Frontline staff exposed to ‘moral injury’ during pandemic

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Frontline and key workers shouldered life-changing responsibilities without the power to act and many have suffered harm. Employers failed to protect staff, avoiding their responsibilities by hiding behind Public Health England's inadequate health and safety guidance. 60 bus drivers died in London alone. Frontline staff in the NHS and transport systems seized the initiative to maximise safety for their colleagues and the public. Serious damage to morale threatens further staff shortages post-pandemic.

Adding insult to injury

Day 5 of the People's Covid Inquiry, 21 April, heard powerful and poignant accounts from frontline staff. NHS staff gave deeply moving testimony on how failure to look after the physical and mental wellbeing of staff, over the past year, had led many to consider leaving their jobs. Dr Chidi Ejimofo, an NHS consultant in Emergency Medicine, whose trust lost staff to Covid, like so many others, said he was aware of at least two or three nurses who were planning to leave their jobs as soon as the pandemic is over. He told the Inquiry panel:

We have had a lot of junior staff throughout who have seen things that I don't think they should [have] (1) ever had to see or (2) deal with - and feel as if they were personally responsible for. I know that has led to a lot of people reassessing whether they wish to stay in the NHS.

Of course we are entering into a time of economic uncertainty so it may be that people may want to hold on purely because of finances, but in terms of enthusiasm for the job and the feeling that it is a profession you want to remain in - No: that has been lost and it hasn't been helped by the final insult which was the non-existent pay [offer] for health workers, especially the most junior.

'Moral injury'

The challenges faced by nurses were elaborated on in explicit detail by witness Kirsty Brewerton, NHS Clinical Sister, who blamed 'moral injury' caused by not being able to provide adequate treatment to patients for her own mental health problems and suicidal feelings. In measured yet poignant tones, she said:

This final wave that we've just overcome was really, really, tough. The staffing was the worst I think I've ever seen it. There were instances when there was one nurse to 21 patients. We've lost staff throughout the pandemic through illness or staff leaving. We're not trained to deal with these types of situation, we're not routinely risk assessed to deal with mental illness or stress.

Mental health support is sporadic and varies from trust to trust, there's no minimum amount of support that should be available and there is a duty of care required, its a stressful job which is getting ever more stressful, and addressing it should be a priority. I worry that the moral injury will have a massive impact on retention, and I hope that trusts are really mindful of it and support their staff going forward.

Insult

There is currently a shortage of nearly 40,000 nurses in the NHS. Many other witnesses throughout the People's Covid Inquiry have pointed to underfunding and staff shortages, caused by 11 years of austerity, as part of the reason why the NHS struggled to respond to the demands of the pandemic.

The 'offer' of a one per cent pay rise has been greeted with outrage among many public sector workers and nurses' trade union RCN recently started planning for a possible ballot for industrial action in protest. Dame Donna Kinnair RCN CEO and general secretary had been due to appear at this session of the Inquiry but had to withdraw.

'A wing and a prayer' - key workers unsafe and unsupported

Tube staff and bus drivers were also left in unsafe working conditions due to lack of employer and Government action, said ASLEF branch rep and tube driver Unjum Mirza.

So many bus drivers told me they were just totally abandoned [as] safety protocols and measures on the buses was just non-existent. Essentially [the Government was] trying to run this on a wing and a prayer, where we do the praying, and they do the winging.

While employers claimed they were following PHE [Public Health England] advice on workplace safety to minimise the risk of employees catching COVID-19, Professor Raymond Agius, Professor Emeritus of Occupational and Environmental Medicine at the University of Manchester said this was not sufficient considering the risk faced:

I think few people would disagree that [making workplaces safe] warranted a very detailed and substantive assessment of the general risk to their employees. Therefore I would say that in the early stage [of the pandemic] saying: 'We read PHE guidance and that is what we are doing' - in my opinion, that would be very disproportionately poor in comparison to the risk.

Mr Mirza added that these workplace risk assessments were not made available for tube drivers until June 2020, and he had been forced to refuse to work under section 44 of the Employment Rights Act to ensure a cleaning rota was displayed in tube cabs for the protection of himself and fellow colleagues. [Section 44 was also used by school staff and affords workers the right not to be subjected to avoidable health and safety risks at work which their employers are fully aware of.]

The panel for the People's Covid Inquiry includes chair Michael Mansfield QC, Professor Neena Modi, Dr. Tolullah Oni and Keep Our NHS Public's Dr Jacky Davis. Lorna Hackett is Counsel to the Inquiry.