I sat back on New Year’s Eve 2021 reflecting the worst was over and we would all begin afresh. Little did we know how hard this year was going to be. Covid has not gone away and the economic crisis has hit hard. We have started to live ‘normally’ again, whatever that means. The triumph of vaccination has stopped the need for restrictions but Covid is now embedded in our DNA. It has hurtled us into a new age of digital and social interaction but has thrusted an imprint on all of us, whether we recognise it or not.

The images of the faces of healthcare workers after wearing masks 24/7 are hard to forget. The smiles were gone, skin furrowed where the masks had cut into cheeks and foreheads. I still wear a mask in theatre and clinical spaces, now with annoyance rather than the fear when it was mandatory. I know it makes a difference, when we gather together and one turns positive, we are not all sent home to twiddle thumbs, feeling alright and wondering if we going to get the dreaded virus.

Masks make us feel safe but do we really take them off? We spend time with people and get on with our jobs. We interact in shops and restaurants but it all feels superficial now. I see and talk to people every day. I talk to colleagues and patients, the hello in the corridor, the invitation to share symptoms and  progress in outpatient clinics. Moreover, in these important contacts, we only just scratch the surface rather than invest in a deep conversation.

When you stop and consider what is being said and follow up with interest, curiosity and compassion, incredible experiences are disclosed. People come to work everyday and do not readily reveal the enormous changes that have occurred in the last two years. The havoc that has ensued losing loved ones or caring for those with long Covid. The fact that family members have lost jobs and that living on the breadline is not a statistic but an everyday lived nightmare. The emotional assault of being locked away in lockdown, isolating people, taking away the normality and safety of human interaction, and leaving mental turbulence unleashing mental health needs.

And this is playing out when pressures at work, especially in the NHS, at an unimaginable high. The drum beats the NHS battle rhythm, day after day. Who can go home, who needs to be admitted, trying to make the numbers add up but they do not. How do we find safe ways of managing the tsunami of need presenting to the emergency department. The novel ways of stemming demand failing, senior decision makers at the front door, diversions to other providers of care and streaming to same day emergency care. The media suggest that primary care has ceased but colleagues are working equally as hard but failing to manage demand.

Funding is needed to make a difference. Virtual wards and investment into social care will make a difference but the investment needs to be immediate into the workforce. They are emotionally burnt out, altruists balancing professional and personal lives, where both need increased attention. Staff went all out to support Covid care with little knowledge of the risks to themselves nor whether the PPE they wore made a difference. This merged seamlessly into the desire to treat those patients who were waiting in the ‘backlog’ for elective care and an increasing public behaviour change where the emergency department was the easiest way of getting care. Mental health services are overwhelmed, underfunded for many years, and emergency departments have morphed into mental health wards without the supportive services that people with mental health needs, at their most vulnerable, require.

I am proud to work with my colleagues, not just clinical, Allied Healthcare Professionals, Nurses and Doctors. So many jobs in the NHS are still unrecognised. Those in ‘backroom’ jobs that make the NHS work. The administrative staff, our bookers and schedulers, our cleaners and porters, the volunteers and our HCAs. They continue to work in the most difficult circumstances and have ensured that the NHS has continued to deliver elective and emergency care.

When I visit centres, the pride of those who are achieving innovation and exceptional care cannot be underestimated. It is breathtaking and all consuming as it envelopes you, and entices you to do more. It is wonderful, and should be rewarded, so that the moral injury that is hides is mitigated. We need to create an NHS that we are all proud of working in with an environment that is clean and fit for purpose. That teams have appropriate rest and on call rooms. Free parking and bike racks are a minimum with a desire to understand and support our NHS staff. This is for Provider Chief Execs, NHSE and Government to decide, as individuals we can support in a much simpler way.

