NHS workers, will you carry on for the duration?

[thesunisoutout]

So for vast swathes of NHS workers, normal NHS has stopped and we have all entered a covid19 NHS where the only priority is this virus. Most of us are being redeployed and cannot do our jobs for what may be months.

There may be relaxing and tightening of rules until a vaccine is rolled out but really, the NHS won't go back to the normal we know for a really really long time. Eventually we will be allowed to go back to our jobs and try to pick up those patients and start the backlog and work out the damage.

We were told today not to expect to go back to our usual jobs for 6-12 months. I've seen patients today not be offered any exploratory procedures to look for serious illnesses, virtually no 2 week wait procedures anymore, no life saving procedures, no speciality teams, chemo is nearly all being stopped, not much cancer treatment starting, people being left with no rehab which will change the course of their functioning in life...the list goes on. These things aren't just going to start in 12 weeks. Once the curve is flattened it's to keep hospitals at a certain capacity for the duration.

I'm an AHP who provides a service which saves lives. But that isn't important to the NHS now. Care for people with covid is all that matters. We're all having real ethical uncomfortable discussions about this. We know by doing very little, we're reducing spread but at what cost to the non covid patients? And we obviously want to do our jobs, not someone else's that we aren't trained to do and there were many today saying they would be handing in their notice soon as this isn't the NHS they wanted to work for etc.

It's just all very sad and very very difficult. I LOVE working in hospitals but I don't want to be there anymore. Never thought I'd say that.

I think it's trust specific based on how affected regions are. Cancers services have pretty much wound up in my area. Chemo and covid are not a good combo.

@MsJaneAusten

It is a double edged sword
HCP are needed elsewhere but also hospitals are now unsafe for immunosuppressed patients to visit

Ideally there needs to be somewhere safe and clean for them to visit to be seen, but this is so hard to do. By keeping them away, you hope to try to keep them safe temporarily. It is not just about redeploying staff away from them

Babyroobs I don’t think there is an issue with us not being compassionate, empathic and reassuring (I know you wasn’t suggesting that we are not)

I have no medical training at all. My work is therapeutic to support moving on to live in the community (some very challenging but that’s the nature of the work)

We are certainly a very caring and compassionate team but we are not medically trained beyond first aid. And as with many who have mh issues some also have a number of physical health issues that puts them at high risk of becoming very ill

It feels like we are just having to manage each day it comes and that is difficult to work under those conditions. Still nothing in comparison to those on the front line (sorry for the moan it’s just worrying)

London trust - continuing chemo, radiotherapy, scanning etc. Staff looking after cover patients won't look after the immune suppressed in as far as we can predict.

My DM's best friend told her today that her double mastectomy has been cancelled for 12 weeks! Heartbreaking.

Thesun
Sorry if I've missed it but what exactly is your job

I don't work in the cancer service but am involved with diagnostics and some palliative procedures. I know that for some newly diagnosed cancer patients the plan is to give radiotherapy first and delay chemo rather than do the usual chemo followed by radiotherapy for the reasons Menora said.
I don't know what this means for their longer term survival. Obviously lots of variables depending on the cancer and stage etc. But they will be getting treatment which isn't the normal protocol and those protocols and treatment regimes have been drawn up following lots of clinical trials. All ripped up and tossed to the winds of Covid.

Wait, what?! Chemo has been stopped?! Seriously?

What about cancer hospitals like the Christie?
What about children's oncology wards?

I understand that things like mental health treatment and minor surgeries have to go on hold but surely cancer and other potentially fatal illnesses have got to continue to be treated as the pre existing priority?

Such variations in different trusts, we have not changed our treatment plans for acute leuks etc.

@manicinsomniac That's not my experience at all, we re upskilling staff so we can continue to give chemotherapy regimes. Admissions happening as normal.

Pomegranate thanks for that 🙂

@kingofkings I'm an SLT specialising in dysphagia. A lot of my work is diagnosing extreme subtleties overlooked by others. I often pick up head and neck cancers, MND, MG, stroke etc and get people seen for these much quicker and get plans in place for them early. Swallowing is very overlooked by the general public, they can't see the problem till we show them. I do endoscopy and x rays on people to look at their swallowing and come up with treatment plans to make them better (can you imagine how awful it is to live life not being able to eat and drink at all). If we don't, they aspirate, get admitted to hospital and may die or become malnourished and may die basically. Eating and drinking keeps you alive. I'm so passionate about it but it's just all been disregarded as a service.

