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Key findings 44% of respondents were not confident their hospitals would be able to provide safe COVID and non-COVID services should there be a second surge of infections. Over one third (38%) of respondents also cited low or non-existent rapid testing for staff at their hospitals and one-in-five (20%) said there are currently insufficient infection prevention and control measures to prevent staff from infecting surgical patients with COVID-19. Results also highlighted the increasing trend in mental distress amongst anaesthetists and the disruption to the training opportunities for anaesthetists in training: nearly two-thirds of respondents (64%) have, to some extent during the past month, suffered mental distress due to the pressures faced during the COVID-19 pandemic over one-third of respondents (34%) reported a low or very low level of team morale, compared with nearly one-in-five (21%) in May nearly nine-in-ten trainees (89%) strongly agree that the pandemic is affecting their training opportunities, career and professional development.

The results of the study, published in Anaesthesia, found that: Wearing PPE posed problems with fit. Several human factor/ergonomic issues were reported when working in PPE, including visual difficulties and problems with communication and hearing alarms. Hand (fine motor) function was impaired, with additional problems for non‐clinical activities including typing and using electronic interfaces. Reaching (gross motor) activities were restricted by both surgical gowns with sleeves and one‐piece coveralls. Skin breakdown, musculoskeletal injuries and overheating. The authors suggest that that more human factor/ergonomic research is needed to improve the functional design of PPE so that healthcare workers are better supported to carry out critical care and other medical treatment.

Patients that I care for remain the same. Medically they are the same as they ever were. They have bowel obstructions, they have heart attacks, they have infections, they break bones, and there will always be a constant flow of patients that need the services of the NHS. One day it will be you and it will be me, at some point we will rely on NHS care. However, the way that care is organised and delivered around us will change. We have no idea what it will look like in the future, but it will be different to what we knew before the pandemic hit. At the moment we are all working in a state of flux. I work part time as a critical care outreach nurse, so there are times when I am not at the hospital for a few days in a row. When I am due back at work, I get what I call the ‘Sunday night fear’. I used to get this every Sunday night before I had to go to school. I would worry about fitting in, had I done my homework, have I got all my books together and whether I was going to have a good hair day. Now I find myself worrying about what new protocols I need to follow, what briefings have I missed, which wards are green, which are red. Now I have a new habit of looking through work emails to find out if I need to do anything different when I come to work. I’m not enjoying this habit one bit. I feel like I am starting a new job every time I turn up after two or three days. One of the roles of the critical care outreach nurse is to provide role modelling and support to staff on the wards. More often than not I have no idea what the ‘rules’ are now. Every decision is difficult. My patient needs to go to theatre urgently; they are slowly occluding their airway. Before the theatre will take them, they need a covid swab result. How do I get a swab result quickly? A new rapid test is now available (I only find this out by someone telling me this as they were passing). How do I get this swab? Does it look different? How do you perform the swab? How do I send it? How quick does it come back? How do I find the result? How reliable is it (at this point, I’m not bothered – just get it done, tick that box). Next call – cardiac arrest on one of the wards. Pre-covid we have been taught "Good chest compressions are linked with better outcomes for patients. Keep time off the chest to a minimum". This has been drummed in to us for years. It is now second nature to make sure that chest compressions are given as soon as we confirm cardiac arrest. But now we are advised by our Trust resuscitation team and the Resuscitation Council UK that performing chest compressions is an aerosol generating procedure (AGP), despite the advice from Public Health England who state that chest compressions is not classed as an AGP. There are a few issues here... As frontline healthcare staff we want to do the best for our patients, and we want to be kept safe by our employers. We need clarity on what we are supposed to be doing; this lack of clarity and standard guidance leads us into different interpretations of the rules and a lack of trust in our leaders. I recently taught on an Advanced Life Support Course. Here, I was teaching a range of healthcare professionals from differing hospitals from inner and outer London. I was amazed at the different practices that were going on. Some were wearing full personal protective equipment (PPE) for cardiac arrests despite covid status, some were not. The lack of clarity here made teaching very difficult as they were not sure who was right and who was wrong. They were then worrying if they had been exposed and are now losing trust in their leaders. In the NHS we use guidance that is evidence based. At present we have such a small evidence base, if any, on how we should treat patients during the pandemic. This is leading to differing local policies of which no one knows which is best. This lack of clarity and guidance also has an impact on the patient. If we are to wear full PPE for AGPs (in the cardiac arrest situation) there will be a delay in performing chest compressions; this has a negative impact on patient outcomes. Cardiac arrests are stressful; donning PPE at breakneck speed so that you can treat your patient is compounding the anxiety. It made me question – if covid is here to stay, should we be rewriting the resuscitation guidelines? Then I thought, how can you rewrite guidance in a time of flux? Things change all the time; nothing is the same from 48 hours ago – so how can meaningful standards and guidance be written if they will be out of date before they get uploaded? And re-writing guidance with consensus from experts and professional bodies takes time. What do we do in the meantime? At this stage we need guidance, we need clarity and we need to feel we can trust in those that lead us through. Call for action We need evidenced-based guidance, we need clarity and we need to feel we can trust in those that lead us through. How are leaders communicating best practice and updated relevant guidance to staff and instilling trust that patient and staff safety is a core priority?

