The Government’s Covid-19 rules don’t
help in sorting out what might be the right things to do either. Whilst the Government
website rules are clear about who can meet inside - only those you live with or
form part of your support bubble - the rules for meeting outside are less
clear. On one hand you cannot meet anyone socially you don’t live with or have
a support bubble with in a private garden or at most outdoor public spaces, but
on the other hand it goes on to say ‘However you can see friends and family you
do not live with (or do not have a support bubble with) in some outdoor places,
in a group of up to six’. Confused.com?
Whilst the rules are set to allow
more freedoms for families to mix between the 23rd and the 27th December, to do so is a dilemma that I think will challenge many people. I fear
that just like the recent Thanksgiving celebrations in the US, unless people
abide by the rules, Christmas will bring a third wave of community infections
and once again our hospitals and primary care services will run the risk of
being overwhelmed. None of my or J’s children or my 11 grandchildren form part
of our ‘Support Bubble’. Faintly clandestine meetings at motorway service stations
have been mentioned. But none of us really wants to do that. Shades of going to
Barnard Castle spring to mind. Who to meet up with and where is a dilemma that I
suspect many families up and down the land will be wrestling with.
Strangely, where to spend Christmas
Day wasn’t always a problem for me. As a nurse and senior nursing officer, I
would always spend much of Christmas Day at the hospital, visiting staff and patients
alike. As my family grew, and I moved into general management, I stopped making
these Christmas Day visits. Of course, there are many health and social care
colleagues who will be away from their families over the Christmas periods. They
will be working in the wards, care homes, A&E departments, in primary care
and in the community. This year, the pandemic has meant that many of these
staff are already exhausted and face the prospect of not having much rest or
respite over the Christmas period.
When politicians and the media ‘shroud
wave’ about the NHS being overwhelmed, it’s because there might not be enough
staff to run the services. And there aren’t. I live in the North West and every day there are
around 11% of staff absent from work due to either being Covid positive, in isolation,
suffering from stress-related mental health problems or some other health
problems. That is 1,500 people not working. This compares to the ‘normal’ average
absenteeism rate of about 4%. It’s true to say that the pandemic has brutally exposed
the reality of the workforce issues facing health and social care services. Last
week the informed, independent and research-based Health Foundation published a
report by its REAL (research and economic analysis for the long term) Centre. The
report was entitled Workforce Pressure Points (Building the NHS Nursing
Workforce in England). You can find the whole report here. Be warned. It makes
for a sobering read.
The report notes that even before
the pandemic, workforce issues had increasingly become the biggest challenge
for health and social care services. Nurses are the key group of workers where
the shortage of staff has become critical. Just under half of all vacancies in
the NHS are nursing posts. So we have a perfect storm of long term nurse
shortages, exacerbated by Covid 19 absences, with those that are in post
becoming increasingly exhausted and less resilient. There are also the negative and demotivating consequences of individual nurses once again being moved from their regular specialist
areas to support the demands being faced by critical care services. Much research has shown that high workload (and the stress this brings)
leads to feelings of not being able to provide the appropriate quality of care.
It can quickly become a professional and personal dilemma that fuels nurse
dissatisfaction and increases the risk of nurses leaving the profession.
If the demand for Covid-related critical
care doesn’t lessen, I predict that much of the elective work that was restarted
in the Autumn will once again cease. In turn reducing or stopping elective work
will store up real problems for the future as waiting lists grow longer by the
day. Causing harm to patients, past, present and in the future is not what the NHS
is about – the reverse is true of course. When, or if, to take a decision to stop
elective services in order to prevent the NHS from becoming overwhelmed is a dilemma
that managers across the NHS are increasingly having to face.
The Health Foundation report charts
the reasons for the shortage of nurses, most of which are probably well known.
There are no quick and easy solutions, but I was struck by two of the issues that
could be addressed immediately. The first was retention. Much more needs to be
done to retain those nurses we already have. Measures to ensure staff wellbeing
during the pandemic have resulted in some success, albeit this is increasingly
becoming limited. More needs to be done with much greater investment required
to effectively support and retain our nursing colleagues. Fair pay,
proper access to supported continuing professional development, flexibility of working
hours and a supportive working environment are just a few examples. The other
issue was overseas recruitment. A national, ethical and properly resourced
approach is required. If we don’t put such an approach in place, we will be guilty
of simply applying an immoral sticking plaster. Both these approaches will cost
money, and there are many choices as to how our scarce public money might be spent.
It is, of course a live dilemma for our politicians to grapple with. I hope,
like my children this Christmas, they choose to do the right thing.
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