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/.

Almost 900,000 public sector workers who have been working on the front line fighting the coronavirus pandemic will be rewarded with an inflation-busting pay rise, but nurses and care workers will not be included.

Chancellor, Rishi Sunak announced the pay rise after months of political pressure to reward frontline key workers. Public sector workers including doctors, dentists, teachers, police officers and the armed forces will benefit from the rise. But no new rise has been announced for other NHS staff including nurses, care workers cleaners and porters who have all risked their lives and more than 300 NHS workers have lost their lives throughout this pandermic. 

With inflation currently just 0.6%, the biggest increase of 3.1% goes to teachers, followed by the doctors and dentists receiveing 2.8%.

Below is a breakdown of the pay rises in full. 

• School Teachers 3.1 per cent
• Doctors & Dentists 2.8 per cent
• Police Officers 2.5 per cent
• Armed Forces 2 per cent
• National Crime Agency 2.5 per cent
• Prison Officers 2.5 per cent
• Judiciary 2 per cent
• Senior Civil Servants 2 per cent
• Senior Military 2 per cent

Chancellor of the Exchequer Rishi Sunak said: "These past months have underlined what we always knew – that our public sector workers make a vital contribution to our country and that we can rely on them when we need them. It’s right therefore that we follow the recommendations of the independent pay bodies with this set of real-terms pay rises."

"Each award is recommended by independent pay review bodies, and this year government accepted the headline recommended rise for each workforce. This year’s pay awards reflect the enormous effort made by those in the public sector in responding to the unprecedented challenges for the country during the Covid-19 outbreak."

The pay awards for the armed forces, prison officers, senior civil servants and NHS staff work will be backdated to April this year, whereas the pay rise for police and teachers starts in September which run on a different pay year (September-August).

NHS nurses are not included in the announcement because they negotiated a three-year deal in 2018.They are already in the final year which expires in April 2021 and hasn't yet been renewed.
The Treasury pointed to the three-year Agenda for Change pay deal agreed in 2017, which it said saw starting pay for newly qualified nurses increase by 12 per cent, citing an average rise of 4.4 per cent for nurses outside of the most senior roles. The Royal College of Nurses has calculated that the average salary for a nurse has fallen by 8 per cent in real terms since the Tories were elected in 2010.

Unions said the pay rises which ministers have failed to commit to for months amid widespread public outcry are minimal in comparison to the real-term cuts seen over a decade of austerity.

They also highlighted that public sector, including social care workers – who have also risked their lives during the crisis – would receive no such increase. TUC general secretary Frances O'Grady said: "These rises are welcome, but there's still a long way to go to restore pay after a decade of real terms cuts," she said. “Many public sector workers, like job centre staff and local government workers, aren’t getting these rises. They deserve a decent pay settlement too." “And the government should urgently announce a pay rise for social care workers, who put their lives on the line to care for others during this pandemic.”

Social care workers are reliant on private firms which is why they not get a dedicated pay rise either. Policing minister Kit Malthouse said social care workers would have to rely on increases in the minimum wage to improve their pay levels.

As almost a million public sector workers were awarded pay rises, Mr Malthouse said: "The vast majority of social care workers are paid in the private sector so our ability to influence pay rates there is limited." He told BBC Radio 4's Today programme that - apart from "nationalising the entire thing" - the minimum wage rate was the best tool the Government had to recognise the efforts of care workers."
"What we have done is raise the level of the minimum wage very significantly over the last few years to get it up towards the £10.50 mark. That, we hope, will push through into these private sector jobs."

"Everybody looks at people who work in social care during coronavirus and thinks they have done a fantastic job in very, very difficult circumstances. But that's the mechanism by which we think we can increase pay in that sector."

Given that the whole nation were clapping for carers and front line NHS staff every Thursday evening for almost 10 weeks to show their appreciation this is very disheartening to those who risked their lives and continue to do so. 

The Treasury said the money for the pay increases of up to 3.1% would come from existing departmental budgets, meaning cash-strapped government departments must work out how to pay for them.

Labour shadow chancellor Anneliese Dodds said the Conservatives had frozen public sector pay for seven years, and the rises they introduced after that failed to plug the gap. She said the pay rise was "good news" but added that it "won't make up for a decade of real-term pay cuts" for many front-line workers. 

The British Medical Association said doctors had hoped for "far better". Dr David Wrigley, vice-chairman of the British Medical Association, said doctors would feel "disappointed and let down" as pay "has fallen way behind" over a decade. He told BBC Breakfast: "These are the sort of rises we'd expect to see in normal times, not in a time when many of us have not had a day off in six months and have been putting our lives on the line."

Health Secretary Matt Hancock said: "These past few months have been an incredibly challenging time for our NHS, and the resolve, professionalism and dedication of staff has been on show throughout. We are able to accept the recommendations of the independent pay review body for dentists and doctors."

"I am committed to supporting the entire NHS and social care workforce through improved recruitment and retention and delivering 50,000 more nurses and 6,000 more doctors in general practice."

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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."

Being concerned about the news is understandable, but for many people this is taking its toll on people's mental health, particularly those already living with conditions like anxiety and OCD. 

People across the UK are now staying at home for long periods without the contact with friends, family and colleagues which would normally be part of everyday life. Some people may find the change easy to adapt to, but for others this will be a very difficult adjustment to make. It can make existing mental health problems worse.

