‘Nursing staff need to have full confidence they are protected!’

Hospital frontline staff outside Downing Street holding up posters of government ministers Hancock, Johnson and Gove, depicting them as having blood on their hands

THE TORIES ‘indecision’ means nursing staff are facing a postcode lottery in Personal Protective Equipment (PPE), leaving some more protected than others, the Royal College of Nurses (RCN) has warned.

The RCN points out:

  • Updated official guidance will deepen current variation between hospitals.
  • Some hospitals offering staff higher level respiratory PPE, leaving a postcode lottery.
  • Staff absence due to Covid-19 soars by 22% as highly infectious strain spreads.

The government’s failure to address concerns about personal protective equipment in the face of new highly infectious variants of the Covid-19 virus is creating a postcode lottery for nursing staff, the Royal College of Nursing (RCN) said.
Updated government guidance on infection prevention and PPE, issued last Thursday evening, deepens the PPE lottery by accepting the use of different masks in neighbouring hospitals, despite similarly high-risk and pressure.
RCN Chief Executive and General Secretary, Dame Donna Kinnair, has written to the government and the workplace safety watchdog warning that this inadequate personal protective equipment (PPE) may be putting the lives of nursing staff, their colleagues, families and patients at risk.
Kinnair was responding to concerns among RCN members that the standard face mask may not be effective in protecting many staff against new strains of the virus and possible airborne spread in healthcare settings.
The College is calling for a review of the infection control guidance and for all NHS staff to be given the higher grade of PPE as a precaution, pending the outcome. Higher grade PPE is used routinely in intensive care units (known as FFP2/3).
The newly-identified UK strain of the virus is said to be up to 70% more infectious and there are concerns that the standard face mask does not offer effective protection against very small airborne viral particles.
Kinnair said: ‘The government’s silence on this issue is creating a postcode lottery for nursing staff whereby some working on wards have access to the higher-grade face masks and others do not.
‘It must stop dragging its feet on this issue. Nursing staff need to have full confidence that they are protected.
‘Staff picking up this virus at work are angered at any suggestion they have stopped following the rules – this is down to the new variant and the dangerous shortage of adequate protection.’
In the letter to health minister Jo Churchill, Kinnair demands the government:

  • Assure professional organisations supporting and advocating for health and care staff that the current UK Infection Prevention and Control guidance is sufficiently robust in light of the new variants of concern in order to protect health and care staff and patients in all settings.
  • Ensure that nursing staff are supported to use respiratory personal protective equipment (PPE) such as FFP2 or FFP3 masks based on local risk assessment as a precautionary approach to protecting staff from airborne spread of infection.
  • Review the effectiveness of ventilation across the health care estate.

In her letter to the minister she adds: ‘We are very concerned that our members may now be at greater risk of infection as a result of their occupation.
‘They are aware that fluid repellent surgical face masks and face coverings, as currently advised in most general healthcare settings and patients’ homes, are not protective against smaller infective aerosols despite the government video outlining risks of infective aerosols in the air.’
In a further letter to Sarah Albon, chief executive of the Health and Safety Executive, which is responsible for the enforcement of workplace safety laws, Kinnair calls for it to conduct an urgent review of the guidance, adding: ‘In the absence of clarity on the reasons behind the new variants’ increased infectivity, we are calling for the Health and Safety Executive (HSE) to take a precautionary approach and to use your role as a regulator to ensure employers and those developing national guidance meet and understand their responsibilities.’
She adds: ‘Adequate supplies of PPE that meet the required specifications are vital to support nursing staff to do their jobs safely. Without support to use suitable PPE, nursing staff are putting their own lives, and the lives of their colleagues, families and patients, at risk.’
In the letter, which is co-signed by doctors’ union the British Medical Association, she calls for the HSE to:

  • Review the Infection, Prevention and Control (IPC) guidance for health and care to reduce transmission, particularly in respect to aerosol and airborne transmission as a result of coughing, talking, calling out or shouting, as commonly occurs in health and care settings. This must include an assessment of the use of appropriate PPE across settings.
  • Assess ventilation across the health and care estate, ensuring it remains fit for purpose given the emergence of new variants – and the risks in stuffy and enclosed environments.

