We’ve seen an increase in the number of people coming into my hospital trust over recent days. And we are sequencing them to check whether there’s Omicron there. It’s a slight increase, which you’d expect at this time of year. But we’re ready to activate well-established plans for a surge in Covid cases if that happens. For example, we’ve got a standing order of the wards we use for Covid cases and the services we close to deal with a Covid surge.

But I think this winter will be worse – it will be harder – than last year. The challenge is bigger because we’re tackling the backlog of care, our A&E is incredibly busy, and also because of staffing problems. This isn’t just Covid, though Covid is a factor. And this isn’t just about people’s difficulties accessing primary care. It’s partly because people coming into hospital are much more severely ill than before.

Our stroke team say they’re seeing people coming in who haven’t been accessing some of the preventive interventions that might have stopped them getting so ill. And our gastro-intestinal specialists are seeing far more people with stage 3 or stage 4 cancers than previously. So there are things that haven’t been picked up. That has a consequential impact on hospitals because patients’ length of stay and recovery period are greater.

The strain on hospitals is very visible and quite visceral – you can see ambulances queueing outside and people sleeping on chairs because you can’t get them into cubicles to be seen because too many sick people are waiting for beds. But what we can’t necessarily see is what’s happening to all the people who are at home getting sicker. That’s a very large, invisible problem.

Many of the people in our hospital are very old and very frail. They don’t necessarily need to be in an acute hospital but they need to be in a bed somewhere, with someone looking after them round the clock. Social care is a massive, massive concern; not being able to get these people who are medically fit to be discharged out and home is what blocks up the “front door”, our A&E.

We’re going great guns at treating people on the waiting list. And this winter we’re doing more than ever to protect that, as well as dealing with all the other pressures we have. We are holding beds for people on the waiting list who are having surgery. But that raises really difficult ethical dilemmas. Do you hold an intensive care bed for someone with an aneurysm that could kill them at any minute, or bring in someone who’s just arrived through A&E and needs surgery? Is there a bed for someone who comes in and needs a thrombectomy, a potentially life-saving operation after a stroke?

You can imagine how some of our staff feel about unvaccinated people with Covid eating into our supply of ICU beds when you’re making these decisions, about whether someone with stage 4 cancer or an aneurysm can have an operation.

Workforce is a real problem. We’re struggling to get enough healthcare assistants. We’ve lost 25% of our stroke care pathway because it’s lost its community rehabilitation capacity that we just can’t staff. And several very experienced consultants have said “I’m going to give you one more winter and then I’m off. I’ve realised through the pandemic that when I’m on my deathbed I’ll remember the time I spent with my family and not the Saturday nights I spent doing an extra shift.”

Our staff are resolute and they’re still delivering absolutely fantastic care. But after the last 20 months they’re pretty weary. It’s mile 23 of a marathon, really – that’s what it feels like – but the problem is that the finish line keeps getting a bit further away.

Staff are pretty worn out. And they’re quite frightened about being redeployed into Covid wards again. The first time it was “once more unto the breach”. But now, when it’s like fifth time unto the breach, people are sick of the bloody breach. They don’t want to go there again. A lot of staff are saying “I’m not going back into Covid wards”. So that’s going to be tough.

Staff will keep going and keep giving, because that’s their values. But I worry about the public starting to lose confidence in us and losing faith in us because of their experience of this as well. It’s a tough and frustrating situation. And there are no quick answers.

As told to Denis Campbell