Coronavirus: Mounting fears over burnout among NHS staff as second wave intensifies

Patient safety is at risk due to exhausted nurses and doctors, experts warn

Fears are mounting for the wellbeing of thousands of NHS doctors and nurses who are suffering from burnout during the coronavirus pandemic, with mental health conditions accounting for up to 20 per cent of absences at leading hospitals.

The issue is expected to become more acute as hospitalisations from Covid-19 continue to rise during the second wave, experts have warned, prompting fears for patient safety.

Use of the BMA’s mental health helpline has risen by 80 per cent since September last year, The Independent understands.

Doctors have called for the restoration of services that had been provided to NHS staff – such as free food, accommodation and child support – to support their emotional wellbeing.

Frontline staff claim that such measures, which helped employees to feel “valued” were removed after the first peak.

The British Medical Association has meanwhile warned that the mental health crisis from the pandemic could carry long-lasting consequences for the NHS, leading to a mass exodus of doctors and nurses once the worst has passed.

"As we enter the second phase, doctors are already exhausted as they have had no time to recover from the first phase," said Dr David Wrigley, BMA deputy chair and wellbeing lead," told The Independent.

“The job was already exhausting and stressful in non-Covid times, but this has really hit us hard.”

Concerns over burnout had been raised prior to the pandemic. The findings of a recent government health and social care committee showed that exhaustion levels among staff were at an 11-year high in the months leading up to March.

But following the onset of Covid-19, rates of anxiety and stress surged, with health leaders fearful that the mental strains of the pandemic are only going to intensify in the months to come.

The Shelford Group, a collaboration between ten of the largest teaching and research NHS hospital trusts in England, including Guy’s and St Thomas’s, Cambridge University Hospitals and Manchester University NHS Foundation Trust, has insisted that the psychological wellbeing of staff must be addressed throughout the remainder of the crisis.

Research by the group found that high levels of absence attributed to anxiety, stress and other psychiatric illnesses continued in the months after the spring peak.

In one member trust, 20 per cent of absences in September were due to mental health conditions, representing an increase of about 10 per cent compared with the hospitals’ pre-Covid rates.

There is also increased demand for staff counselling and other support services among hospital staff who are at work, the organisation said.

The Shelford Group has welcomed the publication of the recent NHS People Plan, which was launched in response to the growing recognition that the NHS needed a longer-term workforce plan.

Among other measures, it outlines the provision of rapid psychological assessment and care for staff – though the Shelford Group has suggested the project is “in danger of faltering because of insufficient funding”.

Ankur Khajuria, an NHS surgeon and lead researcher of a Royal College of Surgeons study on the mental impact of Covid-19 on healthcare workers, told The Independent that more needed to be done to support the emotional wellbeing of healthcare workers.

“During the first peak, there was likely variation in terms of available support depending on where one worked, with somewhat of a postcode lottery in terms of what psychological and organisational support was provided to healthcare workers,” he said. 

“In my own hospital in London, there was provision for speaking with ICU psychologists on a one-to-one basis and presence of wellbeing hubs; but the same may not have been the case for hospitals across the country. And since the first peak, these services are generally less active.”

He said that staff had been provided with free food, accommodation and child care support to help ease the strain of the pandemic and make health workers “feel valued”.

“The problem is that we have somewhat reverted back to the pre-pandemic state,” he said. “As the number of cases started to go down after the first peak, and redeployed staff were sent back to their base specialties, a number of strategies put in place during the first peak, such as the free food and accommodation, were stopped. From a financial perspective, maybe that wasn’t viable.”

His research revealed that female nurses have been particularly affected on a psychological level during the pandemic. “Nurses have been hard hit during the crisis,” he said. “They are by the patient’s bedside for up to 12-13 hours, in full PPE, and often individually responsible for two to three unwell patients.”

Amid concerns of burnout among NHS doctors and nurses, health figures have also highlighted the dangers posed to patients – both those with and without Covid-19 – by exhausted and overworked staff.

Former health secretary Jeremy Hunt said this week that the charity Patient Safety Watch, which works to reduce levels of avoidable harm in the NHS, was investigating the link between burnout and adverse incidents.

“A key factor for patient safety is happy and unexhausted staff,” he wrote in a newsletter to supporters of the charity, which he established after leaving government.

Research from the University of Manchester concluded that “physician burnout is associated with increased risk of patient safety incidents, suboptimal care outcomes resulting from low professionalism and lower patient satisfaction”.

The review added that “the Covid-19 pandemic has exacerbated these issues but encouraged widespread recognition about the emotional burden of providing care within our systems”.

Separate work conducted by the Healthcare Safety Investigation Branch (HSIB) during the first peak of Covid-19 highlighted how exhausted staff on the frontline were fearful of making mistakes.

One NHS staff told the HSIB: “I haven’t been on a clinical shift today, but I’ve bumped into a colleague who has. She’s exhausted. She’s terrified that she made a mistake. She feels out of her depth. She’s been a specialist but put back into the wards.”

Another said: “I’m tired and not sleeping well. But I’ve never been able to phone in sick for work… That was never the done thing before this pandemic, let alone now. The managers need people to fill the slots on the rota, there isn’t the option to … consider the skill mix or if people are in a fit state to practice.”

The HSIB also outlined a number of performative issues within the workplace generated by burnout and stress. It notably warned of “attentional narrowing” – a reduction in the amount of information that is processed by overworked staff.

“In most circumstances, this ‘tunnelling’ is adaptive whereby attention is focused on those tasks of greatest subjective importance,” the research said. “However, tunnelling can lead to undesirable outcomes when information of importance is filtered and ignored.”

The BMA believes that the rising mental toll of the pandemic, alongside the pre-existing strains driven by staff shortages and work dissatisfaction, could culminate in the widespread departures of NHS doctors.

“Doctors are very concerned about the winter ahead as we have too few beds and too few doctors already,” Dr Wrigley said.

“Once we are through this I fear that morale will be at an all time low and many will say enough is enough and either leave their role, retire early or go abroad.

“The government must recognise this and do all they can to support those on the front line – now and in the coming years.”

Dr Hannah Wilson-Scholin, a junior doctor and medical education researcher from Harvard Medical School, said authorities need to be “focusing on what the long term outcome of this is”.

“There was burnout well before the pandemic,” she told The Independent. “Now we’re dealing with an acute problem on top of a chronic problem – and that really does need attention.”

A Department of Health and Social Care spokesperson said: “Supporting the mental health and wellbeing of our staff is a top priority, and we understand the huge pressures they face - particularly during this unprecedented pandemic.

“The NHS has recently injected £15 million to strengthen mental health support for NHS staff and ensure rapid access to mental health services as we head into winter. A range of services are already available, including a mental health hotline, practical support, financial advice, and specialist bereavement and psychological support.

“We would urge anyone struggling to come forward and speak to a colleague, their occupational health team, or to call the helpline so that they can get the help they need.”

This article was updated on March 8, 2021. It had previously referred to research from Guy’s and St Thomas’ NHS Foundation Trust, but the research in fact came from the University of Manchester.