Interview – NHS walk-in clinic worker

Where do you work, and what does your work and workplace look like?

I work in an acute medicine walk-in clinic in a hospital in England. The department I work in has about 25 staff in total, with about 7 to 10 on a shift at any one time, and the staffing is a mix of consultants (doctors), advanced practitioners, healthcare assistants, and ward clerks. We are open 8am to 8pm, and usually see about 20-50 patients a day, mostly referrals from GP surgeries and A&E, and the aim is to diagnosis, treat, and then discharge patients home the same day.

What happened when the pandemic started to become public knowledge?

I was following it all unfolding in China, and then as it progressed across the world, so was probably more aware and worried about it than most of the people I worked with. From what the WHO were saying from the start it was looking serious and likely to hit the UK badly, and then when it was in Italy and the healthcare system there (especially in the north) was struggling I was increasingly worried about how our work (and I guess the wider NHS) might be able to cope, especially given there was no (or very little) discussion about it among the staff.

As it started to become more common knowledge and understood among people here I had a conversation with a senior doctor at the hospital who also thought it was going to most likely be very bad in the UK. I’ve had various memorable moments throughout the pandemic and seeing this normally very calm and professional senior doctor look visibly scared about what was coming was one of them. As the pandemic progressed and the hospital started to change how it worked a sense of panic and anxiety became more commonplace, especially as it felt like that despite the warnings and time we had we left things a bit last minute. The hospital totally changed how it operated, moving departments about, discharging any patients they could, cancelling routine operations and appointments, changing work patterns, banning visitors, and making emergency preparations like turning one ward into a temporary morgue.

How did your co-workers talk about it?

Early on most people at work took quite a macho approach and felt that people (including me!) were over-reacting, and they dismissed it with ‘it’s just a cold’ or similar things, stuff that was common across society really. They laughed when concerns were expressed but then did start to worry about plans (especially holidays) getting cancelled. As the situation developed and they understood the seriousness of it people’s attitudes obviously changed.

One of the things that became really clear to me talking to lots of other workers about the virus is where people get their information and news from, which is overwhelmingly online social media rather than the TV, radio, or newspapers, so of course there was loads of half-baked conspiracy theories and shit being talked about it. Some of it could be challenged and discussed or argued about, but it was surprising how much crap people took in and repeated.

What did management do, health and safety or otherwise?

Ha, very little initially. I was a bit shocked how slow things seemed to change, at least at first. It got better later on, in line (mostly) with all the official Public Health England (PHE) and NHS guidance. The Personal Protective Equipment (PPE) issue was the main area of conflict we (well, some of us) had with management, we can mention that later.

Where people happy with that?

Yeah, people weren’t bothered, at least at first anyway. Like I said there was a refusal to take it that seriously early on.

What happened after the official lock-down that was enforced by the government?

By that point the hospital had totally changed, and so had most of my co-worker’s attitudes. Visitors to the hospital were banned which made it much quieter, the usual flow of non-critical patients coming in had reduced, and loads of patients had been discharged home if at all possible.

At that point in mid to late March there was a steady stream of Covid cases, but the peak was a few weeks off so it felt like we were waiting around for it to get really bad. There were all sorts of horror stories coming out of Italy, and various areas of the hospital were being measured up for how many beds they could take and whether an oxygen supply could be fitted in. The number of cases slowly increased but in our department we didn’t see them as they usually came in via A&E and went to an ICU bed if really bad, or the Covid wing of an acute medical ward. As time went on the wards that had Covid patients on expanded and the hospital filled up with them in the space of a few weeks.

What happened with the amount of work and the number of workers during the lock-down?

It was a funny mix, our normal workload plummeted in numbers (people avoiding coming to hospital was one reason) but there was a huge amount of work moving department locations and getting used to new ways of working as protocols changed loads. We weren’t supposed to be dealing with Covid patients directly at first, just our normal acute medical workload of other problems, but that changed and some of us did get rotated through wards with Covid patients on, especially as the hospital filled up with them.

Did you have more work and tasks to do?

It went through different stages. At first early on it was pretty much the same, and then as the pandemic got more widespread our normal acute medical workload actually dropped right down as people were avoiding coming to hospital as they were scared. As that happened our department ended up a bit over staffed and quieter than normal. When that happened they started talking about re-deploying some on us to different departments. This happened after a few more weeks, and some of us ended up doing the jobs of junior doctors in acute medical wards as plenty of them were off sick at various points. We also ended up rotating through wards that had Covid patients on, although not the sickest. That was stressful and something people weren’t happy with at all at first, especially as it didn’t seem to be done in a fair way (sometimes managers would just send someone seemingly randomly from the shift) but it did settle down.

Early on we were shown how to swab people to test them for the virus, but that very quickly stopped as things got worse our department stopped taking anyone that had anything that could be considered a symptom of the virus and they went to specific areas designed for it.

