Opinion

Chris Cook: The problem of fatigue

Friday 13 November 2020

We’re all tired of the pandemic and its lockdowns. But for the public sector, there are very particular consequences


One of the major problems for the UK – now amid a second wave of the pandemic – is that, in one respect, things have never been worse. And that is fatigue.

The past six months have been disturbing and unsettling. Family rhythms have been interrupted. Some have been able to stay at home to work, but the risk of the disease has made a lot of jobs quite frightening. Even for relatively safe occupations, the liturgy of masks and disinfectant has made them a lot less pleasant. There is a lot of tiredness about.

But in those parts of the public sector where demand for services rose, there are particular issues. Exhaustion hangs in the air across hospitals. As the first wave of Covid patients abated, cases that had been delayed in the spring steamed back in. And now they are switching back again as the Covid caseload rises. There has been no relief.

This is, of course, a human problem. Hugh Pym, BBC health editor, has reported on the “Wobble Room” at the Royal Derby Hospital. A nurse described it as “a room where staff could just go and sit and cry if they needed to”. A large swathe of NHS staff are spent after a year of gruelling, unending winter. And it is those same ones who will be asked to do it again.

This has operational consequences. People have less slack to give. Sir Simon Stevens, the NHS chief executive, recently told a press conference that around 30,000 staff were self-isolating. More mistakes will be made. Corners will be cut. As ever, you fear for what is happening in social care. Headcounts will get thinner and new staff harder to find.

One of the major problems for the UK – now amid a second wave of the pandemic – is that, in one respect, things have never been worse. And that is fatigue.

The past six months have been disturbing and unsettling. Family rhythms have been interrupted. Some have been able to stay at home to work, but the risk of the disease has made a lot of jobs quite frightening. Even for relatively safe occupations, the liturgy of masks and disinfectant has made them a lot less pleasant. There is a lot of tiredness about.

But in those parts of the public sector where demand for services rose, there are particular issues. Exhaustion hangs in the air across hospitals. As the first wave of Covid patients abated, cases that had been delayed in the spring steamed back in. And now they are switching back again as the Covid caseload rises. There has been no relief.

This is, of course, a human problem. Hugh Pym, BBC health editor, has reported on the “Wobble Room” at the Royal Derby Hospital. A nurse described it as “a room where staff could just go and sit and cry if they needed to”. A large swathe of NHS staff are spent after a year of gruelling, unending winter. And it is those same ones who will be asked to do it again.

This has operational consequences. People have less slack to give. Sir Simon Stevens, the NHS chief executive, recently told a press conference that around 30,000 staff were self-isolating. More mistakes will be made. Corners will be cut. As ever, you fear for what is happening in social care. Headcounts will get thinner and new staff harder to find.

This pattern is visible in other places, too. School teachers are filling in for self-isolating colleagues and the reorganised school days are more labour intensive. They will also get little relief: schools across the country are likely to end up having to run new processes for assessment of 16- and 18-year-old students – a fallback in case exams are cancelled or disrupted.

Outside the traditional public sector, university staff have already expended lots of energy to get their teaching online. But there is more pain to come. There is no solution to the problem of running admissions next year when we have impaired or useless exams – and that will mean admissions take more energy, effort and time.

A lack of bandwidth is a problem at a management level, too: a lot of poor decisions have been made by people who have not been able to have much of a break. Some of the chaos in Downing Street may be because, with a few high-profile exceptions, it is a building of people who have not been able to get away.

There are three broad issues to grapple with when managing a fatigued workforce.

The first is that the capacity of state systems may be less than it looks. One of the major constraints on government action is that there is so little left in the tank. People will do as they are asked, but be wary of asking for too much.

The second is that this is a medium-term problem. Good news on vaccines may make the government loath to spend on labour-saving systems to help handle the pandemic or remote working when it thinks we are all in the home straight. But it needs to remember that, even if the vaccine is successful, the crisis will have a long tail in the public sector. The NHS will need to run at full steam for a while to catch up. Schools will need to lay on extra classes.

The third is that this makes the issue of pay more salient. Some of the existing recruitment problems in the public sector suggest that some wage scales were already being pitched in the wrong place. We have to assume this problem will get worse. Two-thirds of teachers have told TeacherTapp, a pollster, that they are burned out – or heading there. They are surely not alone. If there are bigger outflows from the public services, wages are the only lever that may be left.

Letting state employees exhaust themselves might feel like a cheap way through, but it has costs, and the clean-up after the pandemic will take years.