Yesterday, an Essex trust called in the army after declaring a major incident, and patients are routinely being treated in ambulances outside hospitals, due to lack of space inside.

On Thursday, the Government said a further 964 people had died within 28 days of testing positive for Covid-19, bringing the UK total to 73,512. as hospital admissions go well past the April peak.

In an exclusive interview with the Sun, two frontline doctors reveal their tears over the latest Covid crisis and say the NHS – and its staff – are at breaking point.

Dr Pushpo Babul Hossain, a junior doctor working in South London, says:

“I don’t think any health care system in the world is equipped to deal with a pandemic of this scale.

We’re working all the hours we can and it’s absolutely draining.

Sometimes, you don’t feel like you’re saving lives anymore. You’re on autopilot, you’re just firefighting, holding the fort until the next shift comes to rescue you.

When we see the anti-vaxxers spreading nonsense and people refusing to wear masks, or obey the rules, it breaks our heart. How are we ever going to deal with the consequences of their actions? We really can’t.”

She says:

“Being a doctor should be a very rewarding profession but at the moment, we don’t have the time to feel anything.

We are having to deal with an unimaginable number of patients and doing so many extra hours, we’re in a non-stop, ‘eat, sleep, work, repeat’ cycle which is exhausting.

As a medical doctor on the Covid wards, I see patients who have been referred by A&E with suspected coronavirus infection.

Because we are so full, we’re only taking patients that desperately need oxygen.

Everyone else is told to go home, self-isolate, and monitor themselves for signs of breathlessness, chest tightness and chest pain.

As well as the Covid patients, here are some of those who were sick in the first wave but didn’t come in because of the pandemic and have now developed more serious complications of other diseases. It’s a recipe for disaster.

During the first wave, I had to fight to get a patient up to ITU and, just before my night shift ended, we finally got a bed.

I was relieved he was going into ITU and convinced we’d saved him.

The next morning, the bereavement office told me the gentleman had passed away, and I couldn’t believe it. He looked so good and was only in his 70s, so I really didn’t think we would lose him.

I had tried so hard for him and I remember I cried for a good 15 minutes. It still haunts me today.

But this time is worse. In the first wave, I was dealing with one case like that per day. Now it’s two to three cases per day and it’s getting worse.

Never before have so many patients required oxygen at the same time and many NHS hospitals are old buildings which have not been built to deliver oxygen on such a large scale.

We do have the oxygen to supply to patients but what we don’t have is the capacity to provide it to all of them at the same time.

We are constantly reviewing all our patients to see who can come off oxygen, so we can reduce output.

If too much is being pulled out at once, there’s a risk that certain systems can collapse and cause a complete outage, meaning the hospital would have to be emptied out and people’s lives would be in danger.

The weekend before Christmas was the most stressful of my seven-year career because of the huge number of patients requiring urgent attention. We were just drowning – with two to three emergency calls coming at once.

I felt so scared and helpless.

My pager was bleeping non-stop and I was running around the hospital, dealing with two cardiac arrests and bed after bed of people suffering from lack of oxygen.

I did a vital protein level test on a heart patient suffering chest pains and it was five hours before I had time to read the results – which showed the level was 100 times what it should have been and required urgent treatment.

My heart sank. I remember thinking that this gentleman was my dad’s age and that could have been him lying there and receiving no treatment for five hours.

That weekend, I did three night shifts, back to back, without any breaks.

In a 13 hour shift, we’re allowed a 30 minute rest so we can sit down, eat something or just have a cup of coffee. I couldn’t do that.

On one shift, I didn’t sit down and drink water until 5am when my registrar marched me to the mess.

The NHS is on its knees. There are so many sick patients, doubled with the fact that so many of our staff are off sick having caught the virus themselves, despite wearing all the correct PPE.

The new variant is more transmissible and a lot of my colleagues are coming down with Covid, so I don’t think the guidelines on protective equipment are adequate.

On one set of nights, two of my team of four came down with Covid.

The NHS has always been understaffed and staff levels are now lower than ever.

Everybody from clinical directors to medical students are putting in extra hours and we’re trying our best. But at the end of the day, we’re so tired.

I got married in October, in Bangladesh, and spent ten days with my husband, Taufiq, before coming back to the UK without him.

I’ve not seen him since and none of us know when we will next see our families because all our leave has been cancelled.

I work almost every day and a lot of doctors like me are volunteering to fill in the gaps that are left by our sick colleagues.

It’s no longer possible for doctors, health care workers and nurses to deal with this pandemic alone.

We all have to work together. The public has to understand that they need to play their part, we all need to play our part, to be able to fight this.