Each of us is exhausted; we are looking forward to planning holidays this year. We have worked out how taking days around bank holidays will stretch our annual leave out as much as possible. It is important that we do look after our families and ourselves. It is also important that we look out for our colleagues. Take time to ask how people are and listen to responses. Only recently, I said hello to someone I had not seen for a few weeks. I asked how they were and whether they were okay. They had taken a few weeks off as their partner had died suddenly. They had to come back to work as they have young children and do not have family to support. We sat and chatted, and even though I had nothing new to offer, the fact that someone cared made a difference. It is now so easy to hide our true emotions behind masks, and because we are all so busy, to accept the masks on colleagues. We use social media and WhatsApp that allows us to be positive and present a facade of golden normality. WhatsApp allows us to talk without picking up the phone and listening to the catch in a voice that betrays the fact that everything is not right.

This year, I will try to talk to people more often rather than dropping social media messages and to meet up with people rather than spend an extra hour at work. I will try more than ever before to be compassionate and curious at work, to support colleagues and I ask you all to do the same.

I published this 5 years ago. I was diagnosed with a large acoustic neuroma and underwent surgery 5 years ago today. A 12 hour operation and life changed. It changed so much for me but re reading this blog, some of the lessons I learnt then, still apply now.

Do read and share, if you enjoy reading this and the rest of my blogs!

This blog is the hardest to write as I had the most difficult night so far. I was so tired and my brain was obviously not functioning normally but I learnt so many things in the first 24 hours.

Lessons learnt so far…

1. My Name Is..

The late great Kate Granger championed ‘My Name Is’ as a mandatory component of NHS culture. It is an introduction that I have always felt to be important, not only to introduce oneself, but also to ensure that patients have a name to refer back to when further questions need to be asked.

The John Radcliffe Hospital in Oxford runs 12 hour nursing shifts so the same wonderful ITU nurse looked after me for the majority of my stay on ITU. She introduced herself to me and I repeated her name so that I did not forget it, a method I have used for a long time otherwise I forget names at parties instantaneously. This time however it did not work as I repeatedly forgot her name, calling her something similar, and had to keep asking her to clarify. She was patient with me and reintroduced herself until I finally remembered. She was compassionate and attentive, constantly keeping an eye on me. I was unbelievably thirsty after surgery and constantly asked for a drink of water. I was lying flat, as apparently the more you sit up the more you suffer with a headache, and drinking laying flat is a real feat. She was amazing, with ice-cold water and a straw at my beck and call.

A relationship developed as I just could not sleep and we chatted about so many things . She needed to go on her break and another nurse covered for her during this time. This new nurse also introduced herself but I did not catch her name as I must have drifted off. When I woke up feeling thirsty a few minutes later, I did not feel that I could call her as I felt rude not knowing her name at all and just shouting ‘nurse’. She did check up on me and asked if I wished to have water.  I asked her name again and realised how important this small introduction really is for a patient. Without knowing her name I felt very vulnerable but also guilty that I might be interrupting an important task rather than feeling empowered to ask for help. As a professional, I must remember to make sure to introduce myself to a patient at the beginning of a conversation but also make sure I remind them again at the end so that they have a name to remember if they wish to. Even more importantly, I need to make sure that I do not assume that patients will remember my name from one ward round to another even if on the same day.

2. Sleep is SO important

I slept for an hour and fourty minutes during my ITU stay. Nationally ITUs are noisy! If you are intubated, then it is probably okay but if you are awake trying to get some sleep….

The poor nurse did her best to help me. After surgery my hearing has altered so much. I think I can hear a little from my right ear but noises sound so different. Immediately after surgery, I felt as if I was one of those superheros with amazing hearing, as I could hear everything but could not pinpoint a direction. I could also hear a sound that I thought were vehicles reversing outside of ITU, through the window behind my bed, and only realised the next day that it was the noise of the flotron boots (intermittently inflating boots that you wear on your legs to stop development of a deep venous thrombosis or blood clot in your calves). This also meant that background chatter, bins being emptied or monitor alarms going off repeatedly interrupted any chance of getting sleep. Next time I will ask for ear plugs!