Did management have a plan for this or did you have to improvise?

A bit of both! One of the really difficult and stressful things was that management just seemed to be really slow at changing how things were working and communicating that to us at first. It felt like they were in some sort of collective denial about how bad it might be, and they couldn’t quite make the quick changes that were needed. I don’t know whether that was bureaucracy, or waiting for direction from the Government, or just maybe it was all happening at higher levels I couldn’t see. It did get better as time progressed, but at first the whole thing felt like a huge lumbering bureaucratic monster heading towards a cliff edge!

What happened to the general conditions with things like wages, working times, shifts, etc.?

Wages and shift times stayed the same throughout this period for me. Everyone in my immediate team are on permanent contracts with fixed hours and wages so that didn’t change for anyone. People were sometimes asked to do overtime on different wards and departments as other staff went off sick. Everyone had to work more flexibly due to working demands, and those with childcare even more so.

Did relations between co-workers change during that time?

Not in a way I can think of really, nothing more than sometimes there were what were probably stress related outbursts and minor arguments with each other. I guess sometimes there was a feeling among some staff we just have to get on with it rather than raising issues and problems. It is an issue in the NHS that there’s a real feeling of ‘public service’ sometimes, and this can be a break on any chance to do anything that might disrupt the normal standard of patient care. How to politically deal with that is a bigger area that’s worth discussing somehow!

How about the relationship with management?

It really varied between individual workers and what type of management you mean. Simply put there’s 3 levels of management that we have to deal with. The first is the immediate department heads, both clinical and non-clinical. They work alongside you (clinical with patients and non-clinical in a department office) and you see them every shift. Then there’s the management for the acute medicine area that includes A&E, an acute medical ward, and our department. You don’t see them very much and they have offices in the hospital between the areas they manage. You might see them once a week, or if you’re in trouble or they come down for a meeting or something. Then there’s the hospital level management that you never see really, and they have offices in the Trust HQ in another building.

Relationships with the first type are really commonly quite difficult in that they’re often friends to most of the other workers, and they act as a bit of a buffer between us and the higher level of management. If they’re good they will have your back more and stick up for you and the department when needed, but often they’re a bit caught between being workers and being management, and I know they found that hard occasionally, especially when they have to implement decisions taken by the higher levels of managers.

With the second type a much clearer worker and manager type of relationship exists. They were the ones that we complained to about PPE for example, and they’re the ones that will tell us how things are with any changes and decisions, and if we get disciplined for example. They’re the ones that have a more direct impact on our day-to-day work mostly. They also find it easier to be harsh and less like workmates as they often arrive in that position from another department or even hospital, so they haven’t got that confused friend/manager/workmate thing the lower level have. In some ways they’re the ones that sort problems out as well though as they’re the ones that have the actual power to make changes on a department level much quicker than others. And this was especially the case in the pandemic when things were changing daily.

The third type we never see as they swan about the HQ in suits. They might come round at Christmas wearing a hat, telling us how hard we work and giving out chocolates or something, but generally they don’t feature in any day-to-day dynamics that we directly experience. Although obviously the things they do impact on how the hospital works on the larger scale, although it’s a bit of a mystery to me what they spend their days actually doing that helps the hospital function!

What about the relationship with patients and other members of the public?

With patients that didn’t really change at all, or at least not really in any way that is important or that I can think of now. I guess outside work with the public saying you worked in the NHS gave you some kudos or something, at least it allowed you to jump queues in shops sometimes! Personally I hated the weird idolizing of NHS workers, made me feel a bit uncomfortable, especially some of those creepy nurses as angel images that were floating around.

Did many people go off sick?

Pretty steady numbers throughout the whole pandemic. We always had more than 1 person off out of about 25 staff, sometimes more. I don’t know what percentage were off over the whole time, maybe about 50% had some sick time off at some point, either for virus symptoms for them or someone in their household, or just with normal illness stuff. I think probably people were a bit freer to go off sick than normal as it didn’t go on your record, and people were a bit more stressed and likely to want an extra bit of time off, I know I did.

If so, how did management react? How was work done with less staff?

There wasn’t much they could do really. They didn’t put pressure on people to work if they had any symptoms though, and generally management were quite good with that aspect of it, although other staff grumbled when anyone was off as it meant a harder day for those that were working. We just worked short staffed sometimes, and mostly just got on with it, but like I said it some ways it was quieter where we were.

What were the main conflicts during the lock-down? How were they solved or not?

The usual minor day-to-day things as usual continued. Emotions were a bit high, especially at first, so there were some more overt arguments between staff on occasion. Someone tried to get taken off work due to health conditions, and other people in the department didn’t like that and thought they were being ridiculous. They’d got a letter from their GP saying they should be taken off frontline work, but management refused to accept that and said as they were a key worker they needed to stay. I told them to talk to their union, but in the end I think they just worked.

