David Oliver is an experienced NHS consultant physician and medical writer from Manchester.
Now working in the South East, he has looked after Covid wards and patients for many months over the past two years. He also writes a weekly column in the British Medical Journal.
Here he shares his perspective with the Manchester Evening News - revealing that after more than two years working at the centre of the Covid-19 pandemic, followed by the current crisis of unprecedented demand on a hamstrung system, he has had to be signed off work sick.
And the heavy toll of the relentless pressure on those who hold up the NHS is far from unique to him, says the doctor.
I came into the pandemic already tired after three decades on the job
I rarely write about my personal experiences, but practising medicine during the Covid pandemic has finally given me the motivation. I’m just one of hundreds of thousands of clinical and care staff who have lived through it all, and my story is no more important than anyone else’s. But I’d still like to tell it.
I came into the pandemic already tired from three decades as an NHS doctor working on big, busy hospital wards and the acute medical take, combining it all with many external national roles. Ideally, I wanted a break from medicine.
I’d seen the reports from China, northern Italy, and the US about the impact of Covid. By February 2020—when the chief executive of NHS England, the health secretary, and the chief medical officer were fielding stories from the press—I could see the writing on the wall, despite politicians’ desire to play down the scale of the threat and to spread reassurance.
By early March I’d looked after my first patient to die from the virus, at a time when Covid tests were still hard to obtain. Over the next four months, I was a consultant for a designated acute 'hot' Covid ward, where all 28 patients were infected. I was also covering 'hot' areas in escalation wards, the emergency department, and the acute medical unit when on call.
In those early days we had no vaccine, little evidence about effective treatments, and very variable personal protective equipment (PPE), with confusing and inconsistent advice about its specification. People I worked with were coming to work every day at personal risk and with varying levels of anxiety, not just for themselves but for their partners.
I got almost blasé about my own risk of infection at the time and enjoyed being useful and like I was making a difference. But my wife was worried every day, knowing that I’d be more interested in trying to speak to deaf or confused or anxious patients at close hand than worrying about personal protection.
Sent to work on Covid wards with 'flimsy PPE', five patients dying within 90 minutes, then having to break devastating news to families over the phone
I lost close NHS colleagues and friends to Covid, watched many more become sick from it, and saw the daily impact of Covid care on the nurses, healthcare assistants, therapists, and young doctors I worked alongside. Some of their anxiety was about risk to their own health, but much of it was due to the relentless distress we were dealing with.
Covid medicine seriously affected the training experiences of doctors starting their careers. In debriefings with them and other staff members, it became clear that the wider Covid restrictions in society and concerns about infecting friends and family left them with few release valves to help their wellbeing.
Much of the media coverage focused on the sickest patients on ventilators in intensive care. And no doubt, intensive care staff – where bed numbers doubled at times with staffing ratios watered down and unfamiliar staff roped in from other areas - had a tough time and are still affected.
Still, most inpatients with Covid were not in intensive care but on general wards, by about six to one. With only flimsy PPE, we saw patients in their dozens with prolonged respiratory distress, high oxygen requirements, and other complications such as severe confusion, worsening nutrition or severe weakness. They were clinging to life or requiring palliative care.
There are always some dying or deteriorating patients on general wards, but it’s different when they’re the majority. Staff on general wards in regular patient contact were around seven times more likely to be admitted with Covid infection than other NHS staff groups. And those from ethnic minorities were at especially high risk. Not just clinical staff, but others like porters or domestics.
Because of visiting and travel restrictions we had to spend hours on the phone having awful conversations with patients’ distressed family members, breaking bad news or explaining that their loved one was sick enough to die. In usual times, such encounters would have been face to face.
One Saturday, five of my patients died within 90 minutes, and we had to speak to all of their families by phone.
During the second major wave from December 2020 to April 2021, the peak number of patients in hospital was twice as high as in the first wave, rising exponentially and rapidly that January. For the second time, I was a consultant for a 28 bed 'all Covid' ward, for five months. This time we at least had vaccines, a range of evidenced treatments we’d identified from big research trials and a much better understanding from experience of how to treat patients.
But the same pressures and personal risks affected a staff team who were already tired. And isolation rules meant that patients were constantly being moved on and off the ward, depending on whether they’d just tested positive or gone 10 days beyond a positive test. It’s hard to provide any continuity of care in those circumstances — and families were increasingly upset about the visiting restrictions and about their relatives catching Covid within hospital (around one in four of all cases).
The unsung heroes, the repeated failures I find hard to forgive, and how the relentless pressure has made me ill
In the spring 2022 wave I was once again the senior doctor on a designated Covid ward. By this stage, anyone who tested positive was moved or admitted to my ward and then, if still an inpatient, moved off again within five days. This meant a frantic churn of patients.
Throughout the pandemic response, operational and clinical managers have been unsung heroes, doing what they could to flex admission routes, bed bases, ward configurations, and staff roles. They did the best they could in uncertain circumstances, as decisions on patient moves and flow affected clinical staff coping with constant change.
However, the repeated failings on PPE provision, staff testing, confused policies and communications for clinicians, and suppression of staff’s concerns are things I find hard to forgive.
After two years of dodging the bullet I then caught Covid myself in March. While not sick enough to be admitted, I haven’t been right since. Some of my symptoms have doubtless been Covid related, but others were due to burnout, anxiety, and depression — eventually leading to my being signed off work sick in mid-May, unsure when I can return to clinical work.
A George Cross won't compensate for the state of the NHS now
Having been elected as president of the Royal College of Physicians in April – an ambition I had worked towards for years, I reluctantly and with great sadness had to withdraw from the role last week, as I no longer felt able to do it justice. If this has happened to me — a veteran, stress tempered NHS doctor, 33 years in the job, with no long-term conditions and previously fairly robust — then few of us are likely to be exempt from the strains of the past couple of years.
The NHS is now battling such a major backlog of cancelled elective procedures and relentless pressure on urgent care that, three weeks ago, every ambulance trust in England declared a major emergency. The service faces huge recruitment and retention issues, staffing gaps, social care pressures, and health inequalities, further adding to the strife.
The timing — where so many staff find themselves tired, burnt out, demoralised, or unwell — could not be worse. And there is still plenty of Covid infection out there.
These problems were clearly identified last week by the Parliamentary Health and Social Care Select Committee. And a Health Service Journal Round Table of NHS Chief Executives reported them admitting that they were now “presiding over a failing health service”
A George Cross won’t compensate for this, and the mood music created by intransigence on improving terms and conditions won’t help. Nor can I see any meaningful solutions being proposed by current candidates for the Conservative Party Leadership. Without sufficient clinical and care staff, in sufficiently good health, and with sufficient support, energy, and morale, there will soon be no viable NHS or social care system.
An earlier version of this column was originally published in the British Medical Journal on July 20 and is reproduced with the BMJ's permission.
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