I had slipped a disc many years ago and this had been irritated again during my positioning for surgery. I developed sciatica which was very painful and affected my left leg. I normally struggle to lie flat when I am sleeping as my back becomes uncomfortable, so laying flat after surgery with sciatica was a real challenge. Even more of a challenge was working out which position might be comfortable. I had an incision on the right side of my head and neck which was uncomfortable to lie on if I was rolled onto my right side. In addition, I had a catheter inserted into the vein in my right groin (right femoral). I also had two drips in my right arm. So rolling onto my left side sounded ideal apart from the fact I had a left radial arterial line (a catheter into the artery of my wrist) which was measuring my blood pressure continuously. I also had a catheter into my bladder and the aforementioned flotron boots on both my legs connected to a pump at the bottom of my bed! I could not work out how to lie and so just kept having to move so as to stop the leg pain which was much worse that the headache!

The dedicated nurse tried to get me as comfortable as possible by repositioning me. This was no feat as it meant two nurses helping me to move but they did it regularly without any indication that this was an imposition even though they were so busy.

I still could not sleep and eventually I think drifted off as I was just exhausted at 5am and then woke up again to have my bloods done at 6.30!

3. Let others help

I was laid flat and had slipped down the bed. Hospital beds are so slippy and the stockings to stop you from getting DVTs (TED stockings) mean that you have no grip to move yourself around. I could not really move myself much anyway as I was so tired and uncomfortable. The nurses asked me if I needed help to move up the bed. Miss Independent here thought she would try by herself. That was a big mistake, a) I could not and b) I was promptly sick! I learnt that lesson very quickly ie ask for help.

Nausea and sickness were issues. I was thirsty and sipped water regularly and was promptly sick. The nurse suggested an anti-sickness medication. I thought that the vomiting would settle so I refused. Wrong decision, others know better as they look after patients like me regularly. I needed the anti sickness medication later on and this was important as vomiting increases your blood pressure and this carries a risk of a cerebral bleed (bleed within the brain at the site of operation). Letting others help when normally you are the helper is really hard. I cannot imagine that this is very different for anyone else as we all try to be independent in our own lives. Being a doctor brings the additional difficulty of having specialist knowledge in one small area and trying to apply it in another. Making assumptions causes problems and I had to keep remembering to stop thinking what was best for me and let others make these decisions.

4. Time passes slowly

There was a clock on the pillar opposite my ITU bed. I could not sleep soundly and was grateful when I drifted off. When I regained consciousness, I felt as if hours had gone by. Sadly it was only ever a few minutes and the night felt so long. The clock suddenly became the focus of my attention and this made time pass even more slowly. The nurse pulled the curtain around my bed so that I could not see the clock and this made my night slightly easier! This really was the longest night ever.

5. Yes, you can 

After little sleep and a cup of tea, I was informed that I had progressed well and I would be transferred to the neurosurgery ward once a bed became available. The right femoral line and left arterial line were removed and I sat up a little. The physiotherapist came to visit me and suggested that I could stand. This would improve my breathing as my oxygen levels were a little low as I had been laying flat all night. I laughed. I could hardly sit up and could not pull myself up in the bed. And she wanted me to stand? Remember what I said ‘Making assumptions causes problems and I had to keep remembering to stop thinking what was best for me and let others make these decisions’. This applied again, I was in her hands. She asked for help from other nurses and patiently sat me up on the edge of the bed. I felt nauseated and strange but I managed it. I thought she might be satisfied with this as it had been very hard work. But no, she really did want me to stand! I was really anxious as my left leg was so uncomfortable. With the help of two, I did eventually stand and it felt so good. I felt like I had achieved an important goal but was so glad to get back into bed. I felt like I had done a marathon and really needed that second cup of tea!

