NHS healthcare workers are being pushed above and beyond their limits as a result of the rising no. of COVID-19 cases, limited resources and staff shortages.

Staff are both emotionally and physically exhausted and the psychological effects of the pandemic will have a lasting impact on their mental health. The impact of other pandemics such as the SARS is well noted, with increased rates of depression, burnout, post-traumatic stress disorder (PTSD) and anxiety.

Early warning walls were available on the impact of COVID-19 from China and Singapore. Data published from these countries detailed the mental effects the pandemic was having on healthcare workers. Mix this with pre-existing rates of stress-related illness, high suicide rates compared to other occupations and we have a perfect storm. With all this data available the UK was still unprepared.

To assess the factors associated with staff burnout during the COVID-19 pandemic a study of 2,707 healthcare workers identified these to be:

1. Feeling pushed beyond training
2. Exposure to Covid-19 patients
3. Making life-prioritising decisions

To deal with the intensity of the current wave, many staff have been redeployed again to areas such as ICU, with limited experience and training, with increased exposure to Covid-19 patients, and senior staff increasingly having to make life-prioritising decisions, such as whether someone is suitable to be admitted to ICU and go on a ventilator. Staff are doing this day-in and day-out, for months. It is not difficult to understand why our workforce is burning out.

A senior nurse based in a London emergency department reported to the Independent “We were seven short this morning. Some are sick with Covid, some are isolating and some have been off for weeks for mental health reasons. Every day we are relying on the goodwill of colleagues to come in to do extra shifts.”

“The extra support we had in the first wave, with free food, transport, and extra pay for additional shifts has been scrapped. Many of us are not from the UK, feel isolated and drained, and haven’t seen our families for eight or nine months. I have never seen so many nurses cry during shifts. Every shift is a struggle.”

Some healthcare workers have been forced to take prolonged sick leave for mental health reasons or have even resigned. “I have already been off long term for mental health reasons and I became so unwell, I attempted to take my own life,” another nurse said. “On my return, I’m being pushed to be redeployed. I was told I had a job to do and to get on with it. Many of us felt like lambs to the slaughter.”

The support provided to staff during the first wave, such as free parking, food, accommodation, access to psychologists and wellbeing hubs, is no longer in place at most trusts, at a time when the staff need it the most.

A report from the Royal College of Nursing Research Society in May 2020 showed 24% of 4,063 nurses and midwives across the UK, surveyed between 28 April and 12 May, said they were suffering severe or extremely severe depression. This is a dangerous situation for a profession that already had a high suicide rate before Covid-19 struck.

One senior nurse said: “I feel sorry for some of the junior staff. I remember I had to teach someone over the phone how to do non-invasive ventilation, as we didn’t have enough staff and I just couldn’t leave.”

“When junior nurses ask for help and feel overwhelmed, sometimes they are left by themselves to get on with it, as there just isn’t enough support. After months of this, I was forced to take a period of sick leave as I couldn’t cope anymore and felt so guilty.”

The pandemic has also had an impact on the next generation of doctors and healthcare workers. Many postgraduate exams are being cancelled or postponed as have some speciality recruitment interviews, which trainees have dedicated months preparing for. The uncertainty, unpredictability and the detriment to their career pathway has also contributed to psychological distress and burnout.

The goodwill of staff, on which the NHS has run on for many years, is running out. Over the coming weeks and months, the Covid surge is likely to continue. The government, key policy makers and local/national stakeholders must ensure that the mental health of staff is not neglected in the face of the rising Covid admissions and deaths, and that adequate support is in place to curb an impending mental health epidemic in the UK – the aftermath of which may see many staff members off on long-term sick leave or resigning completely.   

If you’re concerned about yourself, a loved one or a colleague the NHS offers an urgent mental health helpline. To find your local helpline please visit https://www.nhs.uk/service-search/mental-health/find-an-urgent-mental-health-helpline.  

For a full list of mental health services available from charities, organisations and support groups please visit https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/.

For those who have recovered from Covid-19, the road to recovery is long and tedious. Once the brilliance of ICUs disappears from the public eye, it will be the turn of rehabilitation services. 

Physiotherapists are not only part of multidisciplinary teams that save lives. They are also part of the multidisciplinary teams that give people their lives back and ensure they are as independent and meaningful as possible.

