Opened by [Prince Charles to great fanfare](http://Charles carries out first virtual Royal opening with NHS Nightingale Hospital), the first Nightingale Hospital in East London was a potent symbol of Britain’s ability to fight back against Covid-19.
A miracle of fleet footed action and coordination between medical and military for a public starved of good news.
But in the three weeks since it was opened doubt about the project has started to creep in. The hospital designed to take 500, with capacity for 4,000, has only treated 41 patients. At a cost of many millions a week there are rumblings the Nightingale is turning into an expensive white elephant.
"We are worried a negative view of the Hospital is being allowed to develop," one senior member of the medical team at the hospital tells me.
"And having so few patients, when we expected to be dealing with hundreds, has not been good for our morale," they added.
Ask the government why the Nightingales aren’t being used and they point to it as one of the coronavirus success stories.
Sir Simon Stevens, Head of NHS England, said: "We have not yet had to make extensive use of the Nightingale London thanks to the hard work of NHS staff – who have freed up more than 30,000 existing hospital beds .... It will count as a huge success for the whole country if we never need to use them, but with further waves of coronavirus possible it is important that we have these extra facilities in place and treating patients."
The senior staff I have spoken to say the real reason for the empty Nightingale is rather more complex.
To understand the situation a little better we have to go back to the week the Nightingale was green lit.
This was the week of the 16 March, the week before lockdown. London hospitals were full of coronavirus patients.
Their intensive care units taken over for patients on ventilators - many unexpectedly young - struggling to fight off the effects of Covid-19.
It appeared highly likely that, like Italy, the UK could rapidly run out intensive care beds and ventilators, that patients would have to be treated in corridors, with doctors forced to make battlefield decisions about who to save.
Watch a timelapse of the NHS Nightingale being constructed:
Against this backdrop, the London Nightingale was conceived, as an overflow facility for patients with respiratory failure. Nursing staff ratios would be considerably lower than conventional ICUs at one nurse to six patients and not the usual one to one.
"If 1000s has been dying from lack of ventilators" the staff member told me, "the Nightingales would have been a safe, effective and efficient way of treating them."
What transpired was rather different. Not only did the health system never get to the point where it was overwhelmed, meaning that few hospitals were willing to transfer patients to a facility judged to have a higher clinical risk.
Also our understanding of the virus developed. Doctors realised critically ill Covid-19 patients were often developing multiple organ failure requiring not just ventilators, but kidney dialysis machines and cardiac support.
The Nightingale, designed as an ITU for respiratory lung support, was not set up to deal with this. Not enough critical care nurses has also been an issue. London hospitals expected to second nurses to the facility haven’t done so.
A nationwide shortage of critical care nurses hasn’t helped. "Hospitals need to send us their staff as well as their patients for this model to work".
Medical staff tell me they are upset more of the Nightingale’s successes are not being trumpeted. Their unrivalled communication with patients’ families, run by family support teams that include the military.
They were one of the first hospitals anywhere in the UK to make it possible for family members to visit loved ones with Covid-19.
A model which has now been picked up by the government, with the Heath Secretary promising that "no one will die alone without a family member allowed to say goodbye".
They also point to the extraordinary, compassionate culture that has flourished at the hospital with high numbers of staff volunteering to fill roles that are a huge leap from their normal jobs: dentists have become nursing assistants and outpatient clinic nurses have up skilled to look after ITU patients.
Senior staff are running on little sleep as the strains of creating an entirely new model of healthcare bite.
The Nightingale concept is still being rolled out across the country, with four open so far and three more to come. But with so few patients some staff feel they are in a fight for their reputation and survival.
So what’s the future?
With cancer and heart specialists warning that death tolls from other conditions could far exceed Covid-19 deaths if normal treatment isn’t resumed.
The Health Secretary pledged on Thursday: "Within very short order, we will start to restart the NHS."
The Nightingale wants to be crucial to that effort, as hospitals move to free up beds for other patients.
"We aren’t designed to take the 50 - 60% of Covid patients with complex problems, renal failure and heart issues. We would always turn them away because we are not the right place for them, but that still means there’s an awful lot of patients we can take."
The Nightingale I’m told, has already been advised to prepare for a new wave of patients.
Success for the Nightingale in the first stage of the pandemic might have been not needing to use it, in the next stage, it’s going to mean actually sending patients there.
Coronavirus: Everything you need to know: