Sara Gorton, UNISON’s head of health, gave evidence to the third module of the COVID inquiry last week (above).
The module examines the impact of the COVID-19 pandemic on healthcare systems in the four nations of the UK.
Speaking on behalf of the TUC, Ms Gorton gave evidence about both her UNISON role and her role as co-chair of the NHS staff council and the NHS social partnership forum through the pandemic.
Her evidence focussed on the relationship between the trade unions and the employer bodies and NHS England through the pandemic. She also spoke to the state of staff wellbeing morale and resilience prior to and throughout the pandemic and the impact that had on workplace issues like recruitment and retention.
Pre-pandemic
Ms Gorton’s evidence began with questions about how prepared the NHS – particularly the workforce – was before the pandemic.
When asked about the resilience levels of staff prior to the pandemic, she said: “There were signs going into the pandemic, for the few years in the runup, that the workforce had been overlooked and neglected by a government and policy makers who seemed to be obsessed with structure and system architecture rather than addressing the needs of the workforce.”
In reference to a TUC report from early 2020 she said: “The survey paints a picture of people who describe themselves at breaking point. Of not having enough staff, of not having access to the breaks they needed in order to work the shifts. It talks about the pressures they feel under to accept more work to cover the gaps.
“And it talks about the personal impact at the time from feeling they didn’t have what they needed to deliver the services they wanted to [deliver for] patients. It describes people feeling very vulnerable, turning up to work dreading their shifts.
“That’s not a description of a resilient workforce ahead of a major crisis – ahead of a major crisis you want people to feel well-motivated, well-rested and able to deal with it. The signs were there, in this report and other evidence, that this was not the condition of the NHS workforce.”
Early pandemic
The inquiry also focussed on a statement made by the NHS Staff Council in January 2020, two months before the first lockdown.
As a joint body of unions representatives and employers, the NHS Staff Council had written a statement urging local partnerships between employers and trade unions to work together to put in place a set of 12 key principles to combat COVID.
The principles included:
- setting up effective communication channels
- identifying and mitigating risks
- ensuring adequate PPE
- ensuring sufficient fit testing for PPE
- making sure staff are able to raise concerns in a way that doesn’t impose a detriment to them
- managing risk to vulnerable staff
- maintaining care levels for staff members.
When asked for her opinion on whether these key principles adequately foresaw the issues that were faced during the pandemic, Ms Gorton said: “All of the key principles to adhere to were set out here, I think the question is, to what extent those principles were able to be put in place.
“How they were interpreted and implemented at a localised level was the major difficulty.”
Consistency of guidance, official channels
Later in her evidence, Ms Gorton was asked about the trade unions’ role in contributing to and communicating guidance for health staff based on these principles. She noted that right from the start of the pandemic the trade unions knew that: “If we had all worked separately, and all reinterpreted the guidance and put those out through our separate networks, that would mean 17 sets of contrary guidance.
“So, we worked really hard together not only producing advice as joint unions, but ensuring, wherever we could, we were a reputable source of information and were referring people back to the original source documents.
“And we worked with employers to supplement those [pieces of guidance] with frequently asked questions to respond to issues of detail. Obviously, there were areas where the trade unions had been reflecting [back to the employer] either confusion amongst the workforce with the content, or where there were gaps in the content.”
As an example, Ms Gorton highlighted: “Early on in the pandemic there was no reference to the situations in either community settings or ambulance settings and we were hearing from workers in both of those settings that they were being expected to go in and out of homes where they were potentially being exposed to people who were COVID positive.
“At that time there was no testing, so people had no way of telling, other than having symptoms if they were COVID positive or not. So, it was gaps like that we were able to flag.”
The ongoing effect of the pandemic on recruitment and retention
Questioning moved on to staff burnout and the effects of the pandemic on recruitment and retention.
Referencing an element of Ms Gorton’s written submission about 2022 evidence of staff “wanting to leave the NHS due to the pressure of not being able to deliver the appropriate quality and standard of care”, the inquiry’s counsel asked: “Was there anything that could be done to prevent staff leaving due to those concerns?”
She responded: “Working conditions are everything. You can see, in the statement, the themes that workers were raising through their unions about not enough access to rest breaks, about not enough access to rest and recuperation.
“Trade unions knew [this] as early as May 2020, we were raising issues at a central level to call for support packages to be put in place to allow the rest and recovery from dealing with that first phase [of COVID in the UK], which turned out to be a hiatus rather than an end that we might have imagined, but the signs were there that the workforce was already suffering.
“And by the period that you refer to, by 2022, it was really evident that the support hadn’t been provided in sufficient measure to make people feel resilient enough and to make them motivated enough to stay in their jobs.”
On the measures which were put in place during the pandemic she said: “A lot of work was done to set up what was called health and wellbeing portals to provide access to emergency mental health triage, hotlines and on-the-spot occupational health type interventions.
“But what’s really clear is that health workers needed an opportunity for rest and recuperation. And with the levels of staffing in the NHS ahead of the pandemic and compounded by the pandemic, that was really difficult to achieve. And it was going to be an uphill struggle to provide support in enough measure.”
Ms Gorton continued: “This meant that by 2021, one in five health workers were telling us that they were considering or very seriously considering leaving their job in the NHS. It had a profound impact on those workers and the ability of the NHS to recruit staff.
“It’s very clear that the effects of having low staffing had contributed to the way people felt approaching the pandemic, that it worsened during the pandemic and as a consequence it was more difficult for the NHS to recruit and retain staff.
The effect on Black NHS staff
The final section of the inquiry counsel’s questioning centred on the disproportionate impact of COVID on Black staff, citing an admission from NHS England, in a social partnership forum document from June 2020, that they had lost or were losing the trust of those staff.
Ms Gorton said: “This was an honest response to the issues that were coming through in the data and the issues that we were referring as trade unions. I think what you’re seeing in this set of notes is that there is a recognition of the need to look at these issues.
But she added: “The issues that are set out here are specific to the practical effect of the pandemic, but they don’t reach into some of the concerns about structural racism that had been raised prior to the pandemic and still persist beyond it.”
When asked if enough was done after June 2020 done to rebuild trust, she said: “I was at an event held last week where we had the opportunity to talk to staff who’d been through the pandemic, staff from Black backgrounds, and the feeling in the room was that not enough had been done either during the pandemic or since.”
The article UNISON gives evidence to COVID inquiry first appeared on the UNISON National site.
