During the pandemic, doctors came together to push for political change. We must continue to use our newfound voice, says Samantha Batt-Rawden
This time last year the UK’s covid situation was in freefall, with our prime minister hospitalised by the virus, intensive care beds filling up, and the number of deaths rising sharply. As we fought to save lives, the spectre of what had happened in Italy weighed heavily on all of us. It was every intensivist’s worst fear: that we might have to ration care if our resources became overwhelmed.
Despite all they had faced, our Italian colleagues had taken the time to reach out to the intensive care community in the UK. In February 2020 I had sat in on Zoom calls and listened to their stark warnings about what would come to pass if the UK did not act quickly. We were a few weeks behind Italy, we heard. In that moment, the UK had a brief window of opportunity to prevent the scale of loss of life seen elsewhere. This was an opportunity we would let slip right through our fingers.
By March 2020 it became clear to doctors just how much trouble we were in. Lockdown would continue to be delayed, even as cases rose up all around us. Instead, we heard the mantra “the NHS is well prepared for coronavirus” again and again and again.
NHS staff knew different. The effects of years of under-resourcing had been laid bare by the toughest winter for the NHS yet. Rota gaps were numerous. Waiting times had spiralled. We were having to close ICU beds as we just didn’t have the staff to care for patients that would fill them.
The NHS was already on its knees. As doctors, we went into fighting this virus with one hand tied behind our backs.
Finding a voice
Doctors had been shouting from the rooftops about safe staffing levels for some time. The profession had come together to warn about the impact of the Modernising Medical Careers programme, the pensions crisis, and of course the imposition of the junior doctor contract on the faltering recruitment and retention of staff.
The various crises that have rocked our profession have steadily been making doctors more politically aware. For me the tipping point was the case of trainee paediatrician Hadiza Bawa-Garba. It was this that pushed me to form the Doctors’ Association UK (DAUK), with the aim of giving frontline doctors back the voice they had lost.
Yet doctors’ repeated warnings went unheeded, and decisions made under the previous health secretary Jeremy Hunt came back to roost as the true scale of the pandemic was realised.
A breakdown in trust
In the early days of the pandemic, rightly or wrongly, the crisis was treated as a level 4 major incident, with all communication funnelled through NHS England. In the spring of 2020 our inbox at DAUK filled up with emails from doctors who had been prevented from speaking out on social media or giving interviews to the press, especially regarding a lack of personal protective equipment (PPE). Several were even disciplined for doing so.
In my opinion this strategy contributed to a breakdown of trust between the government and the public. Unlike the scenes we saw coming out of Italy, the scale of the crisis in the UK was not shown publicly. It is not too big a leap to say that this led to a situation where some people continued to break the lockdown rules, simply not believing that things were “really that bad.” Meanwhile, those of us working on the frontline were broken and traumatised by what we had seen. The disconnect was palpable.
Having lived through the disaster of the first wave after the concerns of frontline staff were roundly ignored, doctors were more resolute to speak up a second time. As we watched on through autumn and early winter, the government seemed more determined to save Christmas than lives.
We reached a tipping point in December as conditions on the frontline became critical. A number of doctors began speaking up on social media and in the press. This was not coordinated in any way, it happened organically. Doctors were no longer willing to sit by and watch the car crash happen in slow motion. They stood up and started speaking. And the public turned to listen.
A target for abuse
Very few doctors envisage themselves in the role of public health communication. Yet confused messaging from the government meant it fell to doctors to convey just how dire things were across the frontline, and to encourage the public to stay at home. As a result, many families chose to listen to NHS staff, ignoring the advice given to them by the government and forgoing their “Christmas bubbles.”
But this came at a cost for those who chose to put their head above the parapet. Around the same time that doctors were becoming more vocal, so were the covid sceptics and anti-masker movements. As the movement gained prominence on social media, a number of doctors became targets of online abuse. At one London hospital on New Year’s Eve, a crowd of protestors even gathered outside, chanting “‘Covid is a hoax”’ at NHS staff as they left their twilight shifts.
For doctors who were already exhausted, it seemed they were fighting a war on two fronts: the virus on one hand, and misinformation on social media on another.
Fighting for change
While there is no doubt that doctors played a vital role in public health during this pandemic, others came together to push for political change.
Without clinicians speaking up about PPE shortages it would never have been in the public eye, forcing the government to act. Many doctors took things into their own hands, fundraising for PPE, collecting data on shortages, and delivering PPE to GP practices and other settings who were relying on using bin bags as aprons. It is doctors who are now taking the government to court to force a public inquiry into PPE shortages and the deaths of healthcare workers.
It is extraordinary that doctors were able to pull together a cross-party consensus on death in service benefit, and even more extraordinary that doctors were able to see the deeply unfair immigration health surcharge for overseas healthcare workers scrapped during the pandemic.
Many doctors recognised that this crisis provided an opportunity to fix long term problems and improve working conditions. This included setting up self-rostering for doctors, even for those on emergency rotas; refitting staff rooms that had long been neglected; arranging for hot food to be delivered during night shifts; installing coffee machines and ensuring access to hot drinks. Others have set up peer support services in the face of a lack of support for frontline NHS staff during the pandemic.
A call to arms going forward
During the pandemic, doctors demonstrated the power of speaking up in unison to leverage change. But we must continue to use our newfound voice. The pandemic has highlighted many of the very real structural problems in how the NHS workforce is valued that we already knew existed. The trauma of the pandemic will only pour salt onto these very deep wounds.
Many doctors are now making plans to leave the NHS or the profession altogether. Without caring for our staff now, there is a very real risk that we will lose them. No amount of applause has the power to prevent the mass exodus from the NHS that many fear is around the corner.
We cannot go back to the way things were. Now is the time to become more vocal, not less.
Samantha Batt-Rawden is a registrar in emergency and intensive care medicine and the president of the Doctors’ Association UK (DAUK). Twitter @sbattrawden
Competing interests: Samantha Batt-Rawden founded DAUK, an independent lobbying group.