There is an awareness that general workforce capacity will need to be upscaled in the future as the NHS opens up to normal services again and in case of a second peak. The Nightingale hospitals have had an ingrained training and reflective learning component and this can also provide a useful model from which to think about creating a permanent training legacy and increasing intensive care capacity on a longer-term basis in the United Kingdom. Although there has been a chronic shortage of nurses in the UK, there is no current plan in the public domain to recruit and retain nurses in the context of COVID-19.
As stated in section 1.4, there is a move to recruit 18,000 people to support the contact tracing effort going forwards, including 3,000 from the NHS and a further 15,000 lay workers. It is not known how much progress has been made in doing this, but it is understood that test, trace isolate will work at 3 levels. centrally, regionally and locally.
The NHS in the UK went into the COVID-19 crisis with an existing shortage of nurses, doctors and allied health professionals in health and social care. It is expected that there will be worsening shortages with sickness and isolation and potentially fatalities. These health workforce shortages were well known prior to the outbreak and were the product of a multitude of factors including chronic underfunding.
To increase or maintain the availability of health workers, the NHS has recruited 750,000 volunteers (https://www.bbc.co.uk/news/uk-52196459) and tens of thousands of ex-doctors and nurses expressed an interest to support the response, though far fewer appear to have been actively recruited. The General Medical Council has also facilitated rapid re-registration of retired doctors and lifted pension tariffs to remove barriers to doctors wishing to work overtime (https://www.gov.uk/government/publications/coronavirus-bill-what-it-will-do/what-the-coronavirus-bill-will-do). NHS frontline workers from abroad have also had their visas extended so that they continue working (https://www.gov.uk/government/news/nhs-frontline-workers-visas-extended-so-they-can-focus-on-fighting-coronavirus).
Medical students’ exams have been suspended but they will be permitted to continue after suspension of the restrictions. Medical and nursing students towards the end of training are being licensed to practice so that they can support the response. Clinical academics have also been redeployed to the front line.
NHS England are now providing frontline staff with refresher training in respiratory management and staff being redeployed from other specialties.
There have been over 10,000 returning health professionals; 27,000 student nurses, doctors and other health professionals who have started work early; 607,000 NHS volunteers; and many in local government, social care, the military, the voluntary sector, hospices, and the private sector have also supported the response.
PHE have recruited and retrained volunteers internally to assist with contact tracing and providing advice, but the workforce is small and has been chronically underfunded and is therefore unlikely to be able to carry out mass population-wide contact tracing.
Social care workforce:
Social care staff were designated as ‘key workers’ on 19th March to enable them to continue to access childcare once schools were closed (https://www.gov.uk/government/publications/coronavirus-covid-19-maintaining-educational-provision/guidance-for-schools-colleges-and-local-authorities-on-maintaining-educational-provision).
Before the covid-19 crisis, the social care sector in England had 122,000 vacancies at any one time (https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/documents/State-of-the-adult-social-care-sector/State-of-Report-2019.pdf). Providers have reported that the staffing situation has been exacerbated due to staff sickness and the need for people to self-isolate when they or a member of their household are showing symptoms
The government’s action plan announced an ambition to attract 20,000 people into social care over the next three months by running a national recruitment campaign (https://www.gov.uk/government/news/adult-social-care-recruitment-care-campaign-launched-to-boost-workforce). The campaign will target returners to the sector, new starters made redundant from other industries and people able to take on short-term work (e.g. those on the government furlough scheme). Regulations and requirements (e.g. for DBS checks) have been relaxed to facilitate swift recruitment.
An estimated 8.8 million people provide unpaid care to family and friends across the UK (https://www.carersuk.org/search/facts-figures). Support offered to them has taken the form of enabling access to the furlough scheme for those with caring responsibilities and providing additional funding to the Carers UK helpline. National charity Carers UK has urged the government to do more to support unpaid carers, both in practical terms (e.g. raising carers allowance and ensuring access to PPE) and in terms of increased recognition. There is concern that unpaid carers are having to do more care as a result of staff shortages and are close to burnout (https://www.carersuk.org/news-and-campaigns/press-releases/research-the-forgotten-families-in-lockdown-unpaid-carers-close-to-burnout-during-covid-19-crisis).
