We now have an opportunity to come to terms with the psychological impact of the last year, argue Claire Copeland and Sally Greenbrook
The covid-19 pandemic has disproportionately affected older people with 90% of deaths in the UK from covid-19 occurring in those aged over 65. It should therefore come as no surprise that members of the British Geriatrics Society (BGS)—geriatricians, GPs, nurses, allied health professionals, care home staff and other healthcare professionals working with older people—have been among those most involved in the treatment of people with covid, both in hospitals and in the community.
Over five weeks in autumn 2020, we circulated a survey to our members asking them to reflect on their experiences during the first wave of the pandemic and to share their hopes and concerns for the coming months. We received 425 responses from across the UK (and a handful of international responses) and across the workforce caring for older people. We believe it to be the only survey that has been carried out across the four nations of the UK which captures the views of the multidisciplinary team working with older people across various acute, community and primary care settings.
We heard from our respondents about the practical challenges of managing the pandemic. These included variable access to personal protective equipment (PPE) and testing for staff and patients, and the confusion caused by constantly changing guidance. Members from across disciplines told us about the well-publicised difficulties faced by care homes, with often devastating consequences for care home residents and staff.
A majority of respondents reported that they were either redeployed during the pandemic or had changes made to their job plan or rota. This took a range of forms including working in a different setting, covering covid-19 wards, acting up to take on more responsibility, or changing working hours to help respond to the pandemic. Many of our members told us that they willingly made these changes, acknowledging that it was a crisis situation and they were happy to help. However, we did hear that some people had these changes imposed upon them without consultation and without extra pay when asked to work additional hours. It will be important to ensure that this does not become standard and that normal working hours and leave entitlements are restored as soon as possible.
The most prominent theme to come out of the survey was the significant mental and emotional toll that working through the pandemic has had on our members and their families. Respondents told us about experiences of dealing with excessive death and the lack of escape from the pandemic outside of work as it engulfed society. Feelings of sadness and exhaustion were evident through the responses received.
“Even if we are not at work, life outside the hospital isn’t normal so we cannot ‘escape’ the impact of covid. The mental strain therefore never really abates.” – registrar in Geriatric Medicine.
Many of our respondents expressed concerns and fears for the future. Some of these were focused on dealing with the second wave of the pandemic which, at the time of the survey, was already starting in parts of the country. In addition, some of our trainee respondents told us about their fears for their career development as training opportunities have been cancelled over the past year.
Our survey provided a snapshot in time and we are well aware that for most, if not all, of our members, the winter has presented even bigger challenges than the first wave of the pandemic. We will be repeating the survey in Spring to assess what has changed. However, we do not anticipate that the mental and emotional impact of the pandemic will have lessened.
At BGS, we are considering how we can better support our members over the coming months and years to help them to come to terms with what they have experienced. However, we cannot be the only ones to do this—it will be important for governments and NHS and social care employers across the UK to take significant and sustained action over the coming years to support the recovery of the health and social care workforce. This issue must be taken seriously otherwise we run the real risk of a mass exodus of NHS and social care staff who are suffering burnout and post traumatic stress disorder. Concrete action must be taken to ensure that services are available to support staff—this must be more than a link to a mindfulness app or a vague referral to services that do not really exist or are under such pressure themselves that the waiting lists are exceptionally long. The arrival of the vaccine brings us hope that the end may be in sight and the opportunity to come to terms with the psychological impact of the last year. Ignoring this would compound the profound and damaging effects of the pandemic on the health and social care workforce.
Claire Copeland, consultant geriatrician and associate medical director integration, Forth Valley Royal Hospital, vice president for workforce, British Geriatrics Society.
Sally Greenbrook, policy manager, British Geriatrics Society.
Competing interests: CC is a trustee for Erskine Care Home on the clinical governance committee.