“A common goal against something bigger than yourself”: Tough,
but all in it together
Staff spoke passionately about the camaraderie and teamwork which
characterised the early part of the pandemic. The sudden availability of
resources to properly fund infrastructure, such as iPads and
long-awaited software or basic estate repairs to buildings which had
been needed for some time, coupled with fully staffed wards, streamlined
services and an eagerness from the public to support the NHS meant that,
in their experience, standards of care were maintained and they felt
valued. Heads of Service who were interviewed reported a time of
enhanced productivity, of freedom to enact changes they had waited years
for, largely due to the removal of bureaucratic hurdles and combined
efforts of Trust leadership. Despite fears for their own health and
worries about ‘taking home the virus’ to their families, many
respondents reported making huge personal sacrifices to be part of
something ‘bigger than themselves’.
“There’s only so much you can be pushed”: Loss of
hope, meaning & value
Freedom to adequately staff and resource the service was short-lived.
Some service users interviewed in the later phases of the study
expressed dissatisfaction with restrictions in areas such as hospital
visiting, access to postnatal care, and changes to their usual midwife.
Though they were aware of the pressures faced by staff and were somewhat
sympathetic, as social restrictions were lifted, they expected a return
to usual services. At the same time, many staff respondents were facing
difficulties including illness, a lack of childcare and unmanageable
working patterns. National implementation of midwifery Continuity of
Carer (CoC) continued as planned, although some respondents reported
that rollout of CoC was paused to maintain the core service due to
increasing pressures on the available resources. Heads of Service
described complex workforce challenges such as increasing rates of
short- and long-term staff sickness (particularly amongst midwives),
staff taking early retirement, and vacancies advertised but unfilled.
Workload pressures were reported to be intensified, with some
participants describing clearly unsafe working practices such as an
inability to provide one-to-one care in labour, excessively long working
hours, and insufficient staffing ratios. Many staff described the
emotional distress of working intensively to maintain standards of care
but feeling only able to do the ‘bare minimum’, focusing on safety but
having no emotional resource to offer the high-quality relational care
they thrive on. This dissonance between the care they wanted to provide
and the reality of the, at times, perceived dangerous staffing, created
the impression of significant moral injury and distress for some
respondents.
“I just can’t do it anymore” : the tipping point of
collapse
As an end to lockdown restrictions was declared on July
19th 2021, residents of England saw the widespread
resumption of something close to normal activities. Contrary to this,
within maternity services, many staff and Heads of Service interviewed
were facing the most challenging times of their career. On several
occasions in late 2021, our interviews were rescheduled due to Trusts
being in critical incident mode. Staff reported being unsure of their
future or their roles and described experiencing compassion fatigue
towards both their colleagues and those in their care. ‘Exhausted’,
’broken’ and ‘unable to carry on’ or similar terms were used by a
majority of professional participants. Just a small number reporting
feeling minimally affected - in one example, the seniority of their role
conferred a greater autonomy over workload and the individual felt that
control was essential to their management of wellbeing. Many senior
midwives, obstetricians and Heads of Service expressed concern about
rising incidence of burnout and breakdown leading to an exodus of staff
whom they could not replace, placing particular emphasis on what was
described by a senior obstetrician as “the biggest midwifery crisis of
all time.”