FRONTLINE’S VERDICT ON COVID ACTION
In an extensive survey, frontline healthcare workers reflect on Wales’ handling of the coronavirus pandemic so far. Health correspondent Mark Smith reports
DOCTORS, nurses, social care staff and other frontline workers have given their brutallyhonest opinions of Wales’ handling of the coronavirus crisis to date.
An extensive survey, conducted by the Senedd’s Health, Social Care and Sport Committee, aimed to uncover the impact Covid-19 has had on staff and their patients.
Some of the major themes included inadequate PPE, problems with testing, the redeployment of staff and the lack of mental health support during the pandemic.
Dr Dai Lloyd MS, chairman of the Health, Social Care and Sport Committee, said: “For us to hold the Welsh Government to account, it’s critical for the committee to hear from those living and working through the pandemic, those caring for us and the impact it’s having on their work and lives and crucially their thoughts on how it’s being dealt with.
“We’re extremely grateful to those who’ve taken the time to share their experiences.”
Here, we look more closely at some the responses to the survey...
■ Personal Protective Equipment (PPE)
PPE has been used throughout the pandemic to try to keep both staff and patients safe from transmission.
Different types of PPE have been used according to the level of risk, the setting or the procedure being carried out.
But frontline staff have claimed that wearing this equipment – in some cases for 12 hours at a time – affected their ability to work and communicate.
“Working long hours in full PPE is exhausting and sometimes painful,” one staff nurse told the survey.
“It also affects our communication in more ways than is imaginable.
Work is physically and emotionally more difficult and tiring.
“Then we have constant headaches from dehydration as we limit breaks to save PPE, and can only drink so much in our breaks to prevent impromptu toilet breaks.”
Another healthcare professional working in a Welsh hospital said communicating with patients was a particular problem.
“Have you tried communicating with a deaf person who cannot read your lips, or a confused patient who longs for human touch and cannot comprehend why you are wearing a mask and gloves etc. and are frightened by you?” they said.
They also added that frequent changes to PPE guidance, as more was known about the virus, put people at greater risk of infection.
“With discrepancies in PPE guidance at the beginning, our staff were put in danger due to misunderstood information being actioned,” said another staff nurse.
“For example was wearing a surgical mask in an ITU setting with cohorted Covid-19 patients, some of which were ventilated. A lot of our staff contacted Covid-19.”
■ Testing
Guidance on testing has changed through the outbreak as new scientific evidence has emerged.
In March, following the move from the “containment” phase to the “delay” phase, testing in Wales was initially prioritised for people requiring admission to hospital,.
It was then followed by a phased rollout of testing for healthcare workers involved in frontline, patient-facing clinical care as capacity increased.
Now we are in a position in Wales where anyone with symptoms can get a test either online, via a drivethrough or in a health or care setting.
But frontline staff in Wales said there were deep concerns, particularly towards the start of the pandemic, that vulnerable people were being discharged from hospitals directly into a care homes without being tested first.
There were also initial worries about access to testing in care homes. as well as knowing when it was safe to return to work.
One staff nurse said: “I unfortunately had the virus and there was no advice from my occupational health department, except that I could go back to work on day eight if better.
“I felt they and managers didn’t care if you were still unwell. They just wanted you back in work and a lot NHS workers went back before they should have.”
There have been repeated calls to offer regular and repeated testing of health and social care staff, including asymptomatic staff.
However, Health Minister Vaughan Gething said the evidence is not there to justify this move.
■ Financial Implications
Dentists in particular, who carry out a mixture of NHS and private work, claim they are in real danger of financial collapse.
They are calling for urgent support to mitigate the financial impact of Covid-19 on their work.
Sandra Morris, a dental surgeon and company director from Powys, said the financial implications of the outbreak on her practice were serious.
“I run a small private dental practice. Our income has dried up to a tiny fraction of what it was,” she admitted. “We have furloughed all staff. In the last few weeks, I have started seeing the odd patient for emergency care if necessary. We have kept going by using my savings and a ‘Bounce Back’ loan.
“It is frustrating that we have to pay business rates even though we cannot run as usual. All NHS practices have their rates paid for them.”
She added that PPE was going to be a headache when the practice does reopen as FFP3 masks are hard to obtain.
“The Chief Dental Officer has imposed stricter rules than in England which will disadvantage patients – and we may need to send them over the border for care if we can’t do it.
“The UK rules in general for dentistry are far more restrictive than other countries e.g. Italy and France regarding PPE requirements and protocols for cleaning. This means that as soon as we reopen we will start to lose money faster. I am praying that this all comes to an end before I run out of money but we can’t stay closed forever. Patients still need care.”
She has urged the Welsh Government to extend the business rates holiday to healthcare businesses.
■ 4. The Impact of Redeploying Staff
In March, the Welsh Government made the decision to postpone all non-urgent NHS work and redeploy staff to the frontline to treat the expected surge of Covid patients.
But now clinicians warn of a huge backlog of routine cases which could take years to revert back to pre-Covid levels.
One radiographer said: “Covid has made many ‘non-urgent’ scans and examinations breach their waiting times, and therefore we are experiencing and will continue to have very long waiting lists for these examinations.
“The delayed impact Covid will have on these patients is almost more worrying for the NHS to deal with (and afford) in the long run.”
An NHS nurse added there have been “huge” changes within their department.
“I work in minor injuries – this has been moved to a different hospital under the guise of Covid - unsure if it’ll be returned.
“Specialist staff were relocated to work in areas of unit where they have no training or experience.
“Injuries that used to be urgent referrals are suddenly acceptable to manage conservatively – this is completely against the grain.”
■ 5. Mental Health
Lockdown has had serious consequences for some people’s mental health, most notably those who were forced to shield or live alone.
Health and care staff have certainly not been immune to these problems.
One staff nurse said: “Emotionally, I have on many occasions gone home feeling completely destroyed, with no-one to hug me and tell me it will be okay as I my partner lives in a separate house. The anxiety and stress at times were unbearable, particularly at the start.”
Another health professional said they have witnessed an increase in suicides, as well as alcohol and drug dependence.
“Patients who are depressed are now unmotivated and desperately struggling with isolation and increased depression,” they said.
“Patients with dementia are struggling to understand and remember why they are not able to have visitors are becoming increasingly distressed.
“Staff come in all spectrums from the highly stressed and very scared to the blasé.”