I’m scared. 

What I’ve seen play out before me over the last few weeks scares me as much, if not more than the events of the few short crazy weeks leading up to the first national lockdown in March 2020. Back then there was a sense of solidarity, of battle readiness, dogged determination, superhuman energy. Necessary change and preparation happened at speed and with a sense of urgency and importance not witnessed before in the NHS. Yes, what we were facing was terrifying but this is what we’d trained for. As the number of covid patients arriving at our doors started to climb virtually everybody else thankfully stayed at home giving us the capacity, the headroom, to cope with the challenges of PPE, departments segmented to try to keep those with covid separated from those without and high numbers of patients needing critical care. We got through.

Wave two was harder for everyone. For those locked down things were always going to be harder through the dark dreary months of the winter. More jobs at risk and lost, a greater financial impact, a grief that played out in the lives of many, both from lost loved ones but also lost hopes and dreams. For those working in the NHS lockdown two seemed inevitable, and those working in acute care, already tired were willing it to start fearing the negative impact of each day of delay. Admissions were higher, patients seemed sicker and although patients with other problems did to a degree stay away from the hospital this was far less pronounced than in the Spring of 2020. We got through.

And then the country started to unlock, and virtually overnight it seemed that a switch turned back on. Now, less than 6 weeks later the number of patients seeking unscheduled, emergency healthcare has rocketed, surpassing the levels of the same period in 2019. The system is simply overwhelmed and both it, and the now exhausted workforce are at risk of crumbling from the strain. The NHS workforce needs time to rest and recuperate from the impact of the pandemic the headlines said; the reality of what is playing out is the stark opposite. 

It’s hardly surprising that patients are flocking to the doors of GPs and hospitals in their droves. Healthcare over the last year has been difficult to access and less than ideal. Innovative ways of working have helped the NHS cope through the pandemic; eConsult, virtual consultations both by telephone and video have been great, but there is something reassuring about actually being seen in the flesh when you have a health need. Unfortunately, many of us have witnessed things go wrong with worse patient outcome due to the inability to actually ‘see’ a GP or secondary care doctor. There are undoubtedly thousands of patients who should have been diagnosed with cancer and other serious diseases over the last year that have yet to arrive at our doors, having spent the last year trying not to bother us or simply afraid to come whilst the scenes of covid unravelled on their television screens. There are thousands more who haven’t been able to have the elective procedure they had been waiting for, the hip or knee replacements, and whom now are suffering from worsening pain as a result and needing increased support or changes in medication. There are those who have drunk themselves through lockdown, and are now pitching up at our doors with serious addiction problems and alcoholic liver disease. There are thousands of people whose mental health has suffered enormously due to the necessary restrictions over the last year. And there are the worried well, with a smattering of serious pathology thrown in for good measure; those with headaches post vaccination, with vague chest pain, with weight loss, or gain. Each requires careful assessment to find the needle in the haystack that serious pathology often disguises itself as and every doctor fears missing.

Some groups of the population have been more greatly affected than others. Not infrequently now I see the aged generations arrive in the Emergency Department after falling, months of enforced house arrest causing catastrophic declines in their mobility. If the fall doesn’t cause them serious harm, the loneliness of the last few months through the winter lockdown most definitely has. Families haven’t seen each other for months and for many the only reunion comes when called in to say goodbye as loved one reached end of their life. 

Lockdown was necessary; I absolutely believe that, as hard as it’s been for so many. You only have to look at the terrible scenes from India, or remember back to the news reports from Italy last March to see the devastating results of a health system overwhelmed. But I have to ask, are we about to plummet head first into a similar fate. It may not be covid causing the system to crack and split at the seams, but it sure does feel that that is the way we are heading right now.  

2019 saw the busiest year in emergency and unscheduled care. Even before covid and all the consequences that the pandemic has had the NHS was on its knees. Under resourced, under staffed, a demoralised workforce, an ageing population. What we have seen over the last 6 weeks surpasses the demands of 2019 but now the workforce is exhausted and the system struggling to recover. And that is why I’m scared. I’m simply not sure how sustainable this is anymore.