Whereas the first wave of Covid-19 was an occasion for government-sponsored jingoism, the second wave is seeing health workers abandoned and left to manage the unmanageable. We spoke to E, a community nurse at a London trust, about how health workers are facing the second wave of Covid-19.
With the winter crisis now interacting with the second wave of Covid, what is the general situation at your workplace like in terms of pressure on services and patients coming in?
I feel that there are positives and negatives. The positives are that we are more prepared, and we know what to expect a bit more in terms of the science – i.e. what’s going to work in terms of patient care and medication and who is going to be affected more – the vulnerable groups we need to monitor more and watch out for. I also think we are a bit more prepared in terms of PPE levels compared to the first wave. We actually have PPE that is mildly appropriate and in-date, which is quite a luxury…
But then on the flip side, I feel like the adrenaline is not there, and the public support isn’t there. Not that I want the Thursday clapping back.
I suppose that the first wave was framed as a kind of ‘national unity’ thing, but the second is much more clearly the fault of the Government, so there is more of a ‘keep it out of sight, out of mind’ mentality.
That’s exactly my next point. In the first wave, people thought ‘shit, we’ve got to pull together, there is this crazy thing happening, everyone’s got to stay inside and we’re going to go out on the frontline and do the work’. And now it’s like, ‘how the fuck are we having a second wave when all the other European countries who are ahead of us said this was going to happen and we knew how to avoid it’. We’ve lost the adrenaline, we’ve lost the motivation, and this time round it’s not an accident.
The first-time round, there were things we absolutely should have learned from – Italy, for example – so that we could have prevented some of the deaths. But this time, me and my colleagues are just so bitter about ‘Eat Out To Help Out’ and all the other risky things that have been happening, like half-arsed lockdowns or no lockdowns at all. We are going into this warzone again, but it feels like this time the public aren’t really behind us. The politicians certainly aren’t behind us; our managers aren’t behind us. But because we are nurses and doctors, we’ll try to get the job done, because we always do.
How bad are things where you work at the moment in terms of intake of patients and pressure on beds?
In my Trust we are doing okay for beds, but a lot of that is because there are lots of nurses in the community doing more ‘hidden’ work to keep things running. When you think of nurses, you think of hospitals, ITU and A&E – basically the ‘sexy’ medicine stuff. Whereas in the community, there are so many health workers keeping people from going to hospital in the first place. Our caseload has dramatically increased. We visit people who came out from the first wave with chronic lung problems who are now house bound, or people with other chronic conditions – diabetes, high blood pressure, etc. These numbers have been so out of control because, during the pandemic, people haven’t been able to get the appointments that they had before, so they are now on our caseload more often.
So you are picking up some of the ‘Long Covid’ fallout of the infections?
Yes, and also ‘not-Covid’ – we’ve got some awful cases at the moment of late diagnoses of cancer, because appointments weren’t happening or people were missing their appointments. I’ve encountered really sad cases of two young-ish people who are in this category. It’s heart-breaking.
I suppose we’ll be contending with those kinds of invisible casualties for years to come…
Exactly. I have a colleague whose sister sadly passed away in the first wave because she had a heart attack. She was due to see the doctor but didn’t go to the appointment because she was told not to go. She had a heart attack, and it was absolutely preventable had she had gone to the GP and had the relevant tests. So, we’re seeing more of that: uncontrolled diabetes, people not taking their medicine, people needing blood tests missing them, and so on.
The waits are extremely long as well. Oh, my gosh, the wait for an outpatient appointment! So, say you get referred to Gastro for issues with your liver, for example – it should be about a three month wait for a routine appointment. At the moment, in London, you’re looking at a 7 to 8 month wait. If you need a wheelchair now, the wait is approximately 10 to 12 months in London. For Physio, I think you’re looking at six to nine months.
You mentioned earlier about it seeming like health workers are better prepared for this wave practically than they were for the first, but there have been reports of quite striking inequalities within the workforce: between BME staff and other staff, between the outsourced support staff and non-outsourced clinical staff. Is that something you’re aware of in your Trust?
It is, though my particular team are pretty good on this. We’re pretty hot on risk assessments. We’ve got a couple of members of staff who are working from home because they meet the high-risk category. My own manager has done pretty well in not pressuring people to come in, for example.
We’re learning more as well: there’s more and more evidence coming out about the relationship between Covid risk and being BME, and we do update the risk assessments according to that and change the policy taking into account who falls into high-risk groups, for example by taking people away from patient-facing roles.
But I’ve heard stories of other Trusts that have been shocking.
You said there’s been quite a lot of disaffection amongst your colleagues with the government’s overall handling of the pandemic. Could you elaborate on that?
Where do you start? There’s so much – Dominic Cummings breaking lockdown rules was a punch in the face for us earlier in the year, and then since then it’s just been consistently embarrassing. Why are we hearing from Grant Shapps, Secretary of State for Transport, instead of the Prime Minister? Then there’s the defence budget. That was a kick in the teeth for me and my colleagues – £16.5 billion on defence! Where did that come from?
And at the same time health workers are looking at a below-inflation pay rise.
Exactly. Partly it’s because we’re not great at unionising and organising. Nurses in the UK have a diabolical record when it comes to organising, especially if you compare us to our Australian and American counterparts, and their nursing unions.
