Off the frontline? Experiences of NHS staff not working on the Covid wards

In recent history, NHS staff have never seen such public support and affirmation. In the first wave of the pandemic, the Thursday clap was a marker in the week; NHS charities were overwhelmed with donations, staff were fed by restaurant chefs and children painted rainbows for us. Or was it for us, colleagues in cancer care, maternity, paediatric and mental health services (where I work as a psychologist) were wondering ….. ? “Were these gestures for us too?”  Because when we think about NHS ‘heroes’, somehow we weren’t feeling like those were us – and frankly if one asks most people what comes to mind when they think of NHS heroes , its inevitably first those images of PPE clad staff in the acute hospitals working frantically to treat patients with Covid-19. 

I’m Jocelyn Blumberg, a clinical psychologist working at the Traumatic Stress Clinic in Camden and Islington Foundation Trust, as well as with the Keeping Well NCL Hub supporting health and social care staff across North Central London. In this role, although I have done a lot of work with staff working on Covid wards, I have also had lots of conversations with colleagues who had to continue providing treatment as usual to non-Covid patients – people with cancer; very ill children; pregnant women and people in mental health crisis. And from those conversations it has become clear that Covid-19 and the unhelpful rhetoric about “NHS heroes” have really polarised the NHS.

Many NHS staff who were not called upon to do Covid-19 ‘frontline’ work, did not stay away from the frontline out of choice. The capacity to be on the frontline or indeed to be redeployed onto the frontline was largely determined by skill set and role; often hurried organisational decisions about who was best placed to do what; people’s own health and individual circumstances such as pregnancy and underlying health conditions, or the need to comply with national guidance around ‘lockdown’ and social distancing for so called non-essential or routine work.

However from those ‘left behind’ – not on the frontline – it is not this that is held in mind. Rather I have consistently heard about feelings of survivor guilt (while colleagues on the Covid-wards were exhausted; traumatised; getting ill and dying), shame and a sense of being undeserving. Maybe this is because NHS staff are a self-selecting bunch – people who chose their line of work to feel busy; useful and potent; and whose identity is defined by working to help others. So when talking to these staff from a wide range of backgrounds, there was always a common theme, this experience of guilt – of feeling bad that they were  ‘just’ seeing to ‘treatment as usual’ or in some cases were underoccupied, because their normal roles were not possible.

If one asks the right questions, professionals providing treatment as usual in their services went on to describe how this really wasn’t treatment as usual at all. They spoke about increased caseloads with other services shut and colleagues redeployed or shielding, patients much sicker on admission, as well as very angry and anxious patients, upset because of long waits. They have borne the brunt of this.

Learning new ways of working online and over the phone has caused massive stress  – feelings of loss of control; worry about what might be missed and about patient safety, as well as difficulties caused by being stuck at home and separated from colleagues on whom we all rely for support and guidance. Despite these challenges, as well as the threats and losses we have all faced during the pandemic, people I have been speaking to still describe at times feeling like frauds or imposters, blaming themselves for somehow not helping more, despite having made every effort to volunteer their services where they might be useful.

There is no doubt that the division between those who have been working in active frontline Covid work on the Covid wards and those who had to continue with providing crucial treatment as usual for the patients in their care, has caused distress: feelings of frustration, anger, guilt, shame, helplessness and worthlessness. Especially, because at times this care and incredibly hard work, which many have felt was unseen, was made increasingly demanding, stressful and complex because of Covid.

These splits and hurts will take work and time to heal. So what might help?

It is important to remember that we are all cogs in the bigger NHS and social care machine, and the nature of this crisis has meant that some of us have had roles in active ‘Covid work’ – whilst for others our duty and contribution, if not ‘frontline’ and centre stage, has been to be working incredibly hard keeping our patients as safe and well as possible and to limit virus spread. So please do remember that as a non-frontline NHS professional you too were doing your duty, just as much as anyone else. ‘Duty’ just looks different for different groups.

So as you reflect on your experience of working “off the frontline” during the pandemic, be self-compassionate. Think about what you know you’ve done well. Can you write down some things that you feel you can be proud of?

Can you also think about what you need to do to look after yourself? Have you taken leave? Or are you overworking, to compensate for working from home or indeed for not being on that Covid ward? Remember that you cannot pour from an empty cup – you have to be well-resourced and rested to be effective and efficient in caring for your patients.

And I know that for many of us, while not being on the frontline was profoundly difficult in many ways, we have also developed creative and effective strategies to help us in our work. My sense is that this has led to systemic advances, which will sustain after the pandemic has passed and about which we can be really proud.

I hope that when the dust settles, we will all come to the realisation that each one of us in the NHS, in all our different roles has something important to contribute; that everyone adds expertise and contributes to the equation, even if we were not caring for patients with Covid.

However, in order for this to be really felt, senior leadership and managers at all levels need to recognise and reinforce this and to make sure that all staff feel valued for their contributions.

And at a team level, reflective practice groups for staff teams can really help us to really listen to others experiences and to share our own.

With the clapping a distant memory and no pay rise to speak of ,we will need to rebuild the brilliant team cohesion, sustaining collegiate relationships and mutual support if we are to move forward together and continue to provide the best possible care for all patients, which we aspire to.