The frontlines are where it all happens: the beeping of heart monitors, the whine of the ambulance as it accelerates, and the chatter of both the nurses and doctors as they take their breaks after gruelling twelve-hour shifts in the emergency rooms. Despite enduring the worst of the COVID-19 pandemic, frontline NHS workers have been deeply undervalued. March will mark a change. Nurses and junior doctors will be on strike for over 72 hours, while ambulances bow out to help those in a state of emergency due to a last-minute cancellation of their proposed strikes on March 6th and 20th.

​

COVID-19 has radically changed healthcare for everyone in the industry. It’s shown cracks in the system that remained undiscovered until now, and highlighted areas that require profound investment and change. This turbulent period for all frontline workers has been one characterised by major risk, a lack of protective equipment, and burnout due to overworking. While talking to Carla, a junior doctor, about her experience in the COVID-19 pandemic, Christmas 2020 marked an identifiable moment of deterioration, with the influx of COVID patients derailing teaching hours and regular ward routines - for her, “chaos was a commonly used word”. Junior doctors in particular had to step up during the pandemic to assist doctors and take charge as they would not normally have been expected to. According to her first-hand account, Carla’s electives and non- mandatory seminars disappeared during her two four-month shifts in the Acute Medical Unit and the Surgery wards. Unexpected assignments to the COVID wards were not uncommon, and picking up the slack caused by absenteeism was key to keeping the hospitals running. The British Medical Journal wrote in June 2020 that four percent of all COVID patients “become critically ill and require admission to the intensive care unit (ICU) for respiratory support”, where many trainees were deployed, despite a lack of resources and training during the worst of the pandemic. (Coughlan, 2020)

​

The levels of burnout this entailed has been seen as hugely problematic for all healthcare assistants, marking up one of the most troubling effects of the pandemic. By the end of 2020, over fifty percent of healthcare workers felt that their mental health had deteriorated, with burnout and compassion fatigue being topics prominently featured in the report. Though official support such as counselling was available during this time, this felt ‘quite impersonal’ to most; Carla herself and those she knew rarely used it. Instead, bonds forged between workers created the most valuable support networks. The lack of PPE, or personal protective equipment, was also reported as a major problem for those working in hospitals - though frontline workers spent up to thirteen hours in masks and visors, working with hundreds of patients, the British Medical Journal discovered that half of doctors relied on donated or self-bought PPE (personal protective equipment) and two-thirds did not feel fully protected from coronavirus. (Patterson, 2020)

​

Moreover, the pandemic led to a backlog of patients who needed to receive non-vital medical care. There are still recorded waits for cancer and elective patient care, with the waitlist at seven million patients, while the proportion of people receiving timely cancer treatment has actually decreased. It has been said that the target to reduce the number of people waiting too long for urgent referral will not be met. Further, the British Medical Journal has stated that NHS workers have still not recovered from burnout during the pandemic, which in 2020 contributed to over 1000 of those people surveyed stating that they would quit the NHS over the government’s poor handling of the pandemic. (Lovett, 2020) This continues to feed the migration of junior and newly-qualified doctors to other European countries.

 

For years, healthcare professionals, such as those who have been striking, have either been denied pay rises in line with inflation, or have been met with pay freezes. This makes a mockery of a system that was once the UK’s crowning glory, and is intended to save lives. This is the key reason behind the large number of ongoing strikes. For nurses, a pay rise of 5% above inflation has been demanded by the RCN, although it has been said that they are open to negotiations and meeting the government "halfway". The Department of Health and Social Care said that, “Using October’s RPI inflation data, a 5% above inflation rise would equate to a pay rise of 19.2%.” (Media, 2022) In contrast, junior doctors in England want a pay rise to compensate for their 26% drop in earnings that have been seen since 2008, with inflation taken into account. Although no figure has been named, ambulance workers and physiotherapists also want above-inflation pay rises - all of which the government states is unaffordable, and they use that to fall back on the excuse that these pay rises are decided by independent Pay Review Bodies. Despite this, fourteen health unions, representing more than a million NHS workers in England, said they would no longer work with such Pay Review Bodies on 2023-2024 pay. (Campbell, 2023)

