Female doctors say they have ‘felt compelled to step up’ during the pandemic, even though they knew they were at risk, as BMA research shows that they have been consistently taking on extra – often unpaid – work to the detriment of their own wellbeing and mental health.
In a diary, written as part of this research, a female doctor from an acute specialty wrote: ‘As the first cases started to be reported in the UK we also heard that men were dying in much higher numbers than women, and the chance of serious illness or death was higher the older they were.
‘All of our team members over the age of 50 were male. I knew that although every extra hour at work created more risk to myself, the risk was less than that being faced by my older, male colleagues. Putting myself forwards to work in the red zones and to take on additional clinical work wasn’t something I debated.’
The Association has been regularly surveying doctors across the UK since April last year to better understand their experiences and the issues they face as they work through Covid-19.
When comparing genders, the BMA’s latest survey of more than 7,000 doctors, found that 27% of women answered ‘yes’ when asked: ‘Within the last month, have you undertaken additional hours’ work over and above your contractual requirement as part of the response to Covid?’ 23% of men answered yes.
When asked if this was because they felt pressured by their employer or themselves, however, more than a quarter (26%) admitted they felt pressured ‘by myself’, compared to 15% who said it was because of their employer.
These figures are concerning in their own right, but even more so when compared to previous results. Since August, there has been a seven percentage points increase in the number of women saying they have taken on additional hours’ work outside of the contractual requirements.
When asked in April 2020, if they consider themselves to be currently suffering from depression, anxiety, stress, burnout, emotional distress, or other mental health conditions relating to or made worse by their work or study, 31% of women said ‘yes, and worse during this pandemic than before’, compared to just 25% of men.
Ten months later, in February this year, that figure had risen to 44% for women and 35% for male doctors. While an increase in levels of burnout and emotional distress are to be expected for all doctors, the disparity between the sexes is marked and growing.
Another female doctor, working at a vaccination centre, told the Association: ‘I woke up early again this morning feeling the weight of all the work I had to do. I had meetings straight after work again. As so often is the case, I didn’t manage to get a lunch break because it was too busy.
‘It’s nearly 10pm now and I’m staring at my cold cup of tea and thinking about all the things I still have to do. I’m grateful I have a day off coming up as I think I’ll need to get a few hours’ sleep in. I am not sure how my colleagues manage to cope when they have caring responsibilities – it takes all the little energy I have left trying to care for myself, let alone anyone else.’
She added: ‘Our waiting lists are bad at the moment. Colleagues have been profoundly affected by the impact of Covid on the service, the patients, their personal lives – to the point of leaving. Every time we hear from our patients about the impact Covid is having on them, it’s so hard to try to encourage them.’
Dr Helena McKeown, a chief officer at the BMA, said: ‘Everyone in the NHS is currently going above and beyond in the fight against Covid-19, but to see the pressures that women are putting on themselves at the expense of their own health is shocking.
‘There is perhaps an assumption that balancing the demands of home-schooling and childcare with their work and personal lives is the only cause of increased stress amongst female doctors, but as these results show, this clearly isn’t the case, and rather something that women from all different walks of life are struggling with.
‘Understanding why this is, is an important step in helping to relieve the pressures that female doctors are currently facing, and it’s important to remember that while doctors – both men and women – have a tendency to just “get on with it”, we are not superhuman and need to take care of ourselves as much as we do our patients.
‘The effects of this pandemic will be felt for a long time to come, both in terms of the impact on the NHS, and the long-term mental wellbeing of our staff. Even as Covid-19 cases fall, doctors and their colleagues will continue to feel the pressure as the health service faces a surge in demand for non-Covid-related care.
‘The BMA is concerned about the current, medium and long-term effects on the workforce of working so hard with so little respite and experiences including caring for many dying and critically ill patients, moral injury and putting themselves at risk.
‘It is vital that staff can access occupational health assessments of their wellbeing with suitably adapted working patterns and psychological support, now and for as long as it’s needed. Supporting the wellbeing of the health workforce must be a top priority in the long-term.’
