Special report: On Lancasters Covid red wards where heroic and scarred staff are exhausted – Lancs Live

“Staff are physically scarred where the masks have melted to their faces. Plastic surgeons say those scars will be permanent.”

Off camera, Dr Shahedal Bari struggled to hold back tears as he revealed the physical and mental impact of the Covid pandemic on the doctors, nurses and support staff in his trust.

The executive medical director at University Hospitals of Morecambe Bay NHS Foundation Trust has been at the forefront of the Covid response in Lancaster, Morecambe and Barrow.

In an open visit to Royal Lancaster Infirmary, LancsLive delved deep into the reality of the coronavirus pandemic for patients, families and those on the frontline risking their lives to save patients who otherwise would have no chance of survival.

Nurses, doctors, ward managers and infection control professionals shared their harrowing, but inspirational stories of the sacrifices made to stop the spread of the virus, which has now killed more than 3,300 people in Lancashire’s hospitals alone and many more in their own homes.

In honest conversations with LancsLive over the course of one day on February 25, the staff shared their experiences throughout the entire pandemic. Cases are finally starting to abate thanks to the success of the Covid vaccination programme, which has seen half a million people inoculated in Lancashire and South Cumbria to date.

Hospital bosses made clear that it is safe for people to go to hospital – there are measures in place to protect patients and staff.

Dr Bari, a consultant for respiratory medicine and general internal medicine, has seen a lot during his medical career, but this past year has been the most eye-opening.

As a lung expert, he spends time on the Covid wards, visiting patients and using his expertise to help staff deal with some of the most challenging cases.

“I have seen the daily deaths in hospitals, I have seen the tears of the family members,” he said. “I have seen the degradation of the skin of the staff. I see it day in day out – the amount of mental and physical stress that the NHS is going through.

“There are young girls with scars on their faces, physical scars.

“When you wear a mask it causes skin dipping, which takes a whole day for your skin to recover. These staff are doing it daily, for 12 hours. Yet still, they are coming to work.”

Dr Shahedal Bari, medical director for the University Hospitals of Morecambe Bay Hospitals NHS Foundation Trust

But the pride he feels for his employees and the sacrifices they have made through all three waves of the pandemic, is plain to see.

“These are very challenging times,” he adds. “I am very lucky our people are absolutely fantastic.

“There have been a significant number of staff who couldn’t work in the time of need, even though they really wanted to. It’s caused significant exhaustion and tiredness, especially to those working on the front line.

“The biggest challenge is a very tired workforce.”

For Dr Bari, the most recent wave has seen a huge influx of patients from all walks of life – a stark reminder that a slight lapse in adherence to the restrictions can cost lives.

He has an important message to those who continue to cite ‘plandemic’ or hoax as his staff battle to save people’s lives.

“We are seeing a significant number of people affected,” he added. “We must be mindful that this hasn’t gone away.

“It is important to realise that this disease affects anyone and everyone. There are very high risk groups, male, over 70, those with hypertension, renal problems or those on cancer treatment. But we have got deaths from young people. There’s no doubt this can affect anyone.

“This is not a plandemic. Please do not put fake news on any media, we have seen our staff losing their lives. We have seen family members and our local community members losing their lives.”

And this frustration can be felt trust wide, with each member of staff who shared their story urging the public to follow the hands, face space guidelines as cases start to decrease across the board.

Gemma Weed, advanced nurse practitioner, works on the Acute Medical Unit.

Gemma Weed, advanced nurse practitioner

For the past eight weeks she has been leading an initiative to stand at the door of the hospital and assess who needs life-saving care for Covid symptoms.

She has witnessed people turn up struggling for breath, and has had to decide whether people are well enough to recover at home.

“There has been a significant amount of Covid patients and some very poorly Covid patients,” she said. “There have been lots of challenging parts from something as simple as having no staff to holding the hands of patients who are dying when it should be relatives sitting with them.

“Normally, without Covid, the relatives would be sat there but you’re holding their hands on FaceTime to their family and supporting those patients through death.

“We have got medications to help but we have not got a lot else.

“It has been difficult, the mental health of most of the nurses – you will find nurses crying in the sluice. And the mental impact from a family point of view. I have two young children and you’re taking those potential viruses home.”

Gemma said it’s ‘very sad’ to hear people say that the virus isn’t real, is just like the flu, or isn’t as serious as is being made out in the media.

