The lockdown instituted in March was a hugely challenging, albeit necessary, disruption for many people’s daily lives – and one which they were eager to move away from, with the gradual easing of restrictions during June and July.
For those who have to ‘shield’ themselves or others from the threat of the virus, returning to normality has not been as straightforward or necessarily as eagerly greeted a prospect.
Shielding refers to the extra level of precautions needed to be followed by people deemed clinically extremely vulnerable to infection from the virus, with the measures applying to at-risk individuals and to those living with them.
With doctors among the most at risk of coming into contact with the virus as a result of their work, personal shielding – and shielding by proxy to protect vulnerable family members – was a reality for many members of the profession from March.
People are being pushed to work in unsafe environments and it is so inappropriateDr Webb
However, following a reduction in community transmission rates, the Government announced on 6 July that the national policy on shielding would be ‘paused’ from 1 August, meaning that thousands of those most at risk, including doctors, suddenly faced the prospect of having to return to their workplaces.
In the latest BMA COVID-19 tracker survey, a total of 405 doctors reported having been shielding, of whom 128 were doing so owing to personal clinical vulnerabilities, with the remaining doing so because of a vulnerable member of their household. Of this total number, 147 reported having returned to work.
For those doctors shielding who have not yet returned to work, 20 told the survey they had an agreed date to return to their normal roles, 23 had a date agreed for a return to different roles and 69 had no agreed return dates.
One of those not set for an imminent return is Bristol-based anaesthetics clinical fellow Carly Webb.
Dr Webb had already been effectively shielding even before the pandemic, having been classed as extremely vulnerable owing to issues affecting her personal health.
She says that once COVID-19 took hold her employer had been accommodating in agreeing a phased return to working remotely, doing auditing work and other non-clinical tasks from the safety of her home.
With the Government’s advice to those formerly shielding that they should only return to work if they are confident that their workplace is ‘COVID-secure’, Dr Webb says that, for doctors as exceptionally clinically vulnerable as herself, she is sceptical that any kind of healthcare environment would be able to reach such a standard.
‘My consultant and medical team have said that I still shouldn’t be in the hospital and are not confident that even an elective hospital can be COVID-secure enough for my risk level,’ she says.
‘I know that other doctors are going back into elective procedures with patients who have been tested [for the virus], but there is still risk that you end up working with colleagues who have seen patients in non-secure locations.’
I know of trusts that are trying to not pay doctors who are still needing to be in a COVID-secure environmentDr Webb
Dr Webb says that while she has been well-supported by her trust in terms of being able to continue to work from home past the 1 August pause, she feels there are other doctors throughout the UK who have not been as fortunate.
She says she knows of doctors emerging from shielding who are being pressured into working in inappropriate, non-COVID secure on-call environments.
‘I know of multiple people who have been asked for letters from lawyers waiving their right to safe working, which wouldn’t be valid as far as health and safety law goes, so that they can cover on-call rotas for departments,’ she says.
‘People feel a lot of guilt about not being in work and therefore when they’re then pressured to come in, they can feel that they are perhaps being over-anxious when, actually, a lot of us have a very real increased risk of dying from COVID.’
Prior to the shielding guidance being paused, doctors unable to work for health reasons had continued to have their pay premiums for on-call work protected.
Dr Webb says she knows of instances where a formerly shielding trainee doctor had returned to the workplace having rotated to a new trust, with their new employer unwilling to honour these payments, despite the fact individuals continued to be clinically vulnerable.
This is contrary to the BMA’s position which is that no doctor should be financially penalised for not being able to undertake certain types of work due to the risk doing so would pose to their health.
‘I know of trusts that are fighting this and are trying to not pay doctors who are still needing to be in a COVID-secure environment,’ she says.
‘It’s quite horrifying. People are being pushed to work in unsafe environments and it is so inappropriate.’
The Government’s advice to people who have been shielding is to continue home working if their workplaces are not COVID-secure.
Employers must either assist staff in continuing to work from home or make necessary changes to allow them to transition back to work as safely as possible.
The BMA’s 13 July tracker survey gave enhanced focus to the issue of doctors in shielding and their experiences.
The survey found that, of the 560 doctors who reported being in shielding, 198 were doing so because they were personally extremely clinically vulnerable, with the remainder living with someone who was classed this way.
When asked whether they had received support from their employer while in shielding, 58 per cent of respondents reported receiving satisfactory support, but a significant minority of 30 per cent said they had either not received support, or it had been unsatisfactory.
