Duty Calls: Clinical lead explains the sacrifices Northampton Hospital makes when Covid-19 cases soar

When the number of Covid cases do not stop rising, organizing care for Northampton's Intensive Care means facing the same excruciating decision every day:

Who is going to take care of them all? And more pressingly - what do you cancel so those staff are free?

This is the greatest challenge facing staff like ITU clinical lead Johnathan Wilkinson. Against a rising tide of positive cases, somebody has to decide who will look after them.

"It's horrendous that any hospital has to cancel surgeries," says Johnny. "But we cannot tackle the second wave without freeing up staff.

"Some of our operating theaters have been converted into extra intensive therapy and ventilator units, and we've filled it. We've quadrupled the size of our CPAP ventilator areas and we fill it. We fill it."

It is an improvement over the impact of the first wave, when all non-urgent surgeries were cancelled while the spread and effects of Covid were less understood.

Heading into the second wave, Northampton General was ready to keep all surgeries on the cards and carry on as normal as possible.

This became unfeasible in early December when 200 positive patients were in the county's two public hospitals. Since then, that number has doubled to 400 as of January 19.

"We ploughed out hearts into making sure surgeries went ahead as normal at the start of the second wave," says Johnny. "There were extra shifts and weekend work to handle the backlog.

"But The reality is we just have a greater number of cases knocking on the hospital's door.

"It means other things can't happen. Elective surgery has gone down, outpatient therapy has gone down - because staff who would support those services have been redeployed to ITU.

"Physicians have got stuck in as Health Care Assistants. Orthopedic surgeons are helping to turn patients. There are support staff who have never been to ITU finding out what it means to console a relative over the phone when their family member has just died."

It's not how anyone expected the NHS to be operating at the beginning of 2020 - but as the country as seen over and over again in the past year, NHS staff will always make it work.

"It's phenomenal," said Johnny. "It's enough to make you tear up.

"They're surgeons and physicians and support staff, but people are willing to 'step down' to help. The stress on staff at the ITU has been so, so rough but they are still carrying on."

Johnny and the ITU team face the same challenge every day - who is going to take care of patients? And if cases don't decline, the day might come where they don't have an answer.