So what’s changed since my last piece for LDV on this ten months ago? – nothing and everything, in a phrase, it’s got much worse.

Last March the fear of an unknown, rapidly spreading and possible deadly virus, the prospect of the NHS being overwhelmed; inadequate ventilators and ITU beds, terrifying pictures from Italy of a modern health system crumbling in front of our eyes and our own government indecisive and floundering, with no plan and even less preparedness, galvanised the NHS workforce as never before in living memory. Things happened fast; the NHS workforce rose to the challenge, found the energy, carried on under almost impossible odds, and paid the ultimate price.

I won’t recite all the twists and turns, everyone knows them very well, except to say that you can build all the Nightingale hospitals you want, but if you don’t have the skilled workforce to staff them, they are pretty useless.

Where are we now in February 2021, and what will happen in the next months and years?

The workforce is exhausted, having used up every last ounce of their reserve. They are clinging on by its fingernails. The almost daily accounts of tearful staff, full face to camera for prime time TV says it all.

Many are already on sick leave for what is euphemistically called ‘Covid-related’ issues, more than 50,000 at any time Simon Stevens told us two weeks ago. Some with family caring duties, some isolating, some with an active infection, some in hospital as patients or even ITU, some with ‘long Covid’ and some just because they have fallen to bits. Don’t be fooled by that stiff upper lip and the veneer of coping, it is just that, and it will fall away as the numbers of infections drop in the coming weeks and months. Approaching 1,000 NHS staff have died of Covid.

It is now acknowledged that the mental health fallout from Covid across society could surpass even the impact of the death toll, depending on how you want to measure it. For Healthcare workforce, it will be much worse; they saw it all, up close and personal; careers, livelihoods and lives are being shattered. How will these staffs be replaced on the frontline, – let alone cared for in their distress and disability?

This will form a large part of the work for the next few years, for professional healthcare unions (BMA etc.) and the Royal Colleges who take care of postgraduate education.

Many healthcare workers delayed retirement to play their part during the last year, will soon be leaving. Others will take early retirement because of exhaustion or fear (or both), or just because they can’t stand it anymore. The ‘returners’ who answered the call to come back to the NHS out of retirement, will go back to their retirement and be very thankful it’s over, and that they got away with their lives. That is likely to happen very soon, probably this summer.

In the medium term, the madness of Brexit and the hostile environment created for European health workers will ensure more do not renew contracts and slip away back home. They will not be replaced by others coming for the experience of working in a country with the most equitable healthcare service in the world. The yawning gap of more than 100,000 NHS staff vacancies will widen. We know the medical and nursing workforce is ageing rapidly and being inadequately replaced. Certainly for the past two decades has depended on this seamless movement across European borders for the majority of recruitment, not any more.

The Royal Colleges want a doubling of the medical student intake from 7,500 a year to 15,000, but there is no sign this will happen any time soon, and in any case, it takes 10years to train a GP and 15 years for a hospital specialist.

So the immediate and longer-term prospects do not look good. What can be done?

Support Christine Jardine’s European Citizens’ Rights bill to get through parliament and become law.

Accelerate processing of doctors seeking asylum in the UK so that they can register with the GMC (General Medical Council) and start work in the NHS sooner; many are being left in limbo and unable to work for years. There are more than 1,000 in London alone.

We can all start taking better care of our health and heeding public health messages; there will be fewer professionals around to look after us.

Fourthly, and this is a bit controversial. As a way of saying a proper thank you to NHS staff the government could open travel corridors and make arrangements with a limited number of holiday destination countries and airlines to allow access for holidays without quarantine on return.

Demanding quarantine for NHS staff is totally illogical when they are returning to a Covid work environment, especially now they have finally been given kits to carry out regular self-testing on a twice-weekly basis.

Being able to go on holiday to somewhere warm and sunny would be a huge boost to morale, health and well-being. Staff who did not want, or could not take advantage of this could be given a tax-free cash bonus, say £500 per week?

This is a much better use of taxpayer money than bent contracts for Tory cronies.

* Catherine Royce is a retired medical doctor, a former member of the Federal Policy Committee and a member of LibDem Women and Liberty Network.