Ministers have been accused of "sitting on their hands" over warnings that the country's largest Covid-19 field hospital is ill-prepared to help the capital cope with a second wave of infections.
Last week, Matt Hancock, the Health Secretary, confirmed that the Nightingale hospitals set up earlier this year would be ready to receive patients once again as conventional hospitals in some parts of the country faced becoming overwhelmed.
However, despite warnings in the spring that the London Nightingale needed to undergo a transformation to play a significant role over the winter, NHS England has admitted that no changes have been made to the facilities since the field hospital was put on "standby" in May.
Watch: Coronavirus-related medicine stockpiles are running low, Labour claims
The hospital, which has the potential to accommodate up to 4,000 patients, was constructed at east London's ExCeL exhibition centre in April.
It was initially set up to provide up to 500 intensive care beds, but only cared for 51 patients, and senior critical care medics had suggested that it should instead adopt the 'step down' model used for the temporary hospitals in Manchester and Birmingham.
Research has shown that far fewer patients require ventilators than was previously thought, but the London Nightingale is designed for patients who have already been put on ventilators and require ongoing critical care.
Dr Rinesh Parmar, a specialist registrar in anaesthetics who chairs the Doctors' Association, said: "Ministers appear to have been sitting on their hands and not learning the lessons from the first wave.
"You tend to have more patients that are not intubated and ventilated than are using other therapies. From a staffing point of view, it would also make sense to have it as a step down facility so you're not then required to staff it with intensive care doctors and nurses who are already in short supply."
Nicki Credland, who chairs the British Association of Critical Care Nurses, said: "What we have learned now is that patients, certainly from an intensive care point of view, are better off being looked after in proper hospitals.
"Therefore, there needs to be a conversation and a configuration of the Nightingales to potentially look at other ways of being able to support the NHS, with the big caveat that you still have to be able to staff them."
In early April, the Health Service Journal disclosed that many critical care doctors and leaders of acute NHS trusts were concerned that the intensive care model in London was less useful than the step-down facilities provided in Birmingham and Manchester.
Such a model would allow permanent hospitals to expand their intensive care capacity to cope with the increase in patients, while knowing that 'step-down' beds were available elsewhere to accommodate those able to be discharged.
Jacob de Wolff, a London consultant in acute medicine, said on Twitter that opening the Nightingales earlier in the outbreak could have avoided "people still actively shedding virus ... being sent back to care homes."
Dr Wolff added: "London Nightingale was set up as a whopping intensive care unit. Not what we actually needed."
In a statement, the NHS in London said: "The London Nightingale Hospital remains on standby ready to quickly step up if needed."
See video below of patients being discharged back in May:
Last week, Manchester University NHS Foundation Trust confirmed that the city's Nightingale hospital was preparing to re-open, "as a facility for patients to have additional rehabilitation".
Vin Diwakar, NHS England's medical director for London, said: “It’s completely wrong to suggest the NHS has not been preparing for a second wave, and in fact as well as improved treatment, redesigned services and surgical hubs, the NHS has increased the number of specialist beds in London’s health system to care for people who are critically unwell with Covid-19.
“Hospitals and the NHS in London have planned for capacity to care for patients needing step-down care during recovery, and our NHS staff continue safely treating people with other health needs, so anyone who needs care or advice for any symptom should keep coming forward.”