You have to hand it to Sajid Javid for sheer, barefaced doublespeak. At the start of the month he wrote an emollient letter to every single one of the NHS’s 1.3 million staff to assure us he felt “a deep affection for the NHS, and the brilliant people who work there”. Even better, the new health secretary insisted: “I want to give you what you need to recover from this difficult period, and make it as easy as possible for you to do your job.”
Well. How we longed just this once to believe our secretary of state. Alas, it took a mere two days for him to go back on his words. Javid wrote an op ed for the Mail on Sunday in which he declared that opening up Britain, even as Covid cases soar stratospherically, would give us a country “that is not just freer, but healthier, too”. Then the prime minister issued the coup de grace, officially announcing his much-trailed new policy of binning all pretence at controlling Covid because if not now, when? I don’t know, we tried to mutter through our broken teeth, maybe when a few more people have been vaccinated?
It’s a struggle to put this in printable terms, but Javid needs to understand there are a few things that will definitely not help NHS staff do our jobs. A George Cross, for instance. A badge, of any description. Another round of fulsome clapping from the steps of No 10. But, and this really is the kicker, the one thing that will absolutely not help is the decision to launch a nationwide experiment in which Covid will be allowed to let rip through an unchecked, super-exponential growth phase.
As a senior colleague put it to me: “Are they fucking mad?” To which I could only stare at the floor, feeling desperate. For this is where we are. The UK population, whether we like it or not, is now Boris Johnson’s personal petri dish. Yet before we even reach the projected 100,000 new cases of Covid a day, the NHS – as both Johnson and Javid must know – is already on its knees. 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.”
This is the crux. Too many frontline staff (as Javid, again, has to know) are broken and burnt out after 18 months of Covid. 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.
I am not, then, dismayed by the government’s decision to pour petrol on Covid numbers. I am disgusted. Of all people, a health secretary who used to be a banker should understand that a pandemic, in a profound sense, is a numbers game. There is a remorseless logic to exponential statistics, which is why, no doubt, the government is refusing to make public its modelling for Covid hospitalisations and deaths this summer. We stopped following the science long ago. I suppose it was only a matter of time before Boris Johnson would actively suppress it, urging people to take “personal responsibility” for decisions about which he is deliberately keeping them in the dark.
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. You force us to play a zero-sum game in which every extra patient with Covid erodes a little more of our capacity to care for someone else without. You are, in short, championing a policy that directly harms all patients, whether they have Covid, cancer, heart disease, dementia, mental illness, a car crash or a brain haemorrhage. It turns my stomach even to think of it.
Rachel Clarke is a palliative care doctor and the author of Breathtaking: Inside the NHS in a Time of Pandemic