Dr David Wrigley, GP and Deputy Chair of the British Medical Association (BMA) council, outlines how the BMA’s ‘Lessons Learned’ inquiry is vital to understanding the concerns of NHS staff and informing future government measures. 

The UK has one of the highest Covid-19 death tolls in Europe, with current estimates being a total of 154,000 deaths. With other comparable nations experiencing a far lower death toll, the government’s management of the pandemic, and by extension its ability to protect those it has consistently hailed as “heroes”, has been called into serious question.  

During the first wave of the pandemic nearly half of intensive care staff reported symptoms of post-traumatic stress disorder, severe depression or anxiety. Endeavouring to provide a high standard of care with a lack of resources, inadequate PPE, and understaffing took its toll across the workforce. This begs the question, what more could have been done to protect NHS staff? 

Examining the struggling nature of the NHS prior to the pandemic it is painfully clear that the resources would not be available to manage a crisis of this scale. Dr Wrigley has worked as a GP in north Lancashire for over 20 years and is an advocate of workforce wellbeing, currently leading on a safe staffing project in his role as Deputy Chair of the BMA council. 

Setting the scene of the prior state of the NHS, Dr Wrigley said: “When the pandemic started the NHS wasn’t in a great place; we had far too few doctors, nurses and others, of course, far too few numbers of beds to deal with the problems that we had, and the funding as well was far lower than comparable nations.” 

While Boris Johnson has promised that a public inquiry will be held into the handling of the pandemic, this is not due to begin until the spring of 2022 at the earliest. A public inquiry may take years to complete and, given that Covid-19 continues to place pressure upon the health service, the BMA has stated that this is “simply not good enough”. 

On 8 July the BMA announced it would begin its own Lessons Learned inquiry, while memories are still fresh in the mind of health and care staff. The BMA will gather evidence from members across the UK and seek accounts from stakeholders which will inform the final publication. 

Five key areas of focus for the inquiry include the protection of healthcare workers from Covid-19, the impact of the pandemic on healthcare workers, the delivery of healthcare during the pandemic, the public health response to the pandemic and the impact of the pandemic on population health. 

“Doctors have told us in our surveys that they have seen an increase in stress, poor mental health and depression, with many developing symptoms of PTSD” 

Dr David Wrigley, GP and Deputy Chair of the British Medical Association 

Protecting the workforce 

The pandemic has shone a light on longstanding obstacles that NHS workforce have faced in delivering care, while also throwing up a whole host of new challenges. Needless to say, the government has uncomfortable questions to answer over its plans to futureproof healthcare workers’ protection. 

Dr Wrigley said: “Over the course of the pandemic we’ve been advocating on many aspects. Right from the outset around concerns over lack of PPE provision and when it is appropriate to use it, also around the number of deaths from Covid in the NHS workforce and the prevalence of doctors from ethnic minority backgrounds who died.” 

Healthcare workers have been exposed to the harshest realities of the pandemic and their mental health has become an increasingly important factor. Safeguarding staff wellbeing, in turn, allows them to deliver their highest standard of care. 

“Doctors have told us in our surveys that they have seen an increase in stress, poor mental health and depression, with many developing symptoms of PTSD. Our helpline and services have seen a huge increase in the number of doctors and medical students utilising it. Doctors will often not come forward and acknowledge that they’re unwell and it is important to recognise that the numbers are going up.” 

Longstanding shortages, amplified by Covid 

In many ways, the pandemic has not actually changed the nature of the problems facing the NHS workforce. Longstanding workforce shortages were already pushing clinical staff to their limits. 

“We [the BMA] estimate that it’ll take until 2046, that’s 25 years, before the NHS has enough practising doctors in training to meet the current EU nation average. We think that fifty thousand extra doctors are needed to meet the country’s health care challenges and to deal with the backlog,” explained Dr Wrigley. 

While the government has announced extra funding for medical schools to allow over 9,000 on medical and dentistry courses for 2021, training the doctors of the future does not offer an immediate solution to a current issue. Further, recent funding announcements from the government for the NHS have failed to offer ring fenced workforce support. 

“Training more medical students is essential but it takes a long time to feed through. You also need the infrastructure in place to look after those students, that is not only in hospitals but in general practice as well, to train them and ensure they can see patients. We need an increased number of medical academics as well.” 

  • The BMA’s inquiry hopes to ensure frontline healthcare staff have a powerful voice in the government’s public inquiry to come in Spring of 2022. 
  • The BMA will gather evidence from members across the UK and publish a call for evidence for stakeholders.  
  • Their accounts will inform the resulting review and recommendations. 
  • The review will pose questions for policy makers and identify questions for the public inquiry to ask. 
  • This review, including evidence and recommendations, will be submitted to the public inquiry.  

“Looking after” the workforce 

Dr Wrigley emphasised the overall importance of “looking after” the healthcare workforce, a component that he felt was missing from the government’s Health and Care Bill currently making its way through Parliament. The BMA has publicly opposed the bill, making a clear statement that this is the “wrong bill at the wrong time”. For Dr Wrigley, with an urgent need to support the workforce, “the last thing the NHS and doctors need is another reorganisation”. 

A recent survey by Healthcare Workers Foundation found that nearly three quarters of NHS staff have considered leaving the NHS in the last 12 months. With nearly 30 per cent of those surveyed considering leaving in the next year, a mass exodus threatens NHS recovery.  

Dr Wrigley said: “We know that doctors and others in our surveys have said that they will likely retire early because of the pandemic and not feeling supported. We’ve got issues around punitive pension taxation rules for senior doctors who are working very hard but, in many instances, just don’t see the benefit of working. This is something that the government can directly tackle as these are the doctors who are the most experienced and we need to retain.” 

The voice of the workforce 

The BMA’s inquiry will focus on the voices of the NHS staff who have worked tirelessly over the pandemic, in attempts to hear their accounts while still fresh in mind. Their accounts will inform the BMA’s report, which will be produced into a series of clear recommendations for the government before the government’s own inquiry has been complete.  

Drawing upon the lessons learned over the course of the pandemic, the BMA will call upon the government to put measures into place to prepare the NHS for a possible future pandemic and unexpected surges in demand and vitally, to support and protect healthcare staff. 

Dr Wrigley affirmed: “It is amazing what the NHS workforce has done to help protect the nation over the pandemic and in difficult circumstances, with a lack beds, lack of doctors and lack of adequate funding, but the workforce is exhausted. They’re concerned about the winter ahead and the backlog of care and facing increasing abuse from frustrated patients. This is what we need to feedback to politicians.” 

With the outcome of a public inquiry still a long way off, it is essential to capture the current reflections of healthcare staff on the management of the pandemic. It is hoped this will help government to learn from mistakes prior to and during the pandemic, and crucially what can now be done in this period of unprecedented service demand. After working through the toughest circumstances many will have faced in their careers, it is only fair that the NHS workforce are not kept waiting for answers.