26.03.2020

Coming home to roost

Richard Galen describes how NHS workers are doing their best to cope following years of Tory cuts.

The coronavirus pandemic is dominating the news cycles, and has brought about unprecedented changes to the daily lives of billions across the world. Current estimates put approximately 20% of the global population under some form of government-enforced lockdown. In Britain, while the public struggle to deal with having to severely limit social and outdoor activities as well as financial issues from the loss of work and the woefully inadequate universal credit system, workers in the national health service are more preoccupied with safety: that of themselves, their families and their patients.

Outside London, where hospitals such as Northwick Park are already starting to be overwhelmed with cases - their intensive care beds full and patients being transferred to hospitals in neighbouring boroughs - most of us feel this is the calm before the storm. Contingency plans are being hastily drawn up: doctors, nurses and other healthcare professionals are preparing to work in unfamiliar areas and having to revisit skills they may not have used for many years. All elective work has been put on hold indefinitely, all but essential outpatient clinic appointments are being cancelled, postponed or conducted over the telephone. The resolve of staff is admirable, with many happily signing up for extra shifts to cover colleagues in isolation, and leave being voluntarily cancelled weeks before the lockdown was seriously suggested.

But, as is the case with any crisis, the current situation has laid bare the inadequacies in the system. Staffing levels - a key aspect of running a safe and effective healthcare service - have been neglected for years under successive Tory governments. The result: a shortfall of almost 44,000 nurses and 10,000 doctors by the end of 2019. This has led the government to ask for help from recently retired staff and final-year nursing and medical students, which, of course, presents its own problems. Many of the recently retired are themselves in the at-risk groups for susceptibility to coronavirus - a direct result of people working longer due to increased demands on the health service. Final-year students, although they will undoubtedly be a useful addition, will likely find themselves being pressured into doing tasks they feel inadequately prepared for.

Mistakes will, inevitably, occur. Not just due to inexperience, but also as staff work over their contract-mandated hourly limits to cover rota gaps. Many doctors and nurses are being asked to cover patients from a different specialty, having to use unfamiliar equipment and perform procedures they may not have carried out since early in their careers, if at all. Comedic memes referring to being intubated by a gynaecologist or having your ventilator monitored by an ophthalmic surgeon are being widely shared amongst even the non-medical public, but the idea is not so funny to a medical profession carrying recent memories of cases like that of Dr Hadiza Bawa-Garba - a paediatric registrar thrown under the bus by her NHS trust and the General Medical Council for a series of systemic failures that resulted in the tragic death of a child.

Another issue surely on the minds of NHS front-line workers is that of personal protective equipment (PPE). Early reports from Italy indicate that almost one in 10 cases of Covid-19 are healthcare professionals, who are at much higher risk than the general population. Yet there have been widespread anecdotal reports of shortages of FFP3 facemasks (an effective form of respiratory protection against viral transmission). These masks have to be changed several times during the day, as they become ineffective and uncomfortable over time, as well as often requiring fit-testing before use to ensure an airtight seal. Many hospitals are now racing against time to carry out fit-testing for staff working in high-risk areas, and staff are re-using equipment designed for single use to cope with the pressures. General practitioner surgeries are often having to rely on ordinary surgical masks - which provide only very limited protection against an infection that can be aerosolised. The problem has not been helped by panic-buying amongst the public, with reports of masks and alcohol hand gel being stolen from hospitals.

Profiteering

The government is trying to ease the coming pressures by requisitioning hospital beds from the private sector. This is, of course, a problem of its own making - more than 17,000 hospital beds have been axed since the Tories took power in 2010. Freeing up beds has become increasingly challenging due to the concurrent cuts to social care and council-run community facilities, with ‘delayed care transfers’ reaching their highest level in two years at the end of 2019. The less palatable term for such patients is ‘bed blockers’ - those medically ready to be discharged from an acute hospital bed, but having to wait for some form of care in the community to be put in place.

Unsurprisingly, given the numerous links between the Tories and private healthcare firms, these private hospital beds do not come cheap - estimates put the cost at £2.4 million per day for 8,000 beds. Contrast this with Spain, where the health minister confirmed last week that all private hospitals can be nationalised and placed under the authority of regional health boards, as well as forcing all private manufacturers of medical supplies to declare and make available their existing stocks within 48 hours.

Shortages will quickly become most apparent in intensive care units (ICU), where the sickest coronavirus patients will require round-the-clock support on ventilators. According to 2012 data, the UK has around seven ICU beds per 100,000 people - half the capacity of Italy and roughly a quarter of that in Germany, which has seen much lower death rates from coronavirus. Very little has changed since then. This is not just a problem for the elderly and medically vulnerable, as a lack of ICU capacity means worse standards of care for everyone who needs major medical intervention, such as the young man involved in a high-speed car accident, or even the working mother who develops a severe appendicitis requiring emergency surgery.

We will get through this period of outbreak, though the ramifications will be felt years down the line. My only hope is that we learn from the mismanagement and inefficiencies that have led to this dire situation, and the next pandemic (which will happen, eventually) sees us in a better position - with a well-funded, well-staffed health service not crippled by years of rightwing government policy.