‘Red levels of staffing are the norm’: NHS workers on coping with Covid

The number of Covid patients in hospitals in England and Scotland has continued to rise this week, as NHS England reached a deal with private hospitals to free up beds amid the outbreak of Omicron cases.

Meanwhile, Covid staff absences in England rose to their highest level since the introduction of the vaccine. The number of NHS workers in England off sick because of Covid was up by 41% in the week to 2 January, according to the latest figures.

Five health workers describe some of the challenges they are facing, including understaffing, waiting times and bed-blocking.

Paramedic, the Midlands

Ambulances are becoming a service for everything

With this new variant, we’re still seeing Covid patients, but they’ve stayed at the same rate as before. The Covid patients that we see are those that haven’t had vaccines. In the last month I’ve seen four or five Covid patients – none of them were vaccinated.

One hospital in the area has a really bad problem with ambulance queues – up to six and a half hours, and the standard wait time is over an hour. At other hospitals, you queue for one or two hours max. There’s no movement. They aren’t able to get people out of A&E on to wards, I guess because they’re not getting people out of wards. That’s due to a lack of care homes and care in the community. If you’ve got somebody who lives alone and can’t walk – we see a lot of that – how can they be sent home until they can walk? And that can take months.

The main jobs we’re going out to haven’t changed – it’s still old people that have fallen, people that can’t walk, people that need antibiotics. Those are the main bread and butter jobs. If GPs, district nurses and care homes were able to cover these jobs, things would function much better. I think the ambulance service is becoming everything, including social services.


A&E consultant, south-east England

No one even raises an eyebrow at a 10-and-a-half-hour wait in emergency

The pressure is increasing on workload and capacity. There’s just so much Covid – staff are catching it and having to self-isolate. So, from mid-December we’ve been running with major gaps across all kinds of disciplines: nursing, medical, radiographers, cleaners. People aren’t terribly ill but obviously they’ve got to stay home.

Our in-patient Covid numbers have doubled in the last few weeks, but the numbers are not rising to the levels of last January. We can manage, we know how to manage Covid, we’ve got the skill set. But the biggest problem is capacity in the hospital because we don’t have enough beds. We’ve got about 40 to 50 Covid patients taking up two wards. We’ve had to close some wards because of having to staff them, so that further reduces our capacity.

This morning we had a 10-and-a-half hour wait – no one even raises an eyebrow at that anymore. Five years ago we’d have all been running around with our hair on fire if the wait was more than four hours.

Critical care nurse, the Midlands

A lot of nurses are going to agencies

We probably have about 10 critical care beds free at the moment but we just don’t have the staff. A lot of people are off with Covid, and lately a lot of senior nurses, who are normally in charge of eight patients, have moved to new jobs. They’ve gone to different places, like specialist jobs in the community, that are just easier for them or their families, if they can do a nine to five kind of job rather than doing night shifts.

They’re still doubling up patients in ITU [intensive therapy units] – one nurse to two patients, as they were in October. We haven’t really seen many flu patients, which is odd for this time of year, it does just seem to be Covid patients. There’s a lot of patients that are classed as “wardable”, but the wards are so busy that they can’t really facilitate it. We say that we’re struggling, but then when we hear how the ward is, they actually do sound worse than us. They barely have a bed free.

The trauma patients who are coming in now, because of a head injury or a cardiac arrest or whatever it is, are often Covid positive as well. So even if they’re admitted for something else, we have to put them in the Covid pod.

A few people are slowly giving up because [the pressure] is still quite heavy, and I think we were hoping it would be easier by now. A lot of people are going to agencies. At an agency, they’ll pay me about £60 an hour for being a critical care nurse, whereas on average, I’ll get paid £18 an hour at my hospital. So a lot of nurses are reducing their hours at my hospital, so they can work more hours elsewhere. That’s probably what I’m going to do. We’re trying not to leave our hospital because we feel bad about it, but we can add more money on the side.


Paediatrician, east of England

You come to accept these levels of staffing

Red levels of staffing have become the norm – we’ve become used to running on minimum staffing now, the issue has moved on to ‘can you run safely at all’. You come to accept these levels of staffing. We’re seeing people who are getting Covid for a second time, including among staff who had it in the first wave. They’re mostly less unwell this time, whether due to the variant, vaccine, and prior immunity. Everyone is grateful they’re less unwell this time, but they’re still off – it doesn’t make any difference to your staffing numbers.

Fortunately, the number of presentations of children with respiratory illness wasn’t as bad as expected – it tailed off a bit before Christmas in terms of numbers. Schools have just gone back so we’re waiting to see what happens next. Respiratory illnesses continued but didn’t spike – we’ve seen numbers of respiratory syncytial virus (RSV) fall in recent weeks, which is reassuring, but we don’t know yet if there’ll be another peak.

We test all admissions, and last week, for the first time, the most commonly isolated virus in the children’s emergency department was Covid. Usually it would be normal winter viruses, like rhinovirus [one of the viruses that causes the common cold]. It’s not the case that more children are unwell with Covid – they’re mostly incidental findings. This just represents the fact that community rates of Covid are so high at the moment.

GP practice manager, Scotland

I’m preparing to hand my notice in

I wake up every morning with the dread of further staff shortages. Last week we had a number of colleagues with Covid or waiting for results. There’s always a big backlog at the start of the year, after we’ve been closed for a few days, and we had to reschedule the whole diary for the practice.

Staff who are well are having to pick up extra shifts to make sure we’re covered. People are doing a lot of overtime – some are doing something like 40 more hours a month. That’s effectively an extra week’s work. Everyone is emotionally and physically drained.

We’re expected to kind of get through the same workload without making any mistakes. When you’re rushing, or when people are tired and trying to get through a huge amount of work, mistakes can happen. Things are being missed – thankfully nothing serious, but it feels like it’s only a matter of time.

GP practices have been getting really bad press. People seem to have this idea that nothing is happening in the practice, when everybody is running themselves ragged. You can’t help but take it home with you. And the thing is that when I leave work, I just become another person living in a pandemic. Right now, I can’t see why I’m staying. When the pandemic started, I think it felt like I was doing my bit. I’ve done my bit and now I’m tired. I’m preparing to hand my notice in and debating whether I can face going back at all or whether to admit defeat and take sick leave.


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