An elderly patient made Dr Liza Thomas-Emrus realise the NHS needed to do more than offer drugs to those recovering from coronavirus.
“One of my most profound memories of treating Covid early on in primary care was a guy in his 80s who’d recovered physically well from Covid but he felt really disconnected and just didn’t feel right,” she explains.
“Everything he’d read in the media was that he was going to die because of his age.
“He’d made peace with that and was expecting to die and he was saying to me, ‘I’ve had a good innings. I don’t really get why I’m still here’.
“Obviously, I haven’t got a tablet to make someone feel alive again or feel any life purpose.”
She turned to what’s known as social prescribing, where doctors and nurses can refer patients to voluntary and community groups for activities like gardening, befriending, cookery, healthy eating advice and a range of sports.
“It’s to help someone feel back to themselves again and get that vitality back,” she says. “Because of him saying, ‘I just don’t feel right,’ what I wanted here was to use art for physical rehabilitation but also rehabilitation of the mind and spirit.”
We’re walking around a cavernous ex-factory which was rapidly converted into one of Wales’ 19 coronavirus field hospitals.
“Covid has brought more and more people who have suffered with anxiety, loneliness, health anxiety and loss of identity,” she says.
“I’ve seen more of that than ever before, so it’s been quite challenging when it comes to dealing with that side of things, because we just have to rely on the art of medicine then, not just the pharmaceuticals,” she continues as we skirt row upon row of the 217 empty beds ready for coronavirus patients if there’s a second wave this autumn and winter.
It’s also where the art of medicine and some of the country’s finest artworks have come together to boost the recovery of patients who’ve had coronavirus and to bolster morale and health of the NHS staff looking after them.
Dr Liza is medical lead at Cwm Taf Morgannwg University Health Board’s temporary hospital Ysbyty’r Seren on the Bridgend Industrial Estate.
Alongside her clinical work, Dr Liza is an advocate for what’s known as ‘lifestyle medicines’ like exercise and meditation.
She’s excited about the health board’s collaboration with Amgueddfa Cymru – National Museum Wales – which has offered up its artwork to the NHS in the midst of the coronavirus pandemic.
Dr Liza leads me to one of her favourite paintings on display inside the field hospital, Kevin Sinnott’s street scene, Running Away With The Hairdresser.
“It reminds me of me because I’ve actually run away with a hairdresser from Merthyr,” she smiles, referring to her fiancé, salon owner Ijan Davies Emrus.
Ysbyty’r Seren will swing into action only if other hospitals are full.
“The likelihood is that we will need it closer to winter time,” the doctor explains. “We’re preparing for a second wave and just making sure everything’s in place.”
She goes on to talk about how we can all play a part in avoiding that second wave, but if the hospital is needed, she says it would take about half a day to set everything up. Those rows of beds would be partitioned into mainly 19-bed wards with room to expand to 450 beds if necessary.
“They [the patients] are not going to require any oxygen or ventilation, it’ll be rehabilitation,” Dr Liza continues. “Some patients will be waiting for their packages of care or for their care home placements.”
The experience of Covid survivors so far is that it’s taking them a long time to recover, she adds.
“People are just losing their strength – people are really, really tired, more breathless and a lot more anxious so we’re just going to have to work in partnership with these patients to get them back on their feet.”
She wants to put the message across that a Covid diagnosis isn’t all doom and gloom and most people survive. They want those recovering to flourish and not feel fearful.
Alongside conventional treatments like drugs and physiotherapy, there’ll be art therapy, yoga, dancing and singing in an holistic lounge lined with pictures taken between the 1960s and the 1980s by Welsh documentary photographer David Hurn.
And then around the perimeter of the wards are other paintings and photographs from Amgueddfa Cymru – National Museum Wales.
They’re all prints rather than originals and are laminated then stuck to the walls with Velcro, so they can be taken off and easily cleaned.
It’s part of a bigger series of projects called Celf ar y Cyd or Art in Collaboration which celebrates familiar routines and landscapes around Wales.
Dr Liza says most of the patients they’d expect to see at Ysbyty’r Seren will be elderly.
“This site will accommodate patients from across the whole of Cwm Taf Morgannwg and what I wanted was paintings from across the whole area so that patients could relate to them,” she says. “These paintings will engage people’s memories, their emotions, their thoughts and that’s how you get someone to feel alive again.
“It’s not tablets, it’s not the medicines. The medicines will help people live longer, but we want people to get that vitality, enjoy being alive and get into that mindset that they’re going home.”
“I’m hoping it will be like, ‘This is who you are, this is where you’re from and this where you’re going’.”
Among the 30-plus pictures at the Bridgend hospital is Ernest Zobole’s landscape of a wintry Rhondda Fawr, Some Trees And Snow, as well as John Petherick’s The Glamorganshire Canal at Ynysangharad from 1854 and an oil painting called Chapel And Tip by Denys Short which depicts children playing outside a Valleys chapel in the 1960s with a looming slag heap behind it.
