Andy Martin on how staff are dealing with the Covid pandemic at Poole Hospital 

IT is 8.30am on Thursday at Poole Hospital, the day after the scale of the coronavirus crisis was laid bare once more in the latest, sobering national statistics.

A further 1,041 deaths, the highest daily rate since April and a further 63,322 cases.

There’s talk of the NHS being overwhelmed as the new variant runs riot and sweeps across the country.

And things will undoubtedly change in the coming hours and days - and not for the good.

I am sitting with the hospital’s emergency planning officer, Libby Beesley.

Bournemouth Echo:

Poole Hospital Emergency Planning Co-ordinator Libby Beesley

She is joining the daily ‘state of play’ or 'beds meeting' on Teams where representatives, medical and otherwise from across all departments assess how things are from overnight and how the day is likely to unfold.

There is a similar meeting going on at the same time at Royal Bournemouth Hospital.

The two hospitals work side by side under the umbrella of University Hospitals Dorset NHS Trust following the reconfiguring of health services.

The Poole meeting, attended by around 25 people each with an update to share, is chaired efficiently by Tania Ball, matron for discharge services, who is in the office next door.

Like everything else, these meetings have taken on a new urgency and importance in the coronavirus pandemic.

The hospital is at Opel (Operational Pressures Escalation Level) 4, the highest alert.

The situation is quickly and constantly changing. Plans are made and then adapted, sometimes within minutes.

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Poole Hospital 

Just a few extra admissions or a handful of additional staff off sick can be a tipping point.

As with the military, the medics have a language all their own, which for precision is how it must be.

It’s difficult immediately to absorb the vast flow of information and the many acronyms.

But there is plenty of talk of blue patients (COVID-19) and green (non COVID).

There are issues with the pace of Covid testing for some patients.

A problem with several chemotherapy patients has been resolved - their tests are being fast-tracked and they will now receive treatment today.

There are references to those who died overnight (they are respectfully referred to as RIPs which softens the language around a grim inevitability) and concerns about the slow rate of patients able to leave the hospitals and the increasing rate of admissions.

In Poole and Bournemouth there are scores of medically fit patients who do not need a hospital bed but there is nowhere for them to be discharged to.

They cannot yet go back their care or nursing homes. At that moment there are 103 Covid patients in Poole, eight in critical care.

At Bournemouth the numbers are 147 and 11.

These figures will out of date by mid morning.

This is roughly three times the number at Christmas when it was around 80 and represents around 25 percent of all available beds in the hospitals.

Meanwhile the projections look scary. We are still at least two weeks from the peak.

Critical care matron Eoin Scott tells his colleagues: “It’s getting challenging.”

There’s talk of mutual aid across the region, with hospitals helping each other out, but there is clearly limited scope for that. And anyway, moving very sick patients any distance at all is a big risk.

Some non-Covid wards are closed because of infection even after patients have tested negative on arrival.

And social distancing means there is less physical space for beds.

Infection control and cleaning remain huge tasks. Big waiting list problems are building.

The meeting hears about the latest staff sickness figures. Several doctors, nurses and other staff are off with the virus or are shielding or self isolating.

And despite the fact that pressure on the Emergency Department seems to have eased a little in the past 48 hours or so, all in all, it already looks as though a long, challenging and emotionally draining day lies ahead for everyone.

It is also clear that things will get much, much worse before they get better.

I am already beginning to get a sense of the physical, mental and emotional stress the latest surge is having on the whole team at Poole and Bournemouth, from the cleaners to the consultants and everyone in between.

And the frustration that many staff feel that too many people in the community are recklessly flouting the lockdown and that some MPs are undermining the public health messaging.

As the meeting ends (there will be another at noon), Libby says: “This time round the virus is really beginning to take its toll. Last year everything else stopped while dealt with the virus.

“Now are we trying to deal with that backlog of elective surgery. We are very aware of all the patients out there without Covid, who need treatment.”

Libby chokes up a little when she talks of her colleagues.

“All our staff from across the two hospitals have been wonderful. They have just stood up and supported each other.

"It’s been really emotional. They are coming to work each day and putting themselves at risk. It’s not just the medical staff but for example the cleaners too who are exposing themselves to that risk every day, but they just get on with it.”

There are always difficult decisions to be made even in normal times. Nowhere more so than in older people’s medicine and especially now.

