Tom Welton – Lancashire Teaching Hospitals NHS Foundation Trust

I keep being asked: “What is it like to be on the front line as a radiographer?” My textbook answer is: “Well the hospital is very different at the moment, but we are settling into a new type of routine,” in a futile attempt to play down the situation to give an air of control. What I really want to do though is answer: “We all just want to know what’s around the corner.” With all departments lacking a crystal ball, there is no way of knowing what is in store but educated predictions can occur.

Delving deeper into what COVID-19 has done to us in radiology, it is clear to me that in my department the NHS attitude of ‘keep calm and carry on’ has truly taken over. There is a great ethos running through the staff currently and it is really showing how good our healthcare is when it is profoundly required. Personally though, I am a realist. I see the positivity (and embrace it) but I must project to the horizon in order to predict the journey ahead. We know what today is bringing but let’s talk about tomorrow. There is a new outlook in healthcare, and we must be ready.

From the beginning in a time of handshakes, hugs and pubs, I vividly remember a discussion I had with a peer. There was a hushed undertone of apprehension running through the staff at the time but already my overthinking brain was jumping ahead. I identified what I believed would be the true impact of COVID-19 on our profession. I was fully aware of the acute effects we would encounter during this journey – and up and down the country and around the world, the fears of healthcare workers have come true. It was within the chronic setting though that I worried more. With drastic underfunding for diagnostic equipment in preceding years leaving aged equipment run by a reduced workforce, I pondered the effects a pandemic would have on the service. A pandemic that would rely 100 per cent on our service; a pandemic that would be unrelenting; an enduring pandemic that would be long-lasting.

So, I guess when someone asks me now: “How has the hospital been during COVID-19?” I will project forward by replying with a degree of certainty about the task that lay ahead of us all. Emergency departments are filling up again, clinics are finding their feet but, more importantly as a radiographer, the demand for diagnostic services has never really gone away, just paused. Cancer waits for no person, heart conditions continue, lung diseases endure, and in the meantime, all radiography staff are trying to shout out about the pivotal role they play in the pathway of care for so many different patient types. It has already begun in many departments: management counting the after-effects of the initial onslaught. Waiting lists are swollen, GPs and other medics are acting as gatekeepers to reduce pressure, but the reality is hitting hard. The waiting lists are not numbers on a computer, each individual event is a human – it is a grandmother, a grandfather, a mother, a father, a son, a daughter – it is a life. This pandemic has affected thousands, but there are the untold stories of millions who have been affected too.

While thoughts are with COVID-19 sufferers and the ripple effects of all in need of our world-renowned healthcare service, it is also important to remember it is affecting the staff too. Painted as heroes and crusaders in the nation’s media and on social media, it is easy to stop seeing staff as mere humans. Instead though, I feel the term ‘moral injury’ is set to become a 2020 buzzword. Making hard decisions about who is in more need of our service is always going to take its toll. In the latter six months of the year, it will be imperative that departments don’t just rely on posters and letters asking staff to reach out if they feel the need. Support services for staff need to reach the core of all departments. Time needs to be taken to give debrief, uncoiling and engagement to systemic issues that lie across departments while still communicating to individuals the services available.

Royal Lancashire team
Left: Senior radiographer Beverley Calsen in the cath lab. Centre: Assistant practitioners Anne Rhodes and Becky Wallser in the ED room. Right: CT radiographer Andrew Bamber and neuro interventional radiographer Sam Harwood in the CT department.

On wards and clinics this in some ways can be obvious to predict. In radiography (both diagnostic and therapeutic) this can sometimes be overlooked. From the cancers that are being detected later, the patient attending from their GP because they didn’t want to ‘be in the way’ of ED services, and the unwieldy task of triaging a mountain of imaging requests, there is a story that isn’t being told. From ultrasounds of complicated pregnancies without both parents in the room to consoling children facing bad news alone, the stresses of COVID-19, in my eyes, are hidden by the headline articles.

So what is it like working on the front line? It’s tough but in a different way. We aren’t currently getting the same numbers coming through the door, but we must be prepared. To enlist some war rhetoric, we are now waiting in the trenches. We are waiting to go over the top and face the true nature of this beast. So, during this time we must prepare and, importantly, feel prepared. Departments must get themselves in order, dust themselves off from the initial bombardment and line up and be counted. Staff must be respected, looked after and organised. The toll placed on radiographers has not yet been addressed. From PTSD to anxiety, from depression to moral injury as well as heightened stresses, we must look out for one another and be given the vehicle to open doors into the new world, otherwise individuals simply will not keep their heads above water.

We are feeling the benefits of a looser lockdown currently and each day there seem to be steps in the right direction in our country. In reality though, staff in health and care systems are coming to the foot of the true mountain that still needs to be climbed. I will tell you this though, I’m proud of what I have accomplished during this pandemic and will continue to strive for improvement and champion staff, student and patient throughout.

When this is all a memory of days gone by (and trust me it will eventually be a memory), I want to believe I did all I could to help the team of heroes I have around me.

We are so used to signing off letters as ‘stay safe’ now but what I want to say is: “Keep aware, keep ahead, keep checking in.” We need all the help we can get through this and each individual employee cog of the system is essential.

Submitted by Tom Welton, lead practice educator/north-west SCoR council member; radiographer Lancashire Teaching Hospitals NHS Foundation Trust.

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