'Verging on total collapse'

A critical care staff shortage crisis has engulfed Guys’ and St Thomas’ NHS Foundation Trust in London, a bombshell Unite survey has revealed.

Nearly 200 Unite members working in critical care at the Trust have reported widespread staff shortages, fueling serious concerns over patient care as staff morale has plummeted to rock-bottom.

Of the 188 critical care staff — including nurses and technical — who participated in the survey, an astonishing 93 per cent reported staff shortages in their unit in every single shift. Meanwhile, 100 per cent said their wellbeing had been affected by understaffing, and almost just as many – 98 per cent – said they felt the staff shortages made their unit unsafe.

The union estimates that 116 qualified intensive care unit (ICU) nurses have left critical care in the last seven months and that the trust is not managing to replace them all which has led to the skill-mix being heavily diluted.

‘Constant worry’

Unite rep Dave Carr, who works as a deputy charge nurse in critical care at Guys’ and St Thomas’ Hospital, told UniteLIVE of the desperate circumstances he and his colleagues are now facing.  

“We look after very vulnerable patients in critical care who are entirely dependent on us for their lives,” he explained. “The shorter staffed we are, the more diluted the skill mix is, and the more pressure there is on us to ensure that patients are safely looked after. When we are short of staff that stretch becomes unsafe.

“If a patient becomes unwell – if they suddenly deteriorate – especially if we’re looking after more than one patient at a time, then other patients’ care will be compromised because our attention is elsewhere.”

Dave described endless shifts of “constant worry”.

“It’s constantly worrying that you are not able to deliver the best care for the patient,” he said. “It’s constantly worrying that you might be compromising yourself as well. We’re trained to a very high level and we’re constantly worried that we’ll make a mistake because we’re tired, overworked and short-staffed. We’re doing the work of two or three people at once sometimes.”

While Dave noted that staff shortages at the Trust aren’t new, nothing has even remotely compared to what he and his colleagues have faced throughout the pandemic.

“Before you’d have the odd day when staffing was really short and you might have some ‘doubles’ – where two ITU patients are looked after by one nurse – but they were rare. Now it’s every single day. These are the worst staff shortages I’ve ever seen in my career.”

‘Utterly relentless’

Dave said that this Monday in particular was a struggle.

“These shortages came to a head early in the week where all elective surgery requiring post-operative care was cancelled due to the shortage of ICU nurses. It is not an exaggeration to say the system was verging on total collapse,” he said.

 “Some patients have had their operations cancelled multiple times. It’s a really horrible, sickening feeling when your job is to look after people after they’ve had big operations and that are critically ill — and you can’t do your job because you just don’t have the people to do that job. It’s a constant mental strain.”

Dave himself was redeployed on Monday onto a ward that was filled with patients who were very unwell with Covid.

“I was sent to break up doubles. It was utterly relentless. And this isn’t going to stop. A lot of people are leaving; a lot of people are off sick. There’s no sense of wellbeing among any of our staff at the moment. It’s a miserable environment and we’ve got no sense of power or control over what’s going on.”

Dave said that colleagues who’ve worked through two successive waves of the Covid pandemic are not only dealing with the pressures of staff shortages but are doing so with the added burden of collective trauma.

“A good third or our staff have got PTSD,” he noted. “We worked above and beyond throughout this pandemic. Personally, the things I witnessed towards the back end of the second wave have irreversibly scarred and traumatized me – I can’t get certain images out of my head.”

‘We can’t go on like this’

As Unite publishes its Guys’ and St Thomas’ Hospital Trust survey of critical care staff, Dave said Unite members are calling on the Trust to come clean.

“The Trust has to be honest — to NHS London, to the Department of Health and to itself about what it can and can’t deliver during this period,” he explained. “The Trust has been saying up until recently we can do everything – we can bring in our elective work and look after critical care patients, not just from our hospitals but bring them in from other areas that need support. We simply can’t do that with the staffing that we’ve got.”

Other measures the Trust can take such as increasing bank rates – the rates staff receive if they work extra hours –and focusing attention on bringing in more trained staff, will all help at this time of crisis. But at the end of the day, Dave added, such measures will only serve as sticking plaster to a problem that is not confined to just one Trust.

“Whatever we do now, we’re robbing Peter to pay Paul. I work in one of the best-funded hospitals in all of Europe and I dread to think what is happening elsewhere. It’s a pan-London, pan-country issue.

“The prime minister talks about a new paradigm of a high-skilled, high-wage economy,” he added. “Well, I am a highly skilled worker – if I didn’t do my job properly people will die. We’re not getting paid adequately to stay in the job. We can recruit people but we can’t hang onto them. We’ve got a huge turnover. The only way we make the system sustainable is for the government to pay us what we’re worth.”

Dave reiterated Unite’s long-standing policy for a pay rise of £3,000 a year or 15 per cent, whichever is greater for all health sector workers. And he added that the government must be honest to the public about how critical the situation is now in Trusts throughout the country – and that it must take action accordingly as winter approaches.

“I’m utterly wiped out,” Dave told UniteLive. “I’ve gone through both waves of the pandemic and I can’t describe to you how tired I am. We can’t go on like this – and we aren’t. Our sickness rates are through the ceiling and people are leaving in droves. It’s not a crisis that’s waiting to happen – it’s here right now.”

‘Damning indictment’

Commenting on the critical care staff survey, Unite general secretary Sharon Graham said, “These results are shocking and very distressing for our NHS members.  They are total professionals but these chronic staff shortages mean they struggle to give the care they are dedicated to, so morale plummets.

“Alarm bells have to start ringing across government and the health service,” she added. “This must be sorted ahead of the busy winter period because safe staffing is central to proper patient care.”

Unite national officer for health Colenzo Jarrett-Thorpe added, “These findings are a damning indictment of a decade of underfunding by the Tory government which we fear will be mirrored across other trusts in England. In response to our survey. The trust management has agreed to extend enhanced pay rates for nurses till January, so they are expecting the issue to last until at least then which is completely unsatisfactory.

“The government must step in to ensure effective health and care safe staffing legislation for England and Northern Ireland, following similar legislation by the devolved governments in Scotland and Wales. Ministers must also put money into the NHS urgently to return our health and social care services to pre-pandemic levels.”

The union has been pressing the health and social care secretary Sajid Javid to redouble his efforts to obtain more cash from chancellor Rishi Sunak for the NHS as it braces itself for a winter season of illness and increased hospital admissions.

Unite is dedicated to advancing the jobs, pay and conditions of its members and will fight back against any efforts to diminish workers’ living standards.

By Hajera Blagg