We get on with things, we carry on until the bitter end. We do it because we are patient-focused, but there’ve been so many times even in this pandemic where we would have had the right to stop. Wearing gowns from 2013 is not acceptable. But we do it, we get on with it. And then the defence budget coming out just made us say, ‘hang on, you told us you didn’t have the money for PPE, for testing, for ventilators!’ So we have had to choose the patients that survive. We have had to weigh up between a 50-year-old man and a 30-year-old man and decide which one is allowed a ventilator. And suddenly you want to make the Navy great again?
We’re in a warzone. That’s what it feels like – we’re in a warzone. There is a war going on, and [Boris Johnson] is shipping weapons to the other side of the world. We need ventilators and PPE and tests and vaccines and what are we getting? Drones and updated Navy ships. It’s just mind-boggling and it’s so disempowering for the staff. And then the flip side is you think, ‘okay, so what are Labour saying about this?’ Well, they’re fucking agreeing!
What you say about having the right to stop but just ‘getting on with it’ – that strikes me as a very gendered thing, as it’s assumed that nurses give their caring labour out of a caring nature, and the tone can switch from lionisation to horrible moral blackmail the moment that care is withdrawn.
Yeah, that’s exactly it. A vast amount of overtime this year has been worked by nurses, doctors, health care assistants, all those allied health care professionals. During the first wave, I think some weeks I did 60, 70 hours. When I’m meant to have 37 and a half. I didn’t get extra pay.
Even before the pandemic, I recall the last NHS staff survey showing that more than half of health workers were doing at least some unpaid overtime every single week.
At least, yes. One reason is to do with safety and the numbers of patients. The safe ratio is one nurse to six patients on a ward, or ideally, the gold standard would be one nurse to four patients on a ward. Even before Covid, we were seeing ratios of one nurse to ten patients.
In the last couple of weeks, the guidelines have changed again: the Trusts are now relaxing it even further and saying, actually, it’s okay to have more than one nurse to 12 patients. I’m wondering if this will this be a way to normalise even more dangerous staffing levels after the pandemic.
There’s been a lot of coverage recently of the naked corruption, sleaze and graft of the Government in NHS procurement – with the Tories essentially awarding huge pay-outs to their mates for fictitious contracts or contracts that will turn up half-missing in twice the time it should take to complete them. Is that something that’s breaking through, in terms of health workers feeling angry and wanting to do something about it?
Yes, definitely. It’s really hard – I am in my Unite branch and we’ve been quite active throughout this pandemic around PPE, around all sorts of stuff. But the sad thing is, I am really trying to talk to colleagues about joining unions who aren’t already in unions… And it’s still not pushing them to join, which has shocked me. It’s almost like they’re still in the stage of the pandemic, thinking, ‘we just need to get on with it for the for the public good, for the greater good, because we’re nurses and we have to look after people’. I thought we’d be seeing a bit more anger this time round that would then result in more wanting to join unions.
I guess one issue with the unions is just the terrible disunity and loads of different unions trying to poach each other’s members. But also the leaderships of the main unions in the health sector don’t really want to be an outlet for anger. It seems they actually want to curate that idea that their members are self-sacrificing Mother Theresas who do everything for the public good, and their strategy is to petition the Government for a handout rather than to fight for it.
That’s exactly it, yeah – and the Royal College of Nurses (RCN) is the worst for it! I mean, you’ll get a Florence Nightingale badge and a lanyard, and all that crap, but nothing real. Before, when I was a student nurse and they were striking for pay, and the RCM, the Royal College of Midwives, balloted and went on strike for the first time in over 50 years. But the RCN at the time – their campaign was for tax-free laundry.
As in, laundry facilities in workplaces?
It was to deal with getting tax off your laundry at home. So, you can now and I think you get like 10 pounds a year or something towards your Daz or whatever. Whereas the RCM midwives had balloted and they were on strike! The nurses on strike were Unite and Unison, and then the RCM and the allied health professionals, so physios and occupational therapists. But I don’t think the RCN even balloted. They had this laundry campaign going on instead. I’m not making this up!
Obviously the issue of pay has crystallised a lot of this. It seems like there was a big outbreak of activity about the demand for 15% rise, but it’s got somewhat bogged down in discussions of which unions are better, which unions are worse and their response, when none of them are being brilliant. Do you know if the pay campaign and demands have made much of an impression among colleagues at your trust, or not?
There are obviously very political nurses. But nurses are generally trained so hard to be so patient-focused that so many of my colleagues feel like they can’t ask for a pay raise at the moment because we are in a pandemic, and we don’t have the money for ventilators or PPE. So asking for a pay rise seems almost tacky to them. It’s like: we’re in this awful pandemic, people are losing their jobs outside of healthcare, people are on furlough, really suffering, and at least we have a wage. That’s what one colleague said to me – ‘well, at least we’ve got a stable job. How can we be asking for a pay raise when we have a job? Some people don’t have their jobs anymore’. So that’s a really, really tough environment to argue for a pay rise.
But when the defence budget was announced, I had quite a lot of messages from colleagues after the defence bill which were more along the lines of ‘what the fuck?’ So people might have kicked themselves a little bit. Maybe we might see people organising.