People’s Covid Inquiry: impact of the pandemic on the population—families, NHS staff, and mental health

The first witness in this session was Stephen Reicher, professor of psychology and neuroscience at the University of St Andrews. Reicher felt that one of the biggest mistakes the government had made was to accept advice early on “from non-behavioural scientists” that the British public could not cope with a lockdown. Throughout the pandemic, the government had viewed the public as “a problem” with a poor grasp on reality and unable to deal with a crisis. In fact, research and evidence show that people tend to come together and support each other in a crisis, and that mutual support is critical to any public response. In reality over 90% of people understood and obeyed the clear message to “stay at home,” out of a sense of community, despite the fact that for many it was a financial hardship.

“(The government’s) paternalist psychology, that people are weak and frail and can’t do things for themselves, their positioning of their best asset, the public, as a problem, is one of the fundamental failures of this whole pandemic.”

Reicher said that a good government supports that sense of community, while a bad government undermines it. He felt that the government had consistently acted to fracture the relationship between themselves and the public, and between different members of the public. They had used a narrative of blame against the public, saying it was their fault if they got infected. But people got infected mainly because they were more exposed. Poor people and ethnic minorities were more likely to break the lockdown because they couldn’t afford to stay at home.

“The government never gave people the support they needed to self-isolate.”

Reicher then addressed the government’s messaging. Communications “had always been woeful.” For instance, 96% had understood the message to “stay at home,” but only 30% thought they understood “stay alert,” because “what on earth does that mean?” Experts warned the government about the confusing messaging, but the government ignored them. People were heroic while they saw the need, but problems arose when messaging became contradictory—travel internationally, but don’t travel internationally, hug people, but don’t hug them. Then the government started to put dates ahead of data, setting up dates like 21 June 2021 as “Freedom day” from covid restrictions, which people invested in emotionally and practically, for example by booking holidays. He also felt the government were now passing the blame on to the population.

“Now their narrative of ‘responsibility’ is effectively saying: We wash our hands of this, it’s over to you. And if things go wrong, it’s your fault.”

And recently the government had begun to politically manage and manipulate data, for instance suppressing evidence on infections in schools. “I think that’s very serious indeed.” 

Finally Reicher addressed the problem of burnout and moral injury among frontline staff. He felt these arose when, however hard you try, you still can’t do your job properly. He felt that some staff would give up the “insulting” 1% pay rise offer if they could only get the resources to do their jobs properly. 

Going forward he urged people to take collective action, which in itself is good for our health. He also wanted the UK to support the global roll out of vaccination. 

The next witnesses were Rachel Sumner, senior lecturer in psychology at the University of Gloucestershire and also a psychobiologist, and Elaine Kinsella, chartered psychologist and lecturer in psychology at the University of Limerick. Using surveys and interviews they had examined how the pandemic had affected the mental health and wellbeing of a broad range of frontline workers in both the UK and the Republic of Ireland (RoI).

Sumner and Kinsella had noted that the governments in the UK and the RoI had reacted in different ways to the pandemic. The Irish government had reacted quickly with suppression and elimination tactics, while the UK government had delayed, allowing events such as the Cheltenham Racing Festival and a Champions League football match to go ahead before eventually going into lockdown.

They found that burnout was higher and resilience and wellbeing were lower in UK workers, and that much of this in the early stages was due a perception that their government’s actions had not been timely or decisive. When they did act, their actions were felt to be inadequate and too late. UK workers criticised the “chaos” of government advice which had been unclear and ambiguous. They also felt that the government had not dealt “consistently or adequately” with rule breaking, particularly with egregious examples. They felt that at the beginning, people had stood together, but that had changed once they saw high profile rule breakers go unpunished.

As a result, frontline workers felt generally let down by the government, especially when they were not prioritised for the vaccine. Individuals felt “depleted, exhausted, and overwhelmed.” Sumner and Kinsella were seeing cases of post traumatic stress disorder, based on exhaustion, and feelings of inadequacy and futility. They felt that while resilience was important it could over time lead to worse burnout.

“I feel hugely let down by the government, cannon fodder absolutely nails it”—healthcare worker

“We worked for peanuts with our flimsy PPE, crossing our fingers that we can beat it, the Government sicken me with their lack of empathy. 30% pay rise for them and a clap for us. What a mug I was for being a nurse.” — NHS nurse

Frontline workers appreciated gestures such as weekly clapping, but felt it needed to be backed up by meaningful support and congruent behaviour. Importantly the interviews were usually the first time anyone had asked them how they felt.

When we asked our participants during the interviews, how they were doing, many of them said, god, that’s the first time somebody’s asked me that, and really broke down, were really, really emotional”

Going forward they felt it was difficult for front line workers to take any collective action when they are struggling just to get to the end of the day.

“It’s hard and dangerous work. And for people to do that hard and dangerous work every day, they need to know that it’s worth it and that it means something. But they are starting to feel hopeless, they are starting to feel that they have lost the point, they’ve lost the drive to keep working.”

