Very little discussion on the lack of non-covid NHS

[sunshinedaisyfatrat]

Last night was the first time I saw a news bit from a paediatric consultant saying they were gravelly worried about the lack of children presenting to hospital etc. We've all heard that outpatients have been cancelled, no ENT, no dentistry, rehab stopped, operations stopped, chemo halted, lack of face to face GP appointments etc but very little reported on regarding the long term effects of this. Hospitals are having few strokes / heart attacks presenting etc. If you have covid and a stroke you get placed on a covid ward and receive no stroke care. It's just awful. Poor nursing staff can't be jack of all trades and know the intricacies of all client group needs at all times.

In my hospital all of the above have stopped bar high emergencies which could result in an admission. We don't even have an outpatient / ENT / paeds department now because it's been repurposed as the covid entrance / assessment area. Lots of people being redeployed but some are still only in the process of shutting it all down and going through redeployment training. This is in place for the long haul and not just the 12 weeks.

How will the NHS ever go back and pick up the work it was doing? All of the above was stopped to ensure covid patient numbers are kept just under the capacity threshold but that won't go away as long as covid is around and cases still occur. Particularly so when lockdown is lifted. Face to face appointment still won't go ahead as transmitting is still a risk and aerosol generating procedures will still be a risk.

Sorry, very rambly, just surprised there hasn't been more reporting / stories / concerns about this whole side of the pandemic.

@HarrietM87 ☹️

I'm not worried but I am intrigued.
I'm more bothered about what happens if one of our cars has a mechanical breakdown. No repairs garage locally is open. Are road rescue services even working? I had volunteered on GoodSAMapp to drive folk places, but not sure I should "sign On" when I know the shocks need repair on my car.

Yes lots of treatments have been scaled back for covid and staff redeployed. As well as the routine non urgent work we’ve stopped some cancer treatments (high risk or not proven to prolong life) and patients themselves aren’t presenting early enough with appendicitis, stroke, heart attacks. We’ve lost quite a few patients who have presented far too late with the latter emergencies. I work in a big city hospital and almost every ward is now a covid ward.

Hospital and GP practices are doing most consultations by telephone, so of course you’re making a judgement on symptoms without the benefit of examination and things will be missed.

After this we will need to examine which patients and how many were effectively denied care because of covid patients.

If we had hospitals not running at full capacity and on minimal staffing we would have been better placed to scale up to this crisis without having to stop all the other work.

Even in areas where most work has continued despite covid lots of the staff have been pulled to covid wards. So the patients in those services are getting a vastly reduced workforce to help them.

Also this is unlikely to be a short term problem. I fear for the state of it as time goes on.

The NHS has created capacity to deal with greater numbers once the lockdown lifts. That capacity comes from doing nothing else. They can't risk doing anything else in case it takes precious beds for covid patients.

This sums it up perfectly and it isn't going to change any time soon. We no longer have the NHS - it's the NCS. Tough luck on those of us who face losing family members to non-Covid issues because they can't get treatment. Probably just another one of those things we have to suck up 'for the greater good'.

It may also get worse. The times had an article saying 1 in 5 dental practices are at risk of folding. There is support for nhs contracts but often the private work subsidises this, so this may not be enough. And private dentistry (of which there are a substantial number) get nothing beyond standard business help. But most other businesses are not healthcare potentially alleviating pressure on the nhs?

OldQueen1969 and HarrietM87, what horrible situations for both of you. All I can offer is sympathy.

Your stories do illustrate perfectly the problems that will increasingly occur if the NHS is forced to concentrate on Covid 19 to the exclusion of virtually everything else, and that seems very much in danger of happening at the moment.

The NHS has not yet run out of capacity for it's Covid 19 patients, but that may be because it has cancelled so much other stuff (some of it pretty urgent too) and re-purposed the wards, operating theatres and recovery areas

We are in an unprecedented situation, but other things haven't stopped happening because of that.

@HarrietM87 that made for heartbreaking reading. I am so , so sorry for what’s happening to you. Xx

Thank you, it actually means a lot to have people sympathise. I know there are many worse off and I know it’s not a life or death thing, so in many ways I feel selfish complaining. but to me I have probably lost my much wanted baby and I just want some closure. I feel they could have given that to me without putting anyone at risk.

My son has a new condition that would usually mean he is referred on a semi urgent basis to paeds for monitoring of his heart and lung development with a view to surgery at some point. GP said he can't refer anything that isn't life and death in the immediate future so to keep a symptom diary and take him to A&E if he is short of breath or goes blue. Luckily I'm a HCP with knowledge of how to navigate the system so I have a low threshold for getting him seen quicker if I think he needs it but it's worrying all the same

That article was really well written. And very emotional.

My neighbour is a Senior NHS consultant at a very large hospital. He is on the non Corona side of the hospital and is very, very worried about lack of procedures, tests and empty beds from no operations going on. He would normally have an 8-10 week waiting list but even if things were to go back to normal in a month it would be much, much longer.

Plus, people untreated and undiagnosed get much sicker. He doesn't deal with much from A&E but says that is empty too.

Cancer, heart attacks, strokes.....

It’s actually scary the amount and types of work that has been cancelled in our hospitals. Dh is the Endoscopy lead and only the very most urgent cases are allowed to be done, and that does not include suspected cancers! On his Gastro ward the usual sick Liver patients and IBD patients are simply not there, he knows they will be still getting sick but they aren’t coming to hospital. It’s worrying him.
He has absolutely no idea how they are ever going to catch up. And he’s deeply concerned about the undiagnosed cancers. He says all of that scares him far more than Covid.