I understand that it is difficult, and frustrating and it’s taking a mental toll on people, because they’re being asked to stay at home. But this is the time when we need to think about the entire nation as a whole and protect the old and vulnerable.

Maybe you’re young and a Covid infection or a hospital stay of 10 days doesn’t affect you that much. But your 90-year-old gran can’t afford that.

And would you be able to forgive yourself if you lost your gran just because you were having a night out drinking at the pub? I don’t think so.

As much as the public think they need the NHS – the NHS now needs the public.”

Dr Pushpo Babul Hossain, DAUK

Read the rest of the article here.

Covid-19 is having “a chilling effect”, says Samantha Feinstein, a staff attorney at the Government Accountability Project, a Washington-based organisation that supports whistleblowers. “In the US, we’ve seen a huge increase in the use of gag orders and we’re also seeing it in other countries . . . people are afraid to blow the whistle, because they’re afraid they’ll lose their job.”

One way to make workplaces safer is to provide secure channels for reporting wrongdoing. In the UK, organisations including the whistleblowing charity Protect, WhistleblowersUK, and the Doctors’ Association UK are campaigning for change. Reform is also the goal of a private members’ bill sponsored by the MP Philippa Whitford and of a House of Lords’ bill sponsored by Baroness Kramer.

Full article available here: https://www.ft.com/content/284f67a5-c221-443d-b525-258a3fc7ee66

DAUK Co-Founder Dr Samantha Batt-Rawden who has authored a number of research papers on empathy decline in doctors and medical students wrote this letter to the Editor, published today in The Sunday Times:

Dear Sir,

In your report “Trainee doctors ‘lose empathy’” (News, last week) Dr Miguel Jorge of the World Medical Association appears to suggest that the way to maintain the empathy of doctors is to enhance training during at medical school. This misses the point: it is not doctors that need fixing – it is the environment we work in.

Our research conducted with America’s Johns Hopkins University, confirms that the empathy of medical students and doctors declines sharply on exposure to clinical practice and our working environment. A number of interventions during medical school to maintain empathy have been trialled without benefit. The reason they were unsuccessful has become obvious. Many doctors told us that they feel the empathy has almost been ‘beaten out of them’.

Our work concluded that a decline in empathy is associated with the reality of a career in medicine: sleep deprivation, anti-social rotas that isolate doctors from their friends and family, complaints, the blame culture and bullying.

I would now also suggest that doctors are suffering from ‘moral injury’ – a decline in empathy as a result of not being able to give patients the care that they need due to system pressures and impossible workloads.

Something is going very wrong when our most compassionate people, who enter healthcare with the goal of helping people, become too exhausted to care. But without a more compassionate culture in the NHS we cannot hope to address this.

Put simply, when no-one being kind to you, it’s hard to be kind to others.

Dr Samantha Batt-Rawden

Co-Founder The Doctors’ Association UK

See third letter in the comment section on the link below:

https://www.thetimes.co.uk/edition/comment/letters-to-the-editor-civil-partnerships-will-save-families-g80f78993

Last year The Doctors’ Association UK Co-Founder Dr Samantha Batt-Rawden raised concerns regarding an article published in the American Journal of Emergency Medicine comparing first-pass intubation success of female and male physicians.

In a collaboration with doctors internationally Sammy co-authored a letter to the editor which was published in AJEM this month.

An extract her letter reads:

“Studies that seek to attribute differences in quality of care, procedural skill, or patient outcomes to innate and immutable traits like sex, gender, or race of physicians are often specious, and likely detrimental to the progress of medicine. Editorial boards that choose to publish such studies must be aware of this reality.

Such works neither expose nor dismantle entrenched systems that promote discrimination and bias. Observational studies that ‘‘prove” women deliver non-inferior, or even superior, care to men perpetuate the marginalisation of female physicians by emphasizing their ‘‘otherness.” The use of quantitative methods in this manner legitimises outdated social stereotypes.

When journals publish such studies, they send a message to our profession and to the public that the competence of female doctors is still open for debate.

We assure you, it is not.”

The full article can be read in AJEM here:

https://www.ajemjournal.com/article/S0735-6757(19)30585-6/fulltext

Dr Rinesh Parmar, DAUK Chair said:

“General Practitioners are the frontline of our NHS and have faced unpresented pressure in recent years. ‘Empty promises’ to win over the electorate do nothing for the millions of patients who depend on GP services and are unable to access them due to the recruitment and retention crisis. All we have seen are pie in the sky promises from a government that has proven its inability to deliver its 2015 commitment of recruiting an extra 5,000 GPs. As GP numbers are falling, we need more than just election sound bites and platitudes about increasing GPs but a commitment to invest in working conditions and retention of our existing GPs who have been neglected for the last decade.

