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After an unrelenting year, stressed-out NHS staff deserve more than a clap

Posted at Jan 12, 2021

O ver the course of this pandemic, I have thought a lot about parallel lives. Back in the eerily quiet spring days of the first lockdown, it became apparent that healthcare workers were living a radically different existence from the rest of us. While many of us were safe in our homes, frightened but distanced from the grim realities of death at the hands of Covid-19, health and social care workers were out there in the thick of it. Try as we might, we could never fully understand what they had been through, and continue to go through, every day.

That feeling – that no one truly gets it – has only deepened with time. I started interviewing healthcare staff and the psychologists who have been treating them in March last year, and since then I have seen morale weaken dramatically. I cannot speak for everyone – the NHS is an enormous organisation made up of hundreds of thousands of people – but I feel that I can shed some light on how the ones I have spoken to are feeling. Strict communications rules, combined with a tendency in the medical profession to not want to admit you are struggling, mean that we are not seeing the full picture in terms of morale. On top of that, there’s the feeling that the public don’t want to hear about it. We want to believe that we are in safe hands; that the people who care for us are invulnerable.

At the beginning of the pandemic, there was a sense of everyone pulling together in an extraordinary set of circumstances. Though the weekly applause felt uncomfortable for some, many I spoke to at least felt supported by the public. There was energy there, particularly on the part of junior staff.

But in the intervening months, disillusionment has set in for many health workers, who were not given the respite that they needed after the first “phase” of the pandemic and were expected to do it all over again. Phrases such as “it is what it is” and “the new normal” reappeared, and while many healthcare staff have felt a passionate duty to the public, there’s a feeling of resigned anger, too. Anger at the government, and in some cases at the public, for not observing social distancing and taking too many risks. It is, after all, the medics who bear the brunt, both in terms of seeing the consequences as patients struggle for breath on their wards, and the mental health impact. One psychologist who supports NHS staff told me that, after the announcement that the weekly “clap for carers” was to return, that the workers she spoke to were “raging”. One said: “Fuck your clapping. Wear a fucking mask.”

“Very often it is the small things that break the camel’s back,” says Claire Goodwin-Fee, of the psychological support service Frontline 19, which has been offering free therapy to frontline staff during the crisis. “People will deal with the really difficult things, like seeing multiple people pass away in a ward. They’ll tuck it away. And then they’ll go home and see somebody not wearing a mask on the tube.”

The psychological impact of the Covid crisis on staff will not be fully known until after the pandemic – there is usually a delay between the traumatic experience, or in this case, repeated traumatic experiences, and the onset of symptoms. The NHS is currently on a war footing, without a war. “Things are as bad as I have ever seen them,” one staff member said. Some workers are already being treated for post-traumatic stress, and as the pandemic continues, those numbers will increase, without fully funded services in place to treat them. The word I keep hearing, again and again, is “abandoned”.

I know I am painting a bleak picture, but it is vital that we understand the sacrifices being made. With a rightwing press largely hostile to lockdowns and Covid deniers protesting outside hospitals and in some cases even breaking into them, it feels as if gratitude is at an all-time low.

The chalk rainbows may have been long washed from the pavements, but there are still ways that we can show we care. The acknowledgment of the contribution made by black and minority ethnic staff members – for example the huge numbers of Filipino nurses – is encouraging. There needs to be more understanding, however, of the role that low-paid NHS staff are playing, such as hospital porters who, unlike doctors, may be far less well-equipped to handle so much death and without commensurate remuneration.

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I sincerely hope that those in power are already looking at how the country can say thank you. Though some have said they wouldn’t mind a medal that they could one day pass down to their grandchildren, our gratitude must go beyond that. Pay rises, time off that allows staff to reconnect with family and friends,and adequate psychological support – all of these should be considered, as they can make a big difference to the future mental health fallout. The more supported staff feel at work, the less they risk mental health issues later on. Outreach and support for the families of frontline workers is also vital.

We must also be sure not to forget social care staff, who are working tirelessly in care homes and are arguably even more invisible. Goodwin-Fee told me of one social care worker whose home had lost 70% of its residents. That care worker washed and dressed every single body, and then went home to cook tea for the family. It is no wonder that, when such people are asked, “How was your day?” they find themselves unable to speak.

The stories I am hearing suggest that the unwritten psychological contract that staff have with their employers – whether the NHS or the social care system – is under strain. This is far beyond what most signed up for, and many are taking early retirement, changing jobs, or leaving altogether. After years of austerity, an exodus of people who are feeling burned out, scarred and undervalued is the last thing our country needs.

• Rhiannon Lucy Cosslett is a Guardian columnist