BTS Survey finds respiratory departments still dangerously under resourced

The survey of BTS respiratory leads (1), representing Respiratory Departments in the UK asked questions about their present level of staffing and about the changes their department has experienced since February 2020.

About staffing levels, they said:

• 71% don’t have enough medical staff to manage their workload.
• 80% don’t have enough non-medical staff to manage their workload.
• 71% don’t have enough bed space to cope with the number of patients they have.
• Despite being promoted to reduce hospital crowding and improve care, only 50% said they have enough resources (staff and equipment) to manage patients virtually/remotely

Figures by NHS Getting It Right First Time (GIRFT) show that over 40% of the COVID-19 patients admitted to hospital require oxygen therapy, predominantly delivered in respiratory wards or on “extra capacity” or “outlying” wards staffed by respiratory specialist teams. Another 17% require extra breathing and other organ support delivered in Respiratory Support Units or in Intensive Care (2).

Respiratory specialists, with acute and geriatric medicine, also contribute to the care of the 43% COVID-19 patients requiring specialist care but less intensive respiratory support.

On top of the COVID workload, respiratory professionals are continuing to provide routine clinics and services for the large population of patients with chronic respiratory illnesses, specialist services such as those for lung cancer, ILD and Cystic Fibrosis, and they have also started to deliver long-COVID clinics.  However, the chronic workforce deficiencies endemic for many years are still not being addressed.

Professor Jon Bennett, Chair of BTS said: “Sadly, the understaffing of respiratory departments is nothing new. Winter after winter for years we have been seeing the NHS buckle under the pressure of increased emergency admissions of patients with respiratory illnesses. These fall disproportionately on respiratory departments, which always step up to the mark, every time, performing over and above their scheduled duties.

 “It is a sad indictment that respiratory services have never been prioritised and thus it is no surprise that they are struggling to cope with a global pandemic of respiratory disease.

 “The warning signs were evident every winter and nothing has been done to address the systemic lack of respiratory staff and respiratory resources. Respiratory professionals want to do the best for their patients, it’s what they train for many years to do, but they are dangerously stretched and close to burn out right now.”

In the survey, we asked if from February there was a change:

• In staff sickness. 87% said it increased
• In workload. 91% said it increased
• In patients’ waiting time. 73% said it increased
• In the extra hours put in by staff. 80% said these increased
• In how possible it has been to take annual leave. 66% said the chances to do so decreased.  

• In the make-up of the patients they are seeing. 60% said they are now caring for increasing numbers of patients that in the first wave would have instead been sent to Intensive Care.

We need to plan for the future by building strong bases now, and BTS has proposed a number of short and medium interventions that could reduce the impact of understaffing while new professionals come through the pipeline.

Professor Bennett added: “We are still deep into the second wave of COVID, and even with vaccines being deployed as we speak, it will be months before their effect will reflect significantly on hospital admissions.

 “Respiratory professionals are committed to their patients and will now dig even deeper to ensure their care, but cannot go on under this pressure forever. It must be clear that the current workforce and resource deficits, such as those causing the winter crisis every year, must now be fixed for good.

“Planning today for better resourced respiratory departments will ensure that the NHS is prepared for the perennial “winter pressures” and future potential catastrophic events such as the current pandemic.”

Notes

(1) The survey was anonymous. Each respiratory lead responded on behalf of a whole respiratory department, which are staffed by anything between a few to over a hundred people between nurses, consultants, physiotherapists and other healthcare professionals. Response rate was 35%, equal to 85 out of the 244 respiratory departments in the UK, roughly a third of the NHS respiratory care capacity. Answers were collected at the end of November.

(2) GIRFT Clinical practice guide for improving the management of adult COVID-19 patients in secondary care – December 2020. Download link