Celebrating 72 years of the NHS: A tribute to those who save lives

AFTER leaving school, I studied medicine for five years in Dundee and I have been a doctor for 19 years this year. I moved to Glasgow in 2003 to do anaesthetic training and subsequently developed an interest in intensive care and finished training in both in 2010. I have been a consultant since then – first at the Victoria Infirmary and then at the Queen Elizabeth since it opened its doors.

I am now the lead clinician for critical care and have been very closely involved in all the planning to do with Covid-19. We were fortunate in that we were ahead of the game in terms of making preparations and making sure we had the best possible response to it but it has still been overwhelming.

It has been a national crisis. We knew as soon as it started that intensive care were going to be at the forefront of it. We got going with planning as soon as we realised it was going to be a big issue.

We knew there would be a high demand for critical care and a lot of other specialities helped to make our plans come to fruition. From a health service point of view, it has been very well co-ordinated.

Most doctors and nurses accept there is always an element of personal risk in the job

I would say, however, that within the NHS both locally and nationally we have done really well.

At the Queen Elizabeth we normally have 18 intensive care beds and we went up to 40. We are quite fortunate in the way the building was designed so that the 80 bed spaces on the critical care floor can function as intensive care beds if need be.

We don’t have enough ICU nurses to look after that many but the first thing we did was establish that we could use the beds and that we had the equipment to support them.

We had additional equipment brought in by the Scottish Government to allow us to do that. The next issue was medical staffing and again we were fortunate in that we were supported by the rest of the hospital in terms of increasing the numbers of both the consultants and the junior doctor rotas.

The nursing ratio in intensive care is one nurse per patient. We could not magically come up with more ICU nurses but we did manage to train an awful lot of nurses to be at the bedside so that every patient had a nurse. It was quite heartening to see how much everybody wanted to help and be part of the response to Covid.

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Most doctors and nurses accept there is always an element of personal risk in the job. We are all used to hearing stories about people being assaulted which is the sharp end of it but we also deal with patients with highly contagious conditions regularly.

For all that exposure, there is a small risk of becoming ill. Most people accept that as part of the job. During the crisis the vast majority of staff were happy to help as long as they were provided with a safe working environment and we did what we could to protect them.

Wearing the PPE is hard work but the level that we were in is similar to the level we use in intensive care looking after people with flu. The difference was that it was the first time we had such a huge number of patients with the same condition.

It meant we could cohort them and wear the same PPE for much longer periods of time. We knew that there was a global issue with PPE supply. That was a concern but we had to balance that against the comfort element of it and what is reasonable to expect staff to do.

The use of the NHS for political gain is very difficult

The pandemic is not something I thought I would ever be part of. I was a trainee anaesthetist during the SARS pandemic and watched from afar the stories from Hong Kong in 2003 but it was one of these things that you watch and never think you are going to see in your lifetime.

We did have to work long shifts and the patients were very sick. The disruption to life outside work meant that none of us ever really got a break. We have two kids and my wife is a consultant obstetrician so it was very much a case of just trying to balance everything with the schools shut and no childcare. However these situations demonstrate your own resilience, the resilience of those around you and the organisation you work for.

One of the difficulties was knowing who had Covid and who didn’t. Tests took time to come back and at its peak we had to assume every single patient that came in had the disease and treat them accordingly. Fortunately we are now back down to normal activity although we know Covid is still prevalent in the community and we are still screening and treating patients for it.

With the clap for carers, the issues we faced were not unique to health care. All key workers were going above and beyond what they were normally expected to do. It was a national response. Once you get into the politics of it, it becomes more complicated. In terms of whether politicians have more recognition of the NHS now, I find it difficult to comment because it’s a complex issue.

I would rather we had built five Louisa Jordans and not had to use any of them than need one and not have one there.

The use of the NHS for political gain is very difficult and obviously there has been a significant disparity between what the Scottish Government are doing and what the UK Government are doing both in their aims and their processes.

Within Scotland, we feel that things have been done very well. The public health messaging has been very much on point and I think most doctors would be very supportive of the conservative approach that has been taken towards public health and the encouragement of the public to behave responsibly and to do the right thing.

Most hospitals were very similar to ours in that effectively, within the space of a few days, we went from normal activity to being fully ready for a pandemic. We were able to accommodate the expansion and because of the timing of lockdown we were never stressed in the way the US or Italian health systems have been.

We planned for that level of activity but fortunately those stages of our plans were never tested. We have the Louisa Jordan and the Nightingale hospitals, and I would rather we had built five Louisa Jordans and not had to use any of them than need one and not have one there.

Because of the timescale and because the NHS is such a big organisation, it is very difficult to expect it to respond quickly to things. We were being asked to plan several weeks ahead in a time of volatility and uncertainty.

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The only way to do that is speculate and make big plans and then scale them back if need be. That is when it becomes very easy to criticise the politicians. I know what my job is and the scale I have to work on - I can’t think for a second how much more difficult it is and the challenge it would be if I were the health secretary asked to do something similar for five or six million people.

I think the NHS is part of the national identity maybe more so in Scotland than anywhere else in the UK perhaps because of our approach to health and education. I was brought up thinking health and education were basic human rights and should both be provided free at the point of delivery to the extent that you need them. I am still fully supportive of the concept of the NHS.

The challenge as time has gone on is the public and political expectation of what the NHS gets and delivers. There has to be an acceptance that all resources are finite and that difficult decisions need to be made and I think if there is a legacy from Covid then that has to be part of it.

