The Covid inquiry has restarted its live hearings with evidence from doctors and patient groups as health ministers and senior NHS managers are expected to appear before the end of the year. The testimony has brought to light how close the healthcare system came to a catastrophic failure during the pandemic. Hospitals had to convert operating theatres, side rooms or other wards into makeshift intensive care units. NHS trusts often had to juggle shortages of equipment, medicines, and oxygen. However, it was more difficult to find extra skilled workers to staff them.
The pressure was often being felt on the main wards and in intensive care units, where thousands of the sickest Covid patients needed help to breathe on ventilators. Patients were dying daily. Temporary Nightingale hospitals, built in the first Covid wave at a cost of more than £500m, only ever treated a handful of patients. It was possible to build the critical care infrastructure almost overnight, but quite another thing to find trained medics to work in them. Volunteers were frequently brought in from other parts of the hospital, often with no experience of intensive care medicine or of dealing with that level of trauma and death.
Difficult decisions were having to be made about which of the sickest patients to move up to intensive care. One NHS trust was under so much pressure it implemented a blanket “do-not-resuscitate order” at the height of the pandemic. If a patient went into cardiac arrest or stopped breathing, it would mean they should not be given chest compressions or defibrillation to try to save their life. Through the pandemic, the NHS did continue to operate and, on a national basis, patients who really needed hospital treatment were not turned away.
Health services in all four UK nations started the pandemic with the number of beds in ICU and staffing levels well below average compared to other rich countries. Five years later, there are still almost 130,000 job vacancies in the NHS across the UK. Sickness rates among the 1.5 million NHS employees in England are also worryingly high, with days lost to stress, anxiety, and mental illness rising from 371,000 in May 2019 to 562,000 in May 2024. All of this comes as the health service struggles to recover from Covid with waiting lists for surgery and other planned treatments still hovering near record levels.
The NHS had to cope with intense pressure during the pandemic, but only just. If the pandemic had doubled for even one more week, or if a higher proportion of the NHS workforce had fallen sick, the healthcare system would have failed. Prof Charlotte Summers and Dr Ganesh Suntharalingam warned in their evidence to the inquiry: “It is crucial to understand how very close we came to a catastrophic failure of the healthcare system”
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