David Oliver: My personal pandemic experience is just one of many
BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1761 (Published 20 July 2022) Cite this as: BMJ 2022;378:o1761
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Dear Editor
I read Dr Oliver's letter describing his experience and felt very saddened by it, but also relate to it very closely:
David, I understand exactly where you are coming from. I have worked in the NHS 1 year less than you. I too saw the writing on the wall with the reports of the first cases of COVID being reported in China, attending the RCP meeting on this emerging virus before many people were aware of it.
I have been a respiratory consultant for 19 years, and worked closely with clinical and non-clinical colleagues stepping up our service at great speed in March 2020. My elderly mother had dementia (her BSc, PhD and MSc long forgotten) and I thought long and hard before my usual weekend visit to her in the dementia unit in mid-March, deciding in the end not to go and see her. By the end of that week, the floodgates had opened, and I was seeing numerous elderly patients, who looked just like my Mum, who were breathless, hypoxic and delirious. We had many deaths in those 1st 3 weeks of wave 1, often of people from the same family. About 3 weeks after my Mum died of COVID-19 in her dementia unit at the height of wave 1 on 14th April 2020, I had to take over as respiratory lead for my hospital. Our clinical and non-clinical team worked incredibly hard and incredibly well together, and we had absolutely inspirational leadership from our COVID ward nurse manager.
We had 3 further terrible weeks at the end of wave 1 when large numbers of long stay ITU patients with NG tubes, surgical tracheostomies, severe delirium and all to often proning-related nerve palsies were discharged to us en masse to "decompress" ITU.
Just before wave 2, I took over as respiratory lead for our acute trust, which includes 3 busy acute hospitals. We have re-configured, reconfigured and reconfigured again over the last 2.5 years, and are now asked to deliver 110%. My colleagues too all carry more baggage and psychological distress than we did before COBID ("BC"). I accessed some psychological support via the BMA for a time - I enjoyed talking to James from Liverpool, and found his advice of some help. I too dodged the COVID bullet until Easter 2022 - for me it was a bad bout of flu for the first few days and 11 days to become negative. I am back to "110%" now - I hope that you are soon as well. Take care of yourself, rest, recuperate and stay safe, and thank you so much for writing your letter,
Competing interests: No competing interests
Dear Editor
David's account is sobering but real. We all wish him well in his recovery. COVID essentially revealed the fault lines in the workings of the NHS which predated it. It has affected society at large, hasn't spared health care professionals and those who work in the service. The mismatch between demand and resources both in personnel and capabilities can no longer be wished away. Leaders must lead, come down to the levels where care happen, gain better understanding, project to the population the realities and challenges of delivering appropriate health care in the 21st century. I am not so confident this will happen. The gains from such introspection is too long term to be given priority. I worry it will be politics as usual unless a fundamental change in perspective and honest debate happens.
Competing interests: No competing interests
Dear Editor
I am so very sad to read this. I retired from the NHS in Jan 2018, then went to DRC where I still am, to help a palliative care team in this forgotten country where even a broken NHS seems like providing paradise.
I returned to the UK during the pandemic and worked as a locum consultant. I saw first hand the tremendous commitment of so many colleagues.
I hope and pray Dr Oliver regains his stamina and joy,
Congo shows me how a health service should not be run and here I always talk with pride about the NHS.
I hope this can continue and that its workforce will be truly valued. I am seriously wondering whether I should return to work at the age of 65 or develop skills to become a listening supportive ear to my dear colleagues in the NHS, so that they could feel supported.......
Get better soon, Dr Oliver and those colleagues who do not have the words to express themselves...
Competing interests: No competing interests
Dear Editor
Professor Oliver so eloquently describes what it was like to be on the front line in the last 2 years. While I escaped personal infection, many of my colleagues did not and while they thankfully survived, it took many many months for them to get back to anything like normal (and I suspect they have underplayed any ongoing symptoms). It is particularly sad that he has felt unable to take up the position of President of the London RCP, but I do wonder how many others will have their potential contributions to health care and its improvements also curtailed through the physical and emotional toll of their dedication to care during the worst of the pandemic.
I have recently retired from the NHS, but am very aware of the ongoing pressures on doctors of all grades to work even harder to deal with backlogs which further curtails their ability to contribute to the wider NHS. Public and private thanks are important but the leaders of the NHS at all levels need to ensure that their plans and demands on clinicians take account of the entirety of what doctors contribute and make sure it is physically possible to deliver it.
Competing interests: No competing interests
Dear Editor,
I applaud Dr Oliver, for writing such a clear description - one which debunks any suggestion that the NHS is EASILY coping with the Covid pandemic - of the effects of the pandemic on hospital staff. It wasn't exactly 'news to me' - not because I have been inside hospitals during the pandemic, but because when the pandemic spread I was in was the process of co-authoring a paper with a barrister, a hospital doctor and a 999 paramedic: so clinical contacts, have made it reasonably obvious how 'stressed' the NHS and its clinicians have been, and still are, as a consequence of the pandemic.
