An experienced doctor fears staff shortages in intensive care could cause real problems for the Welsh NHS as the country heads towards a second spike in Covid-19 cases.
Dr Richard Pugh, a consultant in intensive care medicine and chairman of the Welsh Intensive Care Society (WICS), said there has been no significant uplift in permanent critical care staff in Wales in the last six months.
To make matters worse, he claimed nearly all the NHS workers who were redeployed to help in hospital intensive care units during the first wave have now returned to their normal posts.
He said that staff morale in critical care has now taken a hit, with many dreading a surg
e of new Covid-19 infections and the demands it may impose upon their physical and mental health.
According to latest figures for Tuesday, Public Health Wales (PHW) announced 281 new cases of coronavirus in the last 24 hours - the highest number since April 20.
While there were no recorded deaths once again, there has been an increase in hospital admissions at some Welsh hospitals over the past few days.
"My biggest worry is in regards to staff, for lots of reasons. I don't think there's been a significant uplift in critical care staff in the last six months," admitted Dr Pugh.
"You can create funding and advertise for a job in critical care and then recruit someone, but it takes time to get them released from their current role and another 12 months to get them up to speed.
"Nearly all staff [who were redeployed to work in intensive care] have now all gone back. There were some good discussions with the Welsh critical care network and the Welsh Government with regard to preserving 150% of critical care capacity with some of the 'escalation staff' coming in from other areas, but the reality is that those staff who came to help out in critical care just aren't there anymore."
Since May or June, Dr Pugh said the focus has shifted to trying to restart "essential" services which were halted to deal with the Covid-19 crisis.
But he believes that the Welsh NHS now faces a very difficult "balancing act" between returning to normal activity and devoting time and resources to a second wave of cases.
"At the moment, we are not seeing large numbers of patients in critical care beds across Wales. But we know from the last time that things can change relatively quickly," said Dr Pugh, a consultant in intensive care at Ysbyty Glan Clwyd in Denbighshire.
"I think it is affecting morale. We are worried about the scale of what's coming our way. We are worried about the usual winter pressures on top of all of this. We are worried about how long this second surge could last for. We are worried about the tension and the conflicting demands of [hospital] sites desperately keen to preserve all of their essential services."
To address staff shortages, Dr Pugh said one solution could be getting staff to "rotate" between critical care work and their usual day-to-day jobs within the health service.
He added that testing turnaround times for frontline NHS employees also need to be improved urgently.
"I had a conversation with a colleague this week who had managed to get a test – which is great as I know people have had difficulty accessing them – but then had to wait 72 hours or so for the result to come back. So you are losing a valuable member of staff for that period of time."
However, he said the Welsh NHS on the whole was better prepared for a potential second wave than it was the first.
"I think some things are certainly better. We know more about the disease and we know more about the treatments that seem to give some clinical benefit," he said.
"From an equipment point-of-view we are also better placed. There has been a really significant effort over the past six months to acquire equipment that we might need in the context of a second surge.
"The estates issues in terms of oxygen supply, single rooms and having a large cohort area that we might bring patients into – that has been addressed in a number of sites throughout the country. The space that's potentially available is better [than it was at the start of the first peak].
"Critical care staff are amazing and we are in a better place than we were six months ago in terms of the resource and the equipment. But it is still a finite resource. The situation is a serious one."
In response, a Welsh Government spokesman said: "We’d like to thank all our NHS and care staff who have worked so hard during the pandemic, especially those in intensive care and those who were redeployed to new areas.
"Our Winter Protection Plan sets out how services will deal with the challenges of the months ahead. Frontline staff and critical workers will play a key role and their health and wellbeing continues to be a priority.
"Redeployment processes are well established across the NHS in Wales, with a significant number of staff completing clinical skills training to enable them to work in urgent and emergency care services. The UK healthcare regulators are also operating temporary emergency registers to allow former staff to return to work."