It is difficult to respond to Boris Johnson’s advice when it is hidden behind vagueness and incompetence. It is also difficult to respond to Matt Hancock when his ‘spin’ is removed from the context of the latest statistical data he is misinterpreting.
On May 11th, the Office for National Statistics (ONS) reported that men working in the lowest skilled occupations had the highest rate of death from Covid-19 with care workers and home carers also having a much increased risk. The Minister for Health and Social Care, Matt Hancock, ignored such dramatic and alarming findings, choosing instead to trumpet as good news the fact that healthcare workers (mostly NHS) are dying in similar numbers to other key workers. What conclusions he wanted people to draw are unclear, but presumably meant to imply that provision of PPE has been a success rather than the disaster graphically illustrated in the BBC’s recent Panorama programme. No doubt it was also aimed at reassuring people about a return to work following premature easing of lockdown restrictions. However, this monumental tragedy now has a death toll approaching 60,000 overall, and is clearly something neither to be lauded (‘think of all the people who have not died’) nor considered a ‘success’.
There are recognised limitations to the ONS study, which set out to investigate deaths by occupation. It is the informant who registers the death that states occupation, and this goes into broad rather than specific categories (e.g. ‘nurse’ rather than ‘intensive care nurse’, ‘outpatient nurse’, etc) and does not distinguish between health staff in patient facing roles from those who might have been working from home. In addition, for one fifth of males and two fifths of females in the ONS study, no occupational details were actually provided. We know that occupational risk to health staff has been strongly shown in China, Italy and the US, so it would be strange not to see it in the UK. A recent study of testing hospital staff showed three times as many with the virus when working in areas with Covid-19 patients. In health and care settings, there is also an obligation for doctors to report to the coroner deaths with suspected occupational exposure as a factor, and death certification will then not happen until any investigation has been completed. Importantly, the ONS figures have not been adjusted for factors such as ethnic group, place of residence and deprivation – all well established risk factors for Covid-19 infection. As the authors state, this study “does not prove conclusively that observed rates are caused by differences in occupational exposure”. Another conclusion might have been that this study “cannot tell us how many people have died from Covid-19 as a consequence of their work, but hopefully this will be possible in time”.
There are also good reasons why the death toll in hospital workers recorded in the ONS data may have been limited. Every NHS trust has large numbers of infection control staff, training departments, stocks of equipment and (although struggling immensely) logistics and supply chains. They also have ‘major incident plans’- even if not in receipt of the pandemic planning assistance and PPE stocks that were demanded by the civil service yet ignored by government. Hospitals are designed to contain infectious diseases, unlike shops, buses or taxis for example. Nurses receive three years of training, and work day-to-day to minimise transmission of infection. The rates of death among healthcare staff (a generally young and fit workforce) should be low, had they been given the tools and PPE at the right time and had a timely lockdown, test, trace and isolate policy been implemented (4).
Messaging from the minister saying that ‘NHS workers are at a similar risk to others’ hides the excess deaths in occupations such as social care, security and cleaning – all of which are part of the frontline health and social care sector. Comparing occupations when all are exposed to increased risk while under-protected should not fuel Hancock’s reckless speculation. These death rates also reflect the effect of social isolation, physical distancing and closing of schools and workplaces. It is important that the ONS findings are not in any way interpreted as sending the message: “It’s just as safe being out and about at work as being a health care worker, and health workers are no more at risk than the general population, so what are you worrying about?”. As the Independent SAGE group (formed as a shadow organisation to the government’s official Scientific Advisory Group for Emergencies) have pointed out: “To encourage return to work at short-notice without a new, appropriate health and safety framework having been agreed by Parliament nor with the trades unions, endangers lives and will cause high levels of stress, and in some cases trauma and job resignations in a bid to protect vulnerable families from having the virus brought from work into the home”. Those who are now being asked to return to work should confer with colleagues and consult the advice of their union about whether it is safe to return. (Those who are not yet members of a trade union, but want to be, can find and join one using the Trades Union Congress ‘union finder’ tool.)
The Health and Social Care minister would do well to ruminate on the increased risk and tragic loss among dedicated social care workers – many of whom are from black and minority ethnic groups. These individuals did not need to die in such great numbers. They could have received access to the protection provided to NHS staff if they had been part of a similar, joined-up, nationalised public service. The deaths in care homes also illustrate how the ‘Wild West’ privatised social care sector has failed tragically and spectacularly. The political establishment needs to look at what factors have allowed the NHS to work ‘better’ (although not ‘at its best’ because of shortages of both staff and PPE). The lesson is that when building for a better future we need a nationalised social care service, with high standards and proper pay, in order to protect both those who need social care and those who deliver it, and which can work in close cooperation with the NHS. The political parties must plan for bringing the social care sector into national ownership so this tragedy can be halted and prevented from happening again. Private providers are clearly not doing well enough and when they are hit by the coming recession, as they will be, the government will be forced to step in.
By Nurse Iain Wilson and Dr John Puntis