“In my 41 years as a doctor, I have never known a crisis to hit the NHS like this,” said Richard, an experienced consultant physician in South Wales as he looked anxiously at a list of outpatient clinics that had been cancelled by the hospital due to the coronavirus pandemic. Some of the patients had already waited over six months for their appointments and now, aside from a consultation via the telephone, there was no prospect of them being seen for the foreseeable future.

With the advent of the coronavirus global pandemic, where thousands of people may require hospitalisation and possibly tens of thousands may die, the Welsh Minister for Health and Social Services, Vaughan Gething said:

“It is clear our NHS faces an unprecedented challenge. We have seen the impact coronavirus is having worldwide and we are looking at a level of demand on our services that goes well beyond anything we have seen in our lifetime. Last week I moved swiftly to announce a raft of measures to increase the capacity for our health and social services to protect and care for the most vulnerable in our communities. I chose to act then before we see a significant surge in demand so that our services can be ready to act. The long term effects on the workload from this outbreak could be very significant.”

Wales has always been seen as the poorer neighbour of England; it has an older, more impoverished and sicker population. In sharp contrast to the first ten years of Welsh devolution where there was around a 4.4% increase in the Welsh block grant, austerity measures introduced by the coalition government mean that funding is now down 5% in real terms on its 2010-’11 level. This has inevitably led to delays in waiting times for clinics, A&E attendance and elective surgery.  The delays in treatment are set against a background of a chronic shortage of NHS staff, which more recently is exacerbated by Brexit. Understaffing and underfunding together with the simultaneous crisis in social care has led to a permanent shortage of beds.

Drastic measures in hospitals and general practice have been taken to increase bed capacity and the availability of NHS staff to meet the expected increase in demands. All elective surgery is postponed, all out outpatient clinics have been cancelled and some hospital wards have been cleared of patients to make way for the assessment and treatment of patients with suspected coronavirus, intensive care unit (ICU) beds have been increased by taking over the use of theatre recovery rooms and coronary care units which are being equipped with ventilators. Richard said his hospital was eerily quiet and at the last count had almost 75 empty beds – something he has never seen in his professional life.

GP surgeries are now ‘telephone triaging’ and most patients are not assessed in person but through the telephone. Only the most urgent cases are invited for a physical consultation. This has dramatically reduced the number of patients attending local surgeries in South Wales from an average of 200 to 20 per day.

In spite of reassurances from central and local government, there are increasingly pertinent calls from healthcare workers for three main things:

Firstly, there is a request for the widespread screening of staff for coronavirus which, in spite of the government’s ambition of 25,000 tests per day, have not been routinely offered to staff. Instead,  staff self-isolate for 14 days. It is estimated that at the peak of the pandemic in the UK, one-fifth of all workers will be off sick. Such a large number of absentee workers alongside a chronic shortage of doctors and nurses will only serve to further inundate the NHS.

Secondly, away from ICU, there is a worrying lack of personal protective equipment (PPE) for other frontline healthcare staff. The experience in China has shown that healthcare workers have had serious complications and died possibly due to being exposed to a higher viral load. Many doctors and nurses are afraid that they are being exposed to the virus and will not only become seriously ill themselves but also pass the virus onto others. Given the deaths of healthcare workers elsewhere in the world, NHS staff in the UK are resigned to the fact that they may lose some of their colleagues.

Finally, in spite of the desperate calls from the government on social media for manufacturers to produce more ventilators, there will not be enough to meet the needs of patients in the worst case scenario. If that happens, doctors will have to make difficult decisions on how to ration treatment and inevitably some (usually older) patients will require palliative care. With the crisis in community care provision, it is unclear exactly where and how these patients will be treated.

While it is understandable that attention is focused on coping with an acute crisis of an unknown duration, the long term consequences of the coronavirus pandemic will be felt for years. Prior to this pandemic, the NHS and social care were struggling to meet the needs of patients. With the pause in all elective work, alongside the strain on services due to the influx of patients with coronavirus, the backlog of clinic appointments, diagnostic investigations and treatment will be overwhelming.

Richard, like all NHS staff, remains dedicated to keeping the NHS functioning but issued a warning and said: “For too long, the NHS has run on the good will of its staff who often work overtime in a stressful environment for free. The coronavirus pandemic will push the NHS and social care to its limits and ruthlessly expose the cracks and deficits that have accrued after ten years of austerity.”