Meanwhile, government Covid-19 UK-wide infection control guidelines for protecting patients and NHS staff are ‘flawed and need replacing’, a report commissioned by the Royal College of Nursing (RCN) says.
The report, by independent experts, analysed a literature review which underpins those guidelines and found that this review met just four of the 18 criteria the experts deemed essential for a review of its kind.
Crucially, it concluded the review failed to consider a key way the virus is transmitted – airborne infection – about which growing evidence has emerged during the pandemic.
For these reasons, the experts concluded the review provided only a ‘superficial account’ of the available Covid-19 evidence. It added that the government’s guidelines based on the review were in turn ‘fundamentally flawed and need replacing’.
In their report, the authors Professor Dinah Gould, an Honorary Professor of Nursing at London’s City University, and Dr Edward Purssell, also from City University, said: ‘UK IPC guidelines to prevent the spread of Covid-19 in health care settings and the rapid reviews of the literature on which it was based still identify droplet spread and hands as the major route, based on early advice from the World Health Organisation (WHO).
‘Updated evidence indicates that aerosol spread is much more significant and the original advice from the WHO has been superseded.
‘The UK guidelines are still based on this outdated evidence, however. They urgently need thorough revision and replacing.’
The UK government’s guidelines omit detail on the importance of ventilation and say that higher-grade personal protective equipment (PPE) must only be provided in certain high risk settings like intensive care, but that it is up to individual health trusts to decide whether or not to provide them more widely to other staff.
This has caused huge concern among nursing staff, especially with the emergence of highly-infectious new Covid-19 variants
Some feel, given the lack of action on ventilation in UK hospitals, that the standard PPE, which includes the basic surgical masks currently advised even for close contact, are inadequate and that the government’s failure to provide higher-grade PPE – known as FFP3 – to all NHS staff is putting lives at risk.
That includes nursing staff working in the community, who are treating Covid-19 patients in their own homes.
Airborne transmission – where tiny droplets of saliva from people talking, calling out or coughing can remain suspended in the air – can be a particular problem in poorly-ventilated rooms, research suggests. The government has even issued guidance on the importance of ventilation in indoor spaces but is failing to act on hospitals.
A community nurse who works in England said: ‘I’m at my wits’ end. I’ve had Covid-19 before and really don’t want to get it again. I’ve got FFP3 face masks but my trust won’t let me wear them. They say either wear the standard surgical mask or you can’t work. I don’t want to leave nursing, I love my job, but I don’t want to catch Covid-19 either.’
Donna Kinnair, Chief Executive and General Secretary of the RCN, said: ‘This nurse is raising the alarm on behalf of countless others. We have been battling this pandemic for more than a year now. “Following the science” is a hollow boast when we have evidence showing the flaws. The report and its findings must launch an official review and not be swept under the carpet as an inconvenience.
‘Health care workers need to know everything possible is being done to keep them protected. It is inadequate to say they have masks if they aren’t fit for purpose. Staff are scared for themselves and their families and left any longer it’ll turn to anger.’
The RCN has repeatedly tried to engage the government on this issue, including by writing to the Prime Minister Boris Johnson.
It is calling for all NHS staff to be given the higher-grade PPE pending the outcome of a review. The experts’ report lends more weight to that argument, it argues.
The 18 criteria Prof Gould and Dr Purssell considered in their analysis is based on the World Health Organisation’s advice and included whether or not there was a clear explanation of how the literature chosen for review was selected; stakeholder involvement; whether it was multi-disciplinary; and whether engineering, maths and physics experts were involved for their insight on airflow.
They said that there were around 200,000 articles relating to Covid-19 which could have been part of the review, but which weren’t. The review was first done by Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland in March last year.
The ARHAI Scotland review has been updated throughout the pandemic – the 11th iteration was last month (February) – but it has focused throughout on the two principal ways of passing on the virus identified at the start of the pandemic, the experts said.
Figures compiled by the RCN show that by the end of January at least 988 UK health and social care workers had died in the pandemic, with the number now likely to be far higher. This does not include deaths in Northern Ireland, where no data was available.
It is highly likely that some of these staff will have caught Covid-19 at work.