In both letters, Kinnair describes the more infectious nature of the UK and other variants of the virus as ‘extremely concerning’, adding that the virus has taken a devastating toll on nursing staff recently.
She cites NHS England data showing a 22 per cent rise in the average number of health care staff off sick due to Covid-19 in the first week of this month compared with the last week in December.
Meanwhile, under the headline: ‘Doctors need enhanced PPE now: The rapid spread of Covid-19 means doctors must have respiratory protective equipment,’ British Medical Association (BMA) leader Chaand Nagpaul writes:
‘For doctors on the frontlines of this national health emergency, the soaring Covid-19 infection rate is a source of deep – and, in many cases, deeply personal – worry.
‘While the nation is in lockdown, with most of the population advised to “stay at home”, doctors are still going to work, with many seeing and treating patients with suspected or confirmed Covid-19 at close proximity.
‘Healthcare workers were, on average, already three to four times more likely to contract the virus than a member of the general population. However, the new highly transmissible variant which has spread like wildfire in recent weeks has created further and significant occupational risk for doctors and our colleagues.
‘In addition, there is growing evidence of the spread of the virus through aerosol transmission outside of AGP (aerosol generating procedure) settings, which is not filtered by standard surgical masks. It is therefore imperative doctors are provided with adequate enhanced PPE (personal protective equipment) to protect them from infection, illness, and risk to their lives.
‘For these reasons, I wrote last week to the interim chief executive of Public Health England, Michael Brodie, imploring him to review his organisation’s infection prevention and control guidance urgently to ensure the wider use of respiratory protective equipment – such as FFP3 respirators – across primary and secondary care.
‘When the facts regarding the level of risk which we face at work change – or our understanding of them does – health service managers owe it to us as doctors to change their minds and change their advice.
‘Data shows that doctors working within high-risk settings such as infectious intensive care units – but who are provided with enhanced PPE – are in fact at lower risk of becoming infected. Surely this is evidence enough that boosting the provision of FFP3 masks, goggles and face shields is a necessary step to safeguard doctors, patients and the NHS.
‘With almost 50,000 hospital staff in England absent from work with Covid-19, the rising infection rate among physicians is already exacting a devastating toll on patient services.
‘A BMA survey conducted last month found three-quarters of doctors believe recent staffing shortages have reduced their ability to see and treat patients in a timely and efficient way, with almost 30% stating this effect had been significant.
‘At a time of unparalleled hospital pressures, with intensive care units on the brink, it is absolutely vital that doctors and NHS staff are kept fit and healthy to avoid illness-related absence on the front line.
‘That is why, pending any changes to national guidance, the BMA is also pushing for local action to protect doctors better.
‘Earlier this month, the chairs of our consultants, junior doctor, staff, associate specialist an specialty doctor and medical academic committees wrote to every NHS trust CEO across England to urge them to adopt a precautionary approach to what PPE should be worn in clinical areas.
‘In November, our association published updated PPE guidance calling on NHS employers to make FFP3 respirators or hoods available to all doctors working in infectious environments – not just to those working in red areas (with confirmed Covid cases) but also in amber areas (where Covid-positive patients may be present) and green areas where AGPs may be undertaken.
‘The BMA’s recommendations for reducing infection risk to staff in healthcare set out in detail the steps which we believe must now be taken to protect doctors and NHS staff.
‘Given that we and the public have been repeatedly assured by ministers, government officials and senior NHS managers that PPE supply is no longer an issue, there can be no excuse for more dithering or delay.
‘The government has an absolute duty to protect frontline doctors as they work to protect patients and the nation and must act now to fulfil it.’