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Burnout and exhaustion stalk NHS response to Covid second wave

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NHS workers went into this autumn’s second wave of Covid-19 already feeling exhausted, emotionally fragile and at risk of burnout. As a recent virtual conference discussed, this means supporting the psychological as well as physical health of NHS workers will very much need to be a priority going forward. Nic Paton reports.

Given how long it normally takes for lockdowns to feed through into reduced Covid-19 caseloads and hospital admissions, let alone declining deaths, there is probably one thing we can predict with a fair degree of certainty about last month’s national lockdown in England.

Irrespective of how effective it has been – and at the time of writing we were just entering the month-long restrictions – we can be pretty sure that NHS doctors, nurses, clinicians and support staff will be on their knees by Christmas, especially mentally and emotionally.

Even before the first wave of Covid-19 had dissipated, a British Medical Association survey in April found that fully 44% of doctors felt they were  suffering from depression, anxiety, stress or burnout.

The Royal College of Nursing warned in June that the nursing profession had been left “exhausted” by the first wave of the pandemic. And this grim picture was echoed by a poll in August by the NHS Confederation’s Health and Care Women Leaders Network, which found 72% had felt their job was having a greater negative impact than normal on their mental wellbeing as a result of Covid-19, with 52% saying the same for their physical health.

Heading into the second wave already exhausted

As Lucy Warner, chief executive of the NHS Practitioner Health support service, warned in October, the net result is that many clinicians have headed into the second wave of coronavirus already feeling brittle and on the brink emotionally; at risk of burnout and questioning how – or even if – they want to carry on.

In October we have seen all those signs of people starting to feel very, very tired, feeling exhausted, feeling like their morale is dropping and they are losing motivation,” – Lucy Warner, NHS Practitioner Health chief executive

NHS Practitioner Health is a free, confidential service available to doctors and dentists across England via a self-referral phone line, website or app. Back in the spring and the start of the pandemic, the service had seen lots of cases of “anticipatory anxiety”, or where people were anxious about what was coming.

This had been followed during April and May by increasing numbers reporting feeling guilt about having to take time off for their mental health and the knock-on impact of this on teams and colleagues.

“In October we have seen all those signs of people starting to feel very, very tired, feeling exhausted, feeling like their morale is dropping and they are losing motivation,” Warner told the virtual conference on ‘The health workforce and delivering the ambitions in the NHS People Plan’ run by Westminster Health Forum.

“We are getting lots of people questioning whether their vocation is still what they want it to be; whether being a clinician, whether working in medicine, is the right thing for them right now. I think that is a real warning sign for us. We have to think very carefully about how we support staff as we go through these next stages,” she added.

“For all those people who haven’t yet taken any annual leave this year – and we know there are huge numbers of healthcare staff who are reluctant to take any leave or take just small amounts of leave – when they do take that one day or weekend, or even an entire week, off, how do they really, really unwind or escape from what is going on?

“Because everywhere we look, whether it is sitting down on a Saturday night to watch Strictly or Bake Off, where they have gone into their bubbles, there is still talk of coronavirus; there is still talk of the pandemic; there is still talk of social distancing. So how do we really escape and how do we make sure we make the most of our time off?” Warner added.

Collaboration with occupational health

While Warner conceded the service and its work is very discrete from occupational health, she emphasised both needed to be working together to raise each other’s profile within the NHS.

“Many clinicians, we find, don’t necessarily understand the role of occupational health; they view it as ‘those people who check when you’re about to start a new job’. But they don’t necessarily see the value that occupational health can bring when you’re struggling,” Warner said.

“For us, being able to liaise with occupational health when we’re embarking on treatment, but especially when somebody has completed treatment and they are looking to return to the workplace, can be really, really helpful. Occupational health is so key in determining what those adjustments could be, and making sure people can continue to stay well once they’re back and once they’re recovered.

“I think the other value for us in occupational health is the promotion; really making people aware that, if they’re struggling, if they come to occupational health, that they can then signpost them to us as a confidential service where they can get help,” Warner added.

Wellbeing at heart of NHS People Plan

The conference also had Prerana Issar, NHS chief people officer, as a keynote speaker. She emphasised that focusing on, and investing in, staff health and wellbeing was one of the NHS People Plan’s four priorities (alongside the need for more staff, more innovative ways of working, and the fostering of a compassionate and inclusive environment).

As she put it: “The reality of navigating a global pandemic is that it has revealed more clearly than ever the NHS’s most important asset is its people. The NHS doesn’t exist without its people. Our fourth priority is therefore to support our staff to manage the challenges that we all face together.

“Colleagues working across the service have been under increasing pressure since the response to Covid-19 began, both from their jobs, but also as citizens. Because all of us have experience of the secondary stresses of the pandemic, whether it is worrying about loved ones, losing loved ones, or the financial stresses, or the uncertainty of children in or out of school. So it is the work as well as what is happening in our home lives. And there will be further challenges ahead.

“Risk assessments are not just about PPE; they must be undertaken for all colleagues so that we can establish and make adjustments for everyone’s needs when appropriate. And these are most effective when underpinned by compassionate application,” she added, emphasising there needed to be a focus on psychological as well as physical safety.

“From this autumn, everyone should have a health and wellbeing conversation. Every individual, every one of our 1.3 million people, should have an individual health and wellbeing conversation every year, and especially during the pandemic much more often than that. The challenge is it does happen in many places, but not all. So we want all staff to have that conversation,” Issar said.

From this autumn, every one of our 1.3 million people should have an individual health and wellbeing conversation every year, and especially during the pandemic much more often than that” Prerana Issar, NHS chief people officer

Lack of ‘head room’

The virtual event was concluded by Alastair Henderson, chief executive of the Academy of Medical Royal Colleges, who also focused on the growing worries around workload and burnout.

“The increase in work, the increase in activity, leading to burnout of staff; the impact that has on staff,” he said. “But also, importantly, what I call ‘head room’. That means the time for all staff, but particularly clinical staff, to be able to think about the services they provide and how to improve and better them.

“That is very hard to do if you are on the hamster wheel, and the message that we get is people are so busy dealing with the immediate that we don’t actually have time to deal with the future things. And that to me is a real casualty of the workload problem we have got,” he added.

References
“Stress and burnout warning over COVID-19”, BMA, April 2020, https://www.bma.org.uk/news-and-opinion/stress-and-burnout-warning-over-covid-19

“Exhausted nurses ‘will need support to restart services’ after pandemic”, Nursing Standard, June 2020, https://rcni.com/nursing-standard/newsroom/news/exhausted-nurses-will-need-support-to-restart-services-after-pandemic-161846

“Warning of Covid-19 burnout risk among female health staff”, Nursing Times, August 2020, https://www.nursingtimes.net/news/workforce/warning-of-covid-19-burnout-risk-among-female-health-staff-25-08-2020/

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