In normal times, January is the month for counting the cost of Christmas. The credit card bills arrive. New year resolutions are made. The consequences of recent indulgence have to be faced.
This year, however, the price of having celebrated Christmas with loved ones could be far steeper – and counted in lives. Doctors and nurses in the NHS report that they are seeing record numbers of admissions of people with Covid-19.
Over recent days, the daily death toll has passed 1,000. “The last time we hit this number, we were still 22 days away from the peak,” said Zudin Puthucheary, a respiratory and intensive care consultant at the Royal London Hospital, speaking on behalf of the Intensive Care Society. The daily number of deaths hit a new record on Friday of 1,325.
NHS staff and the public are increasingly fearful that worse will unfold before things get better. The new strain of the virus, which spreads more easily, coupled with the effects of festive get-togethers, have put rocket boosters under infection rates. Ministers have always said that without tough measures, the service could be overwhelmed. The truth is, however, that even after the most draconian restrictions, that may still be the outcome. Three lockdowns on, the moment of truth is approaching.
“Manpower is the key thing, but we have everybody in – everybody who can be,” says Puthucheary. “The next stage is: will we have enough equipment? Probably. Will we have enough drugs? We think we do. But it’s a logistical nightmare and we don’t know the answers yet.
“We are proud of being able to help other hospitals. It’s one of the things we are good at. The really scary thing is that we’re now thinking maybe we can’t. How are we going to keep accelerating for another three weeks?”
On Friday Sadiq Khan, the mayor of London, declared it was in the grip of an emergency. A day earlier, the capital’s medical director, Vin Diwakar, told a briefing, leaked to the Health Service Journal, that London’s hospitals were less than two weeks from being overwhelmed.
Ganesh Suntharalingam, a London-based critical care consultant and former Intensive Care Society president, said: “We’re seeing big numbers through the front door, which has very worrying implications for what’s going to be in ICU in a week’s time.”
The next week to 10 days is seen as critical – the test of whether the system might buckle under the pressure of spiralling case numbers, rising staff shortages and the challenge of administering vaccines. “There are all these races against time going on that could decide if the NHS holds up, or imply can’t manage,” said one senior consultant at a top London hospital.
We are proud of being able to help other hospitals. The scary thing is that we’re now thinking maybe we can’t
Zudin Puthucheary
Jon Bennett, a respiratory consultant at the Glenfield Hospital in Leicester and chairman of the British Thoracic Society, said the workload for staff had been relentless, beyond anything seen before. Doctors and nurses had been “under winter pressures since November last winter” – 14 months without relief. As the caseloads increase, staffing levels on wards and in GP surgeries are falling as the new strain strikes those trying to deal with its terrifying consequences.
Last week the chairman of the BMA, Chaand Nagpaul, wrote to his members saying a total of more than 46,000 healthcare staff were off work with Covid-19 across the UK. He said the need for frontline staff to be vaccinated was acute.
Staff absences across the whole of the NHS last April reached 6%. Sources inside the service believe the real figure now may be above 12%.
Brexit has also played its part – many international staff have left the country. “We lost a vast number of trained staff very, very quickly in the last six months,” says Puthucheary.
“Intensive care units have been staffed by Portuguese nurses, Spanish nurses, Italian nurses, left, right and centre, and they’ve left. The ones who stayed are the ones who’ve got personal ties to the country.”
Kate Tantam, a specialist sister in critical care in south-west England, speaking on behalf of the Intensive Care Society, said rising case and absence numbers made planning uniquely difficult.
“The numbers of people off sick will change by the hour, so when you come into a shift, you don’t know how many staff you’re going to have, how many patients you’re going to have, how sick the patients are going to be, or which department you’re going to be in,” she said. “That’s the level of flux in intensive care across the UK. And you could have people with 10 years of ICU experience, 10 weeks or even 10 minutes.
“The south-east is the newest place, because of the new variant, but Wales and the north-west have had this for months and I think people have forgotten. Regional centres are being overwhelmed.”
There are other pressures, she says. “We are seeing across the UK that there are higher rates of nurses being verbally abused, because people are so angry that Covid is killing their relatives, and they don’t trust that their relative isn’t going to have their oxygen withdrawn, or some other made-up rumour.”
Staffing problems are hitting the NHS at all levels and in all its tasks – including, now, its ability to administer urgently needed vaccinations. In Kent, which has been one of the hardest-hit areas of southern England, about 25% of clinical and administrative staff are believed to be absent. John Allingham, medical director of Kent’s Local Medical GP committee, which represents general practice in the county, said some practices were seeing as many as half of staff absent.
That is hitting practices’ ability to deliver vaccinations, he said, partly because injections are carried out in person, but also because the logistics of arranging appointments are done by administrative staff.
“A big practice which might have eight or nine receptionists on duty could be down to three, and they have to field 300 phone calls on a Monday morning,” Allingham said. “One of them has to open the door because surgeries are generally operating with a locked door. And there are repeat prescriptions, and hundreds of items of mail every day as well.”
Martin Marshall, chairman of the Royal College of General Practitioners, said that even without staff falling victim to Covid, there are not enough people in local surgeries to reach the ambitious target of two million vaccinations a week.
“There are enough right now to deliver the limited supplies that we’ve got,” he said. “But we certainly haven’t got enough staff to deliver a much larger programme in two or three weeks’ time, while at the same time continuing to deliver the flu vaccination programme and delivering normal business in general practice as well.”
Social care, including for the elderly, has also been hit hard. The National Care Forum, a not-for-profit association of social care providers, said some care services had seen more than half their staff off sick.
Vic Rayner, executive director of the NCF, said: “If people cannot be supported to leave hospital, whether that is by moving into a care home or having care at home, then the whole system will fail.”