OVERWORKED doctors must be allowed to rest and recover so we can keep patients safe, doctors’ union the British Medical Association (BMA) warned.
The BMA said: ‘Doctors must be allowed to rest and recuperate from the exhaustion of working throughout the pandemic if we want to have safe patient care in the future.’
In a new report, Rest, Recover, Restore: Getting UK health services back on track, the Association argues that the pandemic has left the health service running on empty, with staff burnt out, disillusioned, and even considering leaving the NHS as a result of the intense pressures and stress of the past year.
BMA said: ‘The report points out that pushing doctors to ‘‘get the NHS back to normal’’, without giving them the respite and support they need, will not only result in increasingly high absence rates and staff reducing their hours, but also threaten patient care and safety.
‘Against a backdrop of current workforce shortages, patient demand outstripping staffing levels, and tens of thousands of clinical and non-clinical vacancies in hospitals and a shortage of GPs, the need for a strong and healthy workforce is obvious.’
As a result, the BMA has set out a series of recommendations to UK governments to ensure that services resume safely for both staff and patients, including:
1. All governments and system leaders across the UK to have an honest conversation with the public about the need for a realistic approach to restoring non-Covid care, and support for systems to tackle the backlog.
2. Health, safety, and mental wellbeing of the workforce to remain a top priority.
3. Additional resourcing to help tackle the backlog.
4. Measures to expand system capacity.
5. Measures to expand the workforce and retain existing staff.
The report also suggests measures for UK governments to make it easier for retired doctors to re-join the workforce and to take meaningful action to retain existing doctors.
Dr Chaand Nagpaul, BMA council chair, said: ‘It’s clear that the backlog has to be reduced, but forcing doctors to just ‘‘get back to normal’’ without respite and support is not the way forward and endangers patient safety and staffing ratios now and in the longer run.
‘While some, exhausted and burnt out, might take more sick leave, others may decide to leave the NHS altogether – talented, committed healthcare professionals that embody everything our health service stands for.
‘Fundamentally, asking too much of doctors too soon could not just have a detrimental impact on patient safety, it could potentially increase already lengthy waiting times – something both patients and doctors desperately want to avoid.
‘As our report lays out, this realistic approach must be complemented with a dedicated effort to attract more staff into the NHS, not only to help bring down the numbers of patients on the waiting list, but to also fill gaps for existing staff taking time to recuperate.
‘The wellbeing of our healthcare workforce must be viewed as a critical priority for the effectiveness of the NHS. This report gives a stark warning to government: to ignore the threat posed by burnout is to put future services and patient care at risk.’
According to the latest BMA tracker survey published last month, more than half of respondents reported a worse state of overall health and wellbeing than during the first wave of the pandemic, while two thirds reported higher than normal levels of exhaustion or fatigue.
In the same survey, when asked if they have changed their career plans for the next year, 26% of doctors said they were more likely to take an early retirement, another 26% said they were more likely to take a career break, and 18% said the same about leaving the NHS for another career.
The Summary of the report ‘Rest, Recover, Restore: Getting UK health services back on track’ states:
To safeguard patient safety and the wellbeing of healthcare staff, a realistic approach to tackling the backlog of non-Covid care is needed.
NHS and public health services have been running ‘hot’ for a prolonged period of time and an overstretched and exhausted workforce must now be given time to rest and recuperate as they meet the challenges ahead. If staff are being pushed too hard to restore routine care
In an unrealistic timeframe and without suitable resources, the likelihood is that we will see a workforce squeeze due to a combination of increasingly high staff absence rates and staff reducing their hours or leaving the workforce altogether.
This would make it harder for health services to get back on track and provide timely and safe care to patients who need it.
Across the UK, the impact of months of lockdown measures combined with the rollout of the vaccination programme is beginning to take effect. As progress continues, the number of people requiring urgent care for Covid-19 will continue to come down – and with this, the NHS in all four UK nations will come under renewed pressure to restore non-Covid services in order to bring waiting times back down and begin to work through the backlog of unmet care.
At the same time, health services will need to be able to scale up Covid-19 services swiftly should this be needed.
The scale of the challenge ahead is not to be underestimated. The backlog from the past year alone is extensive, with millions of normally expected elective procedures and outpatient appointments across the UK simply not having happened.
Since April 2020 there have been three million fewer elective procedures in England than expected (based on 2019 levels), and 143,000 fewer in Scotland.
The number of patients waiting over one year for treatment across the country has risen significantly: in England it now stands at 185-times its 2020 value, a 13- year high that highlights the large proportion of unmet care.
In Wales, it is reported that waiting lists for non-urgent hospital treatment have hit a record high of nearly 540,000 patients with the number of patients waiting more than 36 weeks having increased 728% from Jan 2020 to February 2021.
In Northern Ireland, more than 300,000 patients were waiting for a first consultant-led outpatient appointment as of December 2020.
A return to pre-pandemic levels of service provision is also unlikely for some time given the ongoing disruption to NHS services as a result of Covid-19 and the requirement for more stringent infection prevention and control measures.
There is also extra and rising demand from patients with long-Covid and those who have seen their mental health deteriorate during the pandemic, which will be a continuing requirement for the foreseeable future.
Meeting this challenge will fall to an already exhausted workforce.
Prior to the pandemic, NHS staff were already working in the context of year-round escalating pressures – the result of more than a decade of underfunding and under-resourcing.
Workforce increases over the past decade have simply not kept pace with rising demand for services, and despite the recent increase in FTE doctors there are still significant medical, clinical and non-clinical vacancies across the secondary care workforce in the UK.
In general practice the workforce has barely grown since 2015, while the number of FTE GP partners has contracted. The workforce is also faced with an increase in frail and complex patients.
The impact of these shortages has long been apparent in the worryingly low morale and increasingly high burnout rates of NHS staff, alongside growing rates of poor mental wellbeing.
Anxiety, depression, stress or other psychiatric illness have been the most reported reason for sickness absence for some time now.
The pressures of delivering care during a pandemic have not only compounded the existing wellbeing crisis but added further trauma and fatigue to daily working life as well as moral distress which occurs when people are forced to make, or witness, decisions or actions that contradict their core moral values.
Doctors and other healthcare workers have been going above and beyond for months now, working in intense and stressful environments with little respite. This is taking its toll:
- 51% of respondents to the BMA’s latest Covid tracker survey report a worse state of overall health and wellbeing than during the first wave of Covid-19.
- 59% report higher than normal levels of exhaustion or fatigue.
- Burnout and workload levels are at an all-time high, and many staff will leave the pandemic with PTSD.
- 32% of respondents to the survey say that they or clinical colleagues in their department have been on sick leave due to anxiety, stress, depression or PTSD directly caused from working during the pandemic. This stark picture is echoed in the NHS (England) Staff Survey 2020, in which 44% of respondents report feeling unwell as a result of work-related stress in the past year.
• When asked if they have changed their career plans for the next year, 26% of doctors said they were more likely to take an early retirement, another 26% said they were more likely to take a career break, and 18% said the same about leaving the NHS for another career.’