Covid-19 is testing processes and every skill of those working in the medical and healthcare field. It affects each patient very differently. People with milder cases have tiredness, loss of appetite and decreased stamina, while others are so impacted they cannot sit on the edge of the bed without the physical support of four physiotherapists. Something like this can take up to 12 months for patients to recover from. 

Spending time in bed, not moving, can also result in a significant decline in muscle mass and strength and this has been linked to falls, functional decline, increased frailty and immobility, all of which increases the risk of pressure ulcers and subsequent infection. This needs to be addressed and online physiotherapy can play a key role here as face to face appointments are not currently possible during the lockdown.

Online physio services also address the issues of travel distance and lack of care resources which can be a frequent barrier to accessing care. For many patients, it is also convenient, particularly if fatigue is an issue which is a key feature of Covid-19 along with breathlessness. With this in mind tolerance to exercise will need to be in short bursts, paced to individual needs and take place several times a day. Resilience building this will need to be at their own pace and will benefit from support to progress to self-management.

This could involve a variety of bed-based exercises to increase joint mobility and strength, to chair exercises, to standing which will include balance work and repetitive more advanced exercises. If breathlessness is an issue then some breathing exercises will need to be given. Pacing is essential and patients must be encouraged to listen to their body

The key to recoverment is movement and patients will need to be encouraged to engage in a rehab programme and gently increase activity levels and set goals. 

The NHS is launching Your Covid Recovery for people suffering with the long-term physical and mental impacts of the virus. In the coming months tens of thousands of the most seriously affected coronavirus survivors will be offered online recovery services. Everyone will be able to access advice about recovering from the virus via the portal from later in July, and a second phase of personalised services for those who need specialist rehabilitation will be launching later this summer. 

Patients will be able to speak with nurses and physiotherapists over the phone, join a survivors’ community, follow exercise tutorials to help regain muscle strength and lung function, and access mental health support through the portal. 

This comes after the first centre to provide rehabilitation services for Covid-19 survivors, as well as non-coronavirus patients, the NHS Seacole Centre in Leatherhead, Surrey, began treating patients in late May.

Announcing the launch of the rehabilitation service on the NHS’s 72nd anniversary, the institution’s chief executive Sir Simon Stevens said Covid-19 has been “the biggest challenge in the NHS’s history”. He said: “As we celebrate the birthday of the NHS and look ahead to the next phase of our response, while in-person care will continue to be vital, the health service is embracing the best that new technology can offer us to meet the significant level of new and ongoing need."

“Rolling out Your Covid Recovery, alongside expanding and strengthening community health and care services, is another example of how the NHS must bring the old and the new together to create better and more convenient services for patients.”

Health Secretary Matt Hancock said the Government has invested millions of pounds into coronavirus research and will support the NHS to deliver long-term rehabilitation. He said: “We are learning about this disease all the time, and increasingly know that for some people, Covid-19 has debilitating lasting effects.”

He added: “The new research will help us understand how to prevent and treat the long term complications suffered by some." “I suffered from coronavirus first-hand so I know the impact it can have. I’m determined to ensure we have the best possible treatment for coronavirus, both to save lives, and to help anyone suffering from the aftershocks.”

As the UK begins to emerge from lockdown, buiness leaders have backed one last 'huge' applause to thank key workers on the 72nd anniversary of the NHS. 

People are being asked to come out and clap at 5pm on Sunday 5th July on the 72nd anniversary of the NHS to say thank-you to all the NHS staff who have worked during the coronavirus crisis.

Weekly claps became the norm in the first few months of lockdown with streets of neighbours heading out to their doorsteps, back gardens and windows to give thanks for the effort of healthcare workers during the Covid-19 crisis. The last clap took place on 28th May, after the woman who came up with the idea claimed the show of gratitude had "had its moment" and risked being politicised.

But this Sunday, it will come back as a one-off, with NHS bosses hoping to make it an annual event for the anniversary. Public buildings will be lit up in blue, including the Royal Albert Hall, Blackpool Tower, the Shard and the Wembley Arch, the health service said. As a mark of respect broadcasters will also suspend transmissions for a moment.

People are also being encouraged to put a light in their windows the night before to remember all those who have died from COVID-19, the same day pubs, hairdressers and restaurants will be allowed to open for the first time.

 The Clap for Carers initiative started on 25th March by Dutch-born Londoner Annemarie Plas. The weekly tradition was often accompanied by the banging of pots and pans. It was Ms Plas herself who called for the tradition to end after its 10th week and she expressed her hope that it could instead become an annual event.

