NHS chiefs at Whiston Hospital are bracing themselves for the most difficult winter on record, as staff continue to fend off the second coronavirus wave.

While there has been no major change in recent weeks, admissions are now beginning to fall at St Helens and Knowsley Teaching Hospitals NHS Trust amid declining infection rates across the Liverpool City Region.

At its peak, around 140 beds were occupied by coronavirus patients at Whiston Hospital, out of 700 general beds, although this has plateaued in recent weeks.

According to the latest NHS England data, 87 beds were occupied by Covid patients at the trust as of November 17, down from 97 a week earlier.

Of those, eight were in the hospital’s intensive care unit, compared to 10 the previous week and a peak of 13.

One thing that has massively helped the trust deal with the extra pressure is a prefabricated extension to Whiston Hospital, providing 60 additional beds.

The action was taken by the trust’s board last year in response to growing winter pressures, and will likely prove invaluable in the months ahead.

In preparation for winter, the trust is now working on some numerical modelling to see how bad the situation could be and how it can prepare if it is hit by further waves.

“This is likely to be the most challenging winter we’ve ever faced,” the trust’s chief executive Ann Marr told the People’s Board last week.

“And that’s going some isn’t it because we’ve faced some pretty difficult winters.

“And it’s just a reminder really that normally in the winter we’re kind of full, full up, and all the problems withholding ambulances and A&E being congested and no beds to transfer patients into.

“That happens during the winter normally, and on top of that we’ve got this potentially enormous number of Covid patients that will be with us as well.

“Obviously, what we’re thinking is, if we’re into a bit of a plateau now, the lockdown comes down, off on the 2 December, what happens then? What happens with Christmas?

“So January could be a really, really difficult period.”

Thankfully, a lot of lessons have been learnt across the NHS that have helped prepare staff for the second wave.

One crucial bit of learning is the use of dexamethasone, a commonly used steroid, as an effective treatment in reducing mortality rates.

The NHS has also learnt that continuous positive airways pressure (CPAP) can reduce the need for early intubation and ventilation of patients.

This in particular has taken pressure off Whiston’s intensive care unit, although it still had to trigger “surge” capacity at its peak.

Major strides have also been made in testing.

All patients admitted to Whiston Hospital are now tested for Covid-19, unlike the first wave when only those who were symptomatic were tested.

Ms Marr said national guidance stated at the time that people had to be symptomatic to be Covid-positive, which we now know to be incorrect.

As a result, she said, there were a number of Covid-positive patients who were admitted into the hospital unbeknownst to staff.

All front-line staff are now tested twice a week, whereas previously only symptomatic staff were tested.

Infection control measures have also strengthened, with hospital acquired infections at the trust halving since the first wave and now among the lowest in England.

Ms Marr said the size of the hospital, which turned 10 this year, has also helped reduce the spread.

While progress has been made in dealing with the virus, massive challenges still remain as we head into the winter period.

During the first wave, many key services were stood down to allow hospitals to focus on dealing with the pandemic.

Ms Marr said some non-emergency operations have been cancelled this time round to allow theatre staff to be redeployed to its intensive care unit, which “wouldn’t cope otherwise”, but the majority of elective activity remains in place.

Whiston Hospital’s A&E department has seen attendances return to pre-pandemic levels, having halved during the first wave as a consequence of people being told to stay home.

The trust has also suffered from high staff absences.

Some of this is down to staff contracting Covid-19, and many is due to staff being ordered to isolate by NHS Test and Trace.

Ms Marr added that some staff are “too tired and stressed” to work extra shifts to plug the gaps left by the staff absences.

“We’re desperately trying to carry on treating all other patients,” Ms Marr said.

“We desperately don’t want to stop treating anybody else.

“So as well as trying to care properly for the Covid patients, we really do want to carry on doing all the things we would normally do.”