Alison Twycross – Editor-in-Chief of Evidence-Based Nursing Journal (@alitwy)

Just over a year ago @jakesuett and I wrote a Blog titled: Health Care Professionals with Long Covid: Have they been forgotten? Very little has changed since. Long Covid is a new disease which we know relatively little about. However, we do know that:

• Long Covid is a relapsing and remitting disease affecting individuals differently
• Stress exacerbates Long Covid symptoms
• Trying to go back to work too early can cause an exacerbation in symptoms, potentially prolonging recovery time
• A standard four-week phased return to work (RTW) is not adequate for most people with Long Covid and may cause an exacerbation of symptoms

The Covid-19 pandemic highlighted the impact of the staffing crisis in health and social care (HSC). Across the UK, there are shortages of staff in the NHS and care sector. Data for England indicates that in June 2021 there were 38,952 registered nurse vacancies across the health service. Indeed, in Scotland the Royal College of Nursing has issued a nursing workforce warning in response to the NHS Recovery Plan. Given this we need to focus on retaining the skills and expertise of our staff.

Health and social care workers (HSCW) are the largest occupational group of people with Long Covid (see: https://bit.ly/3osOujF; https://bit.ly/3A7xJg5). RTW is part of individuals’ recovery (SOM guidance). Even without the current staffing crisis in HSC, one might imagine staff with Long Covid would be supported to return to work (RTW). However, this does not appear to be the case. The Long Covid Facebook groups are increasingly full of stories of people losing their jobs due to prolonged sick leave or terrified they are about to do so. For HSCW this is particularly unfair as many/most caught covid at work often due to inadequate PPE (see: https://bit.ly/3mdbS1O). Indeed, the results of a survey carried by the Greater Manchester Law Centre found 45.3% of people who caught covid at work (not just HSC) reported no safety measures in the workplace at the time. Additionally, most people with Long Covid have struggled to access appropriate medical care potentially impacting on their recovery time. (This is discussed in an earlier editorial.)

Guidelines outlining best practice in supporting staff with Long Covid to RTW are now available (see list of hyperlinks below), but few people describe having a good experience. Sadly, many of the stories in the Facebook groups describe an unsupportive workplace and an apparent refusal by some in HR and management to deviate from the standard four-week phased return despite this being identified as best practice and NHS Employers (NHSE) advising this may be necessary. Many employers appear to have little understanding of Long Covid and the implications for RTW.

Hyperlinks to UK guidance outlining best practice in supporting staff with Long Covid

Employers can do several things to support staff with Long Covid and minimise the stress associated with long-term sick leave. First, there is a need for clear communication with employees including changes to pay and/or sick leave. Long Covid terms and conditions vary across the four UK nations but most people working in the NHS have been on full pay while on covid related sickness and not subject to standard sickness absence management procedures. However, this is beginning to change. In England, for example, NHSE have recently changed their guidance and now leave it up to individual Trusts to decide how Long Covid sickness should be managed. When news of this broke in the Long Covid Facebook groups there was understandable panic: “Am I going to go onto half or no pay?” “Am I going to lose my job?”

Secondly, managers need the requisite skills and knowledge to manage long-term sickness in the context of Long Covid. I suspect many relatively junior managers are feeling out of their depth and trying their best to deal with a situation that is completely new to them. Managers and HR advisers need an understanding of Long Covid and how this impacts on employees’ RTW as well as awareness of best practice guidelines.

Thirdly, organisations wanting to support staff with Long Covid back into the workplace need to draw up a RTW plan in partnership with the employee. For the RTW plan to be successful occupational health advice must be considered. The plan must be reviewed and amended regularly. Organisations need to move away from the standard four-week phased RTW and consider temporary redeployment to a cognitively or physically less demanding post which allows employees to pace and/or work from home. The SOM guidance is clear that a reduction in hours is key to a successful RTW, with a very gradual graded approach to increasing hours. Failure to follow these steps means a substantial number of staff being lost from the workforce.

Organisations should give someone in the senior management team oversight of the RTW of staff with Long Covid. This person will have a good understanding of Long Covid and best practice guidelines as well as being able to see the big picture across the organisation with awareness of potential redeployment opportunities. They could work alongside a senior HR adviser to ensure good communication with staff with Long Covid to minimise the stress and anxiety associated with long-term sickness. Any revisions to existing organisational policies and procedures could also be facilitated.

Even in the middle of a global pandemic organisations should be taking steps to improve the RTW experience of people with Long Covid, ensuring their skills and expertise are not lost the HSC workforce. That this is not happening is hard to comprehend and a national disgrace.

Acknowledgements: I’d like to thank all the health and social care professionals who sent me their stories to enable me to write this blog. Particular thanks go to Amanda Lohn (@LohnRSCN), Dr Jenny Ceolta-Smith (@JCeoltaSmith) and Dr Clare Rayner (@ClareRayner6) for reviewing drafts of the Blog.

Disclaimer: I have written this Blog as a Registered Nurse who has previously held senior management posts, doesn’t work in the NHS but is on long-term sick leave with Long Covid.