Senior Doctor Describes Covid Pressures at Wales’ Oldest Hospital

A senior doctor described the significant difficulties encountered in combating Covid-19 at Wales’ oldest hospital and the strain experienced by its personnel throughout the pandemic. Professor Philip Kloer informed the UK Covid inquiry that Glangwili hospital in Carmarthen’s intensive care unit was preparing for 192 critically-ill patients, despite possessing only 11 beds. Although the 65-year-old hospital experienced lower demand than anticipated and sustained one-to-one critical nursing care, staff were compelled to be “incredibly creative” in order to establish space and ensure safe working conditions. Professor Kloer, who serves as chief executive of Hywel Dda health board, stated that the board successfully redeployed 600 staff members to acute hospital care and recruited an additional 1,100 individuals, including those from retail and hospitality sectors, for support positions. Professor Kloer, a former medical director and respiratory doctor, noted that the hospital, established in 1959, suffered from an absence of side rooms, inadequate ventilation, and no air conditioning. Adhering to Covid safety guidelines concerning bed spacing would have necessitated the removal of 113 beds from the hospital’s total of 388. However, partition walls were erected to facilitate patient separation. Despite a nursing ratio of one nurse to 24 patients on general wards, support staff were available to provide “wrap around” care. An additional 113 beds were established at a field hospital located in a local leisure centre and bowling alley, described as “which looked and felt exactly like a hospital.” Nevertheless, he conceded that personnel were operating under immense pressure. Professor Kloer stated that the experiences recorded in a 2021 staff survey “were very difficult to read”. The survey revealed anxiety regarding the working environment, with instances of staff eating sandwiches in their cars during breaks and one individual reporting crying in a cupboard under the stairs. Glangwili experienced a scarcity of toilet facilities, rest rooms, and other amenities for staff. He conceded that communication challenges might have existed concerning access to personal protective equipment (PPE) stock, following a staff member’s complaint about being “told off” for ordering visors. Professor Kloer indicated that, to his knowledge, despite difficulties in the summer of 2020, PPE reserves consistently remained above a two-week supply. However, he acknowledged that a surge could have depleted supplies, leading to “significant concern” for staff. Initial pandemic projections suggested Glangwili might have needed to accommodate 192 intensive care patients. Yet, it possessed only 11 beds and staffing for a potential 16, and Professor Kloer stated that it was offered merely a third of the ventilators that could have been required. He described this as an “almost impossible scenario” to consider, though the worst-case outcome did not occur. Professor Kloer identified that a significantly earlier understanding of the pandemic’s impact on vulnerable groups constituted a crucial lesson. Subsequently, Dr Andrew Goodall, who was then NHS Wales chief executive, informed the inquiry that by mid-March 2020, the health service foresaw a substantial bed shortage if scientific modeling of pandemic figures proved accurate. He indicated that Wales faced a deficit of nearly 6,000 hospital beds and almost 1,450 intensive care beds should these concerns be substantiated. Beyond the modeling, this aligned “visibly with the images we were seeing, particularly of Italy and Spain, how the virus would spread very, very quickly and have an impact on capacity.” Health boards were subsequently requested to provide daily reports on the bed availability within their hospitals.