The main conflict was over PPE. It’s a really complicated story, but briefly it really involves the NHS and PHE changing the guidance on what PPE needed to be worn for healthcare workers. They downgraded the level of it, and it seems to be that was partly due to writing the guidance on what was available as much as what was the safest.

We worked in an area that wasn’t in theory ‘high risk’ like ICU, but we saw patients that did, or could have had, the virus and we were expected to wear a thin plastic apron, gloves, a surgical (non-filtering) mask, and eye protection. It didn’t feel at all safe, and we raised this with management numerous times and every time we were told that it followed the guidance and to refuse to work in it would result in a disciplinary. It didn’t really feel like we had anywhere to go with this, as it was true, they were following the PHE and NHS guidance. (I think some hospitals ignored that and made sure a higher level of equipment was available for their staff.)

We once got delivery of a load of protective glasses (there was actually no shortage of PPE where we worked) that were a joke. Badly made and fitted they were one huge size, and fell off if you looked down or around quickly. We brought this up with management and it was ignored. Then a few weeks later someone at work sent me a screenshot from Channel 4 News with a picture of those glasses being investigated as inadequate PPE!

Did the union play a role?

No! I’m a member of the GMB, but there’s a mix of various union memberships where I work. I did chat to one other person who was also unhappy about the situation with PPE about getting in touch with the union, but the official PHE position on PPE made it really impossible to see how it would come to anything.

Generally people I work with barely ever mention the union really, I don’t think they’d have any faith in it helping unless it was just for individual advice for a dispute hearing or something. It’s not helped that, like I said, in the NHS people are split between a few different unions anyway, so there’s less chance of any collective action happening. The unions feel really weak and distant to most people I work with I’d say.

What was better and worse at work during the lock-down?

Better was that there was a bit more of a feeling of ‘togetherness’ among the staff rather than the tension and moaning that can sometimes happen. It also felt like you could get away with being slacker with some things like your appearance and extra breaks, and also with speaking your mind. There was a bit more of a ‘fuck it’ feeling as we knew they really wouldn’t sack us or give us that much of a bollocking. For example we’d been told we couldn’t wear scrubs rather than our usual uniforms, as we wanted to as it felt safer not taking dirty stuff home, but some of us started wearing them anyway, and after an initial moan management gave up on it. It felt like some of management’s ability to threaten us had been taken away, or at least much reduced.
Worse was the chance of catching the virus and getting really sick and dying! And the stress created by having that as a possibility. Oh, and the PPE being inadequate to protect us, and then feeling like there wasn’t anything we could do about that.

Has the source of income of your household changed?

No, it stayed the same. Though we’re spending more on household stuff, partly as we’re at home more rather than eating out sometimes though, and partly as our foster kid eats more with us as well. I guess our bills are higher, and we did buy a couple of boxes of extra food bits like cans when lockdown started in case we got stuck in the house, and also one of us a bit got the fear society might be collapsing! When this didn’t happen we gave it away to a local food bank.

Did you have any other ways to make money?

No, we didn’t have or need any of that kind of thing as we were in an OK position compared to some.

How did your household cope with childcare during school closure?

Our foster kid turned 17 during lockdown, so we don’t need childcare as such, but she’s been home with us the whole time which has been nice, and I think going through this together has brought us closer really. At first early on in the pandemic she probably thought we were being a bit mad, but actually I think she ended up appreciating it, and realising we were looking after us all, and cared what happened to her and the family, which was maybe different to where she had been previously.

Did family relations change?

Yes, the other adult in the house who usually goes out to work 3 days a week started working from home, and the teenager was at home rather than at school from when they closed. There has been some nice things about that as we have had much more time together and felt more connected as a family, and we’ve kind of forgotten that social services are involved as they haven’t been in touch much at all. But also there have been some strains of home working in terms of stress and also needing the space to do it, which slightly impacted on how the house feels as that work and home separation hasn’t been there.

Did you take part in, or use, mutual aid groups or other charities during lockdown?

A few of us started a mutual aid group as many people did in areas where they lived. It felt like it had promise at the beginning, but we had some difficulties around what to do given we were so restricted under lockdown. We did start off having Zoom meetings among the 6 or so of us that started it, but they stopped after a few weeks. We did make some posters and went out and fly-posted a few around our area, but never got any calls and nothing happened after that in the group at all. I do think it had potential to build some local strength and solidarity, but one of the stumbling blocks to this happening was the activist thing of people just not having much commitment unless it’s exciting and easy, and of course the practical problems of organising under lockdown.

What about your workmates?

I don’t think any of them have been involved in mutual aid groups, and if they had it would have been from a charitable perspective unfortunately.

At work have there been job cuts or have new people been hired?