 NHS chief executive Sir Simon Stevens says he hopes the public will use the anniversary as an opportunity to "say a heartfelt thank-you" to hospital staff.

Sir Simon said: "This year has been the most challenging in NHS history, with staff displaying extraordinary dedication, skill and compassion to care for the 100,000 patients with COVID-19 who needed specialist hospital treatment and many others besides."

"During this testing time our nurses, doctors, physios, pharmacists and countless more colleagues were sustained by the support of the public, not least through the weekly applause for key workers."

"No health service, not even the NHS, could have coped alone with this coronavirus pandemic. From bus drivers and teachers to care staff and food retailers and, of course, the public who took action to stay at home to stop infection spreading, everyone played their part."

A coronavirus vaccine is not yet available, however when it is frontline key workers in the health and social care sectors and those with heart and kidney disease, and the over 50s will be given priority, the health secretary has announced. He said he will priorotise those people for vaccinations who are at higher risk of getting COVID-19.

Human trials began on a second potential vaccine being developed at Imperial College London this week, while production has already started on another possible inoculation at Oxford with the aim of building up stockpiles to be ready for deployment if it is approved for use in the autumn. He said "AstraZeneca has struck a deal for the manufacture of the Oxford vaccine. They’re starting manufacturing now, even ahead of approval, so we can build up a stockpile and be ready should it be clinically approved.”

Speaking at the daily Downing Street coronavirus briefing, Matt Hancock said his approach to vaccines was ”to throw everything at it as fast as we can” in order to have inoculations ready to use as soon as they are deemed safe. 

Millions will have to wait their turn as demand for protection from Covid-19 is high. The Joint Committee on Vaccination and Immunisation (JCVI) issued interim advice that jabs should go first to frontline health and social care workers and those at increased risk of serious disease and death because of age and underlying health factors. Mr Hancock said that work was under way to see whether black, Asian and minority ethnic people should be added to the list because of research showing that they make up a disproportionate share of cases and deaths. 

The health secretary said: "As we learn more about the virus we will continue to take into account which groups may be particularly vulnerable, including, for example, those from ethnic minority backgrounds so that we can protect the most at risk first, should a vaccine become available, and get this country back on our feet as soon as we possibly can." “In the long run, the best way to defeat this virus is of course the discovery of a vaccine. And since the start we’ve been supporting the most promising projects."

In deciding who comes first in the queue for the vaccine, Matt Hancock said ministers will be “guided by the clinical science, prioritising those in most need”.  

The Recruitment & Employment Confederation (REC) has called for the government to ensure that temporary and locum staff working in the NHS and the care sector are provided with equal access to PPE and COVID-19 testing kits. Half (48%) of specialist recruiters have flagged this as a major concern in the fight against Coronavirus. 

These agency health and social care staff are vital in the fight against Coronavirus, and they must be able to carry out their duties as safely as their colleagues who are permanent staff. This call comes as part of a four-point plan from the REC to help bridge staffing shortages and ensure that we harness the expertise of specialist health and social care recruiters during this pandemic. The manifesto, ‘Backing the NHS and care sector at a time of crisis’, also sets out how government can work with the recruitment sector to:

• build agile and sustainable recruitment supply chains; compliance checks and hiring processes must remain effective but must be sped up to meet demand for staff;
• set the right standards for recruitment by developing a formal partnership agreement with the Department for Health & Social Care; and
• take a lead on longer-term workforce planning by launching a review of future NHS and care sector workforce strategy and reviewing immigration policy.

Tom Hadley, Director of Policy and Campaigns at the REC, said: “We want to work with the NHS and care sector to ensure that all workers, including temporary and locum staff who are providing crucial frontline support, are kept safe at work. Looking at the longer-term, 70% of healthcare recruiters would welcome a post-crisis review of how flexible staffing can best be harnessed. The NHS already had 100,000 unfilled vacancies prior to the pandemic – we want to build a genuine partnership approach with government to pre-empt and address both immediate and future workforce challenges.

“The recruitment industry places more than a million people into temporary, contract and locum placements every day. We want to work with the government to harness the contribution of recruitment experts during this time of national emergency, and this manifesto sets out four priority areas that will help to make this happen.”

