The health service will face a “tsunami” of coronavirus survivors discharged from hospitals needing long-term physical and mental support that the NHS will struggle to provide, The Independent has been told.
Coronavirus can leave patients with lasting physical damage and scarring to their lungs, meaning many could struggle to breathe and move around as well as they did before – in some cases permanently.
Patients admitted to intensive care can also suffer physical effects of being paralysed weeks and almost half who are ventilated with a tube in their windpipe will experience a form of delirium that can include terrifying hallucinations and leave survivors with lasting mental problems including post-traumatic stress.
Experts have warned a long-term lack of funding of NHS rehabilitation services and post-discharge care for ITU patients means the health service will struggle to help the thousands of patients who beat the virus but face a long road to recovery.
NHS England acknowledged there was going to substantial demand on rehab services and said it was planning new guidance to help services plan for the spike in demand.
Susan Hayward-Giles, assistant director at the Chartered Society of Physiotherapists, said: “We are incredibly worried about what we think might be a tsunami in demand that we do not have services to respond to. It absolutely needs focus now. The scale is absolutely enormous.”
She said inconsistent discharge planning and poorly coordinated services was an issue across health and social care, adding: “It’s very underfunded, even for bread and butter activity like hip fractures we know around 50 per cent of patients might not receive the rehab they need.”
She said coronavirus patients were complex and patients with severe lung infections could suffer fatigue and many could be reliant on oxygen: “The picture is complex.”
In addition to their physical needs, patients who suffer delirium have a range of needs to help them come to terms with the experience of being paralysed with a tube down their windpipe for as long as two weeks.
Clinical pharmacist Richard Bourne said patients with delirium can experience confusion, anxiety and even hallucinations.
He said: “For some people they can have visual hallucinations, things can manifest themselves like spiders on the ceiling or seeing and talking to someone in the corner of the room who isn’t actually there. Patients can also have paranoia about the nursing and medical staff doing something detrimental to them, that is common.”
He said patients can remember their experiences and some will develop post-traumatic stress disorders as a result.
“Delirium can affect as many as 45 per cent of patients who are mechanically ventilated,” he said.
The Faculty of Intensive Care Medicine is calling for a major national review to improve care for critical care patients after they leave hospitals.
Vice dean Daniele Bryden, a consultant anaesthetist, told The Independent: “Before this, critical care was not resourced and planned as a pathway. It has been seen as a service or as a place, but the care does not stop when you leave the building.”
She said support for patients after being discharged from ITU was “very limited and ad hoc”, adding a national strategy was needed to plan services and cope with the Covid demand.
“People may assume after coming off a ventilator that all of the issues have been resolved but they are not. We don’t know yet what Covid could mean, but with sever lung disease it can take up to six months for people to recover their previous respiratory function and some people never recover their previous function.”
She said patients can suffer muscle aches, joint pains, weakness and changed appetite.
“People who are older and more frail may never return to their previous function again. It can be life changing for them.
“For people who have had a long stay on ITU – and we know Covid-19 patients are staying on average 10-14 days, compared with the average of five – they are more likely to have some of these problems. They will need support for that.”
The Chartered Society of Physiotherapists said it had learnt many patients were being discharge without any rehab plans in place as the NHS rushes to free up beds. It believes many patients may need visits from physios several times a day.
If patients did not receive the right care after being discharged, the society warned they could be readmitted to hospitals or be at risk of losing their independence completely and have to live in care homes.
The CSP said the Nightingale hospitals were a poor option for rehab and that patients need to be as close to their home as possible. It said funding should be diverted to create small local rehab units staffed by support workers, dieticians, psychological therapists and other key staff.
Claire Murdoch, national mental health director of NHS England, said the health service was braced for a surge in referrals for mental health services following the coronavirus outbreak.
She told the Commons Health Committee: “What we might anticipate by way of need coming through over the next few weeks, months, and in fact we do know with trauma in particular that will be years.
“We know from our Grenfell [Tower] experience that not all need for clinical services materialises at the time and, indeed, there’s a very long tail and demand in trauma.”
Asked about what the increase in capacity would be, she said: “The truth is we don’t yet know what demand will be, additional demand will be as a result of this dreadful pandemic.
“We do fully expect it will increase significantly. Whether that’s bereavement, we know PTSD is prevalent amongst those who have been on ventilators in intensive care, loved ones who have perhaps lost dear ones who they couldn’t be with at the end of life.”
An NHS England spokesperson said: “Recovering from intensive care treatment can take months, so there will clearly be significant demand for rehab and other community services as a result of Covid-19, putting pressure on NHS services for a sustained period, and we will shortly publish further details on how these services will expand and respond to this increased demand.”
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