No, but recruitment has been delayed that should have happened, no idea when that will start again. In a related area it does feel like higher than usual numbers of people will leave the NHS in the future. Some people felt let down by management in terms of them being looked after, and of course by the government too.

Has management announced that certain changes will stay in place? What are they, and how do workers think about this?

Where I work nothing has anything been made explicit about any long-term changes, although there are rumours. In the wider healthcare working environment lots of stuff that was face-to-face has moved to remote working, mostly via the phone, especially for things like GP and out-of-hours clinic appointments. There’s a general feeling that much of this remote working will stay now, and I wonder long term if we’ll see the NHS get rid of some buildings and other things that they can release capital from if they’re not used.

I think there does need to be some discussion about all these changes though and which ones we want and which ones we don’t, both among staff and the wider public, but obviously we don’t really have very good mechanisms for doing that. It feels that in healthcare as it does in other areas in society that the pandemic to some extent has just speeded up the changes that were coming anyway.

There’s not been much discussion among workers I’ve been with about these changes really, apart from ones that directly impact them now like the remote working stuff. And opinions vary on that, partly by profession, and partly by personality I guess. Quite a lot of people say they like it though, both healthcare workers and patients, and I can see the advantages for some areas to work like that more.

What do people discuss about the Covid-19 crisis? How do they see the government and the lock-down?

People are increasingly critical of the government response. Everyone has been making Cummings jokes. They are sometimes a bit critical of others they see as being irresponsible for breaking the lockdown too. Everyone loved clap for carers, it gave people lots of pride about being NHS workers. I felt much more cynical about it, like fuck the clapping, I want proper PPE! Also it felt weird when we had neighbours having a party in lockdown while having a rainbow ‘Support the NHS’ poster in their window. People manage to have very simple and sometimes contradictory positions and understandings about the NHS and the workers in it. There was sometimes a real tendency to think of us as ‘heroes’ which is really grim, and also enables a perspective that almost excuses healthcare workers dying as that’s what heroes do right?

Was there any discussion about what essential work is, and its position in society?

No not that I saw or heard. There was a bit more of a collective feeling of solidarity between the various professions and roles in the hospital than there is usually though, as it sometimes is quite tribal between departments and different staff. There was also a bit more of a feeling of pride about working in the NHS and people really liked the feeling of being supported by the public over that. That and all the discounts on food they were getting!

Do you think workers at your workplace come out of this stronger or weaker?

It feels too soon to tell really at my workplace. I feel like healthcare workers generally will hopefully get stronger, partly as we’ve hopefully gained some collective confidence and public support to struggle in ways we haven’t for a long time. Although I think there’s specific problems and dynamics around political organising in healthcare in the UK that will make things very difficult though, the splitting of workers into sometimes quite tribal areas and specialities, and the ‘caring’ dynamic where political action might well impact on patient care short term for example.
There are some new organisations and stuff has been happening recently that’s been partly provoked by the pandemic, there’s been a few healthcare related demos and a new campaigning organisation called Nurses United has started for example, but like I said, it’s too soon to know how these will go longer term.

Have you heard about strikes in the UK or in other countries against the lack of health and safety or other crisis related reasons?

Yeah, as ever I was a bit jealous of France and some of the healthcare workers there who rioted a bit! I was following other news from elsewhere too, but it felt very far away from where we were at my workplace and in the NHS generally with political struggles.

Have you discussed the uprising in the US against police violence at work, and if so what do people think?

Yeah, when it first happened a couple of people brought it up as a topic. The few people (all doctors) I heard talk expressed general support for it. I had a brief conversation about the situation in the US, and the support expressed (by Asian doctors) was from the liberal anti-racist position rather than anything more radical. People didn’t think going on the demos here in the UK was right though, they were critical of that as they were concerned about the virus spreading through crowds.

Do you think the uprising has relevance for the situation in the UK? How about at your workplace?

It’s been heartening to see any public political expressions of anger and uprisings at the moment really, although I’m cynical much will come of them in the long term. I think much of that area of struggle is very easily recuperated, and that it’s likely to take the path of least resistance in terms of demands and directions.

Locally the mobilisations and ideas have been quite confused politically, with some more explicitly radical stuff mixed up with calls for diversity training and to support black owned businesses. It’s also has sadly been marred by personal issues between people involved in the various BLM (and related groups) call-outs. Some of it seems to be ‘community leaders’ struggling to be the authentic representative voice of a ‘community’, and some seems to be more overt political differences.

I do think that there issues around racism in the NHS, on both the personal and structural levels, and of course this could be an area of political struggle, but I find it hard to imagine how this could be done really in the current situation, or at least without it just being about representation and equality within existing power structures.

Any final thoughts?

The NHS and staff are bracing themselves for the winter, here’s hoping it’s not as bad as it could be. Stay safe out there comrades!

(Interview conducted in July 2020)

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