Beyond the first wave

It is, of course, tempting to itemise the ample downside of government strategy, advice and action, whatever they have got right. There is just so much to choose from – responding too late, inadequate supplies of PPE, putting care home staff and residents at lethal risk, the incompetent ‘contracted out’ test and trace system, and the current ‘algorithmic shambles’ of the A-Level and GCSE results. Just to name a few.

I will resist the urge to go on, though that would help me let off steam.  There should, of course, be a reckoning, but it seems crucial, now, to focus on what has happened to us, how we are, what needs urgent and determined attention.  Unprecedented measures have changed our ways of going about our daily lives, our emotional states, and, not least, our social and financial well-being. These things have affected individuals, communities, services and businesses. Some have affected all in the same ways, others have created differences, even hostile divisions.  And perhaps more important than what they mean to us in the present, is what they lay the foundations for in the future.

We have all experienced separation and isolation.  This has involved broken contact between friends and family, and many vulnerable, painfully lonely individuals coming close to, or beyond, the ends of their tethers. It has involved (especially single) parents trying to become the sole entertainers, educators, disciplinarians, caterers for their often frustrated, confused and isolated children.  There has been the suspension of vital links through such things as pubs, gyms and arts venues, sports teams, music and singing groups, religious communities, schools and universities, etc. However much mitigated by the pleasures of working from home, the vital diversions and creative aspects of the collective workplace have been removed for many.  Very low paid workers, driven by poverty or worse to continue to go to work, even when it’s unsafe, feel vulnerable, humiliated, often feeling as if they’re in guilty hiding, or just dispensable. Anger, depression, fear for the future, social, and ethnic, divisions are widespread. How will we all cope with this, move on, re-build community life? The ‘case history’ of hospitals might help us think about this.

In hospitals across the country, for five months at the present count, staff working with patients with the virus have felt alienated from each other, and from patients and their families.  Behind suffocating masks and visors, often in sweltering conditions, these staff have struggled to maintain some kind of human contact and communication.  Their areas for rest, thinking together, debriefing, offering each other support, have often been taken over for Covid beds, or ruled unsafe for coming together. Their engagement with patients, difficult through all that PPE at best, has been further undermined by the sheer volume of work at the ‘peak’ of the pandemic, and the need to move quickly through infectious environments. Contact with patients’ families – a vital human element of their usual practice – has been broken, or reduced to often awkward, deeply upsetting telephone calls.  Their sense of teamwork, vital to their own well-being, but also to the quality, effectiveness and efficiency of their work, has been seriously eroded.  Staff are exhausted, and many feel worn down, miserable, guilty and frightened for the future. 

The family and social lives of staff, already affected by lockdowns and social isolation, have been further infected by what they bring home (if they have been going home, and many have not).  Just like anyone, they have to manage their anxieties and anger about Covid, which can contaminate family relationships.  But in their case there’s an added dimension. How do they carry or cope with, protect themselves and their loved ones from, the anxiety, the horrors of what they have witnessed, and the increased risk of passing on infection because of their prolonged exposure to the virus?  There are serious concerns about staff suffering Post Traumatic Stress Disorder (PTSD).

Then there are the many areas of care that have been suspended, or slowed to a crawl, as Covid has taken centre stage. Even those who have found the improvisation, the rising to the challenge of the virus, exciting are very concerned, often angry, about the effects that an overwhelming focus on Covid has had on the system’s work with other serious, life threatening conditions.  Distrust, even hostility, has been far from uncommon between those whose work with those other illnesses has been devastated and those working with patients with the virus. The return to treating these conditions is, in any case, hampered and slowed by the discontinuities of ‘losing’ staff to ICUs for so long, their exhaustion as they return, and by the effects of the need for massively increased hygiene arrangements, and the wearing of PPE.

