Hospital bosses battling to protect staff from ‘mental health issues and exhaustion’

The chief executive of Barts Health NHS Trust has said that ensuring staff can rest and recover ahead of resuming their regular jobs, having undergone immense pressure while caring for unprecedented numbers of Covid patients, is a “critical consideration”.

Elective procedures were cancelled at Barts from about 21 December, as the increased transmissibility of the new strain of Covid swiftly necessitated the redeployment of staff to help care for patients who numbered 835 in mid-January, with some deferring or coming out of retirement to help.

Chief executive Alwen Williams was quizzed by councillors this week on the balance being struck over when elective surgery may return against the need for staff hardpressed by the latest wave to have leave, with the warnings heard of the potential for burnout among people working under “almost intolerable conditions” while helping care for those critically ill with the virus.

Williams responded: “In terms of the blueprint for resuming with elective surgery, that is what we are working through as we speak. We are very very conscious that the staff that will be deployed back into their original teams who are currently working at the Royal London in critical care, what we are currently mapping is making assumptions.

“If critical care continues to decline at one per cent a day, what can we factor in terms of rest, recovery and annual leave for staff? We think it is probably going to be something like early March for some, but gradually during March and into April we will start to resume.”

Williams added: “It’s a very difficult tension to hold, because on the one hand you can see the needs of the staff, while on the other hand we can see the needs of our patients who really need to be treated and brought in.

“The judgments we take on this are going to be very key, because if we go too fast, clearly staff may go off sick and we do know that staff going into critical care are self-reporting relatively high levels of PTSD.

“What we now do in the next few weeks to give people rest to give them opportunities for access to psychological support, to go back to their home teams and start to build those working relationships, debriefings, counselling.

“The health and wellbeing offer in the NHS is now much better than it was over 12 months ago. It’s got to be like that forever, it’s not just a Covid response.”

Williams added that Barts now have psychologists completely focused on staff, that team leaders are able to access and bring in where necessary, with a guide to all team leaders being prepared about what individual conversations with staff should look like.

She added: “Every individual will be different in terms of what’s needed. We’re planning the future, we have some assumptions but not yet cast in stone.

“We are very mindful that we’ve absolutely got to give our staff rest and recovery so that staff are in the right place psychologically and in terms of their physical health to be able to not only be at work but be engaged and leading what will be again a challenging further Covid recovery, albeit a different one than we’ve been tackling in the last six to eight weeks.”

While Barts is now over the peak, it continues to treat many patients in critical care with the numbers of admissions declining by around three per cent a day, and critical care only declining by one per cent per day.

As a result, Williams foresees critical care remaining “very full” for the next six to eight weeks, for which she warned her Trust does not have the baseline levels of staff to accommodate, hence the taking down of routine surgeries and redeployment of staff.

The hospital boss has underlined that urgent elective patients, including cancer treatment, are still receiving treatment without delay, as just as in the first wave Barts is making use of the independent sector to find capacity to do so, with patients needing radiotherapy and chemotherapy also continuing to be seen.

Barts swiftly reconfigured its hospitals in advance of the current wave, with the Royal London becoming a “mainstay” according to Williams, becoming a surge centre for North-East London as it increased its critical care bed capacity from 44 to 150, helping other hospitals in the Barts group, the Homerton, and Barking, Havering and Redbridge.

Covid-related occupancy at the Homerton is now 21 per cent in general and 23 per cent in critical care, in comparison to around a month ago when these figures were 52 per cent and 48 per cent respectively, according to data presented by Hackney public health.

Overall in London Covid rates have now decreased by 25 per cent from the previous week, with rates in the capital reducing from justs over 1000 per 100,000 population to around 250 per 100,000.

Of all Hackney Covid deaths, 31 per cent (129) occurred in January 2021.

Williams added: “Since we last met we were describing an expectation that clearly there would be some resurgence of Covid. At that time the resurgence was rising but very slowly and incrementally, which was what we expected to happen at that point together with winter pressures.

“But clearly the variant virus affected that very significantly, so by the time we got to mid-December we began to see a very significant escalation of Covid admissions into hospital. That continued throughout December, through the Christmas period into New Year. The peak of the second surge between the 5th and 19th of January.

“Clearly the assumptions over how winter might be taken forward clearly were not the case as a result of the variant virus and the impact that had in terms of transmission and resulting in hospital admissions. That had a very significant impact on the capacity and how we configured our hospitals. We had to move very very quickly to make sure capacity was there to meet patient needs.”