NHS heroes: pressure without support is wearing health workers down.

“Oxford Street” by Teseum is licensed under CC BY-NC 2.0

On the anniversary of the first (late) lockdown, the All Party Parliamentary Group (APPG) on Coronavirus took evidence on the mental health and general wellbeing of health workers. It should surprise no one to hear that it is not good. Nor will it be a surprise to learn that it is deteriorating as they are asked to sustain their extraordinary efforts despite mental and physical exhaustion and a growing sense that the government’s underlying agenda is wealth before health.

The APPG heard that NHS workers’ rating of the government’s effectiveness in the context of the pandemic had declined drastically, with many commenting that notable breaches of guidelines by key figures (Cummings etc) had impacted on their confidence and trust in government. What was more, the impact of these breaches had filtered down to the wider population, leading to a more cavalier approach to lockdown and social distancing/mask-wearing and a greater risk and workload for the NHS. As a result, NHS staff felt ‘abandoned’ and ‘hung out to dry’, no longer valued by government or the public.

Professor Neil Greenberg of King’s College, a consultant occupational and forensic psychiatrist and specialist in Post Traumatic Stress Disorder (PTSD) observed that many healthworkers were suffering from moral injury – feelings of shame, guilt and anger because they were put in a position where they were unable to care for every patient properly because of poor leadership and lack of timely action from the government and being over-stretched and/or under-resourced. Values are an integral part of any vocational job, and when these are assaulted, finding the mental and emotional energy to carry on greatly adds to the burden of stress. Having to refuse relatives entry to sit with dying patients, seeing colleagues get sick and die because of inadequate PPE, being forced into compromising intensive care because staff were overwhelmed – all these elements and more heap up on people driven by conscientiousness, diligence and dedication and break their spirit.

Dr Elaine Kinsella (lecturer in psychology at the University of Limerick and an expert on factors that enhance or diminish wellbeing and neurorehabilitation) pointed out that NHS staff’s strong sense of duty and responsibility meant that they felt obliged to “keep going, no matter what”. They could not let each other down; they had to keep going because there was no one to cover for them if they succumbed to mental or emotional exhaustion.

Media reports on public behaviour and waning compliance with vague guidance from government made staff feel they were sacrificing everything for nothing and that the ‘we’re all in it together’ mantra and ‘protect the NHS’ were just soundbites. Actions taken to make their lives a little easier in the first lockdown – people cooking them meals or trusts keeping shops open 24 hours and waiving parking charges – had fallen by the wayside as time has gone by, leaving them feeling demoralised and undervalued.

“I left hospital after a long shift and found I had a parking fine.”

It’s last straw stuff. Worryingly, but unsurprisingly, we were told that

“they’re no longer loving the job, they’re telling friends and family not to join the healthcare profession and considering leaving it themselves.”

“London Calling” by Teseum is licensed under CC BY-NC 2.0

Dr Rachel Sumner (senior lecturer in psychology at the University of Gloucestershire, focusing on chronic stress, and the environmental and psychosocial determinants of hormonal and immune health) spoke of how the weekly clap for NHS heroes had started off as a heart-warming and kind gesture, but was now a ‘poisoned chalice’ and that the sentiment behind it had not been followed through in pay or PPE or even parking charges. Staff felt that the government had abdicated responsibility and heaped everything on to the NHS, leaving staff feeling hopeless about their ability to deliver.

“They are forced to stay on a pedestal so high that they are frightened to move”.

One worker said “I don’t want to be a hero anymore. I just don’t want to be. I’m all worried out.”

The incogruence between the (imposed) hero label and people’s behaviour in recent months – breaking guidelines and subjecting hospital staff to abuse – all added up to ‘”a kick in the teeth”.

And that, for me, was a key takeaway from the session. It does not help to call them heroes. It places an impossible burden on them – a burden of expectation that is wholly unfair, cruel even. It makes us feel better, but it does nothing for them but heap the pressure on. It’s a form of virtue-signalling, really.

What they need is for action to match up to the words, especially from the politicians. If they are so very valuable, value them. If they are so precious, protect them. If they are so heroic, reward them. And don’t tell them there’s no money when there’s money for a second jet for Johnson, for nuclear warheads, for legal fees to defend the indefensible.

At the end of the session, each expert was asked what he or she would demand of this government. Professor Greenberg felt that NHS staff, who have effectively been fighting a war with all the associated pain, stress and loss of comrades, needed a covenant for priority care, equivalent to that afforded the military, to cope with the mental and physical after effects of the pandemic.

Dr Kinsella asked that government and the NHS reflect on where things had gone wrong and learn from mistakes. She also demanded strong leadership, clear, unambiguous public health messaging, timely and prompt action, an end to divisiveness and blaming and authentic use of the language of solidarity. She also wanted to see workers awarded appropriate pay rises rather than clapping. Amen to that!

Dr Sumner, too, wanted to see a reduction in token gestures and for action to match the words. She described the most recent lockdown as a disgrace, with efforts to contain the disease undermined by the country’s leadership, which had earlier been described as chaotic.

“Do what’s necessary. Health before wealth.”

Amen to that, too. And, yes, say thank you!