‘I can’t fathom how bad it’s going to get’

The Covid-19 pandemic is combining with further government attacks on the health service to push the NHS, and its workforce, into unprecedented crisis. Rob, an NHS nurse, was interviewed for rs21 by Lisa Leak.

Max: The government is still pursuing very contradictory and complacent messaging around Covid. How does that look to health workers on the ground?

Rob: When I talk to my colleagues, a lot of the time I’m actually quite surprised. Just like anyone else, many people were fed up of lockdown and quite happy  to be able to go out and do things again. But people are very aware that last time it was left far too late to control anything by the time a lockdown came in. Everyone is very aware that it’s going to be a very awful winter, and people are surprised that it’s taken the government this long, and that they’re still not talking about doing anything really major to stop the spread.

Max: And I guess it’s going to be an awful winter not just because of Covid but because of Covid on top of the existing now annual winter crisis, the general pressures on the health service?

Rob: Yes. It’s hard to imagine it; even having worked several winters in acute admissions in an NHS hospital and then having gone through the pandemic, I can’t still can’t quite fathom how bad things are going to get. I hope I’m wrong, but even during spring and autumn, not even during winter, we already regularly run at over 100% capacity, so you always already have every single bed in the hospital full and people waiting, and people waiting in ambulances outside the hospital too. That’s quite standard in winter, and in the last couple of years we’ve even had queues outside A&E in the middle of summer. It’s only just October now and there’s already in a situation where, because of Covid, you can’t have patients in the corridor, because you can’t distance. So they’ve now opened up other areas that are the overflow areas – and already we’re finding in September, October that there’s got a queue of ambulances going out into the main road because they physically can’t let any more patients into the hospital. So it’s difficult to imagine what’s going to happen.

Max: What is morale like in that context?

Rob: Morale is already awful because we’ve found that management have used the pandemic as an excuse to repeatedly reorganise based on their own dreamt-up ideas, without any consultation whatsoever. Me and my colleagues  have had at least three reorganisations in six months without consultation. In March when we were told with a couple of days’ notice that we were going to become a Covid ward, people were terrified but we completely understood that they couldn’t exactly have a 90-day consultation on it. But then in the summer and again now, when they’re reorganising everything without consultation, there’s really no excuse. Because of the pandemic they’ve got cover to do what they want. I’ve been trying to get in touch with my union branch, but they’re elusive at the best of times, and it’s quite difficult to work out what’s going on, which makes it hard as someone on the ground who’s trying to convince people that it is worth joining a union. People are asking me “What is the union doing about this?”, and I’m trying to find out.

Max: There’s been a lot of talk about health workers leaving after the pandemic and some big surveys showing large numbers of health workers saying they want out of the NHS within a few years. Do you think an exodus of staff in the next few years is likely, after everything people have been through?

Rob: As far as you go back throughout the last decade it’s been the case consistently that the surveys have shown everyone is going to leave soon. In fact the economy is so appalling that there aren’t a great deal of other options out there. And people do care about what they do in the NHS – that’s often used, wrongly, as an argument as to why we shouldn’t get decent pay – but people just want to have the tools to be able to do their job.

I do think that a lot of people will leave. Not many have left yet but I have definitely seen many people who have been off with stress or other work-related illnesses for long periods of time recently, and that is going to keep increasing. Where I am we have many people who are only a few years away from retirement, and it’s nowhere near the number of people who are qualifying or starting work. I definitely think we are going to see quite a big drop over the next few years.

Max: how do you think that will change the landscape for anyone doing workplace organising in the health sector?

Rob: It’s difficult, because morale is so low it is hard to turn that general anger into organising. A lot of people are under so much stress individually that many people are having to just bow out and do what’s best for them, as we’ve been beaten down for so long, and before the pandemic there were huge amounts of stress, we didn’t have enough resources we haven’t done for years, so it’s just going to make it more and more difficult. It’s going to be very difficult, we already have tens of thousand of vacancies that aren’t filled and there is no chance of them being filled any time soon from the looks of it. So I don’t necessarily think it’s going to help organising, the fact that we’re more short-staffed and under more pressure; it’s just going to make people more and more demoralised.

Max: One of the big events recently among health workers has been the campaign for a 15% pay rise that burst into life quite suddenly a few months ago. Has that made much of an impression on people where you are?

