“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.”