Public education is needed on how to deal with these injuries, as immediate treatment can substantially improve the outcome.”

St John Ambulance acid advice

Dr Grundlingh told the Standard of one case where a victim submerged his head in a bucket of water and escaped with injuries “a bit like sunburn”. But in another case, where a weak acid was thrown, there was a delay in washing it off and the victim was scarred.

He estimated that about half of acid attacks were gang-related and half were during robberies. “The thing about acid is that it’s a concentrated corrosive substance,” he said. “To treat it, you have to dilute it. The more water you use, the better.

“The problem is that very often it is a facial burn. You don’t want to ‘water board’ someone who is already quite distressed, but I think gentle and continuous irrigation with verbal reassurance is the right way forward.

“Keep irrigating the face. If you can open the eyes to irrigate the acid, that is even better. Acid burns. It congeals the skin within minutes. The longer it stays on it, it just keeps burning and scarring.

“This is not something you what to leave and wait for an ambulance to arrive. You want to treat this as quickly as possible. The normal instinct is to try to wash it off, but people don’t do enough.”

It came as St John Ambulance published advice for the public (above) on how to help in the event of an attack after its trainers received an increase in inquiries.

Last week the Standard revealed that police response cars were being fitted with acid crime response kits, including five litre bottles of water and protective equipment. “Five litres is a good start, but very often you need more than that,” Dr Grundlingh said.


Number of patients taking part in clinical trials in London hospitals rises by a fifth


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Patients being treated in London hospitals were able to access pioneering clinical trials in greater numbers than ever before, it was revealed today.

A total of 152,269 people took part in research projects in the capital – up 19 per cent, or 24,004 participants, on the previous year. The number of studies increased five per cent, or 229, to 4,630.

The studies offer access to novel treatments ranging from cancer to stroke and Parkinson’s disease. While not all studies prove effective, many offer a last chance for patients left without other treatment options.

Guy’s and St Thomas’s topped the National Institute for Health Research annual research activity league table for the third year in a row in terms of the number of participants, 25,280. It hosted 500 studies, the highest in the capital and the third highest in the country.

Imperial College Healthcare, University College London Hospitals and Barts Health also featured in the national top 10 for the number of studies.

King’s College Hospital trust enrolled almost 21,000 patients – the fourth highest nationwide. The largest study at King’s, a world leader in fetal medicine, recruited nearly 8,500 patients to analyse cell-free DNA in maternal blood during the first three months of pregnancy.

Professor Charles Wolfe, director of research and development at Guy’s and St Thomas’ said: “We are extremely grateful to people in our local communities and beyond for partnering with us in such great numbers and helping us to lead the country for public and patient participation in research.”

Alero Dabor, a cancer survivor and patient research advocate at Guy’s and St Thomas’, said: “Patients and members of the public are increasingly being seen less as just participants and more as partners in research and this can only be a good thing.”

Improved rating for London Ambulance Service as inspectors praise response to terror attacks and Grenfell Tower fire


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Gemma Taylor LAS Hart paramedic

A specilialist paramedic called to the London Bridge terror attack and Grenfell Tower fire today said that the London Ambulance Service was better prepared to deal with major incidents.

Gemma Taylor, 31, said there had been “significant improvements” in the LAS’s ability to deal with such events since inspectors rated it “inadequate” two years ago amid concerns about its resilience.

She spoke as the LAS’s official rating from the Care Quality Commission was upgraded to “requires improvement” and it was rated “outstanding” for the care provided to patients.

Ms Taylor, a member of the Hazardous Area Response Team, told the Standard: “Within these two years I have seen some significant improvements, which I think have all positively impacted on our patient care.

“We have got more staff on the ground. Our response times have improved. We all feel ready, especially as we have got more experience of these events.

“These were incidents which I hoped I would never have to face. I think everybody who had to face them has responded well. Training does prepare us well for these type of incidents.”

The CQC report said there were now 89 members of the HART team, allowing 99 per cent of shifts to be filled, compared to 24 per cent in 2015. The team’s task is to get immediate medical care to patients trapped in hazardous locations, from terror attacks to people under trains, in water or at height.

