A Unified NHS Is More Important Now Than Ever Before
Dr Sarah James*

A medical professional tells The Platform that NHS Trusts are being left to their own devices in response to the coronavirus pandemic

As an NHS doctor, I am angry at the way the NHS has responded to the COVID-19 crisis. By NHS, I do not mean doctors, nurses, healthcare assistants and all other staff working to look after patients. I mean the NHS.

A unified NHS stance is what we need more than anything now that we are facing the coronavirus pandemic. Devolution in NHS funding and decision-making has meant that individual trusts effectively operate as standalone companies. This means that hospitals, instead of operating under a unified disaster response protocol, are affecting a fragmented and inconsistent approach to dealing with this.

This is, of course, not helped by our prime minister’s frank inability to articulate the seriousness of the situation, as well as convey any coherent, structured plan of attack. The lockdown message received on Monday night was a change in tack, a welcome hardening of control in contrast to his previous floppy advice to please stay home – but it came weeks after it was needed, and even now, possibly with too little control to enforce it.

Most NHS trusts are indeed acting sensibly by suspending non-urgent operations and routine outpatient appointments, converting clinics to telephone clinics where possible, and re-directing staff and resources to where they are most needed. The NHS hospital that I work in, a non-acute central London tertiary referral centre, are still on this day, seeing non-urgent outpatients. That is, rather than contacting these patients and offering a phone consultation or re-arranging, they are expecting them to turn up, then discharging and removing them from the waiting list if they do not attend their appointment.

Do not be mistaken, the waiting lists in this department are chronically swollen. Many patients have been on it for over six months and, under usual circumstances, we simply cannot give second and third chances to every patient that does not attend. However, it can be presumed that in the current situation, a large proportion of these patients have either assumed that the clinics have been cancelled, or they are simply following the advice not to travel unless essentially necessary. Again, due to lack of unified guidance, these decisions are being left to individual consultants, creating huge variability on the care that patients are receiving. The cynic in me is also aware that discharging patients trims down the waiting list, and this looks better for managers on paper.

Just last week, we were told by the higher offices that we were to still be conducting ‘business as usual’ and, inexplicably, were told that the seriousness of coronavirus had been downgraded, allowing us to restart our routine outpatient procedures again, despite the number of cases and deaths growing. Where this supposed downgrading came from, I do not know.

Not only do these practices put the NHS staff at risk, it is also putting the patients at risk. Patients can only access our hospital via public transport, and by asking them to attend today, they are at risk of either picking up or spreading COVID-19 through London’s transport network.

While these appointments continue to go ahead, using up vital resources that are already in short supply, colleagues in other trusts have told me that cancer operations have been cancelled due to having inadequate PPE supplies. Cancer operations must be done in a timely manner in order for the patient to have the highest chance of success. It is heartbreaking for the surgeons and devastating for the patient to have this cancelled, with no clear indication of when it can be reliably rescheduled, leaving them in a time of terrifying uncertainty. Without devolution, there is a possibility that NHS resources and services as a whole could be pooled together and redistributed depending on need.

Ultimately, the actions of this, and likely few other trusts in the country, reflect a chronic stretch of services that have no wiggle room for when crises like this occur. Most trusts were already working with minimal staff numbers, and although these circumstances are extremely rare and unpredictable (that is another argument), when services are at maximum capacity consistently, it only takes a small blip to bring them crashing down. One of London’s largest hospitals, Northwick Park, was at critical care capacity on day one of this crisis, so you can imagine what another three months of this might look like.

There are now 43,000 nursing vacancies in the UK, and applications to study nursing are down 25% thanks to George Osborne’s genius plan to remove any and all incentives to become one. Any person who has ever been a patient, or knows a nurse, will know that without nurses, there is no healthcare. The junior doctors strikes in 2016 lasted for 48 hours. Discussions for nurses to strike were proposing withdrawing services for 12 hours. 12 HOURS. That’s how long it would take for the NHS to crumble without nurses.

What we need, and what we needed from the beginning, was a unified, firm message to all NHS hospitals: to cancel all non-urgent procedures and appointments, and to redirect all staff and resources to the areas that need them. Not advice. Not recommendations. Trusts are not bound to heed advice. And where they aren’t bound, they haven’t been heeding it. They’ve been using up resources in non-urgent settings and encouraging the movement of people in a city that is now Britain’s epicentre. Where I work, there was even discussion of booking in more patients from the waiting list in the places of procedures that have been cancelled.

The lack of a sense of urgency is clear, and it is our government that will have blood on its hands if it does not step up and enforce measures to battle this. People are not following advice, because a babbling, Blitz spirit, puppet UK prime minister is not making them. How can we expect the general public to follow advice to stay inside their homes for the foreseeable future, when I can’t even get a lot of my patients to brush their teeth every day? A lockdown was so desperately needed a week ago at the latest – now let’s hope to God that it is somehow enforceable, because the NHS is not invincible and neither are its staff. Those on the frontline are making impossible decisions already as to who to save, and without help, we are simply making their job even more impossible.

If the government won’t unify, if the NHS won’t unify, we all have to unify ourselves and stop waiting. We must instead take it upon ourselves as neighbours and friends to be responsible, stay inside and ride out this storm. Understand the very real reality that any of us can be a carrier, whether we are symptomatic or not. Stay home. The people lying in ITU beds right now wish you did weeks ago.

*Name of author has been changed to protect identity.


Photo Credit: Tim Dennell via Flickr
Dr Sarah James*

Dr Sarah James*

Dr Sarah James is a medical professional working for an NHS Trust.

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