I think the problem is that corona virus has really changed everything in hospitals, and it is crappy, and care isn't as good. But it's hard to know what the alternative is right now.. like the lady who needs a pregnancy scan-normally they'd do it of course, but normally an ultrasound scan is a harmless procedure. There's no increase in risk to mother or baby or staff by having the scan. But now that has changed. Having the scan does increase your risk of catching corona virus, and with that there is a risk of dying. It also increases the risk to the staff involved. These risks are probably small. But, in normal times, if an ultrasound scan in pregnancy came with a risk of dying of 0.1% say, or 0.01% or 0.001% (so 1 in a thousand, or 1 in 10,000, or whatever) or a similar risk to staff or to the other pregnant women in the waiting room, then it wouldn't be done! It is rubbish, and it's horrible. But everything has changed!

@villamariavintrapp when I’m in the hospital anyway, on a bed, having had blood and urine taken and 2 doctors examining my cervix with a speculum, I do not see how using an ultrasound scanner on my stomach increases any risk to anyone whatsoever. Can you explain?

Sorry Harriet, I wasn't criticising you. I think it's rubbish what you're going through, and as I said, I know care isn't as good now as it was before. All I meant was that 'like before' isn't really an option now. Normally a and e wouldn't scan you themselves You'd be referred to EPAU or similar for a scan. At least in hospital here that's what would happen. And they'd scan you, and if there was any doubt about viability at the scan they'd rescan you a week or so later. All I'm saying is that normally that would be totally safe to do. But now that would mean you having two more appointments, which come with risks.

@villamariavintrapp when I called in advance today the midwife I spoke to said that EPU was closed but they have scanners in A&E so could do it there. I wouldn’t need a follow up in 2 weeks time as I have my 12 week scan booked. I get that it makes sense to have a blanket policy to stop people coming into A&E in the first place, which reduces the risk. But given I was there already I think they should have done the scan as there was no increased risk to anyone. I’ve had 4 previous miscarriages so very familiar with EPU/A&E and how it all works unfortunately.

This is worrying for a number of reasons, one behind that after a telephone consultation with a Dr today I have been referred for a chest X-ray. If no non-essential referrals are being made, does this mean my issue is being treated as an emergency?
I know of two people with recent cancer diagnosis's who have been told that treatment will be delayed/won’t happen at all. It’s horrific.

I'm really sorry for what you're going through. I was more trying to make a general point that all these things that we've taken for granted before as being entirely safe-outpatient appointments, investigations, scans etc, now aren't. And it does change how decisions are being made. Whole departments might be sitting empty, but not necessarily because they're waiting to focus on corona virus. But because they might be doing more harm than good otherwise. I don't think I explained well, sorry.

And you'd also need an expert scan from a sonographer , not an ED doctor who wouldn't be able to do an obstetric ( probably trans vaginal ) scan

So what’s the solution?
How should it have been done differently?
How should these services been kept going in the face of the outbreak?
Many consultants have been rapidly retrained to deal with respiratory cases, they’re not just hanging around with nothing to do.
This virus has affected everyone’s lives either directly or is directly- so what’s the answer?

Could someone please copy and paste the article from Pulse? Thank you.

I am not personally affected but have been worrying about this.

Being cynical, I would say that the government is prioritising covid because covid deaths are being counted and the government’s actions/inactions will be judged on that number.

Non covid deaths caused by this and other aspects of lockdown are not being counted (and will be hard to count even with hindsight) and are less likely to be ascribed to government in the same way.

To put it another way I increasingly suspect the government is not actually interested in which course of action prevents the greatest number of deaths overall. They are more interested in which course of action prevents the greatest number of deaths which they will get blamed for. I may be wrong of course but it certainly feels that way given how little attention is being paid to the long term effects of lockdown.

@Carriemac my cervix was checked by an obstetrician who came down to A&E specially. There is really no reason why they couldn’t also have done a scan too, other than they have a blanket policy which failed to take account of my specific circumstances. But keep trying to come up with reasons if you like.

To put it another way I increasingly suspect the government is not actually interested in which course of action prevents the greatest number of deaths overall. They are more interested in which course of action prevents the greatest number of deaths which they will get blamed for. I may be wrong of course but it certainly feels that way given how little attention is being paid to the long term effects of lockdown.

I 100% agree with this and it makes me very worried. From the start I have been very sceptical about our government's motivation for these measures. I agree covid is a nasty illness and does certainly kill people. But these measures are as much about covering up their massive underfunding and destruction of public services as they are about saving lives. Like the clapping. The government and media have jumped aboard that because it handily provides a smokescreen for the fact that the NHS was poorly staffed and resourced before this, and most front line workers are more in danger because of that, and not directly due to the risk posed by covid.

I work in mental health and people don't stop needing help. But hcps are being redeployed and waiting lists will just grow and grow.

We will be feeling the effects of this time for years

@JemNadies I also had a non-urgent MRI last week and questioned why they were still running. They said the scanner has to be staffed and available incase of emergencies so they were still booking regular patients in but with an extended gap in between for cleaning. They had also converted a fire exit door so patients coming for a scan didn't enter the main building of the hospital all.