Rob: I haven’t heard many people talk about it; people are quite cynical after the last pay deal. They feel that whatever deal we get will have some sort of clause in it that will make things worse in reality. People definitely do feel that pay is an issue; it would be fantastic if the major health unions could agree and actually fight for 15% together, rather than sticking to their own figures that are lower than what nurses on the ground are saying. Like the RCN for example, which has a proposal for a 12.5% rise.

Max: Why do you think the health unions have been so bad on this?

Rob: They have a set of formal excuses as to why they have the proposals they do. Months ago, when they surveyed their members, I filled out the survey and said “Yes” to the idea of a £2000 pay rise for everyone, and said that I’d support that, and would be willing to take industrial action for it. So now the unions point [to that figure lower than a 15% rise] and say, “Our members decided this”, as though that ties their hands, whereas actually they’re the ones who came up with the proposal; if they had put a 15% pay rise to people, people would have wanted to unite behind that.

They’re also very territorial. People waste a lot of time talking about whether to leave the RCN for Unison or vice versa, and the unions each get very territorial about bigging up their own proposal. And they’re probably are quite threatened by the 15% campaign because it’s getting a lot more attention than they are, which makes them retreat into defending their own position. I’m sure there are a lot of people in these union structures who genuinely do believe that it’s an issue of member democracy – they’re just being very formalistic and very bureaucratic about it, instead of looking at the bigger picture.

Max: During the first wave of Covid there were many issues around health workers’ safety, above all PPE and sick pay. I imagine there will still be health and safety issues for the hospital workforce, like sick pay for outsourced support staff. How aware of safety issues would you say staff are, with the second wave coming in?

Rob: People are definitely very aware of the fact that during the first wave we didn’t have sufficient PPE, and concerned about that going forward. Where I work we still don’t have anywhere near the number of Covid patients that we did, so the supplies we have aren’t under any pressure, and at the moment you could say that we have plenty of PPE, but people are very aware that could change once there is an increase in demand and the supply comes under pressure.

When we were down to a few hundred cases a day, the government didn’t use that time to set up a sufficient Test-and-Trace system to eliminate the virus, which they could have done very easily. So I very much doubt that the government used the period when cases were low to actually stockpile PPE, because they didn’t do anything else to fix the roof while the sun was shining, but we won’t find out for sure until the shit hits the fan.

We are now at a point where there are 15000 confirmed cases per day – meaning there are probably twice that number of actual cases per day. They’re now talking about maybe next month doing a 2-week lockdown. If they’d done a 2-week lockdown in July we could have got to a point where we had zero cases per day.

In terms of sick pay and related issues, there were a lot of problems during the first wave, and we’re starting to see some of those reappear already. I know of people who were in France when the need to quarantine on return was announced, and when they came back, they had to use annual leave or take unpaid leave for their quarantine period. In my trust there is now a policy that are basically not allowed to go abroad on your annual leave, even if it’s say Ireland or somewhere that’s on the travel corridor, because any country could taken off that list while you’re there.

Max: Given the proportion of health workers who are migrants and have family abroad, that will be devastating to many people I guess.

Rob: Absolutely. There are a huge number of people where I am who aren’t able to go and see family at all, and haven’t been able to see them in over a year because, as the government has such a mess in the UK, pretty much every other country in the world wants you to quarantine for two weeks when you get there, and they would have to quarantine for two weeks when they get back, and it’s impossible to get that amount of leave.

The policy where I am now, and I think it’s pretty much standard across the country, is that if you go on your annual leave without a written agreement from your manager, and you have to quarantine when you get back because the country was added to the quarantine list, then that’s a disciplinary issue. I’m aware of people who have been contacted by Test-and-Trace who have been told to isolate because colleagues have tested positive, and they’ve had to take it as unpaid leave.

Max: What do you think the most useful strategic things are at the moment for the left and supporters of health workers and the NHS to be arguing and agitating around across the country?

Rob: I think the pay campaign is a really good focus, as it’s a grassroots campaign that’s sprung up around the country has a huge amount of support. We need to get the voices of health workers out there to explain that the government needs to implement a much stricter lockdown – unfortunately that’s the only way now. We need a functional test-and-trace system, and to demand better financial support for people who isolate. Even in healthcare we have a lot of agency staff and somewhere in the country, people will be going to work in hospitals who have coronavirus symptoms, or have got coronavirus, but can’t afford to stay at home due to the out-sourcing of their jobs and the use of zero-hours contracts. We have to push on these things because we really can’t go through what we did in the spring again.