The Ward Round: The Great Isolation

The last week has felt like Groundhog Day.

This winter was already going to be tough, but the most unwelcome of Christmas guests – no prizes for guessing who that is – has made it even tougher for the health service and of course the workforce.

According to the most recent survey of Royal College of Physician members, one in 13 doctors are off sick in London, and one in 24 nationwide, which according to the college is the worst sickness absence seen during the pandemic, other than at the end of March 2020.

RCP president Andrew Goddard said the medical workforce is trying to deliver as much covid care as possible, but is also seeing the usual winter rise in other respiratory conditions.

“At the same time, many colleagues are taking well-earned holiday to spend time with their families and friends over Christmas,” Professor Goddard said.

And at the time of writing, London had also just seen a 2,000 rise in all covid-related absences.

These figures are alarming, but a recent government decision to change the covid isolation period to seven days, providing two negative lateral flow results on day six and seven are done, could help ease some of the staffing pressures.

Danny Mortimer, chief executive of NHS Employers, said the change in guidance provides a pragmatic approach to managing the ongoing impact of covid.

“We hope it will take the edge off the severe staff shortages we are seeing in the NHS this Christmas and beyond,” he said.

He warned the measures still wouldn’t be a silver bullet and there could still be around 130,000 NHS staff being off sick on Christmas Day across mental health, ambulance, primary, community and hospital services.

“The NHS will continue to prioritise essential care and it is vaccinating at record levels against covid, but if cases continue to rise at this rapid rate then widespread disruption is inevitable,” he added.

The Ward Round has already seen evidence that trusts are updating their staff isolation policies to reflect this change and it may provide a little glimmer of hope that staff will become available to work again sooner than they might have.

But what else can be done to reduce staff sickness and isolation? Last week NHS leaders were told in a webinar by NHS England that NHS boards must ensure “assiduous attention to detail” in following existing IPC guidance and that the “optimal implementation of [IPC] measures are in place”.

There is an argument the government and its agencies need to go further, with some clinicians and safety experts describing current IPC measures as outdated.

Helen Hughes, chief executive of Patient Safety Learning, told HSJ that ensuring staff have the right PPE is crucial to ensuring patients and staff are protected.

“Today the World Health Organisation is issuing updated guidance for health workers, recommending the use of either a respirator or a medical mask, in addition to other personal protective equipment, when entering a room where there is a patient with suspected or confirmed covid,” she said.

She argued the UK’s approach is too open to “inconsistencies” and said the IPC guidance needs to be “urgently updated” so HEPA/FPP3 masks are provided for NHS staff.

The missing plan

When commenting on the dramatic rise in staff absences this December, NHS Providers deputy chief executive Saffron Cordery also spoke about how the NHS came into the pandemic with “significant staff shortages”.

“Trust leaders are calling for a fully funded and costed workforce plan so that they have the assurance of the right staff in the right places in the future,” she said.

Despite the obvious urgency for a fully funded workforce plan, Health Education is yet to be allocated any education and training money after the disappointment of the recent spending review.

Complaints about the Treasury’s unwillingness to publish workforce predictions have been made before – most notably by the former health secretary Jeremy Hunt – and this was reiterated again by Dido Harding during a House of Lords debate on the Health and Care Bill.

She said: “Three years ago, I was asked by the then secretary of state to lead the development of the NHS people plan. The Interim NHS People Plan, published in June 2019, set out significant programmes to make the NHS a better place to work, to improve leadership culture, to recruit more nurses and to change the skills mix, but it did not contain any forecasts of workforce numbers.

“Why was this? It was not because the work was not done - it was - and not even because the government disagreed with the numbers. There are no forecasts because we could not get approval to publish the document with any forecasts in it. My experience is clear. Unless expressly required to do so, government will not be honest about the mismatch between the supply and demand of healthcare workers.”

The government owes the NHS workforce more than this honesty. If the NHS wasn’t already in a workforce deficit, would it have been hit quite so hard by absences throughout the pandemic? We won’t know the answer to this, but it’s high time for the Treasury to bite the bullet and protect it from future pressures.