6. Believe what the doctor says

I was eventually moved to the ward. I slept, took painkillers, had observations and slept. My surgeon visited and was pleased with the progress and reminded me that I should expect to feel exhausted and although this would improve, it would last three months or more. Although he had told me this prior to surgery, I had not believed him. I cannot explain how exhausted I felt. Thinking hurt, sitting up in bed hurt, coughing hurt, turning my head hurt as did brushing my teeth. Lying still and flat in bed did not! Tuesday and Wednesday passed without much change. I required another CT scan on Wednesday and all was well. The dreaded urinary catheter was removed on Thursday morning and this meant I had to get up and get to the toilet as otherwise I would need to use a commode. This felt like a challenge and I love a challenge. I needed the help of two nurses but I managed to get there and back but again felt like I had achieved a Herculean task and went back to bed. The physiotherapist came to see me and persuaded me that I could do one more walk to the door and back. I did it and was then again straight back into bed! She also suggested that I try to brush my hair as otherwise this would become an impossible task. This took me 20 minutes as lifting my arms seemed to be so difficult.

I really wanted to have a shower. The male member of nursing staff suggested that he would help me after lunch. Miss Independent came back into action. I really wanted to do this myself. My nurse helped me into the bathroom and brought everything to me. I sat in the shower and explained that I like to get on with it but would ask for help if needed. It took me an hour but I did it. But I did need to ask for help. I managed to dry myself, get my pyjama top and underpants on. I managed one leg of my pyjama bottoms but then ran out of energy and could not get the other leg on!!! My nurse came to the rescue and helped me to finish dressing and then get back into bed! In my mind I had planned to leave hospital on Sunday and this now seemed to be an impossible task.

7. Compassion and Diversity: worth their weight in gold

I had outstanding care through these days from a diverse workforce spanning from the Indian subcontinent, the Caribbean, the EU as well as from UK institutions. The one conversation that unified the nurses looking after me was the lack of assurance to colleagues from the EU living in the UK. The majority of the nurses from the EU were at the beginnings of their careers. Their biggest concern was that their original plan, to spend a period of time here and then return to their home countries with an enhanced skill set benefitting their own communities, was now uncertain. This was forcing many to rethink their decisions, and consider travelling home and forging their careers there or in another country.

You might anticipate, that in this hard pressed environment, these EU nationals would just work out their contracts, preparing to go home.

Absolutely not. I received the highest standard of care. There was excellence in care from all staff groups including those unsung heroes who cleaned the wards and ensured that all patients were fed and watered. I witnessed many staff going beyond what would be expected as normal professional behaviour.

The hard-working nurse who looked after me in ITU took her break and did personal development plans with her team. The nurse managing a difficult patient with memory problems went out of her way to ensure that this patient was looked after with dignity. The member of staff managing the patient, who had returned from surgery for head trauma, patiently managed the expectations of the patient and their family. The junior doctor looking after me came to see me four hours after his shift should have finished to reassure me that my CT scan was normal.

The compassion, goodwill and professional care of the staff in the NHS is worth its weight in gold. The NHS is in crisis with its workforce and surely this is not the time to hold the EU NHS staff group as a bargaining chip in the BREXIT discussions? There is a motion calling for a guaranteed right to live and work in the UK for all EU citizens working in the NHS and care services. Surely this be supported, as without it the NHS will collapse and patient care will suffer.

All I know is that without these fantastic individuals, my care as a patient within the NHS would have suffered. The question remains today as it did 5 years ago. How do we recruit, retain, value and reward our wonderful NHS staff, who continue to deliver more and more. Especially when they are now harrowed and exhausted having battled with Covid-19 over the last two years?

This is a series of blogs that started when I was diagnosed with an acoustic neuroma (a benign brain tumour) and if you find this blog interesting, then please do read the rest. My surgery was 4 years ago and my life has changed so much since, and then more so with COVID. Stay safe everyone!