“The hospitals have been full to bursting,” she said. “I have done 23 year in the NHS and I have never been through something like this.

“Young staff, nurses, particularly those in the first few years of their training have seen something I have never seen in 23 years.

“We are tired, we are absolutely exhausted. We need about six months off to deal with what we have been through. We have all stayed late every single night.

“Over the last 12 months I have spent a minimal amount of time with my children and family. I have missed out on a year of my children’s lives. A lot of nurses moved out from home, they were staying in accommodation to stop taking the Covid home. A lot of us have really missed the family time while everyone else has been enjoying a lot of family time.

“We have pretty much lived here.”

Frustrated by continued comments on social media about the pandemic being a ‘hoax’, Gemma was forced to leave Facebook for her own mental health.

Life has not slowed down for the nurses and doctors working with Covid patients day in and day out

She said that staff are putting their issues to the back of their mind, but that ‘one day’ they will have to sit down together and address the trauma caused by the things they have seen.

On top of this, physical health has become a major issue, with some staff members suffering from long Covid, from nurses ‘in their 20s’ to consultants who have been off for ‘four to five months’, too fatigued from the effects of the virus to carry out their daily jobs.”

And these effects aren’t just limited to the patients, Gemma explained how Covid has seen relatively healthy people take a fatal turn ‘overnight’.

She recalled having to console a consultant after he was forced to tell a patient, who felt well enough to get out of bed, that she would not survive the week.

The same consultant, Mohamed Elnaggar, a specialist in internal medicine, said the incident had a profound effect on him.

“It’s very very different than to speak to people who are already very very unwell. When you have to do that with families there’s a big shock factor to it.

“I had this one patient, she was quite unwell. However, until the very end she was eating, drinking, getting up. She was fine, she was reading the paper.

“I had to tell her that you’re not going the right way, there’s nothing else we could do. I think you might pass away in the next day or two.

“She patted my shoulder and said thank you for doing everything you can. That was one of the hard-awakening moments where you do this day in day out but you get into a position where you need a break. We are not machines, we need to deal with human beings.

“That was a very emotional moment for me.”

Unfortunately the patient’s lungs suffered such inflammation and damage that she was unable to recover and passed away shortly after, despite feeling well enough to get out of bed just hours earlier.

“The difficulty with dealing with an overwhelming situation where you’re used to breaking bad news to patients, you’re used to decisions about end of life,” added Mr El Naggar.

“With Covid unfortunately, we need to do these much more often and with much healthier people. The problem with Covid is someone without any previous co-morbidities or problems can suddenly just, go off.

“You have to have these very difficult decisions with them. At times you forget the impact that that has on your own mental health.

“It did have quite a big impact on a lot of staff members. People who used to work with these patients all the time, become more attached to them and you start losing the fight. It becomes quite emotional and a lot of the time you used to deal with that better but because of the frequency of it happening, the unexpectedness, it has not been easy.

“The thing is the unpredictability of how it would go.”

Mr El Naggar, who works on the Acute Medical Unit ‘Red ward’ Covid bays, said that the hospital could see up to seven or eight seriously-ill patients per shift suffering from the life-threatening effects of the virus.

During the peak of the third wave, in January, the hospital was forced to open up extra wards to take in the high influx of patients.

The hospital is open for business as usual, with people urged to seek treatment if they have medical issues

One of his major frustrations is seeing people who have come in after not adhering to social distancing guidelines, who are then ‘shocked’ or surprised that they have become unwell.

He has urged people who have been successfully treated to share their stories as a cautionary tale to others who think ‘it’ll never happen to me’.

“We’ve had a patient admitted who was so unwell to the point he went to ITU, was intubated, was in a complete coma and when he came out of that coma he still insisted there’s no such thing as Covid,” he said.

“You can understand how disheartening this would be to everyone who took part in his care. He refused completely to believe that it exists to begin with.

“He still thought it was one of those conspiracy theories. Now the problem is when people think like that, it does put all our efforts to shame.

“The effects of Covid on the people here and the way it’s affected our mental, social and our lives has been massive. For anyone to come and say that doesn’t exist, it’s just insulting everyone , the relatives of people who have seen it, you’re insulting patients who have died.

“It’s very heartbreaking for you to feel that way. People who had been looking after that patient all that time felt really unwell because we put in a lot of time and effort to get you better.”

