OH ‘living with’ Covid but fearing we’re not out of the woods

We may all now be expected to be ‘living with’ Covid-19 but, with cases, workplace absence, hospitalisations and long Covid all continuing rise – and feeding through into spiralling NHS waits for everything else – the pandemic remains very much the key worry for OH practitioners as we look to summer and autumn. Nic Paton reports.

What’s worrying you right now? For many of us, the horrifying events unfolding in Ukraine – and the fear of how it might all end or escalate – have been dominating our thoughts, and newsfeeds, for the past few weeks.

In the context of occupational and workplace health, however, the key, ongoing worry very much remains what it has been for the past two years – the Covid-19 pandemic.

The fact we’re moving to a new phase of ‘living with’ Covid-19 is, at one level, good news, especially in terms of mental health and at least some return to workplace ‘normality’.

But the lifting of day-to-day restrictions, especially the need to isolate after testing positive, the scrapping of key nationwide Covid surveillance programmes and not to mention ongoing worries about the impact of long Covid on our working-age population means that, for OH at least, things are very much not yet back to ‘normal’.

We went out to practitioners to try to gauge what was most worrying them about the next six months as we move out of the ‘crisis’ stage of the pandemic.

Rising NHS elective waits

While of course not scientific in its findings, what was clear was that Covid remains uppermost in the minds of many but with the knock-on impact of the pandemic on the NHS another key concern, in particular the impact of soaring elective waits for both physical and mental health issues.

As one practitioner put it to us: “Mental health but also access to treatment via the NHS.” “The backlog in waitlists/referral times is creating additional problems,” said another. “I think mental health will continue to provide a heavy caseload,” said a further practitioner.

The heightened demand for OH that we have seen throughout the pandemic, while at one level a good thing in terms of raising the profile of the profession, was also causing concern in terms of practitioners’ own mental and physical health.

Many were worried about the potential for burnout and the sustainability of continuing to work at the same level of intensity that we’ve seen during the past two years.

As one practitioner put it: “It’s simple – me, me, me, me, me. It’s time to focus on self!”

“I’m worried about working longer hours, emails sent out of standard working hours (likely due to more home working), also the fact that many of us are doing double the job because of cutbacks due to pandemic,” argued another.

“I firmly believe this is a lull before the storm,” OH nurse Astrid Palmer tells OHW+. “While I totally agree with lifting all the restrictions – they were getting more and more ignored anyway – I’m just waiting for the next variant to come along. Because it will.

“We’re not out of the woods yet, not by a long way. It absolutely makes my toes curl the way so many people say, ‘we’ll just treat it like flu going forwards’,” she adds.

Long Covid and burnout

The ongoing impact of long Covid on the ability of many thousands to be, and continue to be, in work was a particular worry, she says, having highlighted in the past that maybe we need to be thinking of long Covid more like polio than flu.

“What worries me even more is the underlying damage that Covid has done to people. We don’t know what it is and we don’t know whether it will persist and we don’t know who to refer people to or what investigations need to be done. Management ask: ‘will this person render reliable and effective service in the future?’. And ‘I don’t know’ is not an answer,” Palmer points out.

“In the last few weeks I have seen four or five people who are not eating properly because their taste buds are still affected. They haven’t got the energy to cook a meal, and when they have cooked a meal it tastes revolting and they don’t want to eat it!” she adds.

Burnout – with too many OH nurses burning the candle at both ends, constantly spreading themselves thinly and never feeling able to say ‘no’ – was a genuine concern. “There are those who work at night and at weekends and on days off. Because so many OH practitioners, particularly the nurses in my experience, are lone workers, they’ve got nobody to say, ‘I’m shutting the department, go home’. Even then, with so much work now being done from home anyway, there is now no cut-off point,” Palmer says.

“Nurses are very good at guilt-tripping themselves, ‘if I don’t do it, who will; that person wants to go back to work and if I don’t do their return-to-work questionnaire, how are they going to be get back to work’,” she adds.

Fear of OH retirement crisis

Even before the pandemic, OH was a small and ageing profession, and the toll of the pandemic is likely to make this even worse. Many who stayed on to ‘see things through’ may now decide to call it a day, so heightening workload pressures still further, predicts Nicki Carver, a senior OH nurse at Yorkshire Water.

“We’ve got a lot of nurses who are retiring at the moment. There is such a gap in the market for nurses – we’re just crying out for them,” she tells OHW+.

While Yorkshire Water has a very proactive OH team and approach to workplace health – as evidenced by its support for long Covid, among other areas – day-to-day economic realities and pressures are still making themselves felt.

“We’ve had an OH technician contracting for us. He’s been able to focus on the medicals for us and also offer wellbeing support to employees. But he’s being paid under a Covid budget and now, of course, those budgets are either being cut back or disappearing and so we will be losing him. We also got a nurse who’s retiring and we can’t replace her because of we have a recruitment freeze. So you think, ‘how are we going to manage this?’,” Carver points out.

“As a senior member of the team my greatest fear is that if I’m captured doing medicals – which I don’t mind doing as they are part of my job – there isn’t going to be much leeway. I’m going to be back-to-back with my case management on some days and then referrals on the other, and then where do I fit in my admin time?

“Then there’s the risk of ending up feeling overwhelmed because you’ve also got a load of emails and voicemails to answer. It just feels like a constant juggling act,” she adds.

Even with its proactive provision, record NHS waits were also having a knock-on impact. “That leaves you with an increasingly poorly workforce, more people who off sick or on restricted duties. How long can that be accommodated? We’ve got all these people coming into occupational health, often with quite complex cases,” Carver points out.

Workforce and capacity pressures

OH provider PAM Group has recently changed its triage process from an initial 60-minute appointment to 90 minutes precisely to allow this increased complexity to be worked through, points out clinical director Janet O’Neill.

“Everyone has a deficit of clinicians at the moment; everyone is struggling. Everybody is having resource issues because the demand is increasing,” she says.

“At the same time, there is a lot of work going on to address that, especially around the idea of the multidisciplinary team. Now there is definitely a multidisciplinary team; almost everybody is seeing the value either of combining with a different speciality or employing different specialities and then widening that team,” she adds.

“I definitely think there will be a focus in the coming months on wellbeing in the workplace. We need to be supporting organisations with tools that are specific to them and their workforce and their demographic,” says O’Neill.

“We also need to be taking more into account around health inequalities, so not just looking at their workforce but looking at what is happening in the wider environment. We also need to be able to drive their health and wellbeing policy; that is a huge space that occupational health should be creeping into more,” she adds.

Finally O’Neill, too, is concerned that continuing workload and workload intensity could eventually take its toll on practitioners in the coming months if they’re not careful.

“We do know what we should be doing. It is not as if we don’t have the knowledge and understanding. Everyone has a responsibility to be looking after health and wellbeing, employee and employer alike.

“That, in fact, was another reason why we adjusted our triage process. As well giving us more time properly to listen to and evaluate patients, it gave our teams the space to manage their workloads more effectively,” she emphasises.

“Occupational health is a lot more complex than it used to be. All of those social factors we used to talk about before, we’ve still got those but, again, things have been amplified by the pandemic. Mental health, too, was of course a big part of what we did before but it is even bigger, much, much bigger. So there is that complexity, as well as the Covid-19 infection element.

“We also need to be encouraging people to start thinking about OH as a specialty when they come into healthcare rather than some years down the line thinking ‘oh that would be an interesting thing’ – if they even hear about us,” O’Neill adds.