Ms Taylor added: “It can be a really testing job – these types of incidents affect everyone who is involved. But we do this job because ultimately we want to help patients and their families and I’m incredibly proud of what I do.”

LAS chairman Heather Lawrence said: “The HART team are outstanding. They practice regularly. They are ready to go.

“As the nation witnessed during recent events in London, ambulance staff are always ready to respond in often very difficult circumstances. We are pleased CQC has recognised the outstanding care we provide, as well as many other improvements.”

Concerns were raised about ambulances “stacking” outside A&E departments, due to delays in hospitals admitting patients, and the failure to meet national response time targets.

However, since April the LAS has been the best performing ambulance trust in the country, reaching 73 per cent of the sickest patients within eight minutes – the target is 75 per cent.

The CQC’s chief inspector of hospitals, Professor Sir Mike Richards, said: “The events of the last few months have underlined what a crucial service London Ambulance provide to the capital, and how hard its staff work to deliver this service – sometimes in unimaginably difficult conditions.

“Overall, the trust has made sustained progress since our last inspection, including significant improvements in emergency preparedness resilience and response.”

NHS Improvement, which oversees the LAS, said it had proved its excellence in its response to the Westminster Bridge, London Bridge and Finsbury Park attacks and Grenfell fire, and was likely to emerge from “special measure” by the end of the year.

Kathy McLean, executive medical director at NHS Improvement, said: “They should be rightly proud of what they’ve achieved. Londoners owe them a debt of gratitude.”

From Westminster Bridge to Grenfell Tower: London doctors reveal emotional impact of dealing with major incidents


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Emergency doctors have spoken of the emotional impact of treating the victims of the Grenfell Tower inferno.

Staff at St Mary’s, in Paddington, have been among the hardest hit, with the hospital admitting a total of 28 casualties from last week’s fire and the terror attacks on Westminster Bridge, London Bridge and Finsbury Park.

Consultant anaesthetist Dr Helgi Johannsson saw Grenfell Tower ablaze from his balcony after being wakened at 3am last Wednesday morning.

Dr Helgi Johannsson

In a blog on the British Medical Journal website, he wrote: “Being able to see the sheer scale of the fire when I woke up made the tragedy much more real, and I had a sick feeling in my stomach as I drove into the hospital.

“We treated a lot of children at St Mary’s and I know many of my colleagues are still extremely upset about what they saw—trainees and highly experienced consultants alike.

“At the time of writing some of the individuals are being identified, their stories being told and the scale of the human tragedy is becoming apparent. I am much more emotionally affected now then I was on the day of the incident.

“Some would say we must remain emotionally detached and equate that with professionalism, but I am human. I saw this tragedy unfold out of my window, and I feel I am a better doctor for giving myself permission to stop, reflect on what has happened, and to grieve.”

St Mary’s response to the Westminster terror attack can be seen in the BBC2 documentary, Hospital, at 9pm tonight [Tuesday].

Speaking at a preview screening last Thursday, Shehan Hettiaratchy, lead trauma surgeon at Imperial College Healthcare NHS Trust, told the Standard that one of his colleagues featured in the documentary was struggling to deal with the number of atrocities.

Mr Hettiaratchy said: “They said to me: ‘I’m getting towards the end of what I can cope with.’”

Dr Philip Lee

Dr Philip Lee, an acute physician at Chelsea and Westminster hospital, which admitted 25 fire casualties, said he had experienced the “worst, hardest week I’ve ever had as a doctor”.

He tweeted: “I hope as long as I live I’ll never have to witness or deal with any incident like this again. But we’ll learn, and be ready. Because that’s what we do, that’s why we’re here.

“Some of the stories I’ve heard, tales of heroism from fire crews and members of the public, the impossible choices and decisions.

“My admiration for the courage of firefighters and police, and what they’ve seen and had to do. These men and women are the real heroes.”

Dr Johannsson, in the BMJ blog, also revealed how the use of WhatsApp had helped St Mary’s to deliver better care during major incidents.

“One of our key learning points from the Westminster attack was not to overload the coordinating consultant with offers of help,” he wrote.