Mr El Naggar said that although the staff don’t feel they need thanks, people should show their gratitude by ensuring that that disease isn’t then spread among the community.

For patients who do survive the disease long enough to make it to ITU, which is reserved for the poorliest people, the treatment required to save their lives is harrowing.

Ventilated patients often need to be ‘proned’, lay on their fronts with the ventilation tube inserted to breathe air into their lungs.

Sometimes, the most severely ill patients will need to be on this potentially life-saving, but dangerous, mechanism for weeks – which can cause damage to their trachea and vocal chords as well as raising their risk of infection.

Sue Smith, chief nurse for UHMBT and deputy chief executive, described the procedure in lieu of inviting us into the unit – to minimise the chance of bringing in new infections and endangering staff and patients.

“The patients are ventilated and lay on their fronts,” she said. “Often for long periods of time. We have seen pressure sores in places we have not seen them before.

“It is the only treatment you can give sometimes. We had a patient with a pressure sore on their tongue.

“These people throwing parties in their homes, they have absolutely no idea. They could spread it to 50 people in a couple of days, some of whom could end up on a ventilator, some could end up in a mortuary and that is very sad.

“It’s heartbreaking for anyone who thinks it’s not real, they are not living in the real world. A lot of people have died and a lot of people have died without having the visitor they would normally have there.”

Sue, who was standing at Lancaster train station about to board a train when the hospital received its first Covid patient back in March 2020, said that the staff had ‘no idea’ what was about to hit them.

“I didn’t get the train,” she said. “I went straight to the hospital. We stayed up all night. Since then it has been a real rollercoaster, way beyond anything we planned for.

“We (the NHS) always plan for pandemics and we are really good at it, but this was above and beyond. It’s been going on for a year. People forget that the staff are people with homes and families. If someone becomes ill, then they will have to stay at home.

“We have had lower numbers of staff at a time when we have sicker patients.”

A standard ITU patient will have one on one care, whereas one nurse on a regular ward will look after eight patients. High dependency patients are generally two to a nurse and slightly lower dependency wards will see one nurse to every four patients.

Because of the influx in high dependency, mid-dependency and ITU patients, the trust – along with trusts across the country – have been forced to try and find more nursing staff to meet this huge rise in demand.

“Our capacity was normal, then it went to surge, then super surge, then super super surge,” she added. “People don’t realise how much they (staff) have done extra hours to ensure patients are safe.

“It’s quite inspiring and it’s an honour to work in an NHS team.”

So high demand has been at points, that trusts across Lancashire have worked together to take on each other’s patients when one trust is full to breaking.

Just a couple of weeks ago, Lancaster opened its A&E department to patients who would have been treated at Blackpool Victoria Hospital – and the same has happened in reverse in the not too distant past.

Sue has heaped praise upon members of her staff, from hospital cleaners to nurses, doctors, the catering teams, porters and pharmacists, who she said have put their lives on hold for 12 months and have done an ‘incredible’ job.

“It has been the hardest time yet with the most amazing response from every angle.”

Sue says looking forward, she is ‘nervous’ about Covid returning, with a tired out workforce who will soon need to focus on playing catch-up with all the elective patients who have been unable to come in for their surgeries.

However, the trust stressed that outpatient and urgent elective surgeries are still taking place and that the hospital is open as usual for anyone needing medical care at this level.

“It’s going to take a long, long time to get people operated on,” she said. “It’ll probably take years to recover from this, it’s not going to get quiet again at any point, it’ll just be a different type of busy.”

One of the biggest changes at the hospital is the way that patients are separated, with entire wards and units changing their approach almost overnight to accommodate the patients and prevent the spread.

Staff wearing PPE on the Acute Frailty Unit

Angela McNally, ward manager for the Acute Frailty Unit, was tasked with merging two wards together and moving her regular patients – those over 75 – to other parts of the hospital for their own safety.

In doing this, the space was able to be used for patients coming in with acute respiratory problems – both Covid and non-Covid related.

Covid patients would be placed on the acute red ward, with non-Covid patients on the adjacent frailty ward next door.

Angela said that the upskilling has been a difficult task, but that every member of staff who previously worked on the frailty unit agreed to risk their safety to care for Covid and non-Covid patients.

“We’ve had patients in their 20s” she said. “The youngest being 18.