​

Though NHS staff in England, Northern Ireland, and Wales have already received an average increase of 4.75%, with the lowest paid staff members guaranteed a rise of at least £1,400. And in Scotland, a pay offer averaging 7.5% has been accepted by some unions, with nurses saying that Prime Minister Sunak has left them with “no choice” but to strike. (BBC, 2022) This is due to shortages in pay that make current care standards “unsafe”. (Doherty, 2023) Ambulance workers similarly state that pay increases will make bridging staffing gaps viable, which is a vital part of making the NHS and the service itself safer and more efficient. The importance of bridging these issues additionally can be seen in ambulance delays rocketing upwards, with figures suggesting that a quarter of ambulances were delayed for an hour outside Emergency rooms. Finally, junior doctors wanted a pay rise to make up for what they described as a 26% drop in earnings since 2008, while taking inflation into account. The British Medical Association says that the offer of a two per cent pay rise has “significantly eroded morale” and in terms of real pay amounts to a pay cut, meaning that staff are “working more than a month for free this year”. (Media, 2022)

​

General secretary of the union, Christin McAnea, further stated that the strikes came as a result of the government’s own inaction. “This year’s pay rise simply wasn’t enough to halt the exodus of staff from the NHS”. (Doherty, 2023) This statement, though demoralising, seems true. Despite the appreciation shown for medical professionals during the pandemic, the clapping and fruit baskets received by various members of the NHS, such as Carla, is not enough. They are still missing the most important variable in this equation - proper payment. Some measures have been taken by the government to halt the strikes, however, such as negotiations with the Royal College of Nursing; though no pay deal has been reached thus far, talks in doing so have been described as “constructive” by the Department of Health and Social care.

​

These talks will form the basis of the new British healthcare system, hopefully one in which the NHS workers that take care of us all will be adequately supported in return. Doctors, nurses, physiotherapists, ambulance workers, and junior doctors deserve fair compensation for all that they have endured and the work that they do every day to keep the UK population alive and healthy, and to keep the country running. They are the crucial backstage helpers without whom we cannot hope to by. All we can do now is hope that these strikes and discussions bring about enough change to alter the course of the NHS and allow it to evolve with the current times, returning it to its pride of place at the heart of the UK.

​

​

REFERENCES

 

Coughlan, Charles, et al. “COVID-19: Lessons for Junior Doctors Redeployed to Critical Care.” Postgraduate Medical Journal, June 2020, p. postgradmedj-2020-138100, doi:https://doi. org/10.1136/postgradmedj-2020-138100.

 

Patterson, Chris. “Half of Doctors Source Own PPE.” The British Medical Association Is the Trade Union and Professional Body for Doctors in the UK., 4 May 2020, www.bma.org.uk/news- and-opinion/half-of-doctors-source-own-ppe.

 

Lovett, Samuel. “More than 1,000 Doctors Want to Leave NHS over Government’s Mishandling of Coronavirus Pandemic.” The Independent, 5 Sept. 2020, www.independent.co.uk/news/ health/coronavirus-doctors-nhs-pandemic-pay-rise-latest-government- survey-a9706836.html.

 

Media, P. A. “Why Are Nurses Striking and How Will It Affect Hospital Care?” The Guardian, 15 Dec. 2022, www.theguardian.com/society/2022/dec/15/why-are-nurses-striking-and-how-will- it-affect-hospital-care.

 

Campbell, Dennis. “Health Unions Refuse to Give Evidence to ‘Rigged’ NHS Pay Review System.” The Guardian, 11 Jan. 2023, www.theguardian.com/society/2023/jan/11/health-unions- refuse-to-submit-evidence-to-rigged-nhs-pay-review-system.

 

BBC News. “Nurses’ Strike: What Is the Dispute About?” BBC News, 9 Nov. 2022, www.bbc.co.uk/ news/health-63561305.

 

Doherty, Caitlin. “When and Why Are NHS Staff Going on Strike?” Politics Home, 3 Jan. 2023, www.politicshome.com/news/article/nhs-staff-strike-dates-nurses-ambulance-doctors-steve- barclay-department-of-health.