This guidance covers the donning (putting on) and doffing (taking off) of personal protective equipment (PPE) in health and social care settings.

For the latest information please visit https://www.gov.uk/government/publications/covid-19-personal-protective-equipment-use-for-non-aerosol-generating-procedures

Further guidance on PPE and hand hygiene can found by following the video links below.

• Safe donning and doffing of PPE: https://youtu.be/3vdLKlNXoCs
• How to safely wear a face mask: https://youtu.be/M4olt47pr_o
• Hand washing guidance: https://www.youtube.com/watch?v=fXWA7TTop_w 

This evening the UK will come together for a national salute to honour the hardworking NHS staff and all carers working hard through the coronavirus outbreak.

In a gesture of thanks to the frontline healthcare heroes, everyone across the nation has been invited to join a mass round of applause from their doorsteps, gardens, windows and balconies on Thursday 26th March at 8pm.

Organisers of the "Clap For Carers" campaign - which started online - say it is being staged because "during these unprecedented times they [NHS staff] need to know we are grateful".

The person behind the campaign wrote on its website: "In Spain, France and the Netherlands they already did this. And being a Dutch Londoner, I want to pass this on in the country I feel so at home, and the NHS had been nothing but amazing to my family and myself!"

Landmarks such the Wembley Arch, the Principality Stadium, the Royal Albert Hall and Lincoln Cathedral are set to be lit up in blue during the salute. It is part of the #lightitblue campaign which has been organised by members of the events and entertainment industry as a way to say thank you.

In a statement, organisers said: "The events and entertainment industry finds itself in an unprecedented state of enforced inaction.” 

"The best thing we can do - apart from staying at home - is to use our skills and networks to say thank you to everyone who is supporting the NHS and risking their own health to help others during this pandemic."  

Shadow Health Secretary Jonathan Ashworth said: "Never have we owed so much to our brilliant and hardworking NHS staff. Just as they are caring for us, we need to care for them and give them every ounce of support they need. I welcome this fantastic initiative to encourage the public to show their appreciation to all our NHS workers." 

It comes as the total of confirmed cases of coronavirus in the UK since the start of the outbreak neared 10,000.
As health professionals battle the spread and tend to the patients, more than half a million people have also signed up to be NHS volunteers to support in the crisis.

Staying up to date

The government is continually providing updates. For the latest information and advice please visit Public Health England.

There is also guidance for health professionals on the NHS website www.england.nhs.uk/coronavirus.

Track confirmed coronavirus cases in the UK 

The coronavirus dashboard is now available to find out and track confirmed cases in the UK. 

Coronavirus Tracker - Mobile friendly guide

Coronavirus Tracker - Desktop guide

Symptoms of coronavirus & what to do

Coronavirus: Guidance for Health Professionals

With the impact of the coronavirus (COVID-19) the health and safety of our workers, staff and clients is paramount. We are closely monitoring the guidance from the government and implementing their advice.  

We have already made preparations to ensure business operations can continue as normal as possible in all scenarios.  

We have facilities for remote working and access to all our systems, which allows us to react to and mitigate the risk of spreading the virus.

All members of our work force have been passed instructions on hand-washing and action to take if they feel unwell, this has also been published on the company’s websites and posted in our offices.

Guidance for educational settings

Guidance for healthcare professionals

Symptoms of coronavirus and what to do

Guide to hand washing

We are taking the following specific actions:

• Wherever possible, we are offering client meetings to be "online" rather than face-to-face and avoiding any physical contact, such as handshakes
• We are asking all visitors to wash their hands with soap and water or hand sanitizer before entering our office
• We are following all government guidelines with respect to international travel
• We are suspending conferences and large internal meetings taking place in March and April that require travel
• We are undergoing regular deep-cleaning our offices
• Colleagues and temporary workers returning from travel, either business or personal, from a high-risk area are being asked to work from home for 14 days irrespective of symptoms

We do not currently foresee any impact on the continuity of our service, but should the situation change we will notify all our staff, workers and clients immediately. Although we believe the actions, we have put in place are appropriate for the current levels of risk, they are in constant review.

The government is continually providing updates of Coronavirus (COVID-19) in the UK.

For the latest information and advice please visit Public Health England.

You can also view the Government’s Coronavirus Action Plan.

There is also guidance for health professionals on the NHS website https://www.england.nhs.uk/coronavirus/

Track confirmed coronavirus cases in the UK

The coronavirus dashboard is now available to find out and track confirmed cases in the UK.