“What’s changed over the last six months is that we’ve had to create escalation beds, we have more wards to staff more to cover, all our medical and nursing teams are fully stretched.

“We’ve stayed and looked after the patients here and created a big 54-bedded footprint. In order to provide safety and skill mix we’ve blended the two teams together.

“It’s been extremely challenging. One of the hardest things we’ve had to deal with is our own staff being unwell. That’s been a really difficult time, patients and relatives have come in and our staff have had to look after them.

“Our own staff members have been at home sick, shielding or isolating.

“Managing the staffing issues have been really complex. We’ve had lots of staff with family members who are poorly. You have to provide the services that you can. Sometimes it’s just me ringing them up on a daily basis. Sometimes family at home, they don’t understand the pressures and how scared we are.”

Despite initially high levels of staff sickness at roughly 17 per cent in April last year, the figures are now starting to come down and stand at 8 per cent in March 2021, due to Covid and non-Covid related illnesses.

Angela, whose 27-year-old daughter is on the vulnerable list due to learning disabilities, said that the experience has been a ‘scary’ one.

Her family has remained relatively unscathed by the virus, with her daughter getting the vaccine just last week, removing at least one of Angela’s constantly underlying concerns.

“I’ve done acute medical admissions in the past and I found it really challenging to refresh my skills,” she said. “All the team agreed to stay together and work with the team next door.

“We really did what Morecambe Bay do well which is stay together and help each other.

“It’s misunderstood how easy we can catch it, why we catch it and why some people get it and get it worse than others. I think that’s probably where the fear is, that unknown.”

One of the hardest things, says Angela, is the way in which patients have been unable to say goodbye to their loved ones.

A patient at Royal Lancaster Infirmary
(Image: LancsLive)

“There’s nothing nice or compassionate about sitting with an iPad having those conversations between families,” she said. “It’s probably been the most challenging thing I’ve been involved in in 30 years.

“There doesn’t feel any compassion or any care in any of it. And I think that’s where we struggle as nurses because we are very hands on, very tactile we like to hold hands and be with our families when it’s that time.

“It’s been very difficult with Covid patients, they deteriorate very quickly and that’s hard to deal with as well because sometimes you haven’t always got the families on the phone or had chance to have those conversations with them before the patients have deteriorated and died.

“The only reassurance we have been able to offer is the fact that they have never ever been alone. I think we would consider it really really difficult if we couldn’t be with our patients at that point.”

Angela says she has rang nurses who have come in at the drop of a hat to ensure that the patients have been cared for, which has left staff ‘mentally and physically exhausted’ after the most difficult winter they have ‘ever had’.

“This is not normal,” she said. “We’ve got escalation beds open, we are calling bank staff and agency staff in order to support and provide a service.”

On top of this, there are several international nurses who were called in to help at the beginning of the pandemic, who have since been unable to be repatriated and see their families.

One of the most integral parts of the hospital’s journey has been the escalation in infection prevention, which has seen the team grow in size quickly to cope with the spread throughout the wards.

Despite this, there have been outbreaks, in which wards have seen the virus move like wildfire regardless of the boundless energy spent by staff to prevent it.

The Acute Medical Unit dealing with Covid patients

Amy Mbuli, infection prevention nurse at UHMBT, has been living distanced from her Fife-based husband and children in two week periods since the pandemic began in a bid to help support the patient-facing staff.

“Every bit of work that happens in a hospital, we have to prevent every bit of bacteria that naturally lives in the environment being of impact to the patient,” she said.

“We were being fed information and supported by Public Health England in terms of what was coming. The first piece of guidance we wrote was January 29 last year, about a month before we saw our first case. I’m not sure we knew what was coming and how it was going to impact us – other than it was.

“There was preparation, there was readiness being made in terms of PPE and isolation and how we would manage.

“Because it’s a new virus we had a baseline in terms of spread and how it was spread. The guidance on it came out gradually and changed frequently, it was then trying to get that guidance out in a timely manner to ensure support to them.

“Any organism that spreads by droplet is going to spread faster, particularly with those that are symptomatic and a coughing – there is that risk.

“Precautions were in place, isolation was in place. As we understand new variants, sometimes we have seen it move faster than in others.”

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A huge focus has been put onto hand hygiene, despite this already being an incredibly important factor within hospitals. As a result cleaning staff have been working ‘tirelessly’ to go over and over regular touch points such as bed rails and door handles.