Mental health and wellbeing of the health workforce will be crucial in the sustainability of the response and sustaining the health workforce. There has been a lot of work in the United Kingdom to acknowledge and provide mental health and wellbeing support to healthcare staff in recent years. This has included:
1) The creation of the Practitioners Health Programme (a service designed to support the health of NHS workers)
2) The Health England Mental Wellbeing Report (2019)
3) The interactive NHS England Health and Wellbeing Framework (2018)
4) A series of available resources published by NHS England
The COVID-19 support for healthcare staff therefore harnesses these existing resources and NHS England has prioritised three key areas including:
1) Prevention (increasing awareness, promoting mental wellbeing check-ins and reducing stigma;
2) Interventions (targeted to manage burnout and stress and to promote resilience);
3) Self-care culture (including the use of apps, mindfulness and lifestyle changes.
Historically, there has been less emphasis on the health and wellbeing of carers and health workers outside of the NHS but services are starting to become available very quickly in the COVID-19 response.
NHS England has created a ‘How are you feeling today’ tool to create a culture of openness about emotional health and to assess the impact of emotional wellbeing, to plan actions to promote more good days than bad days.
There are also Wellness Action Plans for teams, which include guidance, templates for employees and line managers, which have been created by the charity Mind as well as suicide prevention training for managers. In addition, Head First have also published mental wellbeing resources for ambulance workers who will often be the first responders and have been heavily involved in managing this crisis from an earlier stage than many others in the pandemic response.
The Royal College of Psychiatrists have also published guidance on maintaining organisational wellbeing during the pandemic, focussing on team resilience, how to appropriately re-deploy staff, organisational stability and leadership and managing the recovery phase: https://www.rcpsych.ac.uk/docs/default-source/about-us/covid-19/organisational-wellbeing-during-the-covid-19-pandemic.pdf?sfvrsn=eae67688_2
There is a hotline for NHS staff, which is manned between 7am and 11pm on weekdays by trained staff able to offer psychological support and to signpost to available resources for further interventions. Outside these hours, there is a 24/7 text service.
The Royal College of Nursing also have a free counselling service for nurses and the Mental Health at Work also provide free services for health and social care and all key workers, and those in the emergency services: https://www.rcn.org.uk/get-help/member-support-services/counselling-service
Frontline 19 has also teamed up with The Practitioner Health Programme and Helpforce to offer free online psychological services to frontline workers by trained therapists (https://www.frontline19.com/)
3. Self-care culture:
The NHS and Public Health England campaign, Every Mind Matters has a series of resources to support self-care in general to promote mental and physical wellbeing. While not specifically for health workers, these are a useful resource and signpost to available services. In Scotland, the ‘Clear Your Head’ provides a similar approach.
The Royal Colleges have also published a variety of resources for staff, including apps for emergency and critical care services, which also signpost to various mindfulness and wellbeing apps.
Despite all these measures, levels of anxiety are reported to be high in the health and social care workforce and many health workers report concerns about a lack of Personal Protective Equipment and fears that they are unable to speak out about these fears. In social care and in other sectors, some have been signed off for stress and others have resigned from their jobs in fear that their line of work may prove fatal to them. There is no available data as yet to fully understand the impact of mental health on the workforce.
The government has also now announced a death in service benefit for the health and social care workforce (https://www.medscape.com/viewarticle/929430?nlid=135281_5642&src=wnl_newsalrt_uk_200427_MSCPEDIT&uac=161387CJ&impID=2361450&faf=1), but there has been criticism over the government’s decision that health and social care worker deaths should not be referred to the coroner for investigation (https://blogs.bmj.com/bmj/2020/05/12/covid-19-rigorous-investigation-of-healthcare-workers-deaths-is-indispensable/). At present the health and safety guidance also does not necessitate reporting of all health and social care worker deaths unless it is clear that the individual contracted the infection at work, rather than in the community, which is extremely challenging in most cases (https://www.hse.gov.uk/news/riddor-reporting-coronavirus.htm). Nonetheless, the ONS has now released statistics that show that whilst health workers do not seem to be at greater risk of dying from COVID-19 when compared to the general population, social care workers were. However, patient -facing health care and resident-facing social care workers in the community are at greater risk of contracting the virus in the first place (https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/coronaviruscovid19relateddeathsbyoccupationenglandandwales/deathsregistereduptoandincluding20april2020#deaths-involving-covid-19-among-health-and-social-care-workers).