• Coronavirus Tracker - Mobile friendly guide
• Coronavirus Tracker - Desktop guide

Symptoms of coronavirus

Coronavirus infects the lungs. The symptoms start with a fever followed by a dry cough, which can lead to breathing problems. It takes five days on average for symptoms to start showing.

The most common symptoms of coronavirus (COVID-19) are recent onset of:

• new continuous cough and/or
• high temperature

For most people, coronavirus (COVID-19) will be a mild infection 

How to avoid catching or spreading coronavirus

DO:

• wash your hands with soap and water often – do this for at least 20 seconds
• always wash your hands when you get home or into work
• use hand sanitiser gel if soap and water are not available
• cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
• put used tissues in the bin immediately and wash your hands afterwards
• try to avoid close contact with people who are unwell

DON'T

• do not touch your eyes, nose or mouth if your hands are not clean 

What to do if you have symptoms of coronavirus

• You do not need to call NHS 111 to go into self-isolation.
• Use the 111 coronavirus service online assessment
• To protect yourself and others, do not go to a GP, pharmacy or hospital

• if you have symptoms of coronavirus infection (COVID-19), however mild, stay at home and do not leave your house for 7 days from when your symptoms started. This action will help protect others in your community whilst you are infectious. Read more advice about staying at home.
• plan ahead and ask others for help to ensure that you can successfully stay at home.
• ask your employer, friends and family to help you to get the things you need to stay at home.
• stay at least 2 metres (about 3 steps) away from other people in your home whenever possible.
• sleep alone, if that is possible.
• wash your hands regularly for 20 seconds, each time using soap and water.
• stay away from vulnerable individuals such as the elderly and those with underlying health conditions as much as possible.

If your symptoms worsen during home isolation or are no better after 7 days contact NHS 111 online.

If you have no internet access or unable to get help, you should call NHS 111. For a medical emergency dial 999.

Treatment for coronavirus

There is currently no specific treatment for coronavirus.

Antibiotics do not help, as they do not work against viruses.

Treatment aims to relieve the symptoms while your body fights the illness.

You'll need to stay in isolation, away from other people, until you have recovered.

Ending self-isolation 

You should remain at home until 7 days after the onset of your symptoms. After 7 days, if you feel better and no longer have a high temperature, you can return to your normal routine. If you have not had any signs of improvement and have not already sought medical advice, you should contact NHS 111 online at 111.nhs.uk. If you have no internet access, you should call NHS 111.

Cough may persist for several weeks in some people, despite the coronavirus infection having cleared. A persistent cough alone does not mean you must continue to self-isolate for more than 7 days.

Track confirmed coronavirus cases in the UK 

The coronavirus dashboard is now available to find out and track confirmed cases in the UK. 

• Coronavirus Tracker - Mobile friendly guide
• Coronavirus Tracker - Desktop guide

Staying up to date

The government is continually providing updates. For the latest information and advice please visit Public Health England.

There is also guidance for health professionals on the NHS website www.england.nhs.uk/coronavirus. 

Find guidance about coronavirus (COVID-19) for health professionals, businesses, schools and other organisations.

This guidance was last updated on 12^th March 2020, for the latest information please visit https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance

The advice for anyone in any setting is to follow these main guidelines.

1. If you have been in contact with someone with coronavirus or have returned from an affected area identified by the Chief Medical Officer as high risk and you are feeling unwell with a cough, difficulty breathing or fever, stay at home and use the NHS 111 online coronavirus service or call NHS 111.
2. Wash your hands more often than usual, for 20 seconds using soap and hot water, particularly after coughing, sneezing and blowing your nose, or after being in public areas where other people are doing so. Use hand sanitiser if that’s all you have access to.
3. To reduce the spread of germs when you cough or sneeze, cover your mouth and nose with a tissue, or your sleeve (not your hands) if you don’t have a tissue, and throw the tissue away immediately. Then wash your hands or use a hand sanitising gel.
4. Clean and disinfect regularly touched objects and surfaces using your regular cleaning products to reduce the risk of passing the infection on to other people.

At the current time and based on our understanding of what is known of COVID-19 and other similar respiratory viruses, it is likely that older people and those with chronic medical conditions may be vulnerable to severe disease. As more information emerges, recommendations may change.