Burnout is a word too often overused.
It’s more than just the September blues, that sluggish end of summer unwillingness to get back to the office. It’s not just about feeling stressed or exhausted or overwhelmed, either, but about feeling all of those things all the time, plus a gnawing sense of hopelessness on top. What’s the point of endlessly pushing boulders uphill, only for them to roll back down tomorrow? Is this really what you trained for? And at its worst, it’s compounded by what’s known as “moral injury”, or feeling forced into acting against professional and personal conscience. It’s not just about what happens in the working day, but the things that keep you awake at night.
Moral injury is what British soldiers will be feeling outside Kabul airport, having to force desperate families back into the arms of the Taliban as the airbridge collapses. But it’s also what some teachers felt in lockdown, knowing what might well be happening at home to pupils who had vanished off the radar. And it’s what eight out of 10 doctors responding to a BMA survey this spring said they’d experienced during the pandemic; the sick, helpless feeling of having to choose between turning patients away and treating them without personal protective equipment, or cancel cancer surgery for lack of intensive-care beds, or work on wards so short-staffed that mistakes were inevitable. Public sector professions that combine gruelling workloads with the risk of moral injury are ripe for burnout, and that’s why the under-explored risk, as a new wave of Covid-19 gathers this autumn, isn’t some new variant or twist in the viral tale: it’s key workers deciding they just can’t take it any more.
The NHS lost more days to mental health leave in the year to June than were lost to Covid, according to evidence presented to the all-party parliamentary group on coronavirus this week. FirstCare, which monitors health service absence, found it had begun rising sharply this April – after the second wave had subsided – and by May it was up 55% on last year. That chimes ominously with what the Commons health select committee found in June, in a report concluding that burnout in health and social care was now a “widespread reality”, which risked precipitating an exodus: older staff taking early retirement, younger ones quitting altogether.
Perhaps the most urgent crisis brewing is in social care, where a “no jab, no job” policy obliging workers to get vaccinated, plus post-Brexit difficulties recruiting abroad would surely have been enough to precipitate a crisis even without the trauma of the pandemic. Providers warned this week that they might soon be forced to close care homes; last week on the Isle of Wight, agencies ran so short of workers they couldn’t guarantee visits to vulnerable islanders reliant on them, and the council had to round up relatives to help. It’s appealing for former care workers who have left the profession to come back, but how many will decide after the horrors of the last year that it’s not worth it for minimum wage? While part of Britain agonises about having to go back to the office this September, we’re in danger of forgetting the majority who never stopped physically going out to work, on whom the strains are now showing.
What makes the end of summer a pivotal moment across the blue-light services is that the burnt-out rarely leave mid-crisis. They leave when things have calmed down just enough to take the holiday they thought would fix things, only to come home feeling just as bad; or else they leave when it becomes clear this crisis is just going to be followed by another. Among key workers traumatised by earlier waves of the pandemic, who have learned the hard way what tends to happen whenever the rest of society starts relaxing back into normal life, there is a palpable sense of mounting anxiety.
After only a few heady weeks of freedom, Covid-19 cases are rising sharply again, just like last summer. This weekend, teenagers too young to have been fully vaccinated yet are descending on Reading festival, days after almost 5,000 new cases were publicly linked to Cornwall’s Boardmasters festival. In less than a fortnight’s time, they’ll all be back in school together, without masks, social distancing or year bubbles. It doesn’t take a genius to anticipate what may be coming.
Thanks to the vaccine, the death toll will surely be far lower than last winter. But this time round, the cumulative pressures on an NHS that has been running far too hot for far too long, even before Covid, will be greater. Staff who have been running on empty are now struggling to clear a vast backlog of patients waiting for operations, while simultaneously bracing for a winter flu outbreak and the return of Covid. It may not take much to tip some over the edge.
There’s always a time lapse between doom-laden warnings of exodus and the reality, just as there was with predictions that Brexit would help trigger exactly the kind of labour market chaos now unfolding: crops rotting in the fields, gaps on supermarket shelves. But it’s in that pause that governments have a chance to act; to lighten workloads, raise morale, ease rules on recruiting abroad, revisit pay. If not then something will have to give, and that something may be the people who last year stood between the rest of us and disaster.