After months in lockdown, the UK is slowly beginning to emerge, with pubs, restaurants and hairdressers opening. The government has mandated that ‘all staff in hospitals in England will be provided with surgical masks which they will be expected to wear from 15 June’ (Gov.uk, 2020). This has been a difficult message to balance for staff as we try to establish safe working environments.
COVID-19 has challenged healthcare leaders to manage staff health and safety at a scale I have never before experienced in my career. The Health and Safety at Work Act (1974) states: ‘It shall be the duty of every employer to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his employees.’
The COVID-19 pandemic has required numerous risk assessments, resulting in colleagues redeployed out of their clinical areas. In my organisation, this includes 300 staff shielding, and several hundred staff who have long-term conditions or are from a black, Asian or minority ethnic (BAME) background.
Colleagues have said that this is stressful and, while initially undertaking roles from home such as staff welfare calls, and supporting planning for the COVID-19 response, as the NHS starts to resume and recover, many fear that the workplace is not safe and they are trying to understand when they will be able to return and what their role will be.
Barnes and Sax (2020) explored ‘excluding’ staff from the workplace, citing Furukawa et al (2020), who stated that contagiousness does not always correlate with the clinical severity of disease, and that mass exclusion of workers may not have the desired effect of reducing transmissions. He also highlighted that exclusion from the physical workplace is replete with clinical, ethical and legal challenges, due in part to exclusions resting on statistical generalisations applied to individual persons.
Barnes and Sax (2020) looked at ‘testing’ as a strategy to limit risk in returning employees to the workplace, highlighting that a comprehensive testing programme appears to offer a high degree of certainty about which people to allow back into the workplace.
A large-scale study, yet to be published, has been undertaken in my Trust. It identified that personal protective equipment (PPE) and social distancing are key measures designed to mitigate the risk of occupational SARS-CoV-2 infection in hospitals. Almost 10 000 staff were tested both for the presence of SARS-CoV-2, the virus responsible for COVID-19, and antibodies to the virus. In combination these tests give an accurate view of who has had COVID-19 to date in the workforce, combining data from both symptomatic and asymptomatic staff testing programmes. The programme was able to:
The study also demonstrated that the risk to healthcare workers is not borne evenly across hospital staff.
The results of the testing showed that 11% of staff had had COVID-19 at some stage. However, this figure rose to 21% of staff working on COVID-19 wards.
The figures showed that BAME staff were at greater risk of infection than their colleagues. The overall figure for COVID-19 infection among BAME staff was 14.7%, compared to 8.7% for white staff. This figure rose to 17% for black and Asian staff.
The departments in which staff work also played a role in their chances of contracting the virus. Although those working in intensive care and the emergency department had infection rates of 9.9% and 12.1% respectively, likely to be related to the PPE requirements in the higher risk areas at an early stage, the figure in acute medicine was 27.4%, and among porters and cleaners 18%.
Operating through the pandemic, and now trying to navigate through the recovery phase, poses significant challenges to all workplaces. Barnes and Sax (2020) have cited the so-called low-tech prevention measures such as homeworking, social distancing and the use of PPE and handwashing as effective in infection control processes. However, we need to consider our inability to control other areas such as underlying health issues in staff or transmission risks such as use of public transport, and activities outside work hours.
This raises potentially insoluble problems, where, on the one hand, we want to ensure that we do not indirectly discriminate against any group, but, on the other hand, the prioritisation of certain groups for safer work could face direct discrimination claims from other groups.
The ability to use staff testing as part of our strategy undoubtedly adds value; however, in the hospital setting there is more to do to reduce the risk to healthcare staff in preventing acquisition of COVID-19.