‘Laid-off cabin crew with resuscitation skills’ – what is the answer to the NHS staffing crisis?

Faced with an NHS and social care system ill prepared for the coronavirus pandemic, a call went out for 250,000 volunteer community support workers to help up to 1.5 million people who have been asked to shield themselves from infection because of underlying health conditions.

The response has been staggering, with more than 400,000 coming forward. The recruitment target has now been raised to 750,000. They will deliver medicines from pharmacies, drive patients to appointments and bring them home from hospital, and make regular phone calls to check on people isolating at home.

Quite how vetting, safeguarding, training and safety issues will be addressed is unclear, but that this is tapping into a strong desire on the part of many people to be helpful to their fellow humans cannot be doubted. There have also been large numbers of retired NHS workers offering to return to work and help their struggling colleagues. 

The Tories have been obsessed with getting unpaid labour to support the failing health and care systems, now wrecked by years of their austerity and underinvestment. In the process, they have also given volunteering a bad name. After Cameron’s ‘big society’ initiative sank without trace, 2018 saw the launch of a charity called helpforce. This planned to massively boost the numbers of NHS volunteers from 74,000 to “millions” and was the (as yet unrealised) ambition of merchant banker Sir Thomas Hughes-Hallet, better known to his friends as ‘Huge-Wallet’. The aim appeared to be for volunteers to do the work that hard-pressed doctors and nurses (through staff vacancies) did not have the time for. With 40,000 empty nurse posts, and bursaries that had been axed, NHS England managed to find £2.3m for helpforce in the Long Term Plan.

Currently, the NHS Nightingale nursing workforce is to be supplemented by recently laid-off air cabin crew with resuscitation skills, and first aiders from St John’s Ambulance. This unit has more than 80 wards each with 42 beds; around 16,000 members of staff could be needed should it reach full capacity. 

An unresolved question is just where the trained NHS medical and nursing staff will come from to add to the small numbers of military personnel and staff promised from the private sector. Chief nurses around the country have been asked to state their numbers of spare critical care staff – the replies are not difficult to imagine. One suggestion has been to send staff from distant parts of the country relatively behind London in the course of the pandemic and give them crucial experience before sending them back to their own hospitals. One of the objections to this is that the average length of stay for a critically ill patient is two weeks, and the surge in patient numbers likely to be maintained much longer than this. Staff sent to London would probably be kept there, greatly reducing NHS capacity in the regions just as the caseload rocketed. However, if we had a properly coordinated national response to the crisis, the possibility of NHS workers moving temporarily to hot spots might be a valuable strategy.

Of course many people still have a sense of social solidarity and want to find ways to help others. Such altruism should be both lauded and facilitated. It stands in stark contrast to the neoliberal ideology of Conservative governments – it appears there is such a thing as society after all. 

In response to the pandemic support for medical and care staff, as well as vulnerable neighbours, has been provided by members of the public all over the world, independently of the state.  This is indeed evidence of the thrilling and transformative force of mutual aid. In this context there is plenty of room for volunteers, and an energy that needs to be harnessed in the fight for universal health care in the post-covid era.

However, volunteers recruited by the government or their agencies should never be used as a substitute for trained staff. They should only ever be in supporting roles. Look to supermarkets: now in urgent need of extra hands, they have created new jobs and hired people to work. In the first instance community support staff could be recruited from those workers who have lost their jobs and livelihoods. They could be given a contract, a wage and some training. While I would prefer an experienced ICU nurse to look after me if I become ill in hospital with COVID-19, since they will be at a premium and caring for six patients rather than the usual one, I will not object to them being assisted by redeployed cabin crew with some medical skills and experience of keeping cool in emergencies. There may well also need to be willing volunteers in non-clinical support roles to keep the show on the road. 

Volunteers are not the solution to the crisis in staffing that existed pre-pandemic, and is now exacerbated by illness. But together with additional paid redeployed staff recruited with some level of skills, given basic training and afforded the usual protections of employees, they will be part of the solution until the crisis is over. Some of them may then even join the fight for restoration of a truly public, universal NHS.

Dr John Puntis is a consultant paediatric gastroenterologist, the co-chair of Keep Our NHS Public, and a member of Doctors In Unite.

commissioning COVID-19 Government Guidelines Government Policy

Coronavirus: how will an overstretched NHS cope?

Wuhan Novel Coronavirus (CoVid-19) has claimed over 1,300 lives and infected 60,000 worldwide so far, with no sign of slowing down. The NHS has become an increasingly fragmented service supplied by multiple providers, which is at risk of failing to deliver the co-ordinated, effective response that Coronavirus requires.

The last potential pandemic the NHS responded to was swine flu in 2009. Since then, the NHS has altered significantly – although privatisation was well under way, there were some notable differences that meant it was in a better position to respond to pandemic flu.

At the time there was a clear hierarchy from the top table decision makers: the Chief Medical Officer, Department of Health and the Health Secretary, down to the Primary Care Trusts and GPs. The Strategic Health Authorities operating above the PCTs had power to realign funding priorities between PCTs as needed.

An excellent report from the Centre for Health and Public Interest in 2014 reviewed the response in 2009 and found this hierarchy had a “clear line of sight,” allowing the co-ordinated response that swine flu required. There were flaws, such as a lack of evidence base for the widespread delivery, and the unnecessary stockpiling of anti-influenza medication, but in terms of interdepartmental communication and a joined up response, things worked well.

None of the organisations that existed then remain today, due to the top-down reorganisation that followed the Health and Social Care Act in 2012. We are now undergoing another costly reorganisation with the creation of Sustainability and Transformation Plans and Accountable Care Organisations. £79.9 billion of the NHS budget is controlled by Clinical Commissioning Groups, who purchase services from local providers. There is a fragmented landscape of different providers and disparate service provision across different regions. According to NHS England there are 150 independent providers of health services in England on top of the 233 NHS providers.

The Secretary of State for Health retains emergency powers to demand co-ordinated action, but these are yet to be exercised. It remains to be seen how these disparate services, with different contracts and arrangements, can be centrally directed to deal with a possible pandemic. We have lost the organisational memory that the swine flu response developed. With so many different providers with varying contractual arrangements offering widely differing health care services, an effective response to Coronavirus may be far more challenging.

Monitoring of the contracts with private providers is often poorly done, so it is conceivable that these arrangements might not be conducive to scaling up service provision in the event of a global health emergency. The chaotic healthcare architecture is exacerbated by the continuing cuts to local government public health services, as much as 8% from 2013 to 2018, and by our already overwhelmed emergency departments.

Coronavirus may well spread in large numbers. The neglect and fragmentation of our health service by the last 10 years of Conservative government could make a difficult situation catastrophically worse.

Dr Sammy Luney is a junior doctor and member of Doctors in Unite. A longer version of this article can be found on his Medium page.