“I set up a major incident WhatsApp group which was initially met by some puzzled looks, but after two further major incidents it has proved invaluable. Fast mass communication, the ability to coordinate our response, and being able to plan the service for later on that day vastly improved the care we were able to provide.

“WhatsApp has end-to-end encryption and therefore is confidential as long as you know whose phone is in the group, and it has a passcode. It is widely used in communication within NHS teams already, yet officially it is prohibited on information governance grounds. Is it time for the NHS to take the opportunities that this kind of technology offers and incorporate it into our everyday practice?”

London nurse tells of emergency care given to victims of Grenfell Tower fire


A nurse today told how a patient revealed she had called a relative to “say goodbye” because she feared she was going to die in the Grenfell Tower inferno.

Daniel Almeida, 30, a charge nurse at the Royal Free in Hampstead, said he feared for the long-term mental health of the victims, such was the emotional impact of the blaze.

“One patient made a phone call while in the building to the relative to say goodbye,” he told the Standard.

“It’s quite frightening. You don’t know what sort of consequences there will be, or what will happen in the future, after these sort of things.”

Daniel Almeida at the Royal Free

Charge nurse Daniel Ameida at the Royal Free: “It was only when we started to have the blood results back that we realised that some of them were really, really sick.

The Royal Free received 12 patients, including children. All were suffering from smoke inhalation rather than burns. Several, including a child, had to be anaesthetised and intubated to allow their breathing to be controlled artificially. By last night, eight of the 12 patients had recovered sufficiently to be discharged.

Mr Almeida said one of the most difficult things was dealing with families that had become separated in the blaze, including a mother who was desperately searching for her child.

“We had a patient, and luckily this was one of the patients we could clear from a medical point of view quickly, who in the middle of all the chaos had lost her young child.

“Obviously the patient was not even thinking about her own health. It was all about the child.

“We tried to help as much as we could, and liaised with the LAS [London Ambulance Service] to get them information. You still feel helpless.” He did not know if the mother and child were reunited.

When the major incident was declared, people waiting in A&E were asked to go home unless their condition was life-threatening and the team of about 16 nurses and five doctors prepared for an influx of patients with burns and breathing difficulties.

No burns patients arrived – a situation believed to be true of all six London hospitals that treated more than 70 casualties.

Mr Almeida said: “We mainly had exposure to smoke and smoke inhalation. What is very important in this situation is to have a quick reading of their carbon monoxide levels. That involves a blood test.

“These patients all came in by ambulance and were already on oxygen. Depending on the [carbon monoxide] values, we would decide where to put these patients in terms of their severity and potential to deteriorate.

“They were shocked, generally speaking. They were not particularly talking too much, but at the same time they were disclosing some information to us when we were assessing them.

“It’s a thin line with what you are going to say to these patients, because you know what they have been through. We need to give them as much support as they want.

“Clearly the patients were in shock. They don’t even retain half of the information you give them.

“When they come to us, we do our best to help them. When the patients started to come in, they were in shock but they didn’t look particularly unwell. It was only when we started to have the blood results back that we realised that some of them were really, really sick.

“That is when we started to have close monitoring of some of the sicker ones and we have taken the decision to intubate some of them to avoid problems down the line.

“The benefits of intubation is that we can control the rhythm and depth and pressure of their breathing. They go to intensive care for this.

“We had a [staff] debriefing and I think everybody was quite happy how things went. We got these 12 patients but we were ready for way more. Luckily we didn’t get more. The main thing the staff were saying was that we help them medically but we were worried about the mental aspect of things. We can get them better medically but what is going to happen in the rest of their life?”

* An edited version of this story appears in tonight’s Evening Standard

Doctors  at cyber attack hospital used What’sApp groups to marshal response to London Bridge attack  

A doctor today spoke of his pride that all 12 seriously injured victims of the London Bridge attack who were treated at the Royal London hospital had been saved.

Malik Ramadhan, who rushed back to work to run the major trauma centre’s resuscitation unit on Saturday night, said the patients benefited from “gold-standard care” in Europe’s biggest hospital.

