Why the NHS needs a Covid-19 rota 'dimmer switch'

General Secretary Paul Donaldson explains why HCSA is calling for a rota 'dimmer switch' to guard hospital NHS staff against burnout during the Covid-19 pandemic

Covid-19 has affected all our lives. People across the globe have had to change the way they live and work. NHS staff are working in high-risk, stressful and unimaginably difficult circumstances at times.  

For hospital doctors, the type of care they offer has had to change. Their training was stopped or curtailed at the height of the pandemic. This particularly affected junior doctors. They were often placed on extra shifts. This sometimes happened at short notice and lead to breaches of the Working Time Directive. For many the pay they would receive was not known in advance. There are those who did not know - even afterwards - what pay they would get. Even worse, a few doctors have had demands for return of their wages, with Trusts claiming they had been overpaid.  

Unfortunately, for large numbers, this situation of arduous rotas, contestable pay and the 'unknown' continued for a long time - even as the first wave was noticeably receding. The changes to the individual and capacity overall were much in excess of what was needed. This was not known in advance and initial over-estimation was understandable and prudent even in retrospect.  

However, for many the excessive rotas and pay uncertainty all just suddenly started and then just as abruptly stopped. It was like the flicking on and then switching off the light switch. 

It is now imperative we learn lessons from the first wave that can be implemented during the second wave.  

For staffing this is where the ‘Dimmer Switch’ is needed. Many staff groups had been affected by an excess of shifts and sometimes were working in unfamiliar settings (both speciality and geographical location). This was, and still can be, compounded by not knowing the rate of pay for the work they are carrying out.  

HCSA has proposed that a mechanism is needed that will allow for an increase in staffing with known proposed rotas and known locations ahead of any pandemic related work. It is suggested that there should be plans for different levels of demand. 

We have suggested three levels of activity above normal expected level of activity. Triggers for each should be determined locally for each Trust/Health Board. It should be clear what the triggers are and the activity expected at that level. Similarly there would be triggers to step down activity and level based on the same criteria. Clearly an edict nationally would over-ride any local level of activity. 

HCSA has put forward both in a medical/dental arena and to other NHS Trade Unions the concept of the ‘Dimmer Switch’. We expect it to continue to receive support.  

The light that can go on and off progressively rather than on/off would be a benefit to all of us. It would enable some idea of future demand to staff affected and not come as shock when changes happen; it would be a protection of the ‘precious resource’ that is the NHS staff and should help reduce potentials for stress/burnout; it would help Trust management get better and more effective staffing; it would help the NHS finances by not having too many people working when they are not always needed. 

It’s a win-win situation. HCSA would like this scheme adopted nationally with the detail of staffing and triggers locally. The ‘Dimmer Switch’ is what we need and we need it now. 

We don’t need to be in the dark but we don’t need to be dazzled by the bright lights either. 

Dr Paul Donaldson was a consultant microbiologist for more than 20 years until he left the NHS in April 2020. He was elected as General Secretary of the HCSA in March 2020.