Our manifesto: Election 2019 – Key Priorities for our NHS outlines key policy commitments we would like to see all political parties make. https://www.dauk.org/s/Election-2019-Key-Priorities-for-the-NHS-DAUK.pdf

The edited letter reads:

You report that “Tories make more ‘empty promises’ on extra GPs” (News, last week). These will do nothing for the millions of patients who are unable to access their GP due to the recruitment and retention crisis. This is a government that has proven its inability to deliver on its 2015 commitment of recruiting an extra 5,000 GPs.

As GP numbers are falling, we need more than just election sound bites — we need a commitment to invest in the working conditions and retention of our existing GPs, who have been neglected for the last decade.

He wrote:

SIR – Your report, “Hospitals paying locum doctors record sums of £4,000 per shift”, cites the current pensions crisis affecting senior doctors.

It is fair to say that this additional form of taxation is influencing many NHS doctors’ decision not to accept extra work, although waiting lists in England are increasing and winter is approaching. However, this entirely avoidable situation is a direct consequence of the pension taxation policies of HM Treasury.

Patient safety remains the primary concern of doctors, who are often working on understaffed rotas and covering the positions of colleagues who have left or retired. With adequate investment in recruitment and retention, however, the system would be able to meet the demands of patients and not be “held to ransom” by a reliance on locums.

There has been ample time to remedy the situation and address the concerns of NHS staff and patients. The Government must now pay more than lip service to the pensions crisis, and work constructively towards retaining its highly trained and dedicated NHS workforce.

The letter can be found here:

https://www.telegraph.co.uk/opinion/2019/10/14/lettersits-crunch-time-brexit-future-britains-democracy/

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The lexicon of a “just culture” in the NHS has become popular over recent months, notably in the publication of Being Fair: Supporting a just and learning culture for staff and patients following incidents in the NHS by NHS Resolution.

We are taught that to create this culture, when things have gone wrong, we need to focus on three questions (Dekker 2017): Who is hurt? What are their needs? And whose responsibility is it to meet those needs?

There is much to celebrate in the increased focus on “just culture”– not least that this has become accepted parlance within the NHS mainstream and more widely in the regulatory community. The phrase can be found in the National Patient Safety Strategy from NHS England/NHS Improvement.

It is advocated in the General Medical Council-commissioned review on gross negligence manslaughter and culpable homicide. There is A just culture guide, from NHS Improvement, which “encourages managers to treat staff involved in a patient safety incident in a consistent, constructive and fair way”.

Yet from the perspective of patients and families, the narrative to date can seem somewhat one sided. In our view, a “just culture” has to give equal importance to being fair to staff and patients.

In the aftermath of a patient safety event resulting in serious patient harm or death, the response of the organisation to the patient or family is crucial. Yet too often, rather than the restorative approach Dekker calls for, harmed patients and bereaved families experience a response that in many cases significantly exacerbates their grief, trauma and distress.

Given the notion of justice encompasses concepts of fairness and equity, the pursuit of a just culture must also ensure further harm to patients and families is avoided.

At recent events hosted by AvMA and The Doctors’ Association UK, harmed patients and families sat side by side with clinicians and researchers. It was moving and heartening to hear the empathy felt by both “sides” expressed for all affected by the fallout from patient safety incidents.

Read more

This week I had the opportunity to interview Charlie Massey, the chief executive of the General Medical Council (GMC), for a BBC Radio 4 documentary on why doctors are leaving the NHS. It didn’t start well. I found myself on a train to Portsmouth instead of London having been up most of the night; proof that tired doctors do indeed make mistakes.

Generously Charlie did meet with me, some hour and a half late. I felt it was crucial that we acknowledge the impact that the blame culture has had on recruitment and retention.

I was surprised and encouraged, when Massey admitted publicly that the decision to take Hadiza Bawa-Garba to the High Court to have her erased from the medical register was wrong.

To me, this was an incredible acknowledgement from the GMC. But I have no doubt that doctors will be asking: why did it take so long?

Read the full article in the BMJ:

https://blogs.bmj.com/bmj/2019/06/12/a-change-of-tone-from-the-gmc-but-can-they-win-back-doctors-trust/

Read the Jenny’s full analysis in the BMJ here:

https://blogs.bmj.com/bmj/2019/06/06/medical-manslaughter-will-the-findings-of-an-independent-review-be-a-tipping-point-for-change/