President's view: We need more than warm words to avert a post-Covid staff crisis

Hospital doctors are growing used to praise, but words without action will not avert a post-Covid staffing crisis, writes Dr Claudia Paoloni.

Hospital doctors have risen to every challenge which has been placed before them by Covid-19.

Twenty-two have paid the ultimate price. The youngest was just 44.

NHS staff do not see themselves as heroes, because they are just doing their job.

But neither do they wish to be taken for granted.

All too often extravagant praise lavished on the NHS workforce is not matched by deeds. This has been all too clear during the Covid response.

The recent Comprehensive Spending Review was a prime example of such exercises in PR.

In a seeming effort to avoid the accusation that NHS healthcare workers’ efforts were not being recognised, prior leaks suggested that they would be exempt from an otherwise universal public-sector pay freeze.

Setting aside one’s own view of the wider policy, when it comes to the NHS the devil is in the detail.

What we eventually heard from the Chancellor was the minimum possible acknowledgement of the huge and ongoing efforts of front-line staff.

Not a line in the detailed accounts presented related to pay, although another £15 billion is to be earmarked for test and trace. There was merely a promise to “take into account” the recommendations of the DDRB pay review body.

The Chancellor’s tight-lipped announcement naturally fuels speculation that hospital doctors can expect only to be less badly treated than the rest of the public sector.

The government may well be hoping that by the time it announces our pay award it will have created enough distance from the peak of the pandemic to follow through on its promise in a technical sense only.

If so, this will be a huge misjudgement.

Locally, across the country, hospital doctors have witnessed a growing culture of complacency towards their worth and wellbeing during this pandemic.

When doctors’ leave is arbitrarily cancelled or refused, or they are asked to return wages paid during the chaotic first wave months, it sends an unspoken message.

When doctors terrified that Covid threatens them or their families are bullied in to hospitals for fear of losing their income, it gives the lie to claims that wellbeing matters.

When they are placed on emergency rotas on a whim, and these continue with little opportunity for recourse – services come first is the management mantra – it reflects the disempowerment and dehumanisation of those who are bearing a double burden.

We are not just dealing with gruelling toll of the pandemic at work but facing the challenges it brings into our home lives just like everyone else.

Doctors are not heroes and neither are they superhuman.

Inevitably this pandemic has taken a toll on everyone involved. Staff who have been holding things together for months are now being asked to make a winter push without proper rest since the first wave.

The NHS has pointed to its success in delivering elective care and diagnostic services, which in many areas have reached near pre-Covid levels. But these advances have been built on the back of the workforce.

The return of non-Covid services represents a tremendous achievement by hospital doctors and NHS colleagues. It reflects a heroic effort to keep the NHS machinery working throughout the summer months and into the autumn, even as a second wave began.

But everything has a breaking point.

When it comes to Covid, running the NHS too hot places both staff and patients at greater risk – now and in the future.

Tired doctors make mistakes. Exhaustion can even lead individuals to become apathetic towards their own safety.

Wellbeing is not just a mantra to be spoken, it is a state which every one of us deserves to feel.

The stakes are high. We cannot afford to let our staff crumble. We need a cultural shift which puts an end to wave after wave of blows to their physical and psychological wellbeing. It’s a case of “care for us so we can care for you.”

It is past time to call out the emotional blackmail we see all too often from some managers which pushes us to the limits of human endurance because staffing budgets are set too low.

This is something HCSA confronts at a local level on a daily basis.

Similarly, too often policy-makers this year have betrayed their misguided belief that physical objects are “the precious resource”, as the Secretary of State infamously stated in Spring.

They have shown a willingness to throw billions upon billions at schemes which have in many cases failed to live up to their promises.

The one thing that has delivered consistently, and still does to this day, is the hundreds of thousands of committed individuals whom the service must nurture and retain if it is to sustain quality patient care.

The government must now act on the lessons of Covid and deliver real action to resolve systemic short staffing. But while pay and reward are not the reason hospital doctors turn up to work every day, nor the only cause of the short staffing we now see, they are not a disconnected concept.

Real-terms pay decline and the failure to value the NHS workforce are having a corrosive impact. Misjudgement at this crucial juncture can only contribute to a malaise that eats away at wellbeing.

When this winter is done, the decisions which are taken now will chart a course for future waves of the pandemic, and for the future state of the health service.

Words of praise are simply not enough.