What of the future?  Well, I hear of real anxiety that the pared down and dehumanised working practices I’ve described will become the ‘new normal’. There are fears that the unprecedented (and shattering) ‘efficiency’ they have achieved will feed demands from management and politicians to continue to work that way.  Cuts to staffing (even in Intensive Care) are already happening in some places.  Bureaucratic hurdles and demands, somewhat suspended through the worst of the pandemic, have already begun to intrude, without recognition of the practical challenges that continue, or of the emotional climate.  I know of NHS hospitals where staff on the front line have not seen, let alone shared their experience with, anyone from the Board or top management. In too many places, staff have been threatened with disciplinary action if they speak to the press of their experiences or concerns – even their triumphs and successes. All this, as well as amplifying the sense of alienation, exhaustion and anxiety people feel, raises the real possibility that interventions from the top in the future will be completely uninformed by, even damaging to, the lived experience of the people doing the clinical and caring work. These anxieties are fed, even confirmed, by the rumours of restructuring the NHS, plans to abolish Public Health England, and the likelihood of further privatisations.

As in these hospitals, so for society as a whole: the risks are the same.  Focus on the spread of the virus will distract from other, vital issues.  The needs of sick and vulnerable people without Covid, and the research and development work that addresses their needs, will continue to be side-lined.  Climate change, and serious threats in the global political arena, will not get the intelligent attention they require. The predicaments of schoolchildren and students, workers, families, communities, businesses and services will be responded to, if at all, through short term, clumsily developed, ideologically driven policies and interventions. The mental health costs, for normally ‘healthy’ people and for those with pre-existing difficulties, will be side-lined or ignored. Social care will continue to be under-valued and under-funded, even if some gestural structural changes are made, such as ‘integrating’ it with a centrally ‘commanded’ health service. The vital contribution to well-being on so many levels of the arts, and other enriching diversions and forms of social engagement, will be downplayed – people have survived without them, so what the hell.  Policies and interventions will have a poor fit with where people are, how they feel, what has happened to them, what they need. 

It is not good enough to make public statements about heroic staff, or about knowing just how much everyone in society has sacrificed in the ‘fight’ against the virus.  It is close to idiocy to try to cheer everyone up with (inaccurate) celebrations of ‘world-beating’ responses, or happy-clappy encouragement to get out, to party (and spend) again. Uncertainty about the arrival or effectiveness of any vaccine, and about whether it will actually be available, or taken up, means we may be moving into a period of long-term dangers. It is not even adequate to make careful plans for the ‘next wave’ of the virus. A comprehensive strategy needs to be developed, based on addressing the realities, the lived experiences, of our communities during lockdown, and the long-term big issues that have been neglected. Such an approach will require transparency, continuous engagement, dialogue and informed planning and action. Government must prioritise shaping itself, the Civil Service and Local Authorities, in partnership with specialist bodies, so that our country can properly think, plan, and work to address our situation and challenges comprehensively and safely. All of us must resist the temptation, when, or if, the Covid crisis ends, of trying to move on without facing up to, and addressing, what has happened to us, where we are.

John

2 thoughts on “Beyond the first wave

  1. Such a good piece John and thank you. There is an indisputable need to have the voice of staff who have worked directly with covid sought and heard to go forward, as well, of course, as the patient voice. Understanding their lived experience is vital to inform policy and practice, and to give support to each other. The toll on staff needs recognising, as well as patients whose lives have been tragically shortened, or devastated by the virus and its seemingly longer lasting impacts. Any lessons from the best in the military for those returning from active duty?

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  2. Thanks, John. A powerful reminder of the amazing work done by frontline staff throughout these last months. It is hard to find the word that best describes my response to the various pieces I gave read in the press or seen on the screen but “awe” comes close. The impact on physical, emotional and mental capacities must have been immense. The resourcefulness, resilience and resolve to come back day after day to perform complex works of skill, kindness and courage is amazing.

    I find it important to keep all this in mind while reflecting on the contrasting record of the government’s policies and behaviour in responding to this crisis. I am weary of hearing ministers prop themselves up by their constant referencing of “unprecedented”. I have to say that the way they have conducted themselves merits the same descriptor, whether it be with regard to the contempt they have shown to Parliament, the civil service and the media; their adherence to “never apologise, never explain”; avoidance of accountability, announcement of important policy statements late at night via Twitter; and now the constant blame shifting to those they regard as soft targets. And I could go on about the ideologically-driven procurement of services from private contractors who have been found fallible. And now while the pandemic is still with us, announcing a reorganisation of public health services which will be in great demand when Covid revives its virulence as it is predicted to do in the coming winter months.

    To go on would be self-indulgent. And I have not mentioned the way Leicester has been treated! Or the A Level results fiasco!!

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