In our trust chemo has been largely stopped because the risk of being on chemo outweighs the risk of not getting chemo apparently.

But it's not just that. You can't get neurology reviews. You can't scope people to look for head and neck cancers. Biopsies aren't being done as people aren't looking and are very hands off now. PEGs aren't being sited, frailty patients aren't being admitted for example. Some of those speciality teams have been dismantled and redeployed. Chemo is just one example but it's far more reaching than that.

It's not my experience either that cancer services have stopped. I've got a couple of patients at the moment who are about to begin chemo.
In our trust, everything non-urgent has been stopped and resources redirected, but urgent care is continuing, albeit in a different way.

I had a distressed client on the phone the other day with newly diagnoses Oesophageal cancer who had just found out one of his chemotherapy drugs had been omitted from his regime. Whilst he understood the reasoning behind it, he was beside himself with worry that his chances of beating it will be diminished.

@manicinsomniac Chemo hasn't been totally stopped, nor have diagnostic procedures. But definitely delayed and juggled around where possible to try to minimise patient admissions and keep patients safe by keeping them out of hospital.
My DD is having an unexpected gap year experience - I helped her get a job as HCA in theatres and now she is being rotated in to help with running in the new respiratory ICU in the theatre dept. But it is well supported, they are having debriefing after bad experiences. And rotated to the other theatres, so they don't spend too long in the Covid ICU, still plenty of her more usual work going on which includes cancer surgery.

It's the ward nurses who are struggling. I went up to one of the Covid wards yesterday to assist my colleague with a procedure we would normally do within our department. We took all our PPE with us, including the FFP masks and visors. I was desperate to rip it off after an hour and dripping in sweat. The wards nurses are just wearing standard masks and aprons and gloves.

Massive admiration for those of you who have returned to practice and those who are gamely getting on with redeployment.

We must be very lucky, we are still running theatre slots for central lines/PEGS. Scanning -CT/MRI/USS. Staffing for chemo and radiotherapy. A lot or services have been redeployed but not cancer/immunology. We are postponing any patients where a delay won't compromise survival rates - it's not many. We had 3 new diagnoses last week - terrifying time to be diagnosed.

I work for an agency, but the only work they are offering me is the new nightingale hospital or swabbing staff with suspected cases. I'd normally be fine with this, but found out yesterday I'm pregnant after IVF. I tried 111 call centre from home work, but don't have experience in their systems. What are your hospitals doing about pregnant staff, and does anyone know of a role where I could still help?

It's all so variable in different trust OP.
We have sited two rigs this week so that people can be discharged home.
Also our home IV service is awash, getting people on long term antibiotics out into the community.

I work in community nursing, we are moving towards a 24hr service soon to cover the possible
Influx of palliative patients being discharged or managed at home. We are now not seeing non essential patients e.g. blood pressures, support visits etc. We will soon be working from a hub or our cars. We will continue to see those patients who get regular blood tests etc

Dh usually spends his days doing endoscopy looking for cancers such as oesophageal, gastric, bowel. He removes polyps, inserts stents, removes stones from the bile duct, inserts peg feeding tubes. He is an accredited bowel cancer screener. All of that work has been stopped. No idea when it will restart.

I can foresee us getting more palliative cancer patients further down the line due to lack of screening as well

Gosh. Congratulations @Elouera I hope your pregnancy is trouble free and try not to be too anxious at this difficult time.
I don't have any particularly helpful suggestions, obviously every trust is different.
I wonder if the Nightingale hospitals might have dedicated phone liaison staff?
With visitors not allowed the ward staff yesterday complained that it means relatives are constantly phoning for updates on their loved ones. There will surely be a need for empathetic knowledgeable voices at the end of the phone reassuring relatives - and presumably the opposite, breaking bad news and helping direct bereaved relatives to the next steps at these Nightingale hospitals. ?

missy - That's shocking. Patients could actually starve to death if they don't get a peg tube fitted at the appropriate time ?

I work in mental health and our redeployment is being negotiated at the moment. I am worried about services being seen as dispensable. How is prioritising one group of people at the expense of some of the most vulnerable, ethical or fair?

I got angry in a meeting about it today. I understand that we have to prioritise saving lives but a lot of the work we do, does do that, or at the minimum, allows someone to have a quality of life.