The next witness was Rachel Ambrose, a mental health nurse working in child and adolescent mental health services (CAMHS). She works with in-patient services, dealing with young people in significant crisis who can no longer be safely cared for at home with their family. CAMHS already had too few hospital beds and staff before the pandemic, and very often there weren’t any available beds for children at significant risk. The pandemic exacerbated many mental health problems in children and adolescents, and following the first lockdown there was a surge of mental health referrals. These commonly involved eating disorders, depression and self-harm—problems which thrive on isolation. Many children were also very stressed over missing so much schooling.

Going forward, Ambrose felt the service needed a cash injection to deal with the burden of mental health problems in young people, and to ensure a safe environment for patients and safe staffing levels in CAMHS. There was also a need for professionals to go into schools to help children access support that hadn’t been available during the pandemic. Asked about the long-term consequences of mental health issues and emotional traumas in young people, she said they would continue to have an impact on their relationships and education. 

“(They impact on) generations to come. We know that what a young person experiences today is going to have an impact on how they parent their children.”

The next witness was Kevin Courtney, joint general secretary of the National Education Union. Courtney said that not only had the UK had the highest death rate from covid in Europe and the most economic disruption, but also the longest periods of closure or near closure of education.

“Our schools were largely closed for much the longest period, and I think that is a record of failure by this Government.”

Education, like the NHS and social care, was already in crisis when the pandemic struck. School funding had been cut “dramatically” since 2015, (when the coalition ended) and the schools with the poorest children had suffered the largest cuts. As a result, class sizes had increased to where they were 40 years ago, without any compensatory increase in space. Thus social distancing was much harder than in other countries, and schools suffered more disruption.

The teaching unions had called for school closures in March 2020 and, along with SAGE, for a “circuit break” in October 2020, but had been ignored. They had gone along with schools re-opening in September 2020, but had been “badly let down” when children went back as there weren’t enough tests available. They had also called for children in secondary schools to be taught on a rota system, with one week at school followed by a week at home, but that had been ignored too. At no stage had the government talked to or taken advice from the teaching unions—”we were completely blanked by the prime minister.” Courtney believed that if the government had listened there would have been less disruption of education and fewer deaths.

Teachers had felt “very vulnerable” because of a lack of masks at the beginning, the inability to observe social distancing and the overcrowding and poor ventilation in schools. Courtney felt that Gavin Williamson, education secretary, had been wrong to remove the mask mandate for schools in May 2021, as there had been no disciplinary problems around pupils wearing masks in classrooms. SAGE estimated it would have cut transmission in schools by a third.

He then moved on from safety issues to talk about the many other problems that had arisen, including the failure to deliver laptops and broadband, and the determination of exam grades by algorithms, which had been “a farce” and very stressful for pupils. Children from poor homes had been particularly badly affected by the pandemic as they typically had little space and few resources at home, and their parents were unlikely to work from home.

“Teachers see the differential impact that social class and inequality has had. It’s a fundamental issue that has to be addressed. There are massively discriminatory impacts of the school closures, the school disruption. The government has to work with us to put those things right, not only as a result of covid, but also the inequality that existed pre covid, that was shown up during covid.”

Going forward Courtney wanted the government to be much more generous in helping education catch up after the pandemic. £15 billion was needed, but only 10% of that, £1.5 billion, had been offered. The corresponding offer in the USA (calculated per pupil) would have been £21 billion and in the Netherlands £18 billion. He also wanted more money invested in ventilation in schools, to deal with both covid and other airborne diseases.

The final witness was Zahra Ali, a 17 year old student hoping to study medicine. Ali said it had been very difficult for students like herself who had all been working really hard towards important exams. It had been very difficult to accept that after all their hard work it would be other people determining their fate (by awarding grades) rather than by taking exams.

“We didn’t know what was happening, the government were silent, there was lots of room for students to become anxious and worried about their futures.”

She said parting with friends during lockdowns was “really really upsetting.”

“I had to say goodbye to everybody and that’s not normal.”

Strong and familiar themes emerged from this session. The government had failed to recognise and take advantage of a strong sense of duty and co-operation that existed in the community when faced with the crisis. Confusing and inconsistent messaging and a failure to deal with high profile rule breakers had then alienated the public.

Frontline workers had suffered burn out and moral injury as a result of not being supported to do their jobs properly, and this had been exacerbated by a perception that UK government actions had been too little and too late. As a result front line workers were depleted and exhausted.

Mental health services for children and adolescents had already been in crisis before the pandemic and thus had been unable to cope with the rise in mental health problems in this group during the pandemic.

Finally the UK had suffered longer periods of educational disruption than other countries, partly due to the problems arising from cuts in education before the pandemic, but also because the government had “blanked” advice from the teaching unions about how to best manage education during the pandemic.

Jacky Davis, consultant radiologist, founder member of Keep our NHS Public, panel member of the People’s Covid inquiry.

Competing interests: none declared.