Chapel And Tip is one of Sharon O’Brien’s favourites. She’s head of corporate nursing for the health board and clinical nursing lead for Ysbyty’r Seren.
“It’s lovely that they picked such a wide variety [of artwork],” she says, pleased it’ll encourage patients to stand up and walk around the perimeter walls and into the holistic therapy room. “It’ll be a lot of history and I think it will evoke a lot memories for the patients who are here.”
Further west, Carmarthen Leisure Centre’s Ysbyty Enfys is the only one of Wales’ field hospitals occupied at the moment, with no patients no longer at Ysbyty Calon y Ddraig at Cardiff’s Principality Stadium.
The 19 hospitals were put up in under eight weeks with the cost put at £166m from Welsh Government coffers. At least £2.8bn has come to Wales from the UK Government in response to the pandemic, which includes funding for the field hospitals as well as a range of other measures including tackling homelessness and help for charities.
Anna Llewellin, who’s interim head of nursing for Covid-19 operations at Hywel Dda University Health Board, explains how social distancing rules mean they’ve needed to move non-coronavirus patients into the 24 beds it currently operates at Ysbyty Enfys Caerfyrddin.
As in Bridgend, the Carmarthen hospital has no natural light, so the west Wales land and seascapes are transformational, says Anna.
They include Lionel Walden’s sea scene, Moonlight On The Sea, James Dickson Innes’ Pembroke Coast and John Brett’s Forest Cove, Cardigan Bay.
“It has made a huge difference because it felt quite bland and plain,” Anna says. “The environment was very white and clinical, but with the pictures on the wall it really has brightened up the room and made it feel a lot more homely.
Staff, too, find it uplifting, she adds, with something other than blank walls making a 12-hour shift much more bearable.
“It makes the environment a bit more relaxed and welcoming. Without windows, the outdoor scenes bring some of the outdoor inside as well.”
In Bridgend, Dr Liza and her senior nursing colleague Sharon give hollow laughs when I comment they both look remarkably fresh. I ask them what things were like before and after the time coronavirus reached its peak in mid-April.
“It’s been exhausting,” Sharon says, relating how she’s recently caught up with her parents for the first time in five months.
“I sat outside and said, ‘Unless you’re in it, it’s really hard to explain how hard it has been because it’s constantly changing’.
“In particular with the field hospital and the population testing, you’re trying to be proactive as best as you can, but then things change, people’s behaviours change and the rules of engagement change.”
Liza adds: “It’s the uncertainty that’s made it a huge challenge. We’ve been really lucky to have a really strong team that’s been really resilient, but it is a rollercoaster so some people will have days where they feel a lot more stressed or overwhelmed, then the rest of the team take the helm, they’ll just steer the ship.
“It’s been a real testament to people’s dedication and it’s just shown why people come into the NHS in the first place. They come in because they want to serve the population and they’ll do that no matter what and they’ll put their lives on hold in order to step up to the challenge, so we really have to be mindful of looking after our staff wellbeing because by looking after the staff’s wellbeing, they can look after the patients’ wellbeing.”
Sharon has been in the NHS for more than 30 years and she’s never seen different parts of the organisation work together like this before.
“Everyone’s come together with a can-do attitude,” she says, describing how staff who wouldn’t normally work in critical care were trained up from January onwards so they could pitch in where the need was greatest.
“Everyone’s been deployed so we had all the school nurses in our [Covid] testing unit.
“And they’ve been absolutely brilliant, we’ve had dental nurses and we’ve had nurses from the private sector saying, ‘What can we do?’ and it’s just brought everyone together.
“Our school and dental nurses have just been fantastic, some of them didn’t want to go back.”
Dr Liza says they’ve found inventive ways to make sure staff who needed shielding were protected.
“We’ve had different ways of working, because not all of our staff can be frontline staff but they still wanted to be a part of it,” she explains.
“There’s not been anyone who said, ‘I don’t want a part of this Covid, I’m just going to sit at home’, and the staff who have needed to shield have been protected by the other staff and they’ve been able to work from home and do different roles to keep the NHS going.
“Everyone has really stepped up to the plate to keep the whole service running and I really hope that, from now on, people will see that working in the NHS in so many different roles is a wonderful career. There’s so much they can do inside the NHS and it’s been a real insight into how teamwork makes a difference.”
They will only have patients at the hospital if there’s a second wave of coronavirus. How likely do they think that will be?
“I think that comes down to people actually following the government guidance and following what works,” says Dr Liza. “And what works is hand hygiene and social distancing. Those simple measures are extremely effective.
“If we can keep that up, we can drive down all sorts of infections, not just Covid but also flu.
“We’ve got the winter season coming up and our hope is that by everyone following those simple hygiene rules we actually don’t get an overwhelming rate of infection which will overwhelm the NHS, so that we can manage through the winter.
“But, if we do get a big second wave or high rates of other types of infection that puts pressure on the NHS, we’re well prepared now so we can deliver the care that patients need.”