On a more personal note, I hope that Dr Oliver does recover, and return to his normal self, from his own bout of Covid. I am 'convinced' that I had Covid in the spring of 2021, before I had been vaccinated, and although I am close to seventy years of age, in my case the symptoms were minor [if deeply confusing: the only symptom I really noticed was 'Covid Toe and Finger', and at the time I didn't realise they indicated Covid - only a few months later, did I find images of these rashes online]. I believe there is 'a lot of luck' in how any particular individual reacts when infected by Covid: 'the cards you happen to have been dealt' in the context of your own immune system.
Politicians who claim that 'the NHS isn't struggling with Covid - 'it is now in the past'' should be forced to respond to Dr Oliver's article.
Competing interests: No competing interests
Dear Editor
I read this account with great sadness, especially knowing as the author alludes to, this will by no means be a unique account. Likewise I know that I’m not unique in wishing Dr Oliver well in his recovery and very much hope that the opportunity to serve as President of The Royal College of Physicians presents itself again.
The account demonstrates the interdependence we all have on one another in society, for us and it to function. And a functioning society is instrumental to our population health. In my experience of the pandemic I quickly noticed by their absence, the importance of the entertainment and arts industries in helping me to decompress from the rigours of work during my career up until March 2020. I probably could have survived better had I just been able to go to a gig. One of the most heartbreaking all-too-common discussions I had with relatives of the critically Ill was the calamitous wider effect it had on families when the main breadwinner on a zero hour, gig economy, contract could no longer work; financial uncertainty for the whole family. Union activity through the industrial revolution had hugely positive implications for public health and health and safety which also affected the expanding private sector. As an unhappy burnt out workforce approaches challenging an insulting paycut, affecting my whole career as a 2008 graduate, we must promote the understanding that the public and private sectors rely on one another and that our terms and conditions set precedent for theirs. This is not “us and them”.
Competing interests: No competing interests
Dear Editor
In a world where experts are often decried and denied by armchair critics and superficial spectators, David Oliver's account and recollections are sober, sage and saddening. Without overplaying his hand, he articulates the heroism of so many struggling against lack of information, lack of candour and lack of resources at the front line. COVID relentlessly probed the many inadequacies and sticking plaster solutions we have seen over decades in the health and social care services in the UK - chronically neglected and under-resourced as they have been now for two decades. Pretending that all is well, and that all involved are cheerful - a recurring British malaise - was a sort of defence mechanism, as was hurling oneself at the mountains of urgent and priority tasks. Those who could, like David Oliver, remain grounded, focussed yet compassionate and caring were treasurable examples of what is best about the NHS.
However, all of this heroism and self-sacrifice comes at a price. NHS staff are not cannon fodder, and this was not the first world war when the answer to previous failures was to replay the same moves, only using more people. The slow but mounting attrition due to the burnout rate through acute and chronic stress as well as the exposure to acute and chronic consequences of COVID, are just too high to brush away with a cruel curt "business as usual" approach which seems to be the mantra of those high up in power. David Oliver's observations which are not bitter but purposeful come on the day when many in the NHS have been thanked for all of their hard work and sacrifices by being compelled to take a significant cut in wages. While wages are not everything, the NHS is not any longer a pure vocation.
Essentially this is now a broken system, dealt a fearful blow by COVID because of a near complete lack of institutional and financial resilience; it is now barely able to manage its day-to-day activities never mind the surge needed to catch up with pent-up demand, from which so many 100,000s more will sadly still die. The apparent lack of interest in or comprehension of the multi-layered complexities and challenges facing health and social care by the current crop of politicians and aspirant leaders-in-waiting is both a remarkable and a powerful demonstration of the lack of honesty and insight which a highly-politicised system like the NHS operates under. It is time at least to separate the running of the NHS from the politicians, who in most cases have completely failed the nation (across many domains), and also to deliver 3-5 years funded planned settlements so that the NHS can get on with the job without interruption or meddlesome outside interference. Above all, what is needed is an understanding that either we fund health and social welfare through general taxation - which means additional substantial tax receipts - or we stop a one-size-fits-all cradle-to-grave all-encompassing system like the NHS and do what many other countries have done, namely to have several significant funding streams to support both day-to-day as well as exceptional work patterns.
To carry on like this is a clear demonstration of failure of leadership within the NHS and government. The definition of insanity has famously been said to be doing the same thing over and over again and expecting different results (not Albert Einstein, but, it seems, Alcoholics Anonymous). David Oliver's quiet heroism (what a loss to the RCPL) should be a signal call to arms for those interested in grown-up debate and solution-focused approaches.
Competing interests: No competing interests
This should be required reading
Dear Editor,
David Oliver has written an honest and profoundly moving piece. Although I suspect the contents will not surprise any involved in acute secondary care. This should be required reading for all NHS managers, politicians, those involved in health care planning, medical students and prospective medical students, as well as those members of the public with concerns about our public heath service.
Dr Oliver's health must come first and I wish him a full and rapid recovery.
Competing interests: No competing interests