Never before have I felt in constant fear from the risks of doing my job

VISITING battlefields, I have often wondered how very young conscripts coped with the fear and confusion of battle. This is something most NHS staff never find out. NHS ambulance and A&E staff are sometimes physically threatened or assaulted. But we are more likely to face burnout and cumulative damage to our well-being.

The Covid-19 pandemic has changed that. In 31 years as an NHS doctor I have never been scared of immediate personal risk from my job. But fear is now a constant companion for many of us: fear of becoming infected, perhaps fatally; fear of infecting our patients, families or colleagues.

People are anxious and fearful, but they keep turning up regardless out of a sense of duty to patients, loyalty to their professional values and, perhaps most of all, out of fierce loyalty to colleagues. The fear has been compounded by anger at the slow delivery of adequate personal protective equipment to keep us as safe as possible, Covid-19 testing capacity and what has seemed like ever-changing official guidance on what to do when we have symptoms.

These are now being tackled and improving. But I see people frustrated that they cannot get straight back into the fray. I guarantee that most staff having to sit at home (unless they have a bad, disabling dose of the viral symptoms) would rather be involved.

We also risk what some researchers have termed “moral distress” at having to provide a standard of care, staffing or expert supervision that is less than we would want because of unparalleled demand and staff absences. We will watch more people die of respiratory distress syndrome than most of us normally would – albeit with the best palliative care we can provide within our resources. And our own need for distancing and protective equipment can stop us having the same close conversations and touch we would normally use.

As demand on rapidly expanded but still scarce intensive care unit beds grows, there may yet be some awful decisions to be made between patients who could all in normal times have been reasonable candidates for intensive care and ventilation. Many staff members will be pushed into unfamiliar roles. Despite reassurances from professional regulators this will make many clinical staff feel vulnerable. They are the visible face of the service, but managers with operational, logistics and HR roles and occupational health teams are also under severe duress.

So are others, such as porters or cleaners, who put their own safety on the line without the same recognition and for less reward. Being in and out of hot, restrictive protective gear and on constant vigilance for infection control is tiring. But the way in which the whole of acute care has reorganised, doubled up on rotas to provide more continuous cover, increased capacity in intensive care and even stepped up to the challenge of creating field hospitals in exhibition centres has been a marvel – much of it fuelled by gallows humour and team spirit.

I am proud to work alongside these people. I feel immense gratitude to have a secure job, unlike so many others. But I don’t underestimate the impact on the mental and physical well-being of staff. Psychological and emotional support, and some rest, will be needed as we go on with the battle.

‘Staff are anxious but keep turning up regardless out of sense of duty to patients and fierce loyalty to colleagues’