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A few patients we are caring for still deny Covid exists, even as we strap oxygen masks to their faces. That is perplexing. Staff find that particularly hard and I think it will be an interesting and difficult part of this next phase. I wonder if we’ll be caring for a select group of patients who think the very disorder we’re treating them for is a sham. How do staff, who are so exhausted, navigate that?

In between previous waves the hospital returned Covid wards to normal wards and increased our elective operating programme. Sadly, we are seeing those wards being turned back into Covid wards again. Although we’ve not yet reduced our elective operations, I cannot see how we’ll cope as Covid admissions increase.

We’re back to planning an increase in critical care capacity and anticipate this will be required to manage the influx of Covid patients. We’re much more adept at pivoting back to Covid measures, having lived through this before. But a number of things are hampering us this time round. We have unprecedented numbers of A&E attendances, with waits in excess of 10 hours. So overall demand has increased massively. The hospital is full, similar to entering a bad winter, so turning wards into Covid wards isn’t easy. There just aren’t enough beds.



Unlocking? NHS staff are humans too and we desperately want society to get back to normal. But it seems almost unfathomable that as Covid infections are rising that the last few lines of defence are being torn away. The most bizarre decision is the mask mandate. It seems almost wholly political. And it’s clear already that mask-wearing is going to become a political statement. That’s totally unnecessary. Masks can protect those around you. They don’t prevent businesses from opening, nor do they hamper the economy. So why ditch the mask mandate? I can’t think of a single good explanation.

One key aspect of the current policy has not been discussed at all. The vaccine appears to have broken the link between infections and deaths, which is fantastic. But there are 5.3 million people with non-Covid related diseases waiting for treatment. If Covid infections are left to run rampant, with no policy measures to slow them down, how on earth is the NHS going to address the backlog?

As infections rise, so too will admissions. As the hospital beds fill up with Covid patients, we will have to stop other work. There seems to be no planning for this whatsoever. It’s all very well for Sajid Javid to say we need to learn to live with the virus and we need to think about other diseases. But until the government understands that a virus running rampant and filling hospital beds means that other works can’t go on, we’ve got a real problem.



The question of whether the workforce will be able to cope is entirely academic. Demand is already unmanageable, staff are already sounding the alarm in droves and patient safety is already being compromised in hospitals up and down the country.

Take the hospitals where I work. We have run out of beds multiple times this year, not only during the last Covid surge in January but many times since, when pressures were supposedly abating. Our recent waiting times in A&E have routinely topped six, seven or even eight hours. We have found ourselves back in the dark old days of gravely unwell patients lining trolleys in corridors, with all the misery and indignity that entails. And we are no 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 avoidable deaths: “What’s been going on for the last six weeks, the levels of activity we are seeing, is creating a significant and sustained threat to patient safety … We know research evidence has consistently demonstrated that excessive occupancy in emergency departments is inevitably associated with an increase in short-term mortality.”

Javid only needs to glance at social media to see the torrent of ever more frantic posts from NHS staff at the end of their tether. One A&E doctor in a district general hospital tweeted that their department’s highest ever recorded number of attendances in 24 hours has been broken by 10.4%. Another doctor told me: “I work in a hospital with an A&E capacity of 180 patients. Yesterday at 9am there were 300 patients down there … Don’t anyone try to tell me numbers are manageable, it’s total crap.”

An NHS consultant friend in London, who is too worried of repercussions for me to share her name, sounded wretched when I called her: “It feels inhumane. Our emergency department is spilling over. Patients are scared, unsure of where else to go, worried that their diagnosis has been missed. But staff have suffered the psychological impact of the pandemic too … It feels like we’ve been set up to fail.”

Nearly half of NHS critical care staff, for instance, have reported symptoms of PTSD, depression or anxiety, with one in five ICU nurses expressing 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.



Distressingly, frontline staff know exactly what is coming because we are already inhabiting its foothills. This week, some hospitals were opening up additional overspill Covid wards as new patients overwhelmed the existing ones. Other hospitals are being forced to cancel vital operations, including cancer surgery, because there are no ICU beds in which to care for the patients post-operatively. If, as the health secretary said over the weekend, dealing with the backlog is one of his top priorities, he would not be removing social distancing restrictions.

Can you imagine what it feels like, Sajid Javid, to hold someone’s gaze as you break the unforgivable news, on the very morning they expect to be anaesthetised, that you have been forced to cancel their life-or-death surgery? No, of course you can’t

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