Complaints from staff are not being heeded. Why is it that healthcare staff's opinions and pleas for their safety and the safety of patients do not matter? Here are just some examples of where safety has been compromised: Disposable gowns are being reused by keeping them in a room and then reusing after 3 days. There were no fit tests. Staff were informed by management that "one size fits all, no testers or kits available and no other trusts are doing it anyway". Only when the Health and Safety Executive (HSE) announced recently that fit tests were a legal requirement, then fit tests were given. I queried about fit checks only to discover that it was not part of the training and, therefore, staff were wearing masks without seals for three months before fit tests were introduced and even after fit tests! I taught my colleagues how to do fit checks via telephone. There was no processes in place at the hospital to aid staff navigation through the pandemic (no red or green areas, no donning or doffing stations, no system for ordering PPE if it ran out); it was very much carry on as normal. A hospital pathway was made one week ago, unsigned and not referenced by governance, and with no instructions on how to don and doff. Guidelines from the Association for Perioperative Practice (AFPP) and Public Health England (PHE) for induction and extubation are not being followed – only 5 minutes instead of 20 minutes. Guidelines state 5 minutes is only for laminar flow theatres. None of the theatres in this hospital have laminar flow. One of my colleagues said she was not happy to cover an ENT list because she is BAME and at moderate/high risk with underlying conditions. She had not been risk assessed and she felt that someone with lower or no risk could do the list. She was removed from the ENT list, told she would be reprimanded on return to work and asked to write a report on her unwillingness to help in treating patients. The list had delays and she was told if she had done the list it would not have suffered from delays. Just goes to show, management only care about the work and not the staff. It was only after the list, she was then risk assessed. Diathermy smoke evacuation is not being used as recommended. Diathermy is a surgical technique which uses heat from an electric current to cut tissue or seal bleeding vessels. Diathermy emissions can contain numerous toxic gases, particles and vapours and are usually invisible to the naked eye. Inhalation can adversely affect surgeons’ and theatre staff’s respiratory system. If staff get COVID-19 and die, they become a statistic and work goes on as usual. The examples listed above are all safety issues for patients and staff but, like me, my colleagues are being ignored and informed "it's a business!" when these safety concerns are raised at the hospital. The only difference is they are permanent staff and their shifts cannot be blocked whereas I was a locum nurse who found my shifts blocked after I spoke up. Why has it been allowed to carry on? Why is there no Freedom To Speak Up Guardian at the hospital? Why has nothing been done? We can all learn from each other and we all have a voice. Sir Francis said we need to "Speak Up For Change", but management continues to be reactive when we try to be proactive and initiate change. This has to stop! Actions needed We need unannounced inspections from the Care Quality Commission (CQC) and HSE when we make reports to them. Every private hospital must have an infection control team and Freedom To Speak Up Guardian in post.

Follow the link below to watch a short video on how you can access dental care, treatment and advice as dental practices begin to reopen.

The key challenges identified are: funding; capacity; rehabilitation; health inequalities; regulation and inspections; system working; and managing public expectations. It puts forward a number of practical solutions for the phase three guidance and beyond, including: An extension of emergency funding across all sectors of the NHS, given significant extra demand across all services. Longer term funding will be needed for rehabilitation and recovery services in the community, including for mental health, to manage patients at home and in the community. Putting in place an ongoing arrangement with the private sector – this will be vital to provide capacity to respond to the backlog of treatment. A review of the impact of COVID-19 on the NHS and social care workforce given the unprecedented pressure staff have been under A delay in returning to the inspection regime of the CQC to take into account the positive changes that have been achieved as a result of the lighter touch approach to regulation that has been in place during the pandemic. A commitment to acknowledge and address health inequalities wherever possible through upcoming guidance and policy reform. Clarity over when there will be a return the greater autonomy local organisations had before COVID-19 returned, as we move from Level 4 to Level 3. This should be considered as part of a wider move to less central command and control when the pandemic has subsided. A call for assurance that there will be a fully operational and robust test, track and trace system, as well as appropriate supplies of personal protective equipment (PPE),as services are resumed.