The first thing to say about today is that it has ended well. My biggest concern was damage to my facial nerve. Of course, I listened carefully to the 20% risk of nerve injury but also to the 80% chance that there would be no long-term damage. I had read of all the possible management options depending on the degree of injury and had discussed the options to mitigate this complication with the Surgeon. I had made my choice and now I was in the hands of others.

Today started with an inability to sleep and getting up at 5.30am. I waited in bed after brushing my teeth, washing my face and taking my tablets. Wanting to have a shower, I went in search of the nurses as I needed my operating gown. The nurses were at the handover desk at the end of the ward and I had worn my brand-new slippers (and my new pyjamas and dressing gown!). The majority of patients were asleep, the ward was dark and quiet but the nurses were still busy with the patients that were unwell. Trying to stay as quiet as possible, I tiptoed through the ward, as I had learnt from my many nights on call but despite this my bed slippers were squeaky and whatever I did they did not get any quieter!

The nurses gave me my gown and two fresh NHS towels, reminded me of the need to wash in the triclorosan and to take my tablets with a little water. I showered, enjoying the hot water and the feeling that I was independent, a feeling I knew I would lose in the short-term. 

I thought how different today would be compared to the lovely family meal we had yesterday at an Oxford pub. There were so many pubs to choose from to enjoy a Sunday roast but the one that had caught my eye was the Eagle and Child. Apparently, this is where J R Tolkien and C S Lewis frequented and where my favourite books were born, The Lion, the Witch and the Wardrobe and the Hobbit. It was good to spend family time, although rushed, as I needed to be admitted at 4pm to the West Wing at the John Radcliffe. 

I got out of the shower and dried myself on the towels. To the NHS, please make your towels bigger as many of us are not a size 8!!!! I put on my gown and remembered to do it up correctly so that I maintained as much dignity as I could for as long as I could!

Having tidied the room, putting all my belongings away tidily and not being able to think of anything else to do, I got back into bed. 

My husband and kids arrived, followed closely by the duty registrar who consented me. The second anaesthetist also arrived and made sure that all was well. My Surgeon also came and reassured me that all was on track and that I should be on my way down to theatre by 8.30am. He asked if I had any further questions and I replied that I did not but I needed to get on with it! My husband was worried and the Surgeon promised that he would contact him as soon as he had finished or in between if there were any concerns. And he did what I do regularly. He took the phone number down and wrote it on the notes, as there it cannot get lost and is on hand if you are scrubbed in theatre and need someone else to find the number for you!

I kept it all together until I left my husband and kids. As soon as I laid down and started being wheeled out of my hospital room, a feeling of sheer panic overwhelmed me. I have never really experienced this before. I should know better and knew the operation was a calculated risk that was in my favour, and that doing anything else was not an option. How absurd and silly, but the panic was there as I really had lost control and there was no going back. 

I closed my eyes and went on the journey to theatres and into the holding bay. I confirmed my details and shuffled from my bed onto the theatre trolley. I was then taken into the anaesthetic room. Everyone was professional and calming. The anaesthetic team had a great balance of humour and professionalism that really did confer a sense of normality to this bizarre situation. 

An intravenous infusion of propofol (I assume) was attached and one minute I was talking normally and the next I was asleep!

I have no idea as to what happened next. I know I needed a catheter, an arterial line, a femoral line as well as other new venous cannulae. I was placed on an operating table in a park bench position (lying on my left hand side). I had holding pins to make sure that my head did not move during surgery. I am glad that this was all done when I was asleep as there was no further anxiety or concern regarding dignity from me. 

The operation apparently took 10 hours. The operation involved a craniotomy (making a hole behind the ear through the skull) and then pushing the cerebellum back to allow access to the tumour. Neurosurgery is complicated and involves changing the way the brain functions by reducing the fluid around the brain and so allowing access for the surgeons to operate as there is a very limited space within the skull. The tumour had grown into the brain, was stuck to the brainstem and was slightly different anatomically to what had been anticipated. The growth was towards the lower part of the cerebellum and brainstem so the auditory (hearing) and facial nerve were preserved as much as possible. 