People do appreciate what we do and most interactions with the NHS are positive but that doesn’t make for good copy sadly

It would be good if people understood that we are in a position where we have to make difficult decisions on a daily basis and that is part and parcel of our job. This is not a new challenge for us. Like every doctor I am very supportive of the NHS but I understand there are limitations to what we can do.

I would also like to see a continued appreciation that a lot of the time the NHS works quietly in the background to the better interest of the vast majority of the population.

The problem with things like targets and the way a lot of stories are portrayed is that there is a huge focus on the negative aspects of it which represents a tiny minority of experience within the NHS. The vast majority of the patients we deal with have good outcomes and are immensely grateful and I think that is what you see in the clap for carers. People do appreciate what we do and most interactions with the NHS are positive but that doesn’t make for good copy sadly.

I would like an ongoing recognition of the contribution of the NHS to life in Scotland and continued discussions about what is realistic for it to provide.

Gael Rolls (51). Lead nurse, Royal Hospital for Children, Glasgow.

I WANTED to be a nurse from a very early age. The children all round me when I was growing up were boys and they would play at soldiers and I was always the nurse that came along and fixed them up. I would come out with my wee box of bandages and pile them on everybody else.

I wanted to work in paediatrics and after my Highers I got a place at Yorkhill School of Nursing and I have now been a nurse for nearly 35 years. I enjoy making people better, I enjoy understanding how things work and being able to recognise when someone is not as well as previously thought and being able to interpret the clinical side of things.

As you would expect, NHS healthcare has changed very much throughout that time. When I started in critical care we wouldn’t even been able to imagine what we can do now.

The technology and developments that have come on in my time are immense and amazing. We can do so much more than we ever could and we are seeing people survive that never would have before.

Emergency care is a truly fascinating area to work in. There is always something new to do and more improvements. Initiatives like the Back to Sleep campaign resulted in a drop of Sudden Infant Death Syndrome (SIDS) and cycle helmets have made such a difference to the trauma that children come in with. When the meningitis vaccines were brought in the rates really dropped and car seats too have made a difference.

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All these things have made a huge impact on the children we care for and what they are presenting with.

I hugely believe in the NHS. It is absolutely right that we provide health care for everybody and it is free at the point of care. You come to the emergency department and get the care you need at the right time, from the right person and you are promptly seen and taken care of. It is a good system and it works well.

Our colleagues in the adult services have all our respect for how they have gone above and beyond.

I am proud of the people I work with because it is a really caring system.

Nobody comes into the NHS without that real empathy of spirit and the desire to do well and see your fellow humans do well and get better. I am a big fan of the NHS.

I would like to see the commitment to the NHS continue so that it remains dedicated to deliver high-quality health care to everybody free at the point of care.

I also think there are people in the NHS who have gone above and beyond in their treatment of patients during Covid-19 and the crisis that the adult health care services witnessed.

Our colleagues in the adult services have all our respect for how they have gone above and beyond.

In paediatrics it has changed how we work so we now wear a lot more PPE. We have to wear the full gowns and the FFP3 face masks when we are doing certain procedures or caring for certain children such as those who are ventilated and patients in theatre.

That itself takes a toll as the PPE is hot and heavy to wear. The staff need to have breaks and drink plenty because it is so hot.

We risk assess every patient to see what level of PPE we require to care for them. We do what we can to personalise it – the nurses are doing a trial in the haematology and oncology ward with badges and stickers they can wear outside their PPE which has their name and a big picture of them. It’s a ward where staff are always in masks at all times because the children are shielding.
 

Jamie Kennedy (38). Ambulance technician with the Scottish Ambulance Service.

I SPENT 11 years in the military and when I came out I joined the Scottish Ambulance Service. I was serving my country so coming out of the military and going into public service isn’t really that much different – it’s just a different kind of work.

I have been with the service for almost three years. I love the job and don’t see myself leaving. I want to stay until retirement age if possible.

When I came into it I didn’t have any medical experience so the training was quite intensive. Technicians are clinically trained and there is not much a paramedic can do that we can’t.

I’ve learned a lot since I came into the job and I work in an accident and emergency ambulance so it is predominantly emergency work.

I’ve attended a number of trauma cases and I’ve had to do CPR more often than I would like.

The health care that everybody gets is world-class. It’s an institution that needs to stay.

You don’t really know until you see the patient what you are going to be dealing with but there is no point worrying about it before you are there.

Different jobs affect you differently but you treat every patient individually and with respect and all the care they deserve.

Paramedics can administer a few more drugs than technicians so I am going to start a paramedic course through the service.

During the Covid-19 crisis the work got more intensive and I moved out of the house into a hotel in East Kilbride for five weeks to minimise the risk to my wife and our five-year-old son and eight-year-old daughter. They coped well enough but they missed me and I missed them so it was good to get back.

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Five weeks was long enough. Living in a hotel sounds nice but I was either working or in my room and kept in touch with video calls and phone calls.

From the start of the lockdown it was almost constant Covid cases. We did not know at the time if they were positive or negative so we treated them as suspected Covid and wore the PPE.

There was a lot more to think about with the additional PPE and the additional risks. It was quite tough but we got through it all right. The service has done really well over the past three months.

I think the support from the public has always been there but I think it has been demonstrated more over the last three months. It’s been nice. It has made the staff feel more appreciated.

The NHS is definitely a good thing. The health care that everybody gets is world-class. It’s an institution that needs to stay. I think we should continue the way we are. The NHS works the way it is and will hopefully go for another 72 years.