No Exit Strategy Without Healthcare Workers

The NHS was already in crisis before coronavirus, now research shows 300,000 of its workers want to leave – any end to the lockdown has to put their safety first, and commit to real investment in improving conditions.

Covid-19 has caused unprecedented strain on our health and care system. Our entire strategy has been designed to keep demand below the system’s finite resources – by “flattening the curve.” The consequence of failure would be catastrophic for the health service and the nation. 

Undeniably, not everything has gone right. Many have seen their treatment delayed or cancelled. Health and care professionals have been pushed to work without the right protective equipment – putting them at unacceptable risk. Even so, it does now look like the Covid-19 peak will not entirely overwhelm the system’s capacity. Our huge societal effort of social distancing, combined with the immense bravery of our health and care staff, has helped avert the immediate worst-case scenario.

But, tempted as we may be to let out a sigh of relief, now is not the time to kid ourselves. We’re not out of the woods yet. Indeed, we still remain on course for a catastrophe for the public’s long-term health.

A Workforce Catastrophe

Our long-term trajectory will be defined by the impact the crisis has on health and care workers. IPPR and YouGov polling shows we’re on the cusp of a catastrophic, long-term loss of capacity in our healthcare sector. Specifically, it revealed that more than one in five are more likely to leave healthcare as a direct result of Covid-19. 

In the NHS, that means about 300,000 workers are considering leaving. 

It cannot be understated how scary this is. We are already beginning to see how damaging a loss of capacity could be for the nation’s health. Many of us have seen appointments cancelled or treatment delayed. Last week, it was reported that ‘urgent’ cancer referrals since the start of the pandemic have dropped to just 25 per cent of the usual level. Those attending A&E for heart attack symptoms has also dropped by 50 per cent. Behind each number are thousands whose health is at risk.

This is the new normal we face if Covid-19 is allowed to drive a collapse in the health and care workforce. In the NHS, it would be another rollback of universality – another step away from Aneurin Bevan’s founding principles. In the social care system, it would be yet another nail in the coffin of a marketised system that hasn’t had proper funding, stability or the necessary capacity for decades. And this would not just be felt for weeks and months, but for years and decades.

The Blame Game

If workforce numbers do begin to decline, we’re likely to see blame shifted to health and care workers who leave – for not ‘sticking it out’. The 2016 junior doctor strike was testament to how easily they can be scapegoated. Indeed, this is already beginning again, in vitriolic stories bemoaning health and care workers daring to dance in TikTok videos. 

The shallowness of solidarity with frontline workers in some sections of the commentariat is becoming visible. So let’s be clear now. It is not workers who will be to blame. 

Even before the crisis, the strain of working in the healthcare sector was immense. The problems start with austerity. Throughout the last decade, the NHS was not given the money it needed, so it had to struggle on through other means. Pay and conditions were cut, hours made longer and working conditions worsened.

This created a vicious and self-perpetuating cycle. As staff surveys attest, burnout, stress and mental ill health all increased. In turn, people left the service (or, decided not to join it). At the start of this year, we were short of thousands of nurses and GPs, tens of thousands of nurses, and over a hundred thousand social care workers. This reduced capacity and increased the burden on those who were left. 

Then Covid-19 hit. From a low base, Covid-19 has made working conditions exponentially worse. IPPR polling shows that one in three healthcare professionals has seen their physical health worsen during the crisis. One in two say their mental health has got worse. And equally large numbers cited problems around their welfare – from childcare to personal finances, from job security to housing.

The fact they tirelessly work on through this is all testament to the courage and sense of collective purpose that health and care workers have. But it also exposes a wider trend – our willingness to exploit the goodwill of our health and care professionals. This was never sustainable and, now, we’re approaching breaking point, it certainly isn’t.

Of course, a collapse in capacity is not inevitable. Government still has options to ease the pressure on the frontline, and change the long-term trajectory. But this will need – at the very minimum – a far quicker, stronger and clearer commitment to their health, security, pay and recognition in the weeks and months to come. 

No Exit Strategy Without Workers

Opposition parties have been pushing the government to be more transparent about their ‘exit strategy’. But all political leaders must be under no doubt: there is no exit strategy without workers. A comprehensive and urgent support package for the frontline – covering health, mental health and welfare – will be critical.

The government have compared Covid-19 to war – over and over again. But war, and events on its scale, always necessitates a change in the social contract. Put simply, they require significant uplifts in welfare, security and support; particularly for those, like our health and care frontline, who have given the most. 

Badges and medals just will not cut it. If World War 1 had ‘Homes Fit for Heroes’, and World War 2 ‘from cradle to grave,’ then the onus must be to provide something similarly tangible and on a similar scale. It is time to provide ‘Care Fit For Carers.’

This should focus on five guarantees that will help protect our frontline and avoid a crisis of capacity post-pandemic. First, we must ensure their safety. All workers must get the PPE and testing they need. But mental health is also critical, and we need to see all workers getting the personalised, bespoke support they need – whether that’s peer support, or full 1-2-1 therapy. 

Mental health needs are often accentuated by anxiety around childcare or housing. On childcare, we should be following the lead of Wales, who have expanded provision for all key workers. On housing, no-one manning our Covid-19 response should feel insecure. They, at the very least, should have a rental amnesty.

Finally, many are further struggling with finances – whether because they are only entitled to Statutory Sick Pay, or from the legacy of the public sector pay freeze. We must do better – by paying full pay during sick leave, and by providing a 10 per cent Covid-19 service award.

This kind of intervention should not be seen as radical. Rather, it is the very minimum we should be doing for health and care workers at a time they are doing so much for us. At our hour of need, they were there for us. It’s time for us to be there for them. 

If we aren’t, then the consequences will be catastrophic for us all.