The Surgeon did not phone my husband during surgery as there was no need. Apparently, my husband did get a phone call from the hospital at around three hours in and this caused him to worry. It turned out that it was the ward asking him to take all my stuff home as I would be moving ward on my return after surgery. 

I took a long time to wake up causing enough concern to send me straight to the CT scanner. The CT scan was normal and reassured the surgical team. Most of the tumour had been resected and there was a little air (as expected) and no blood or signs of a stroke to cause concern. 

I remember being wheeled across to recovery and thinking, I am glad to be alive, and then, I can hear. My back was painful and I seemed to have severe left-sided sciatica (pain from your hip to foot). The nurses in recovery were patient with me and the anaesthetic SHO who came to see me was reassuring and understanding of my concerns. 

The Surgeon came to see me and explained what he had found. He told me that my facial nerve had been preserved and I had no obvious facial dysfunction. I had been very lucky. I trusted him and did not ask for a mirror to check. He was happy with the surgery but knew I would need a night in the intensive care unit (ITU) to recover. He had already phoned my husband and the family would come and see me in ITU. 

My head was painful and I was so sleepy. I had no energy and could not wriggle or move my body to get comfortable. Smells were different and my mouth tasted weird. I was also thirsty but also so sick. Once as comfortable as possible with the pain, I was moved to ITU. 

I imagine that those first hours must be how it feels to be on drugs as the world just seemed to slow down and fact and fiction seemed to merge. I was introduced to my nurse in ITU and her name drifted in and out of my head so that I kept having to ask her to clarify her name. My husband, two boys, and brother and sister visited in pairs and were obviously relieved to have got this far without a major complication. At one point, someone’s phone rang and I remember telling them off for having it on in ITU and being told that maybe my hearing was better than I thought it might be. 

I was now very tired, my head hurt and I asked everyone to go home and get some sleep as well. It had been a long day for everyone and we had several months of convalescence to get through and everyone needed their energy. 

I tried to get comfortable and drift off to sleep but also to remember anything that might be of value for others going through this experience. 

I had been awed by the complete honesty of others who had been through this process already and who had taken time to get in touch with me. These were strangers who wrote on the blog and gave me an alternative to the despair that I read on the internet. The desire to help each other is immense and I cannot tell you how moving and deeply honest these posts and direct messages were. Other messages were from previous trainees, friends and colleagues who shared experiences of their own (aged 5 as well as older) and of family members, which again, were realistic yet full of hope.

Other messages, which are the real reason that this blog will continue to record my progress and hopefully become a resource for others, are from people about to go through this journey. If there is only one sentence that you find helpful in this sea of words, then I will feel that my blogging journey was worth it. Of those of you who offered me support via direct message, I will ask you later whether you are willing for me to share your words of wisdom with others, as they truly meant a lot to me.

All I can say for now is that I am one of the 80% who has kept full facial nerve function and so my ambition from now on is live life to the full!

PS

I have added a resource page to my blog and will continue to add resources that I have found helpful. Liz O’Riordan’s blog as well as the blog from Maureen Kenny are a great read. The late great Kate Granger’s blog is a must read. Please let me know of any others that you have found useful or interesting. Thank you.

The NHS turns 72 years old today and never have we needed her so much.

I have worked within the NHS for the last 30 years. It is a career that brings challenge, heartache and so much pride but anything witnessed before has recently been blown out of the water.

I am so proud of the NHS teams that I have had the privilege to work with. I am seeing surgeons, physicians, nurses, physiotherapists, managers, GPs, porters, radiographers and so many more just coming together as #TeamNHS. The support networks have been amplified with food, well wishes, hand creams, masks, scrubs and even small hearts!