“When it comes to Covid, obviously that changes the need for increased cleaning due to the sheer number of patients coming in with Covid,” she added. “It increases the need for a deep clean or terminal clean which means you are stripping the room down, changing curtains and all of that increases their workload. They work so hard in the domestic team, so hard. They are well and truly frontline workers as well.

“The biggest challenge of it all was the newness. As an unprecedented situation as a pandemic and the supportive factor that we are, there’s obviously going to be fear around what it means, what it looks like and what’s going to happen.

“It’s as much as psychological impact as it is a physical one in terms of healthcare workers. It was new and it was all you heard about. Because the guidance was catching up with the newness of it, it meant that changed things and when there’s a change it can cause anxiety naturally.”

Amy said staff members were coming to her scared, but that their overarching resilience and kindness towards each other was what stood out in the earlier days, and still to this point in the third wave.

Away from the hospital, many frontline staff continue to give patient-facing care to elderly or sick people left housebound by their illnesses.

Perhaps the most unspoken of are the district nursing team, who day after day enter the homes of sick patients with no idea what may be on the other side of the door.

Despite GPs moving to predominantly virtual or telephone consultations, to stop super-spreading events in local surgeries, many patients still require hands on treatment such as insulin injections, wound treatment or help with serious bone fractures – to name just a few.

District nurses have remained up and running throughout the pandemic, visiting care homes where appropriate and sheltered accommodation.

Claire Mclean, team leader for Morecambe’s district nurses, said that the risk has been so uncertain for her staff – who are often unaware of what they will be faced with.

“You never know what’s behind that door when you get there,” she said. “Although we were pre-planning our visits and we were ringing asking questions before we went to see if anyone had any symptoms, especially in the early days when we didn’t know all the symptoms, you don’t always know what you’re going to find when you get there.

“We have gone to patients and they have been symptomatic, but thankfully as the pandemic has gone on, we wear PPE for all of our patients now. We’ve got the correct mechanisms in place so that we are able to still visit those patients who might be Covid positive or symptomatic.

“Obviously if they have a health need and need us for that moment in time then we will still visit them, we are still looking after them. We are still here as a service. It might be that we assess from a distance and the patient says actually, I can manage my health needs for the day.”

In the initial period of Covid, Claire says that the uncertainty over symptoms led to a high level of sickness due to periods of isolation while staff got tests.

However, lateral flow and self-tests have resulted in an improvement in staff numbers.

Claire added that the focus has been on continuing to give ‘high levels of care’ to patients, no matter what the workforce situation is at the time.

Part of this has included teaching patients and their families how to care for themselves, including instructing relatives on how to give insulin injections.

Claire believes that certain aspects of this new way of caring will continue long after the pandemic has ended.

One of the biggest challenges that the service has faced is an influx in patients at the end of their life, many of whom have died from Covid complications but who have been unable or unwilling to go to hospital.

“We have had a lot of palliative patients over the pandemic,” she said. “We have had a lot of patients coming home who have recovered but who have long Covid.

“We work really closely with our colleagues in the respiratory teams and the community teams to help those patients get their strength back to go back to some sort of normal life.

“We have large numbers of patients who have unfortunately contracted Covid-19 and who have been palliative and sadly passed away. And we have had patients who have sadly contracted Covid-19, not wanted admission and recovered as well, which is good.”

For now, the staff at the Royal Lancaster Infirmary and across the whole of the Morecambe Bay Trust are continuing to do their job to the best of their ability – with many aware that the current output cannot last forever.

Senior members of staff, doctors, nurses and support staff are at breaking levels of exhaustion, with many pushing their own mental health concerns to the back of their minds in favour of supporting patients and families with their care.

The pandemic has shone a light on the heroic efforts of all staff within the NHS and their tireless efforts to save lives, or simply to be a dying patient’s last experience of comfort and humanity.

But despite the clapping, the chocolate, the free meals, many are still flouting the rules, holding house parties and even weddings while depleting numbers of staff battle on.

Their message is clear, ‘we are exhausted’ and if you do nothing else for us, please, please stay at home, wash your hands and stay two metres apart from anyone not in your household or bubble.

To deny them this is to deny their sacrifices and ultimately undermines every minute of their work since the first case breached the hospital walls a year ago.