Let down

Since it was founded in 1948, nothing has tested the abilities and durability of the NHS as COVID-19 has. The selfless and courageous response from health professionals over many months of the pandemic contrasts sharply with criticism of the Government’s handling of the initial stages of the crisis, labelled by the Parliamentary health and social care and science and technology committees as ‘one of the most important public health failures the UK has ever experienced’.

While there are two ongoing inquiries into the pandemic, one led by the UK government and one by the Scottish parliament, the former is yet to even agree a final terms of reference for its remit – let alone begin to examine the facts.

Recognising the urgency of finding answers, the BMA undertook a detailed study of doctors’ views and experiences through an online call for evidence conducted between November and December last year.

Drawing on doctors’ submissions, as well as data compiled through multiple COVID tracker and viewpoint surveys, the results of these investigations now form the basis of five reports on the pandemic.

The first and second of these reports, which focus respectively on the protection of the medical profession from COVID-19 and the effect of the pandemic on the medical profession, have been published.

Their findings paint a harrowing image of what thousands of doctors had to endure, and how failures in government policy before and following the onset of the pandemic, had a dramatic effect on staff’s physical safety and mental wellbeing.

One of the most damning findings from the BMA’s first report is that 81 per cent of the nearly 2,500 doctors participating in the call for evidence state they did not feel fully protected during the first wave of the pandemic in 2020.

Deficiencies in PPE (personal protective equipment) either through shortages, being of incorrect type or poorly fitting, was a phenomenon commonly reported by doctors across the board during the first weeks of the pandemic.

Respondents to the call for evidence from doctors working in AGP (aerosol-generating procedure) settings revealed across-the-board shortages or a complete absence in a range of PPE.

This included 71 per cent of respondents citing shortages in full-face visors, 65 per cent citing disposable goggles and 54 per cent reporting deficiencies in FFP3 (filtering facepiece 3) masks.

One GP based in Northern Ireland told the BMA they were ‘amazed at how paltry it was’.

‘[It was] like going over the top in WW1 with a bow and arrow.’

‘At the start, despite knowing of the virus spread, no PPE was provided,’ says a consultant based in Wales.

‘Not even masks let alone thinking of level 2 PPE for aerosol-generating procedures. This was when many of my colleagues and I became ill.’

In its first report, the BMA determines that initial shortages in PPE were exacerbated by a failure to enact pandemic-preparedness measures in the years prior to COVID and inadequate or poorly communicated safety guidance once the pandemic began.

The latter included some doctors being instructed by their employers not to use PPE during the early weeks of the pandemic, with Government guidance failing to keep pace with the rapidly changing situation on the ground.

‘I was not allowed to use the PPE that I had personally paid for,’ one medical academic consultant from England told the BMA.

‘They [the trust] said it will be unfair to the rest of the staff if I used my own. When I said that I would be happy to share with people that I work with, they said, unless I could provide [for] everyone in the trust, it wouldn’t be “fair”.’

The report says the situation was further compounded by the IPC cell, the pan-UK body tasked with reviewing and developing infection prevention and control guidance, downgrading the requirement in March 2020 for those interacting with COVID patients.

Staff were required only to have a fluid-resistant surgical mask, ‘ostensibly driven by the unfounded assumption that aerosol transmission only occurred during aerosol-generating procedures’.

It was already becoming clear COVID could be spread by talking or coughing, but the guidance – on which employers tended to rely – did not change.

‘The PPE guidance was based not on safety, but rather the lack of preparedness,’ one staff, associate specialist and specialty doctor based in Scotland reported.

‘False platitudes of staff safety were peddled out, when in fact staff were left at higher risk.’

There were also worrying disparities in the experiences around COVID risk assessments, with staff from ethnic minorities reporting higher levels of dissatisfaction with the risk-assessment process and ethnic minority staff and women experiencing more issues with fit testing in their workplace.

Forty-eight per cent of ethnic minority doctors told the call for evidence their individual risk assessments had been either mostly or completely ineffective at protecting them during the pandemic, compared with 35 per cent of white doctors.

Shortages in PPE and having to care for seriously ill patients, often while not feeling properly protected personally, had a huge mental and physical effect on thousands of doctors during the pandemic.

At least 50 doctors are to date known to have died of contracting COVID-19, while many more are thought to have suffered prolonged and debilitating symptoms of the virus through long COVID.