We have turned wards and theatre recovery areas into intensive care units, normal wards into intensive respiratory wards and challenged our staff at every level to work harder and harder. We have seen such death and illness in a short time frame and have done our best in difficult times.

We are used to looking after ill people, it is our bread and butter. The tragedy of illness and death is interwoven with the human interaction, a squeeze of a gnarled hand, the smile of a memory and a shared laugh even when death can be the only outcome. Patients and relatives rely on the human interaction, meeting with doctors, learning how to cope and the joy of going home to loved ones. All of this has had a hard stop with COVID-19. The masks, gowns and need to physically exclude friends and families have added barriers to patient care in a way never seen before.

Healthcare professionals talk about emotional injury where we support you and relatives in illness and death, but we keep the emotions we feel, of sadness and pain, internal. This is balanced by your thank yous and the joy of discharging a patient in better health, able to resume their own lifestyle.

This mental stress that has challenged our wellbeing has been added to by the daily battle for personal protective equipment causing a fear of coming into work, especially for those from a BAME background.

COVID-19 has stripped us all of the ability to cope. We are not NHS Heros, we are normal people, trying to do an exceedingly difficult job. The emotional injury has been high as wards have dealt with heart wrenching stories that have developed often overnight. Relatives relate seeing their loved ones deteriorate rapidly, taken by ambulance to hospital and then not seen again. This has been even more difficult when these patients are one of our own and were working with us days before. The numbers of healthcare staff affected has been huge and the faces of those who have passed are remembered in the picture below. To make this time even more difficult, the solace of families and colleagues coming together for funerals has been destroyed.

The NHS is beginning to open up services again, so that patients awaiting operations and outpatients clinics can visit safely. As the levels of COVID-19 decrease both the NHS and society can start breathing again. I hear talk of going back to normal, but we will never go back to normal.

Within the NHS, we have learnt to use technology to communicate with patients and colleagues. Rather than bringing you to an outpatient appointment at a time that maybe inconvenient to you, we can reach out whilst you are still at work, so that you do not need to take a whole day off but rather just a 15 minute break,

Rather than travel into London for a short meeting, we can Team in, and get so much more done. We have moved healthcare into communities and redefined our paternalistic view of healthcare risk. Perhaps we have finally realised that the patient knows best.

This new norm comes with societal responsibility if we hope to enjoy the freedom of social interaction, good health, travel and economic growth.  As a society, we need to realise that we have to work and care together if we wish to develop an equitable society.

The recent scenes of beaches on the south coast or in Soho and Brixton are just appalling. COVID-19 has not gone away, it is just hiding, waiting to raise its head again. The loud voices protesting that they are young and therefore invincible should remember the vulnerable (and often in ways invisible to the naked eye). It is their lives that you put at risk when travelling home or during your food shop on your way home from your day frolicking in the sun. Social distancing must be the new norm unless we have a true track and trace or a vaccine for all. Huge gatherings with no public toilets open just is too ugly to think about.

So much good has been and can be achieved. We have seen a shift change in the care of people who have become homeless. We now need to see dramatic shift changes in many other aspects of societal norm.

Organisations must address inequalities of representation within their workforce and senior boards. Historic privilege will be challenged and equity, inclusion and diversity representing those around us must be the new norm.

This is the time where kindness and doing the right thing must be the minimum standard. So many people have shielded for the last four months and are now taking tentative steps to developing a new routine. Let us support them and each other by thinking of the greater good.

Those who say that we are going through the most difficult time, need to remember that our senior generation have been through two world wars, an economic depression as well as wars such as Vietnam. They have been through rationing and the harshness of a global recession.

What are we asking society to do? To wash hands, wear a mask and keep a social distance.

Is this so hard? Let us set the standard together and challenge ourselves to protect others. This is not about COVID-19. This is also about flu, norovirus,and everything else that challenges the NHS in the winter months.

So Happy Birthday #NHS, let us raise a huge cheer for what has been achieved and for overcoming what is to come.