Interview: Dealing with the mess

Junior Doctor Stacey Williams speaks to Max S about the anger of NHS staff at the government’s coronavirus strategy, and the prospects for organising to defend lives and the NHS through the crisis.

Max S: The government’s public message went through several gyrations over recent weeks, snapping between assertions of near-normality and the sudden announcement of much more serious social distancing. What was the effect on health workers – did the internal messaging track with the government’s oscillations?

Stacey Williams: My colleagues and I were in disbelief at the government’s snail pace actions. In countries such as Italy and Spain, case numbers grow and patients are dying at exponential rates, despite much stricter isolation policies than in Britain at the time I write this, at the end of March. Wuhan is planning to lift the isolation measures, but only after months of total lock down, comprehensive testing, prioritisation of national industry towards providing medical and ventilation equipment. At the rate of Britain’s actions, how many months, or years longer will it be for us?

The medical and scientific community looked on in dismay at the evidence base for Public Health England’s (PHE) initial strategy. The concept of herd immunity, introducing the infection into the population and waiting for a sufficient proportion to become infected and recover, to prevent ongoing wide transmission, was presented without transparent evidence. Only when alternative modelling showed this best case scenario to be vastly out of keeping with how the virus had spread in other countries did PHE’s strategy change. But this lost us weeks of precious time, when we could have shut the schools, closed non essential facilities and focused on stocking and training staff to use PPE.

We knew from our Chinese and European colleagues that more than relying on herd immunity needed to be done. The time wasting both made us anxious, in the calm before the storm, but now overwhelmed and asking, why didn’t we listen to those countries, or to countries with a plan, having been affected by SARS in 2003?

Health workers are going into action against Coronavirus after a long period of underfunding, under-staffing and undermining from successive Tory governments. It’s well-known that morale is low, but is this sentiment taking on a clear political character at the moment?

SW: We train to be health workers because we are drawn to be kind and compassionate towards others, especially at a time of need. It is undeniable that the NHS is in the worst shape it has ever been to ramp up productivity and service provision required to treat coronavirus patients. And of course, while the NHS is overhauled to provide care to these extra patients, many of whom will require intensive care, it cannot do its day-to-day work, for instance caring for those with chronic conditions, cancers or requiring routine surgery. But in regards to morale, the outbreak has both caused huge disruption, to training, the nature of the work we do, but at the same time it has brought health workers together. It will be the NHS that provides care to all patients, despite the government’s blustering, and that has given people inside the NHS a morale boost. There is clear anger at the government, but also a sense that we have been left to deal with the mess, and we will deal with it in the best way we can.

It’s been widely reported that Personal Protective Equipment (PPE) is still not arriving in sufficient supplies or of sufficient quality. Meanwhile, health workers are dying in Italy and Spain due to the high viral loads they are exposed to and the lack of adequate protection. What have the dynamics between management and staff been like around this issue?

SW: Different Hospital Trusts have taken different approaches to this. There is no comprehensive national guidance that directs hospitals what to do: from inpatient ward measures, to finding additional intensive care beds, to arranging testing for patients and staff. In theory, this is to allow a degree of flexibility in the approach that Trusts take. This results in considerable discrepancy between hospitals in both their actions, but also the people involved in making decisions. It is not always management who are leading on this, but senior doctors and nurses, often with infectious disease experience. The management structure during this crisis is not the same as day to day Trust managers, although it does include them. When we have run out of masks, as we have done over and over again, we escalate this to the ‘command’ of our directorate. They have a responsibility to act on this, and the masks do turn up.

I’m interested to know why we are left to run out, why aren’t there plans to know the stock, and the requirement? The pressure so far has been focused, through social media, at the Department for Health and Social Care. But more organising could be focused on these new forms of crisis management. On a ward level, for the first time I am in a message feed with my seniors and consultants, as a measure to plan for absence and sick leave. There is an emerging support structure that I have never seen before, that would have been very welcome every winter I have worked so far.

