Dr Rod Dacombe, writing for the Social Liberal Forum, argues that following the impact of the pandemic, NHS workers require an NHS Covenant.

What do we owe those who have faced the worst of the pandemic?  The last year has seen near-universal sacrifice across the UK but it is clear that a particular burden has fallen upon those frontline NHS staff who have formed the backbone of the country’s response to the Covid-19 crisis.


Amid the fierce debate over the proposed increase in NHS pay that has emerged since the budget statement earlier this year, much has been said about the ways in which we should value the particular contribution made by NHS staff during the pandemic.  While there is widespread acknowledgment that key workers in many industries have faced hardship and danger during this time, comparisons with the NHS fall flat in the context of the critical role it has played in confronting the gravest effects of the pandemic as well as the distinct pressures faced by frontline staff. 


I know better than most how hard the pandemic has been for healthcare workers. During the first Covid peak, and again in the early part of this year, I spent time working on the NHS front lines. Many memories, good and bad, will stay with me from these times.  But my strongest impression from working alongside these dedicated and caring professionals is of the many sacrifices they have made.


Many of these are not well reported and are little understood by the public at large. For instance, few will know that many clinical NHS staff moved out of their family homes during the worst periods of the pandemic, leaving their children and loved ones for months to avoid the danger of transmitting the virus. 


Frontline staff have also been working under the frequent threat of physical harm, and this has not eased during the pandemic.  Figures from NHS England suggest that around 17% of NHS staff have experienced physical violence in the last year[1].  This is an ongoing problem for those in patient-facing roles: every one of the female clinicians I worked with had been physically assaulted at some point during their careers.


Perhaps most significantly, the constant pressure of frontline healthcare during the pandemic will likely have lasting effects, with previous research showing the stress of tackling traumatic events can foreshadow lasting psychological issues[2].  Almost half of NHS staff in England have reported feeling unwell from work-related stress in the last year[3].  And one doesn’t have to look hard to find accounts[4] of the toll that the fight against Covid-19 has taken on the NHS.


So, how might we properly recognise the sacrifices made by NHS workers during the last year?  Any response needs to reach beyond narrow discussions of remuneration to take in the broader ways in which society values and rewards public service.  If we believe that there is something distinctive about the value of healthcare work – and the contribution of the NHS to the pandemic response has surely demonstrated that this is the case – then questions over pay and conditions need to be considered in this context.  Ultimately, we need to ask whether, as a nation, we are truly repaying the debt we owe NHS workers.


One way of addressing this issue is to establish a covenant with the NHS.  This would not be without precedent: we already have a well-established (and well deserved) arrangement with our military in the UK[5].  This Armed Forces Covenant takes the form of a commitment between the nation and its military to ensure that servicemen and women, both past and present, are treated fairly and valued by society.  The benefit of the covenant lies in the way its scope does not simply take in specific conditions of employment but positions these in a wider context, articulating a broader commitment to those who have served and ensuring that access to opportunities such as education and employment are not hindered as a result of public service.  Individual organisations can also ‘sign up’ to the covenant, publicly declaring their commitment and taking specific steps to support veterans and those still serving in the military.


Covenants like this are not enshrined in law but are instead affirmations of the value of public service built on the mutual obligations between those who serve and the nation.  As a public commitment, the Armed Forces Covenant has entered the mainstream of public discourse and is widely accepted by the public at large.  Incidents where it has seemingly been broken have drawn swift condemnation from across the political spectrum[6].


A covenant with the NHS would provide a concrete means of ensuring that the kinds of debate we have witnessed over pay take place in their proper context.  But it would be more than a means of framing policy debates.  Throughout the pandemic, the public have signaled their clear support for the recognition of the sacrifices made by NHS workers.  Regular Thursday night clapping[7], calls for a ‘Covid medal’[8] and proposals for a ‘National Day of Recognition’ for all NHS staff[9] indicate a widespread view that the work of the NHS during the pandemic is valued in a way that is distinct from other sectors.  Surely, then, it is time to extend the same kind of recognition afforded to the armed forces and introduce an NHS covenant.


Rod Dacombe is Director of the Centre for British Politics and Government at King’s College, London.


[1] https://www.england.nhs.uk/2020/02/nhs-staff-morale-improves-but-too-many-facing-abuse/#:~:text=However%2C%20more%20than%20one%20in,patients%20over%20the%20last%20year%20%E2%80%93

[2] https://www.frontiersin.org/articles/10.3389/fpsyg.2020.569935/full

[3] https://www.bmj.com/content/372/bmj.n703

[4] https://www.amazon.co.uk/Breathtaking-Inside-NHS-Time-Pandemic/dp/1408713780

[5] https://www.armedforcescovenant.gov.uk/

[6] https://www.independent.co.uk/voices/editorials/leading-article-britain-must-honour-its-commitment-to-our-troops-401142.html

[7] https://www.theguardian.com/society/2020/may/28/clap-for-our-carers-the-very-unbritish-ritual-that-united-the-nation

[8] https://www.mirror.co.uk/news/politics/lord-ashcroft-recognise-courage-those-21804148

[9] https://www.independent.co.uk/news/uk/home-news/coronavirus-nhs-staff-national-day-clap-carers-matt-hancock-a9623626.html

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