Many are beginning to realise that this unique moment requires a focus on mental health as well as physical. 

So how can we ensure our mental health is protected during the Covid-19 lockdown? Here are some tips for minding your mental health during the lockdown .

1. Get dressed and set up a routine

Creating a routine will help bring a sense of purpose to your days. With nowhere to go or nobody to see, it may seem pointless to get dressed and showered, but you’ll feel untidy and dirty by the end of the day. So, by just starting with simply getting dressed will help make you feel fresh and more like yourself. Without doubt, this is the quickest, easiest thing you can do that reaps the most benefits.
Think of a few things you could do that would make you feel accomplished – like studying for an hour, cooking, gardening or doing a workout video – and a few things you want to do – like gaming, binging Netflix. Perhaps do work around the house that you haven’t got around to all these years due to a lack of time. Lists are super useful here and will help you to look back and see what you have achieved with your day.

2. Stay connected

Advances in mobile technology in particular mean that we can stay connected through calls, text, WhatsApp, email, social media etc. Use this time to get in contact with people.
Try to connect with people who you haven't heard from in a while or people in your community who are likely to be isolated right now. The additional time at home can bring tension but it can also be an ideal opportunity to reconnect and strengthen relationships within the family.
Remember you can always mute WhatsApp groups and Facebook groups if you’re finding them too overwhelming. You can also mute keywords and unfollow accounts on most social media platforms., which will help limit unwanted content on newsfeeds.

3. Maintain a healthy lifestyle

The negative impact of sleep disruption on mood is well-established. Without the structure of having to get to school, college or the workplace, it can be easy to fall into unhealthy sleep habits like going to bed later and getting up later. Changes to your sleep cycle now could go on to impact your mood in the weeks and months ahead.
Scheduling a balanced range of activities in your day including:
• Getting adequate and healthy sleep
• Daily routine of working and resting
• Eating nutritious food
• Exercising at home, there are lots of video on YouTube you can try out
• Practice meditation or try to relax when you can
• Do not be afraid to discuss your anxieties and fears with someone. It helps to ventilate and talk things out.

4. Working from home

If you find yourself working from home for the first time, it means figuring out how to stay on task in a new environment that may not lend itself to productivity. But there are ways to deliver results and avoid going stir-crazy, from setting up a good workspace to the way you talk to your team.

• Have a clear workspace is crucial for your state of mind, and not just in terms of being in a "working" mindset but also so you're able to turn off when the working day is over.
• Washing and dressing appropriately is very important when working from home. It will not only improve your state of mind, it will psychologically prepare you to start work. Likewise, changing out of work clothes when you clock off for the day helps your brain to understand that the working day is over.
• Remember to eat. With no access to a canteen or shops you most likely will have to make lunch. Try to plan ahead what you will make so that it is built into your schedule and it’s a healthy and nutritious meal.
• Taking breaks regularly is very important to avoid being burnt out. Overworking will only result in less productivity and frustration. Being cooped up inside can lead to fatigue, therefore even walking around the garden or even watering plants around the house will help keep your mind active and focused.
• Establishing boundaries is very important, especially if you're employed by a company, you'll probably have set hours of work, and it's important to stick to these when you're working from home. Be ready to start your day at the same time as you would normally arrive in your office or workplace, and finish your day at the same time. Setting a “to do list” will help you stay on track, organised and create order. Sharing this with your employer is also helpful so they are aware of your work.

5. Maintain hygiene

Whilst it is important to maintain hygiene, do not be preoccupied with it all the time. Be mindful of washing hands, and not touching metal surfaces, do not cough or sneeze without tissue paper.

6. Limit social media usage

Whilst it’s important to stay digitally active, it is also important to carefully choose your news and media sources, particularly if some of the information you are receiving is leaving you feeling overwhelmed. Remember that some of the information online is driven by the views, opinions and agendas of individuals, and it may not be helpful for you to take those on as your own right now.
Choosing one or two well-informed sources and limiting yourself to set times during the day to check for ups for example at 9am and 5pm.
Try and share the positive stories you see: of people who have recovered or even a post on social media that made you laugh.

7. Understand the risk

Stay up to date on COVID-19 but only trust the information that comes from authentic sources.
From the government: https://www.gov.uk/coronavirus
From the NHS: https://www.nhs.uk/conditions/coronavirus-covid-19/
Try not to be glued to the news 24/7
Do not believe every message or tweet circulated in social media

8. Be prepared

Make a list of helpful contact numbers and emails – such as for healthcare and keep enough supply of non-prescription medicines to last at least a month. Talk to family and friends nearby about how you can support each other, in case one household is quarantined. For example, dropping supplies outside the front gate. Use self-help tools. There is a list of clinically approved apps that have been put together by ORCHA – who’ve been set up to help regulate the safety and value of these apps and make sure people find the right app for the right reason. They have recommended Wysa to cope with stress or anxiety issues. Wysa has released free tool packs for everyone to cope with the stress of isolation and current health anxiety. They want to ensure that everyone has mental health resources during this crisis.

At this time, it is important that everyone gets the help they need – and this includes looking after yourself.

Please continue to follow NHS guidance, stay at home, protect the NHS, and save lives.