Doctors and nursing staff say they feel under pressure to work extra shifts, often unpaid.

Some doctors say they are already exhausted and fear that they will be pressured to doing extra shifts without adequate rest to help reduce the huge backlog of patients needing treatment.

In the most recent BMA ‘tracker’ survey the findings revealed that over half of the doctors surveyed in Northern Ireland had worked extra hours (53.7%), with 23% reporting that these hours were unpaid. Most felt some pressure from their employer or colleagues to work additional hours, but the majority said they put themselves under pressure (28%) to work additional hours.  

A quarter said they were rarely able to take their breaks and 11% reported they were never able to take their breaks. This has left staff exhausted with nearly 62% of doctors reporting a higher than normal level of fatigue or exhaustion.

These experiences are also echoed among registered nurses (RNs) and nursing support workers as figures from the Royal College of Nursing’s survey of members’ experience of the pandemic. In July 2020, one third of nursing staff in all sectors reported they are working longer hours. Of these, 40% of respondents are not being paid for the additional hours, with a further 18% only sometimes being paid.

Dr Tom Black, BMA NI council chair, said: “Doctors right across Northern Ireland are exhausted and need a break, and we know the Trusts and employers are doing their best to facilitate that, which is very welcome. But its not just about getting the time to have a break, doctors need to recognise they can’t keep going working at the same pace they have been.

“The survey showed that many put considerable pressure on themselves to do additional hours and that they were deeply concerned about patients who had missed being seen during the pandemic, but an individual doctor can’t sort this alone, we need now, more than ever, to work as a team to address the huge issues in our health service. Everyone needs to be involved in developing realistic plans for the next stage of the pandemic and for recovery.

“Our members have worked throughout the last year, in some cases to the detriment of their own health, and we now need to seem them properly recognised for that work. Those who are waiting for payment for additional hours need to be paid promptly and there needs to be an appropriate pay award this year in line with the DDRB’s recommendations.”

A Northern Ireland consultant said: “My team and I are completely exhausted – I can’t remember the last time one of us had a break during the working day, and lunch is eaten during meetings or other clinical work.  Several colleagues have talked about leaving their current NHS roles, and I personally have considered resigning more than once in the last 12 months. If things continue this way it is inevitable that we will lose staff either through sickness absence or retirement/resignation.”

A junior doctor added: “This Covid-19 pandemic has created a huge burden on the daily workload we already have. We are exhausted almost every day beyond capacity. I know many of my colleagues haven't managed to take any annual leave since the start of 2020. Mental health issues have also been rising among the staff, with no form of adequate support. The increased hours and lack of rest time is negatively affecting productivity and work morale.”

Rita Devlin, Acting Director of the Royal College of Nursing in Northern Ireland said: “Health care staff in all settings are exhausted and must be properly supported in order to recover.

“We are already significantly understaffed in Northern Ireland and we cannot afford to lose another nurse out of the service. The RCN has consistently raised concerns with employers and the Department of Health about the wellbeing of health care staff and the long-term impact of working in a pandemic on a scale we have never seen before.

“Our members have reported feelings of fatigue, anxiety and moral distress associated with dealing with high levels of death and dying patients and the difficult experience of supporting relatives who have been unable to see their relatives.

“All of this takes its toll and we believe staff need proper access to support, time for rest and recuperation, and proper engagement in plans to rebuild services. Staff stood up when the pandemic was at its height and delivered care to the population of Northern Ireland in unimaginably difficult circumstances.

“It is now time that these same staff were rewarded and that their voices are heard as we move towards the next phase of this pandemic. Their experiences must inform rebuilding of services and they must be rewarded with a meaningful pay rise.

“We need decisive action to retain the staff we have as well as address our safe staffing issues through the implementation of legislation promised last year.”

Edna Grant, a district nursing sister and RCN Northern Ireland Board member said: “Large numbers of nurses are feeling burnt out and experiencing severe anxiety as a result of what we have been through. At the height of the pandemic, community nurses were continuing to treat and care for patients despite issues with PPE and being unable to rely on the some of the services we would normally have access to.

“Across all areas, we now have the huge task of ‘catching up’ with cases that were put on hold during the pandemic, so for us the work is not over. I worry for patients who have been unable to access services they need, as well as the pressure on staff as we try to rebuild. We have long had the issues of unsafe staffing levels in Northern Ireland and we need to ensure this problem is addressed. A good start would be ensuring that safe staffing legislation is implemented quickly.”

As lockdown restrictions begin to ease in Northern Ireland, the BMA and RCN want to ensure that the government does not rely on the goodwill of staff to deal with current backlogs. Instead they should look to ensure that services resume in a way that is safe for both patients and those providing care. To do so, the health department and system leaders must start having honest and open conversations with the public about what can be realistically delivered so that an accurate expectation is set. There must also be a robust plan, which addresses actions outlined in the BMA’s Rest, recover, restore report and the RCN’s Principles for return to service – staff recovery and patient safety, including:

• Prioritising protecting the health, safety, and mental wellbeing of the workforce
• Providing the service with additional resourcing dedicated to helping to tackle backlogs
• Ensuring that staff with signs of stress have access to a rapid referral, including self-referral, independent specialist occupational physician-led service
• Expanding the healthcare system’s capacity
• Putting measures in place expand the medical workforce

 

ENDS

 

Notes to editors

The BMA is a trade union and professional association representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.