Boris Johnson blood on his hands
Illusration by Colin Revolting

Towards the start of the pandemic, out-sourced cleaners at Lewisham Hospital, where Coronavirus patients were being treated, staged a walkout over unpaid wages and successfully secured their demands. Many support staff up and down the country are currently being paid less than a living wage and are working in poor conditions. How much scope do you think there will be to demand better pay and conditions during this ‘national emergency’ period?

SW: The Lewisham cleaners are an inspiration for how to campaign for workers’ rights and pay, and not just in healthcare but across the essential services sectors. The essential work of cleaning a hospital has been undermined for decades, and now we are in the midst of a pandemic where everything has to be cleaned, sterilised, but the people asked to do this do not have the same sick pay protection as their other NHS colleagues. This is a unique situation: fewer people prepared to work to undermine a strike, other roles are too stretched to replace them, and that cleaning is a key step to limit the virus spreading. While workers are keen to organise, I wonder how willing the union structure will be to support them. So far, Labour and the trade unions have been very passive.

The emotional dynamics of health work are often side-lined in discussion of the sector. In the next few months, health workers are going to witness harrowing scenes, with hospitals overrun and patients dying in circumstances where it is difficult to maintain a sense of dignity. Are preparations being made to provide support to staff? Could this be a demand to organise around – either now or in the weeks and months after the pandemic recedes?

SW: We are all very aware of this. The ‘storm’, as it is being termed, has seen Emergency departments split into ‘clean’ and ‘dirty’, separating infectious patients from non-infectious, seeing areas for those sick but fit enough to be ventilated, and areas for those sick but likely to die. These are large, open, busy areas. No one wants to die in an emergency department, without the staff with time to give the care that dying demands. No one wants to work on a team that can’t care for the dying with dignity. The huge ramp up of healthcare provision at the ExCel centre (NHS Nightingale Hospital), creating a 4,000 bed field hospital has called for doctors with experience in intensive care, but also generalist skills required to look after those at the end of life. I’m pleased that those skills are being recognised as essential, but feel for the health workers who will be on the frontline there.

Before Coronavirus, there were emerging initiatives to support staff through difficult experiences at work, such as Schwartz rounds, a standardised group-therapy style session for staff in emotionally demanding jobs. During Coronavirus, these will become essential to keep staff emotionally fit enough to do their job.

Behind this all, there is also the emotional strain of not being able to provide the regular, routine care that doctors and nurses give; patients that they have known for years now cut off from life prolonging or symptom controlling treatment. At my workplace, in line with NICE (National Institute for Clinical Excellence) guidance, cancer patients are having non-curative chemotherapy stopped, which regardless of the evidence base for this, has huge psychological impacts on patients and staff.

The NHS will be in extreme disrepair in every way by the time the pandemic subsides. I wonder if you have any thoughts on what will likely come afterwards. Will there be an opening to turn the tide on Tory cuts and privatisations in the health service? Or do we have to brace ourselves for an attempt at disaster capitalism, with further privatisation promoted to ‘reform’ a shattered NHS?

SW: This is very hard to predict. The wave of economic provisions to keep the economy in hibernation during the pandemic shows the Conservative government is taking a new path. They have shifted away from the kind of market driven, sink or swim, neoliberal approach that we have seen in other disasters, as explored so brilliantly in Naomi Klein’s The Shock Doctrine. That does not mean that Johnson won’t use this disaster to orientate back to the priorities of the right, for instance on immigration, or policing of public space, when we are closer to the other side of this storm.

With regards to the NHS, more people are going to see the limited services at their worst. More people will have loved ones die in undignified circumstances. Unlike in a private sector, hospitals will not be allowed to fail economically, but they will fail patients.

The public opinion of health workers is likely to remain strong, but will the public look to our privatised colleagues in Europe, say Germany, who are much better equipped and resourced to deal with this crisis, and say, why aren’t we like them? Would a private system have coped better? Will Johnson agree with them?

We need to be clear in arguing that it was their systemic underfunding of the NHS, their staffing crisis, their privatisation which caused the crisis going into the storm, not an inherent failure of a universal healthcare service. Who knows what we are about to persist through, and what will remain at the end of it all.

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