Those who gather on the doorstep to clap the NHS of a Thursday might very well clap so loudly they strip the skin off their palms, after watching this urgently timely film. It took us behind very much closed doors to what is perhaps the very front of the frontline in the fight against coronavirus.
Filmed by the staff themselves, using small cameras and mobile phones it showed people working with courage and resourcefulness, as an entire hospital, the Royal Gwent in Newport, adapted to the pressures of the first peak of the Covid-19 pandemic, in essence becoming the biggest Intensive Care Unit in the country. Staff were drafted in from other departments as space and staff resources began to be commandeered by the needs of coronavirus patients: this was critical care on a simply industrial scale.
Some of the most telling insights came from the simplest moments. A montage of nurses heading into work showed their shared anxiety. One mentioned dreading going to work. Another described how the mere thought of going in set her heart racing. They worried about childcare, infecting their families, the way their place of work was physically changing as it prepared for surge capacity, where they had to go beyond the normal nursing ratios. One-to-one nursing care was soon replaced by one nurse looking after two patients. But they coped, even as news came in from Italy about terrifying decisions being made about how to save and who to abandon.
One of the most prudent decisions they made at the Royal Gwent was to insist that the Personal Protective Equipment the staff used was to the highest standard, much above those laid down by Public Heath England. Of course, this was a subject filling so many news headlines but the documentary underlined not only why this was needed but also what it involved. Hours of mask-wearing left nurses’ faces full of pressure sores. These were people working away from fresh air, in artificial light, in hot and desiccating conditions wearing visors, masks and gowns. But these protections from the virus also brought new challenges, such as not being able to recognise anyone, so you could work a twelve-hour shift with someone and they would remain a stranger, a man or woman behind a mask you wouldn’t know if you say them in Tesco.
There were periods when shortages of equipment and resources, such as kidney machine fluids threatened to overwhelm them, when they were down to five days’ worth of supply. Doctors wrote their own wills, just in case. And, of course patients died, stranded away from their loved ones in wards that naturally had to ban visitors. Yet ingenuity prevailed, even in the middle of such impossible situations. One family was offered the chance to use video-conferencing facilities to join a loved one for the end of life. They accepted with alacrity and were given the chance to say what they needed to say before the alarms were amended and the support switched off. There was some comfort in the fact that they saw their loved one surrounded by people who care right up to the very end.
‘Critical: Inside Intensive Care’ benefitted from having highly articulate members of staff such as Consultant Dr David Hepburn, who has been one of the most sage and clear voices to emerge out of the melee of spin and deception that has seemingly typified the opening months of the Covid-19 pandemic. In one of his no-nonsense self-recordings Hepburn informed us how Wales had the lowest number of intensive care beds in Western Europe and the Aneurin Bevan University Health Board had the lowest number of critical beds in Wales. Making it, of course the worst provision in Western Europe.
He also set such stark and sobering facts in context, noting that “Traditionally this has been an area of high social deprivation and particular health problems, and Newport is known for seeing more extreme pathology than in some of the more metropolitan areas like Cardiff, so not a desperately healthy population. But at the minute, we are at the epicentre of this outbreak, outside the big metropolitan areas of London and Birmingham. Per head of population, we are seeing more people in Newport who are desperately unwell than most areas and certainly than anywhere else in Wales.”
As it approached the first peak the Royal Gwent’s intensive care provision was looking to work at four times its usual capacity, with one extra strain being the longer periods patients tended to stay in ICU. But some did get better and were cheered out of the building. And everywhere there was ample evidence of the kindness of strangers – such as the people who donated food for staff to eat, some of these working 24- hour shifts. There were those who surrounded the hospital on a Thursday night to thank the staff by clapping, including members of the other emergency services, blue lights blazing. And of course, there was the constant care shown to very ill folk.
As the whole place sighed a collective sigh of relief as admissions slowly dwindled Dr Laura McClelland – another of the programme’s clear and articulate contributors – spoke of her hope for the future: “From a personal perspective, as much as the lockdown has been difficult, it’s been quite a period of reflection and prioritisation. I believe that the inclination of mankind to recognize the value of the family and the community and time spent just being and appreciating what they have, their health, the health service, is something we can bring forward into the future.”
Produced by Steve Robinson’s BAFTA Cymru award-winning team, this return to the Royal Gwent after the previous three-part series showed NHS staff responding to enormous pressures and will surely garner some more prizes. But for the porters and anaesthetists, the student nurses stepping up, the retirees volunteering to come back to do their old jobs, indeed the entire selfless army – that seems to be powered by compassion, care and snatched chocolate snacks – the greatest prize is saving life. Which as this timely and necessary documentary attests, does not come without human cost.
Critical – Inside Intensive Care can be watched here.