In its second report on the pandemic, the BMA cites a survey conducted in February this year which found that among doctors who had developed long COVID, 11 per cent said that they had been forced to reduce their working hours.

A further 51 per cent said that, while they were still able to work, their condition had affected their quality of life. One medical academic trainee from England said that, after contracting COVID from their workplace on two separate occasions, they were left permanently disabled. ‘My second COVID infection has left me with damage to my spinal cord,’ they explain.

‘I now walk with crutches and cannot walk more than about 200m without them. I also have bladder and bowel problems and have to intermittently catheterise. There is not a day that goes by where I don’t have some form of pain.’

‘I caught COVID in March 2020 from a colleague at work,’ a junior doctor from Scotland told the BMA. ‘I have been mostly bedbound since. My life as I knew it had ended. These are supposed to be the best years of my life but I’m spending them alone, in bed, feeling like I’m dying almost all the time.’

The mental and emotional toll of the pandemic upon the medical profession has also been enormous. Demand for BMA counselling services between February 2021 and January this year saw a 173 per cent increase compared with the period of February 2019 and January 2020.

Responses given to the BMA highlight the huge psychological effect the pandemic had on many doctors’ professional and personal lives.

‘I was worried for my own mortality [and] more so for my family’s,’ explains a locally employed doctor from England.

‘I didn’t physically go inside their house for at least six months. One day I arrived to [see] my father crying in the window waving at me. He opened the front door and asked me to quit my job, he was worried I would also die as a result of COVID exposure at work.’

One SAS doctor based in England told the call to evidence that the pandemic had been ‘one of the worst periods of my life’ adding that they had had to seek private therapy having at times felt suicidal because of their experiences.

A Scottish GP meanwhile confessed to still having flashbacks of wheeling former patients to an ‘overfull morgue’ and having to deny visitation access to families whose loved ones were dying.

‘There is no escape from it,’ another SAS doctor told the BMA. ‘I see dead colleagues in the trust news emails, local and national press. I dream about it at night. I’m intermittently consumed by the ocean of sadness it has caused.’

Yet, at a time of unprecedented mental and physical stress, many doctors responding to the call for evidence spoke of how, far from receiving much-needed support, they were often left feeling abandoned or even attacked by the Government.

Doctors working in general practice in particular found themselves being targeted by the UK Government and national press and, as a result, some patients, after being falsely portrayed as ‘not working’ and failing to provide the public with access to care.

In its second report, the BMA states that the UK Government’s failure to publicly back and defend doctors in the face of this growing hostility undoubtedly damaged the morale of the medical profession as a whole.

‘Extremely demoralising as a GP to have worked very hard for the last two years adapting to a new world/technology and ways of seeing patients to help keep everybody safe and meet demand, to then be derided in the press and by politicians as lazy and told to get our act together and see patients face to face,’ said a GP from Scotland.

‘This attitude in press and by politicians is doing possibly irreparable damage to the morale of GPs and the respect/attitude patients have for us.’

‘I am now finding demand from patients has risen exponentially and with long delays in referrals to secondary care, we are receiving a lot of verbal abuse from angry and frustrated patients,’ said a salaried GP from England.

‘This has not been helped by the negative impression of primary care perpetuated in the media and by the comments of some politicians. It has made me question if I want to continue in primary care once the pandemic is over.’

Responding to the publication of the first two of the association’s reports into the pandemic, BMA council chair Chaand Nagpaul says the studies represent a landmark in research about COVID-19, how it affected doctors and how Government failures and mishandling frequently exacerbated the situation.

He says: ‘These reports are probably the most significant body of evidence about the pandemic ever prepared, containing the lived experiences of doctors during one of the most traumatic times in NHS history. [They] also reveal, unequivocally, that the Government failed in its duty of care to the medical profession and point to critical lessons that must be learned for the future.

‘Some of the decisions made by the UK Government during the pandemic had tragic consequences. At least 50 doctors have died as a direct result of contracting COVID-19 whilst many thousands more have suffered or continue to suffer anxiety, burnout and moral injury. Doctors have had to care for dying colleagues, hold smart phones in front of dying patients so loved ones could say good-bye, and go to work sometimes daily with inadequate personal protective equipment, poor risk assessments and little or no respite.’

He adds: ‘We are determined that doctors’ voices are heard and so by bringing together for the first time their experiences and their evidence, we can present our findings to the public inquiries with total clarity.’