Greater Manchester-based neurology specialty trainee 4 Mike Kemp entered shielding back in March to protect the health of his clinically extremely vulnerable daughter.
Working from home since then, he was told in July following a risk assessment by his employer that he could continue home working at least for the duration of August, but potentially for longer.
As with Dr Webb, his own experiences of shielding and home working have been positive and productive. However, he feels the approach to shielding, particularly risk assessments, has been widely inconsistent.
‘If we look at the NHS response to the need for risk assessment, I think that’s been inadequate,’ he says.
‘A lot of the people who have been shielding are having to do a lot of the leg-work themselves, to make sure risk assessments are being done. It shouldn’t be that the employee is having to seek risk assessment [ahead of returning].’
He says that some assessments took a comprehensive, score-based approach, while other assessments appeared to be more arbitrary and at the discretion of the staff member administering it.
‘The people being tasked with doing these risk assessments are generally clinical supervisors or managers who have no training in occupational health or in how to quantify and manage a risk, so they are reliant on the tool they’re provided with.
‘There are some very good risk-assessment tools out there, and I am fortunate that my employer’s is a particularly good-quality one, but with other employers that’s not the case.
‘Why are we relying on individual trusts to create their own risk assessments? The risk for a doctor in one hospital versus a doctor in another hospital might be working in different environments, and the assessment needs to be made about their workplace, but the tool used to make that assessment shouldn’t be different.
‘I don’t understand why NHS England hasn’t created one tool and mandated its use for everyone.’
Speaking to The Doctor in late July, he said he knew of some people in shielding who were due to return to work on 1 August who had still not undergone a risk assessment.
‘We’ve known about shielding since March, so I don’t understand why it took until July for anyone to get around to thinking about setting up a risk assessment tool for when these staff eventually return to work.
‘This is work that could have been being done gradually over the last couple of months, instead it is being done in a rush.’
The BMA has sought to give advice and support to doctors returning to the workplace following shielding.
A briefing paper published in July outlines staff’s rights and the responsibilities of employers and training bodies in areas such as how to perform individual risk assessments, how these should help to inform a plan for an individual’s return and what can be done to make workplaces safe.
The paper also explains what can be done to support vulnerable staff who can’t return to the workplace
We hadn’t even heard of shielding and we were wondering how we were going to protect herDr Watson
Bristol-based anaesthetics registrar Sethina Watson was one of those involved in drawing up guidance on workplace shielding for doctors at higher risk who were working in anaesthesia and critical care.
She went into shielding early owing to her daughter being clinically vulnerable, and has since been able to return to work.
She says she feels she has been extremely fortunate in her shielding experience, in that her employer has facilitated everything without questioning or negotiating with the terms of her arrangements.
‘At the beginning there was a certain amount of uncertainty as to what impact the pandemic was going to have. We hadn’t even heard of shielding and we were wondering how we were going to protect her, which caused us quite a lot of stress prior to shielding being announced,’ she says.
‘The first six to eight weeks were very difficult. Dealing with feelings of guilt, isolation and uncertainty while watching the pandemic, coming to terms with being stuck at home and then wondering when it is all going to be over.’
While at home, she was able to use her time effectively through work including teaching and developing training programmes for doctors working in ITUs.
Her employer also stayed in regular contact with her to check on her wellbeing and making sure she was being adequately supported to work from home effectively.
There is a lot of uncertainty about whether a second wave of the virus is comingDr Watson
Aware of the fact that not all doctors’ experiences of shielding were as positive as hers had been, Dr Watson used part of her time while working from home to set up the Shielding Doctors group on Twitter. Initially aimed at fellow anaesthetists, the group quickly broadened to include doctors from all specialties and levels of experience.
‘I started getting contacted by other doctors who said they were eager to talk to someone in the same position as them,’ she says.
‘Through the group, a lot of experiences [of shielding] have been shared, some of which are really bad examples of unsupportive employers.
‘Even now that people are returning to work, there’s a great deal of variability in terms of people’s experiences of things like risk assessments and support.’
Following discussions with her employer and her daughter’s medical team about how her return could be most safely facilitated, Dr Watson was able to return to work in early July. Although happy, she remains wary. ‘I think there is a lot of uncertainty about whether a second wave of the virus is coming,’ she says.
‘The numbers of infections at the moment are OK
and I’ve taken some reassurance from that, but it’s still very much in the back of my mind that those numbers might start to change and we [shielding doctors] will all be in a different situation again.’