Doctors should not treat patients without the protective equipment they need to keep them safe, the president of the Royal College of Anaesthetists has told The Independent.
As hospitals in Britain struggle to provide doctors with the gowns, masks and other equipment they need to safely deal with patients, Professor Ravi Mahajan – who represents the largest specialism working with coronavirus patients – said it now appears the UK no longer has sufficient reserves. He said his organisation would support staff who chose not to work if they felt it was unsafe.
In an unprecedented move, the RCOA president said trust was being lost in Britain’s top health officials, as the UK hospital death toll increased by 449 to 16,500 patients.
Public Health England medical director Yvonne Doyle, appearing alongside chancellor Rishi Sunak at the No 10 daily press briefing, said staff would have to decide themselves if they had enough protective equipment before choosing not to work, adding: “People have to make their decisions based on whether they are in a risky situation or not.”
The Independent understands supplies of gowns, which were not included in the original pandemic stockpile, are reliant on new international deliveries, while hospitals have been sent masks with lower safety specifications than requested. At one trust, nurses were given “cagoules” rather than gowns to protect themselves.
Anaesthetists sedate patients who need a ventilator tube in their windpipe to help with breathing. This puts doctors at risk of infection due to the small particles of virus released from a patient’s airway.
A survey by the RCOA, due to be published later this week, found almost one in five anaesthetists reported being unable to access the personal protective equipment (PPE) needed to do their jobs safely, with a quarter saying they felt pressured to treat patients without having adequate PPE.
Professor Mahajan, a consultant at Nottingham University Hospitals Trust, spoke out after Public Health England issued new advice to doctors on Friday night suggesting single-use respirator masks could be folded and kept in a plastic bag to be used again. Prof Mahajan said he could find no evidence for the suggestion and said it would put doctors “at greater risk”.
He said: “What we are advising our members is that you have to take stock of everything. Your health, the patients, the compromises that you may have to make, are they safe enough? Take the whole picture into account. And then if your decision is, I can’t provide this treatment at this time, then we would support you.”
He added if the new advice was a compromise because of the global pandemic situation then, “we have to be upfront about it, and we have got to be honest and transparent about it. Because of the lack of honesty and transparency, I am not very confident that this guidance provides the same level of protection.”
“When you get reassurances, which are then not followed by the reality, then trust starts to get eroded. And that’s what’s been happening in the last week. The promises that were made and the problems that were explained and how those problems are being addressed have not materialised.
“There is that erosion of confidence because statements in public are not matched by the reality on the ground.”
Prof Mahajan questioned the UK’s available stockpile, saying the recent shortages “gives me an impression that we haven’t got enough buffer in the system. You haven’t got enough stockpile to buy time.
“It is a common sense inference that if you’re having to depend on the plane arriving with the stockpile, and that determines whether or not you can meet national demand, then then you must be at a very low level of reserve.”
An RAF plane has left for Turkey to collect a consignment of gowns, while another delivery of 144,000 gowns from Myanmar was unloaded on Monday.
At Mid Yorkshire NHS Trust, staff have been issued with “cagoules” instead of gowns. One member of staff said while the gowns were waterproof they questioned whether they were as safe: “I think staff are generally worried now. I think will see a lot of staff go off with stress and anxiety as a way of avoiding to refuse to care for their own safety.”
At another trust, a manager who had received only a few thousand of what they really needed, added: “I can’t be the only one now without enough to get through this week.”
The Royal College of Nursing last week advised nurses they had the right to refuse to treat patients if they did not have adequate PPE.
At Downing Street, the chancellor insisted the government was doing all it could.
Mr Sunak said: “Absolutely everybody working incredibly hard on the front line deserves to have the equipment they need to do their jobs safely and we’re working round the clock to make sure we can deliver on that.
“We’re improving our sourcing internationally and domestically to make sure we can get the PPE we need in what is a very challenging international context.”
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