The NHS has reached a tragic milestone – here’s how we recover

“We have reached many tragic milestones over the past year. Record numbers of patients awaiting treatment, record COVID-19 infections and record numbers of intensive care patients. But this week we reached a figure incomprehensible at the start of the pandemic, 100,000 deaths.

“Before the first COVID-19 patient even arrived, the NHS was struggling.  ICU bed occupancy levels were above 87% and workforce shortages left the health service at a disadvantage from the get-go. Whilst intensivists, anaesthetists, critical care nurses and so many others stepped up to the challenge of caring for the sickest patients with COVID-19, the sustained length of this pandemic also has had its effect on the staff. We know many are overworked and demoralised, while the critical care facilities reach full capacity and waiting lists for planned surgery continue to increase.

“Currently, it is hard to look beyond the tragedy of the pandemic. While so many patients are desperately ill and thousands are dying.

“It’s understandable to want to focus solely on the here and now. However, that is not something that either our NHS or patients can afford to let happen. So where do we start with a task as herculean as building a better future for our NHS beyond COVID-19? The answer is and always will be staff - after all beds, ventilators and medicine mean little without the skilled clinicians who can utilise them.

“As doctors we have all seen the unimaginable pain of patients and their loved ones. During the pandemic, for those working in ICU including the many anaesthetists and others redeployed to cope with the surge, these events have gone from occasional, to multiple times a day. The exhaustion and stress increased due to an ever-decreasing workforce, has left its mark on the mental health of many, with some questioning their very place in medicine.

“The government’s People Plan pledges to put staff mental health at the heart of the NHS. Signalling what we hope to be their greater understanding of the link between the wellbeing of healthcare staff and patient safety. While the planned promise to improve the experience of working in the NHS and the short-term funding announced in the Spending Review were very welcome, the lack of long-term sustainable investment brings a risk that ideas could be lost in the rush to repair after the pandemic. A sustained, coordinated, funded approach to mental health and wellbeing, would be a lifeline for some staff who currently feel they have given everything they can, and cannot give anymore. 

“In an NHS that already has significant gaps in staffing, we know retention is not enough. While the hardship of the past year can feel overwhelming, it is important to also look to the positives.  Many inspired by the NHS are now looking to it for a career. The government must grasp this unique opportunity and urgently increase funding for medical training places in the UK. They must also be careful to protect the current doctors in training, many of whom have been thrown into the frontline making heroic efforts to help colleagues courageously fighting the pandemic.

“In all of this we must not forget the core focus - our patients. COVID-19 has had an impact far beyond the ICU's, with the NHS having to make the difficult but necessary decision to halt planned surgery. We know that the increased waiting times will mean many patients will become sicker, with more complex needs, the boundaries between intensive care and the wards will blur even further. The NHS must learn to work more efficiently by connecting the silos that house different specialties, smoothing the patient pathway and becoming the champion of the ‘prehab to rehab’ perioperative model. It is essential investment occurs in care prior to surgery including nutrition and fitness, ensuring patients are ready for the NHS when the NHS is ready for them. Alongside more funding for enhanced care giving patients the treatment they need away from the ICU. Commitment to funding these changes, will help to improve the outcomes for tens of thousands of patients who are the forgotten victims of COVID-19, with the benefit of quicker recovery times, freeing up stretched space and hospital staff.

“But the solutions to recovering the health service do not only lie within hospitals. If building back better is core to the government’s plans, it would be a significant missed opportunity if they did not also build back fairer. The pandemic has shone a glaring light on health inequality in this country. With significant disparity in COVID-19 deaths across communities, we have all been reminded of the importance of building a healthier nation. The government must implement a cross departmental health strategy, making sure the implications of all policies take in to account the effect on the most disadvantaged in our society. The healthier the country becomes the more sustainable the NHS will be.

“We must allow ourselves to grieve for the loss of so many to this deadly virus, however we cannot forget the tasks that lie ahead. The NHS can and will recover from this pandemic, but that isn’t enough. We must learn the lessons of the past and build back an NHS that not only heals the damage caused by COVID-19 but addresses the significant issues that were already in the system.”

Dr Alison Pittard OBE, Dean of the  Faculty of Intensive Care Medicine

Professor Ravi Mahajan, President of the Royal College of Anaesthetists