Friday, January 28

The NHS is already overloaded: removing Covid restrictions will spell disaster for patients | Rachel clarke


YYou have to give it to Sajid Javid for a pure and cheeky double talk. At the beginning of the month he wrote a emollient letter to each of the 1.3 million NHS employees to assure us that they had “a deep affection for the NHS and the brilliant people who work there.” Better yet, the new health secretary insisted: “I want to give you what you need to recover from this difficult period, and make it as easy as possible for you to do your job.”

Well. How we yearn just this once to believe our secretary of state. Unfortunately, it took him only two days to retract his words. Javid wrote a Mail on Sunday op-ed in which he declared that opening up Britain, even as Covid cases skyrocket, would give us a country “that is not only freer, but healthier as well.” The prime minister then delivered the coup de grâce, officially announcing his long-held new policy of removing all pretense to control Covid because, if not now, when? I don’t know, we tried to mutter through broken teeth, maybe when some more people got vaccinated?

It’s a struggle to put this in printable terms, but Javid needs to understand that there are some things that definitely not help NHS staff do our job. A George Cross, for example. A badge, of whatever description. Another round of applause filled with the steps of number 10. But, and this really is the trick, the only thing that will not help at all is the decision to launch a nationwide experiment in which Covid will be able to let an uncontrolled test pass, super-exponential growth phase.

As a senior colleague told me: “Are you fucking crazy?” To which I could only stare at the ground, feeling desperate. Because this is where we are. The UK population, like it or not, is now Boris Johnson’s personal petri dish. However, before even reaching the 100,000 new Covid cases projected per day, the NHS, as both Johnson and Javid must know, is already on its knees. The question of whether the workforce will be able to cope is entirely academic. The demand is already unmanageable, staff is already sound the alarm en masse and patient safety is already engaged in hospitals across the country.

Take the hospitals where I work. We have run out of beds multiple times this year, not just during the latest Covid wave in January, but many times since then, when pressures were reportedly easing. Our latest waiting times in the ER have typically exceeded six, seven, or even eight hours. We have found ourselves in the dark old days of seriously ill patients lining carts in the hallways, with all the misery and indignity that this entails. And we are not an outlier. Last month, the Vice President of the Royal College of Emergency Medicine, Dr Adrian Boyle, warned of the risks of overwhelmed A&E departments leading to preventable deaths: “What has been happening for the last six weeks, the levels of activity that we are seeing, is creating a significant and sustained threat to patient safety … Emergency departments they are inevitably associated with increased short-term mortality. “

Javid only needs to glance at social media to see the increasingly frantic stream of posts from NHS staff at the end of his life. An emergency doctor in a district general hospital tweeted that The highest number of attendance registered in your department in 24 hours has been divided into 10.4%. Another doctor told me: “I work in a hospital with an A&E capacity of 180 patients. Yesterday at 9 in the morning there were 300 patients down there … Let no one try to tell me that the numbers are manageable, it sucks ”.

An NHS consultant friend in London, who is too concerned about repercussions for me to share her name, sounded miserable when I called her: “It feels inhuman. Our emergency department is overflowing. Patients are scared, not sure where else to go, worried that their diagnosis has been missed. But the staff have also suffered the psychological impact of the pandemic … It feels like we are prepared to fail. “

This is the crux. Too many front-line staff (like Javid, again, you have to know) is broken and burned after 18 months of Covid. Almost half of NHS intensive care staff, for example, have reported symptoms of PTSD, depression or anxiety, and one in five ICU nurses expressed thoughts of suicide or self-harm. As the entire workforce grapples with the pandemic backlog – more than 5 million patients now languish on waiting lists – morale has never been lower.

So, I am not dismayed by the government’s decision to pour gasoline on the Covid numbers. I am disgusted. Of all people, a health secretary who was a banker should understand that a pandemic, in a deep sense, is a numbers game. There is relentless logic to exponential statistics, which is why the government is undoubtedly refusing to release its model of Covid hospitalizations and deaths this summer. We stopped following science a long time ago. I suppose it was only a matter of time before Boris Johnson actively suppressed it, urging people to take “personal responsibility” for decisions about which he deliberately kept them in the dark.

Sadly, the frontline personnel know exactly what is coming because we are already inhabiting its foothills. This week, some hospitals opened additional Covid wards due to over-patient as new patients outnumbered existing ones. Other hospitals are forced to cancel vital operations, including cancer surgery, because there are no ICU beds in which to care for patients postoperatively. If, as the Health Secretary said over the weekend, dealing with the backlog is one of his top priorities, he wouldn’t remove the social distancing restrictions.

Can you imagine what it feels like, Sajid Javid, to hold someone’s gaze as you give them the unforgivable news, the very morning they are waiting to be anesthetized, that they have forced you to cancel their life and death surgery? No, of course you can’t. You force us to play a zero-sum game in which each additional Covid patient erodes a little more our ability to care for someone else without it. In short, you are advocating a policy that directly harms all patients, whether they have Covid, cancer, heart disease, dementia, mental illness, a car accident, or a brain hemorrhage. It makes me sick to my stomach even thinking about it.




www.theguardian.com

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