“We all knew that COVID-19 would hit us hard back in early February.” My friend David[i], a junior doctor working in a central London hospital, reflects on the early stages of the pandemic, when China was seeing its exponential growth in cases, and UK governments seemed relatively unfazed. “I recall vividly speaking to an intensive care registrar around that time,” he writes, “who told me that there was a lot of anxiety up in ITU. There didn't seem to be a lot of planning at all, rather just a 'wait and see' attitude. This, I believe, reflected the attitude of the Government, and so the initial NHS response as a whole.”

“It seemed as though we were waiting to be hit mildly, rather than preparing to be hit badly. It was only when our first cases started trickling in, and the situation became alarming in Italy, that we really began to see the concerted efforts to prepare and brace for an outbreak.” We now know that this early underestimation of the scale of the crisis and lack of national preparedness would come to have devastating consequences.

David shares his experiences of working in a hospital which saw some of the earliest admissions for COVID-positive patients in the country. “The general feeling was of confusion, and sometimes of being taken for fools.” His first encounter with a patient who later tested positive was on 3 March. “The patient tested positive a week later and was one of the first in the Trust to test positive. I received an email informing me of this, and that I had subsequent contact with this patient, over a week following the positive result.” David would himself later contract the virus, fortunately with only mild symptoms.

It was clear very early on, just how critical and costly levels of PPE would be for the workforce. “Our stocks of FFP3[ii] masks dwindled, and concurrently the recommendations changed to wearing only regular surgical masks. When our stocks of regular surgical masks dwindled, the Trust brought in out-of-date masks (use by 2016) and put stickers over the top with a new use-by-date.” According to Amnesty International, at least 540 health and care workers in England and Wales have died after contracting the virus, second highest in the world. Amnesty report that early studies indicate that BAME health workers are significantly over-represented (more than 60%) in the total number. Amnesty International UK’s Director, Kate Allen identifies the “catastrophic failure to provide proper PPE” as having led to this terrible and avoidable outcome.[iii]

“In general, morale is poor,” he reveals. “A small number of colleagues have died from contracting COVID-19, and those close to them had been badly affected.” I ask him about what support is on offer. “Small gestures such as free meals, free groceries and goodies on occasion have been well received, but ultimately felt very superficial. Support networks and invitations to discuss problems and concerns were made. […] I am sure that they were helpful to those who needed them.”

I ask him if there are any positives he has taken from the pandemic. “For junior doctors, the greatest positive is perhaps the clinical and practical expertise we have gained from working throughout a serious pandemic. Hopefully, when we are in those key positions in Trusts and NHS upper management, we will be able to make more cautious and pragmatic decisions.” It is clear that the renewed public respect and appreciation of the work and dedication of the health and care workforce has made a significant impression on him. “We can only hope for greater public appreciation – though on the whole it is relatively good already – of how the NHS works, but we worry that it will be quickly forgotten as other problems in society take precedent.”

David shares his concerns about the stepping down of emergency measures. “We cited concerns about a second peak, erring on the side of caution, and our own mental wellbeing, but ultimately we were not listened to.” I ask him what he is most nervous about going forward: “A combined flu and COVID-19 winter season”, he says. “We are strained enough as it is with just the flu, and if we see even a small COVID-19 second wave, it could be enough to push us into a crisis. It seems improbable that such large provisions will be made for the NHS again, as had been for the initial outbreak.”

We then turn to recent reports of plans for a major restructuring of NHS England – to ‘take back control’ of the health service, increasing the Secretary of State’s powers over its direction, and restricting NHSE’s operational independence.[iv] I ask him for his view on NHS reform, and rather than focusing on the question of political accountability versus operational independence, his response is telling of a system under immense pressure:  

“From a selfless point of view, I want to see true, non-politicised, ambitious but pragmatic reform of how the NHS works for a 21st century Britain with an ageing population and the funding to support that."

“From a selfish point of view, I want myself and my colleagues (from senior junior doctors to the way to nurses, phlebotomists, healthcare assistants) to be paid more. I want us to have health, dental and travel benefits like those enjoyed by many in the private sector. I want our employers to provide us with life insurance, so our loved ones are not left with nothing when the next virus manages to kill us."

“I want us to be given a reason to not go somewhere where we would be treated better.”

Emma Stevenson is the Parliamentary Liaison Officer for the Fabian Health Network, and works in public affairs for Macmillan Cancer Support. She has written articles for Anticipations on health inequalities and the voluntary sector, and recently contributed to the Fabians Health and Care Policy Group pamphlet Fabian Perspectives on Mental Health.

She tweets at @_ELStevie

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[i] Name has been changed.

[ii] The masks that offer the highest level of protection are FFP3. Current NHS guidelines stipulate FFP3 face masks for virus and bacterial infection control when the contagion is spread through coughing and sneezing.

[iii] https://www.amnesty.org.uk/press-releases/uk-among-highest-covid-19-health-worker-deaths-world

[iv] https://www.theguardian.com/society/2020/jul/10/boris-johnson-plans-radical-shake-up-of-nhs-in-bid-to-regain-more-direct-control