Dr Matt Thomas is the deputy chief medical officer and consultant in OPM, the most vulnerable group.

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Dr Matt Thomas

“We do have tough decisions and very difficult conversations in terms of how and if to escalate care for some of our older patients.

“If a 90-year-old has a number of other illnesses and is on multiple medication, if they get Covid they are not going to survive on a critical care admission.

“Having that discussion about the reality of the situation is devastating for the patient and family but it also takes its toll on the staff.

We always try to unpack these emotions at the end of the day before they go home because it’s a huge thing to be carrying with you all the time.”

Dr Thomas is on leave this week but has come in anyway because “there is pressure all the way through the system. It’s a really difficult time.”

He also spoke about those who are not following the rules in the community.

“It was easy to see the new lockdown was absolutely needed. Hands, face and space is still the message.

“But for those not sticking to the rules, I wish they could be a fly on the wall in the hospital or in our team meetings and see the fears and frustrations and the tears shed over those conversations I was talking about that the staff have with patients and families of the most vulnerable.”

Around 90 per cent of all blue patients in the hospitals are being looked after by general physicians and elderly care physicians on the normal wards, not in critical or emergency.

Downstairs in the Emergency Department, matron Bruce Hopkins admits it has been tough and Covid has had a significant impact.

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Poole Hospital Emergency Department matron Bruce Hopkins

"We have had fewer walk-ins but the same number of ambulance admissions and the same amount of severe illnesses. The big difference is the increase in Covid patients coming in.

"Normal business is carrying on but people may have to stay with us much longer, 15 or 16 hours because they cannot moved quickly elsewhere in the hospital. This kind of waiting time was unheard of a year ago.

There is more 'corridor care' - 12 hours in total the previous day. Ambulances often have to be held in a queue before delivering their patients.

"We manage day by day and the plan is ever-changing to reflect the reality of each day," adds Bruce.

The department is three nurses and four doctors down and it is felt hard. It's also a struggle to get locums and agency staff.

He says the latest surge and the new variant has been "a hammer blow."

The last ten days have seen a sea change in what the hospitals have been experiencing explains Rob Howell, medical director for surgical care for both Poole and Bournemouth.

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Rob Howell, medical director for surgical care for both Poole and Bournemouth

His 'day job' is consultant colorectal surgeon.

"The pressure is massive" he says. "Post Christmas everything changed.

"The number of Covid patients is increasing in line with what’s going on in the community. It’s just going up and up and up, way more than anything we experienced last year.

"The difficulty with these sort of numbers is you start to get positive patients popping up all over the hospital.

"This makes it all the more difficult to manage the flow of patients around the hospital."

The intensive care units especially have come under a lot of strain.

"It only takes one or two more patients to come in and that can be a tipping point. Suddenly you have big problems because you haven’t got enough staff or enough kit or bed spaces.

"You have to make sure you have got enough oxygen for all these patients."

In Bournemouth ICU earlier in the week, major alterations were needed in terms of where Covid and non-Covid patients were being treated.

Staff needed more capacity because the Covid wards were full, so the areas were 'flipped' to create more space.

Is it likely the hospitals will be overwhelmed?

"We worry we might be," says Mr Howell. "The fear for all of us is not having enough staff either because you too many patients or in the right specialties because they are sick or self isolating, looking after their children off school or because they are really struggling mentally with all this.

"A lot of this is about looking after patients in less than ideal circumstances as well as working in ways that can constantly change."

"It’s always difficult when you feel you are not providing the standard of care you were a year ago. But we have to manage the situation with the resources we have."

Elective surgery has been reduced to ease the pressure, this week it's around 50-60 per cent down.

"We are looking to continue with all the urgent care and cancer care. We want to protect cancer services in Dorset and we feel we probably can.

"But are trying to stop routine work where we don’t feel the will come to clinical harm."

Mr Howell is honest about the future.

"Realistically it is going to take years to clear the backlog if we ever do. Some specialties may never recover.

"We still want people to come to us but there has to be an understanding that some routine work has to be put on hold.

"People generally are understanding but it’s when we don’t communicate with them properly that they get angry."

"But one of the things the pandemic is teaching us is that we will need to deliver healthcare in different ways in future."

That will mean a continuation of some of the remote appointments and communication, which many patients prefer.

He signs off optimistically: "In a year we will be in a much better place."

Pictures and words by Andy Martin