PLAYBOOK INTERVIEW — ANDREW GODDARD, ROYAL COLLEGE OF PHYSICIANS
DISPATCH FROM THE FRONT LINE: With the NHS coming under unprecedented strain, Playbook caught up with Andrew Goddard, president of the 500-year-old Royal College of Physicians, which represents 39,000 medics, to give an update on how the health system and, critically, the people within it are coping. Professor Goddard is a consultant physician and gastroenterologist and has been working shifts on the wards at the Royal Derby Hospital caring for COVID and other patients.
The bottom line: With roughly 50 percent more admissions than during the first wave, the NHS is in a “far worse place” this time around, Goddard said. “This is busier than anybody currently working in the NHS has ever experienced.”
Regional picture: Things are better in some parts of the country than others, with case rates now seemingly falling in London and the South East, hopefully translating into a sustained fall in admissions. “But they’re still continuing to increase in the North West and in the Midlands,” Goddard said. “We know that the number of hospital admissions lags by two weeks … The Midlands is already struggling. It’s going to really struggle in two weeks.”
Differences to first wave: Although there are more COVID inpatients overall, there are actually about the same numbers in intensive care as at the previous peak in April. That’s because doctors know so much more about how to treat COVID now, so fewer need mechanical ventilation, Goddard said. “This has put much more of an onus on respiratory medicine teams and other medical teams. The use of steroids and CPAP [a form of ventilatory support which uses a mask] is much greater than in the first wave.”
Sharing the load: It also means that nearly all of that 50 percent increase in patient numbers is being seen on non-intensive medical wards. Goddard believes the NHS will have enough beds to cope, but it may well require many more patients being transferred away from their local hospital to where there is bed capacity further afield. That has already been seen with intensive care patients during this crisis, but is “almost unheard of” for non-intensive care patients. “Everyone’s going to have to muck in. I think then there will be enough beds. But we will be sweating the NHS asset harder than it has ever been sweated before,” Goddard said.