This included world-leading advances in treating major haemorrhage that has seen one patient a week at the hospital survive injuries that would have been fatal a decade ago.

“Of the 12 we received, they have all survived,” Dr Ramadhan told the Standard. “Very unexpected things happen. I think the last person who was intubated [put on artificial breathing support] was extubated [on Tuesday].

“I think they have had interventions that we use every day. I think they are interventions that other hospitals don’t have available to them. That is the whole point of the major trauma centre. We have got a much better understanding of the order in which we transfuse blood products.”

Prince Charles and the Duchess of Cornwall visited the hospital, in Whitechapel, to meet patients and thank the staff. 

Dr Ramadhan had been cycling home after his shift on Saturday night when he saw a convoy of police cars racing north on Old Kent Road. He called a friend to ask what was happening. “She rang back and said you should pedal as fast as you could to work,” he said.

As staff flooded back, a trauma team was assembled for each of the eight resus bays – an emergency medicine doctor, an anaesthetist, an ODP (operating department practitioner, a surgeon, an orthopaedic surgeon and two nurses.

Such was the response from staff that he had 10 A&E consultants, five to six surgeons and a similar number of anaesthetists more than he required to form the trauma teams.

Six patients were taken direct to theatre for life-saving interventions. Another five underwent surgery the next day.

“We could see how some patients had been hit by something and some had been stabbed,” he said. “We got one shooting. I didn’t know what had been going on. I went home at 3.30am, got home at 4am, and turned on the telly. At that point they were saying 20 patients were involved, at five hospitals. I thought, well, we have got 12 badly injured people, which suggested there was a lot more than 20. The next morning they were saying 48, and six dead. 

“At the time, it wasn’t relevant. My job is to make sure we are ready to see the next, and the next, and the next… if it gets to 150, how do we get to 200?”

He told how the Royal London had been preparing for a terrorist atrocity since the suicide attacks in Paris in November 2015 that killed 130, including 89 at the Bataclan theatre. This included guarding against a secondary attack on the hospital itself as it treated casualties.

“Each thing that has happened reinforced to me that it was going to happen to us at some point,” he said.

“With Westminster Bridge, we were not particularly involved [in treating casualties]. But we looked at that and I thought: supposing that happens and there are 50 on the bridge, what would we do?

“The point the Government escalated the terror alert level [after the Manchester bombing] got me thinking they must know something. We did a lot of thinking, including thinking about secondary targets. If they are blowing up children, the next step is schools and hospitals. Sometimes they attack the hospital the victims have been taken to.”

He said they feared that with 50 shots being fired on Saturday night they could have a similar number of casualties.

“With 50 shots fired, there was the assumption early on that lots of people would be injured. We didn’t know who had the guns. 

“I don’t think 12 patients is a particularly big challenge for the Royal London. We regularly have 12 trauma calls over a night shift. Twelve at once is different. Twelve over a 12-hours period is not unusual. We see 3,500 poly-trauma patients a year – where there is trauma in more than one part of the body.”

Ironically, the recent cyber attack on the NHS, in which the hospital’s parent trust, Barts Health, was the worst affected in the country, helped to speed the response to the London Bridge atrocity.

Junior doctors and consultants had set up What’sApp and mobile text groups to get round the problem of having no access to their NHS email. This meat that alerts spread instantaneously on smartphones as off-duty staff alerted each other to the need to come to work.

“When people talks about What’sApp and how the terrorists use it to talk and how we’ve got to stop it, it makes me smile,” he said. “We were pretty much relying on What’sApp to get all the staff in.”

He is on constant alert for the next attack. “I’m worrying about Thursday [the General Election]. Then I will worry about the weekend. Then I will worry about the weekend after that.

“Let’s just make sure it absolutely doesn’t happen again. I’m thinking – Westminster Bridge, Manchester, London Bridge, all within two months.

“If we did it again [tomorrow], that would put a bit more strain on us. People are a bit tired. If this becomes a regular occurrence then relying on goodwill probably isn’t enough.”

* An edited version of this article appeared in tonight’s Evening Standard (below)