Covid-19: NHS doctors demand urgent clarity over ‘Level 4’ powers

6th November 2020


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Doctors warn some hospitals are already full as they cope with a second wave described as “far worse” than the first.

Ministers should actively support NHS trusts seeking to postpone non-essential surgery and take other emergency measures to ease hospital pressures during the second wave of Covid-19, senior doctors have warned.

Sources for this blog, all senior hospital doctors (consultant level and above), have described the second wave of the pandemic as “far worse” than the first – because NHS staff are dealing with the annual spike in admissions due to winter-related illnesses, as well as the huge backlog in elective procedures postponed during the first wave.

The NHS in England was moved back onto ‘Level 4’ alert status at midnight on Wednesday to coincide with the start of the second lockdown in England. It follows news that almost 11,000 people are currently being treated for Covid-19 inside England’s under-pressure hospitals.

But senior hospital staff said that, unlike with the earlier move to Level 4 status, they have received little guidance from central government or the NHS over what it means in practice. In particular, they want ministers or the NHS to make a clear statement in support of trusts which take bold measures such as the cancellation of elective surgery designed to increase local capacity to fight Covid-19.

In late summer, when Covid-19 admissions began to fall, all NHS trusts were sent a letter urging hospitals to move to ‘Phase 3’ of pandemic management – including clear warnings that they should re-commence elective procedures and implement delayed NHS reforms.

So trusts and hospitals are currently wary of taking measures to postpone elective procedures, without the stated support of the NHS and ministers.

One senior consultant in London said: “We need ministers and senior NHS management to let us know that they have got our backs, as they did last time.

“We have been told to move back to Level 4 procedures, but we have not been told that we will face no sanctions for cancelling certain procedures – which, in theory, is what hospitals have faced since the Phase 3 letter was sent.”

A second consultant, in the north of England, said: “We are asking for support in making the difficult decision to cancel elective surgery and take other measures…but we don’t know whether we will face sanctions from NHS England. We had clear guidance the first time around, but not now.”

Prime minister Boris Johnson announced the second public lockdown across England last weekend, as an emergency measure designed to prevent the NHS from becoming overwhelmed. He said the move was necessary because hospitals would otherwise be full in two-to-three weeks.

But many consultants have also warned that their hospitals are already full. The London-based consultant said: “The government needs to act fast on this. Hospitals are filling up across the country. Some are already full and have no spare capacity. We are quickly going to be snowed under.”

Other doctors have also reported that, unlike during the first wave of the pandemic, A&E departments are busy. Ironically, because Covid patients were directed away from A&E receptions during the first wave, many hospitals saw a decline in A&E admissions. Staff and resources were instead often diverted to Covid wards and critical care units.

The situation across some of England’s hospitals is already desperate. Liverpool University Foundation Hospitals Trust (LUFHT) was last week warned that it could face sanctions after a Care Quality Commission (CQC) inspection raised fears that patient safety is currently compromised.

The watchdog was sent into LUHT by NHS England after officials raised the alarm over higher-than-normal rates of hospital-acquired Covid-19.

One source told this blog: “The inspectors couldn’t unsee what they had seen at LUHT.”

In response, senior doctors at LUHT accused NHS bosses in the northwest of putting politics ahead of patient safety by ‘prevaricating’ over a proposal that would allow the trust to reduce elective activity and deal more effectively with the crisis.

Tristan Cope, LUHT medical director, said the trust has been “abandoned” at a time when it is “essentially overwhelmed” by rising demand for hospital services.

In a WhatsApp message shared with senior colleagues, Cope wrote: “It is clear to me that the politics is outweighing the patient safety issues of the acute crisis. I am utterly demoralised by the catastrophic leadership failure at a national and regional level.”

A senior doctor at a separate NHS trust in northern England described a “deep disconnect” between central government and the regions at this stage of the pandemic. “During the first wave…the government essentially covered our back. We’ve not yet had the same support this time,” he explained.

“In the meantime, our hospital is now full. We are dealing with the second wave of the virus, the usual winter surges linked to flu and other conditions, and the backlog of elective appointments. The first wave was nowhere near as bad as it is now.”

The same consultant also warned that staff morale is lower as the winter phase of the pandemic intensifies – a situation made worse by rising staff absences caused, in part, by the belated roll-out of the government’s ‘test and trace’ software.

“I think we used up a lot of resilience during the first wave,” the source added.

Levels of absenteeism at hospitals consulted by this blog were as high as 15%. However, most doctors reported rates of between 8% to 12%. Some ambulance services, meanwhile, have faced absence rates of up to 30% during Covid-19.

The government’s “test and trace” system, an app-based attempt to map and control the virus, has been partially blamed for increased staff absences. Under the scheme, NHS staff – like members of the public – receive a message informing them when they have been close to an infected individual. Consequently, asymptomatic NHS staff are often forced to take time off work until they receive a clear test.

Yet any hospital staff showing early symptoms of Coronavirus or Covid-19 can already undertake a test at work.

A second consultant at an NHS trust in London explained: “It’s an uncomfortable reality for hospitals, this. Staff often receive warnings – however vague – through the ‘track and trace’ programme but remain asymptomatic. They isolate and return to work [after 14 days].

“People might think that medics are whingeing about something essentially positive: software that helps us to map the virus. But all of this takes time. In the meantime, wards hit by staff absences are struggling to cope with a new wave of patients.

“‘Test and trace’ is a well-meaning programme, of course. And similar systems have worked effectively abroad. But ‘the law of unintended consequences’ applies: it can leave us short of key staff.”


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