'We drew up the plan over a brew' - inside operation Nightingale

Dan Sabbagh

London’s emergency coronavirus hospital at the Excel conference centre has been built from scratch over the last nine days in an unprecedented civil-military partnership and is ready to receive its first patients this week.

Planning has involved soldiers with experience from Afghanistan and the west African ebola crisis, working in support of health service staff to create NHS Nightingale, which will be the largest hospital in the UK, with 4,000 beds at full capacity.

The military team leader, Colonel Ashleigh Boreham, Commanding Officer, 256 City of London Field Hospital, an expert on building field hospitals in crisis zones, said the design and build was easily the largest he had undertaken in a 27-year army career.

“We literally got a phone call, arrived here, met up with the NHS about nine days ago, sat around a table and basically did what you always do. We draw a plan up, over a brew, and then from that you start to build up a plan and create the product. It’s the biggest job I’ve ever done,” Boreham said.

Related: ExCel: from a mayor's fun palace to coronavirus warzone

Up to 200 soldiers a day have been working alongside NHS staff and civilian contractors – including plumbers, carpenters and electricians – building row upon row of beds in cubicles in the vast 88,000 square-metre centre normally used for trade fairs and conventions.

The principal challenge has been to complete the first phase of the build before hospitals in London and the south-east run out of room to treat patients, who are likely to require ventilator support to be kept alive while their bodies fight the virus.

The NHS will not say exactly when Nightingale will be ready to open – other than to confirm it will be able to take patients “this week”, with up to 500 beds ready in the first phase.

Nightingale’s size dwarfs field hospitals built by the army, which usually aim to treat a few dozen people with battlefield trauma injuries. “The difference here is that it [Nightingale] is at scale,” Boreham said.

“We build hospitals that are trauma hospitals that are multi-discipline. This hospital is built with a much more simple plan with less variants so it supports a particular type of patient group,” Boreham added.

The soldiers’ work has also included building a morgue, work that Boreham said had made “people focus their minds”.


Symptoms are defined by the NHS as either:

  • a high temperature - you feel hot to touch on your chest or back
  • a new continuous cough - this means you've started coughing repeatedly

NHS advice is that anyone with symptoms should stay at home for at least 7 days.

If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.

After 14 days, anyone you live with who does not have symptoms can return to their normal routine. But, if anyone in your home gets symptoms, they should stay at home for 7 days from the day their symptoms start. Even if it means they're at home for longer than 14 days.

If you live with someone who is 70 or over, has a long-term condition, is pregnant or has a weakened immune system, try to find somewhere else for them to stay for 14 days.

If you have to stay at home together, try to keep away from each other as much as possible.

After 7 days, if you no longer have a high temperature you can return to your normal routine.

If you still have a high temperature, stay at home until your temperature returns to normal.

If you still have a cough after 7 days, but your temperature is normal, you do not need to continue staying at home. A cough can last for several weeks after the infection has gone.

Staying at home means you should:

  • not go to work, school or public areas
  • not use public transport or taxis
  • not have visitors, such as friends and family, in your home
  • not go out to buy food or collect medicine – order them by phone or online, or ask someone else to drop them off at your home

You can use your garden, if you have one. You can also leave the house to exercise – but stay at least 2 metres away from other people.

If you have symptoms of coronavirus, use the NHS 111 coronavirus service to find out what to do.

Source: NHS England on 23 March 2020


Although he worked as a medical commander in Afghanistan in 2013-14, Boreham said the closest parallels were the “experience from working with partners in West Africa during the Ebola crisis” which he said was working against a tight time scale and building up capacity incrementally.

Royal Engineers have provided some additional specialist skills, while members of the Royal Anglian Regiment – some of whom were in Sierra Leone a fortnight ago - have helped with unskilled tasks so the contractors can work more efficiently.

Lt Michael Andrews, a platoon commander with the Royal Anglians, said he and his troops had been at the Excel since Thursday. “So far we’ve been laying vinyl flooring in the medical bays, assisting with the build of the hospital beds and mattresses and other low level tasks, which frees up specialist trades.”

Once operational, Nightingale will be staffed by NHS specialists working around the clock with the support of hundreds of volunteers from the St John Ambulance Service – and, after they have been trained, cabin crew from Easyjet and Virgin Atlantic, who are otherwise out of work.

Richard Lee, the chief operating officer at St John Ambulance, said the numbers of his charity’s volunteers at the site would eventually reach 500 in around three weeks, split into two 12-hour shifts. “Our people have needed little encouragement to step up,” Lee said.

The St John volunteers, who normally provide first aid care at public events, will work in pairs with nurses on site, tending to patients and ensuring they are as comfortable as possible.