May these clouds have solid gold linings
This urgent letter was sent to us for posting.
It is from an NHS midwife who needs to remain anonymous.
As a midwife I’m not in the business of scaremongering, but I am deeply concerned. The ability, or inability of the NHS to cope with the CoVID-19 pandemic will reveal its eroded resources over the last decade. Prior to the coronavirus outbreak hitting the UK which - as hindsight so clearly tells us - was inevitably going to be catastrophic, our busy maternity unit was struggling.
More than 6 months ago our director of midwifery resigned and, shortly after, our head of midwifery was suspended. Both posts are yet to be filled. Interim management enforced mainly cost-saving measures despite the evident need across the unit for long-term solutions requiring investment. Meetings in the last year have seen resilient midwives in tears, desperate and tired. More recently, these meetings have been punctuated with awkward silence as the disconnect between management and frontline staff becomes increasingly perceptible. Management insist that financial savings are a cause for celebration even if they come at the cost of patient safety and staff wellbeing- a recruitment freeze and scores of midwives regularly working 13-hour shifts without breaks and enduring intolerably high stress levels.
Inadequate cleaning is commonplace. As unions demand that these outsourced contractors’ employees receive fair pay in line with the NHS agenda for change, there are delays in replenishing soap, sanitiser, hand towels and changing bins. Meanwhile employers working to maintain hospital estates are delayed in fixing toilet blockages and faulty plumbing that inconveniences staff and patients alike. The buildings are old and perpetually in need of repairs.
Attempts to address staff shortages as well as inadequate clinical and office spaces are dismissed or bound up in weeks of email trails that appear to go absolutely nowhere. Inevitably, frontline staff begin to accept the status quo. It is not for want of trying but want of agency. It is exhausting enough to provide safe and compassionate care, let alone fight these big picture battles that create daily headaches. There is stress, in-fighting, fatigue, sickness and apathy. This is why more midwives leave the profession than join and, dare I say it, why the timing of CoVID-19 will be a painful reminder of the many NHS staff we lost in the wake of Brexit.
Less than 3 months ago China faced global criticism for its dangerous food habits, and for dismissing early warnings of coronavirus, but we should respect their government’s quick response once the reality of the threat was acknowledged. Travel restrictions, isolation for suspected as well as known cases, and testing were implemented rapidly in the life-saving shadow of SARs.
On the contrary, here in the UK, callers to 111 may receive contradictory advice. Occupational health and line managers advise NHS staff differently, and health professionals with known contacts or mild symptoms are not always isolating - not even being tested - because their symptoms do not fit criteria. Social distancing has been recommended but slow to catch on and, frankly, impossible to achieve in the tiny changing rooms and offices that staff use in hospital.
Soon-to-qualify and retired health professionals will join us on the frontline and teams of nurses will be trained up for new specialisms in a day, as we anticipate a significant reduction in the NHS workforce.
The free hand creams and the takeaway discounts for NHS staff from private companies are very welcome gestures but we need staff, we need beds and we need equipment. The government insists the public, ‘Protect the NHS’; unfortunately, the lack of testing and personal protective equipment blatantly neglects this very same principle. How I wish our government had not just protected but invested in our NHS in the lead up to these torrid times. Of course, we would still be in need of extra beds and ventilators but at least there might be more staff, themselves in better spirits, to cope with the ever increasing and changing workload.
Midwives care compassionately for women and, slowly but surely, the culture within maternity services is evolving and we are looking out for each other. We need to be cared for by our managers and our managers need to be cared for by their managers, and the poor souls who have to run these stretched NHS services need to be cared for by a government that values the work we all do.
The bottom line is that a world-class health service requires continuous, adequate investment. Here on the frontline we will learn to work better together, to work more flexibly, to work more efficiently and streamline essential care. We will gain perspective in this national crisis and come to see the very best of what the NHS can be proud to offer and, no doubt, when this is all over we will have learnt valuable lessons that will contribute to a stronger health service in the future. But today, I call for our government to acknowledge it was complicit in the broken NHS that is now tasked with handling this pandemic. This is a call to those in power: in these dark times of lockdown and uncertainty. May you take time to reimagine an NHS whose infrastructure, systems and values create a safe working environment that will regain the trust of its staff and the public they serve. Let this opportunity for altruism heal the scars of individualism and greed upon which our society is increasingly reliant. Let the clear canals of Venice and the smog free skies of Shanghai tell us there is goodness come. May these clouds have solid gold linings.