As Covid-19 levels rise again, the Royal Free London prepares to roll out a mass vaccination programme, but it faces a staffing crisis that in turn threatens vital cancer operations.

Covid-19 patients are again being transferred to intensive care, but clinicians now have a wider array of treatments used to fight the virus, including experimental drugs and convalescent plasma.

This episode focuses on the perpetual challenges of trying to discharge older patients as the hospital experiences a bed shortage, alongside the added complexities of Covid-19 infection risks. 

As autumn begins, the hospital's Emergency Department is seeing a resurgence of patients after a summer of low attendances. More people are arriving in A&E than almost any other day since last winter, and they are admitting more patients than they are discharging. Every patient being admitted must be tested for Covid-19, but the results can take up to 48 hours to come back. Staff must deal with the conundrum of where to place patients, as they must isolate symptomatic patients and manage the constant risk that those without symptoms later test positive. If a patient that was deemed low risk, and therefore placed on a ward, is then found to be Covid-19 positive, all patients that were in proximity to them must isolate, and therefore occupy one of the hospital's precious single rooms. 

This issue, combined with the recurring challenge of older patients staying as in-patients for long periods, means that Barnet's bed shortage, which was an issue even prior to the pandemic, has suddenly multiplied. As the hospital hits capacity, the brand new Rainbow Ward, specifically built with a £4 million investment during the pandemic to ease the pressure created by Covid-19, stands empty. Building problems have delayed its opening, so the pressure to discharge patients is higher than ever.

This episode explores the impact of Covid-19 on the Royal Free Hospital's transplant services, which treat some of the hospital's most vulnerable patients.

The Royal Free London faces the long-lasting effects of Covid on their patients, staff and services, amidst the looming threat of a second wave.

The UK lockdown is over, but London's Royal Free Hospital is counting the cost of having to prioritise Covid-19 above almost everything else as they battle to treat the patients left behind.