As the NHS battles to recover from the tsunami of patients afflicted by covid-19, already exhausted medical and nursing staff need to find the energy and compassion to carry on, despite working through 12 months of unrelenting and distressing work, far removed from anything they envisaged ever happening.
Press coverage has naturally focused on the telegenic, more dramatic and, dare I say, more controlled environment of the ICU. Without downplaying the massive pressure those units are under, and how remarkable the escalation in numbers has been, it remains a fact that 90% of hospital inpatients with covid-19 are not on an ICU.
These people were predominantly being looked after by acute medical units, respiratory wards, and care of the elderly units, often needing advanced respiratory support including CPAP and hi-flow oxygen, while the staff, if not redeployed because of the skill mix, are working escalated rotas for months at a time with severe disturbances, not only to their training, but also their work/life balance, both of which have high risks of severely stressing their wellbeing, both physically and mentally.
The pressure all teams are facing at present can never be underplayed, but to focus on my speciality—acute medicine—those working shifts there face almost singular issues. They are having to assess patients, not only with proven or suspected covid-19, but also those without this infection. They must work within the time pressures needed to try to keep “flow” happening from the Emergency Department, the constraints of infection control, the critical illnesses of patients on the acute medical units (AMUs) requiring ‘level 1.5’ care waiting for beds in HDU/ICU or downstream wards—and all of this while maintaining the services usually associated with an AMU, for example same day emergency care (SDEC).
Of note, this is without the almost “safety nets” afforded to some units of definitively knowing a person’s covid status and routinely using the enhanced personal protective equipment (PPE) for all encounters, rather than the thin plastic pinny/surgical face mask/gloves and goggles routinely advised. It was of no surprise to see those working shifts in AMUs were amongst the highest groups in hospital to suffer from Covid themselves. Data from sero prevalence studies and the Society of Acute Medicine surveys has shown >30% of the AMU workforce has suffered from covid directly.
Although, in a way, we are privileged to be able to go out to work and have some human interaction, much more can, and should, be done to care for the medical workforce. A survey conducted by SAM in February 2021 has highlighted some stark facts—27% of our workforce who replied said they had felt overwhelmed at work most days or everyday. 30% felt their trust had “tried hard” to support their wellbeing with 41% saying their trust had “made some effort”, but a worrying 13% said their trust had failed or had shown minimal effort on supporting them during the pandemic. Despite what trusts may trumpet in the press and social media about what they are doing, this is simply not good enough. Is it that the measures put on are impossible for hard pressed staff on the front line to access, what was suggested did not help, or there was simply nothing offered?
There are several obvious “wins.” Staff must have safe socially distanced spaces for their breaks. Hospitals really should provide catering sufficient for hot drinks and food for most of the 24 hours in the day. It is no longer acceptable to limit “out of hours” catering to the ward kitchen for fluids and a microwave for food purchased from a barely restocked vending machine serving whole hospitals.
We need transparent equality across and within trusts for the small and larger issues that worry staff, including the ability to take breaks and use leave they may not have been able to take during the pandemic
Lastly, whilst we all realise the massive need to catch up with elective care, we must not forget that urgent care needs will persist—as they have done for the last decade—at a pace that was nearing unsustainable even before the pandemic struck. Front line staff need to maintain parity with those offering more elective care in terms of support from the NHS.
Nick Scriven, immediate past president of the Society of Acute Medicine
Competing interests: none declared.