Author: Giancarlo Bell
National Change in Crisis
The coronavirus crisis has exposed the flimsy foundations upon which many seemingly immutable truths were built. Millions who begrudged the chore of the commute and the tyranny of the office find themselves writing emails and filling in spreadsheets from their living rooms. Accommodations long deemed impossible to find for disabled people became commonplace. In cities across the UK, thousands of homeless people were housed overnight, albeit in temporary accommodation. After a generation of “necessary” austerity, the Conservative government has injected billions of pounds into the economy and launched the unprecedented furlough scheme, alongside several more targeted economic interventions. In light of these nationwide upheavals, as we recover from the strange and emotional experience of working through the crisis, it is useful for doctors to look at what has changed in our own workplaces, and to consider which innovations we should keep.
Glasgow Royal Infirmary
The Glasgow Royal Infirmary campus is a strange collision of imposing Victorian façades and concrete modernist monstrosities, spattered around a labyrinthine link corridor. Despite the architectural delights of the site, when I started FY1 there in August, I was bitterly disappointed by many practical aspects of the physical work environment. The hospital canteen closed at 2pm and didn’t open at all on Sundays. After 2 o’clock, there was nowhere to get hot food, or even a ready meal. The tiny WHSmith, stocked with a limited selection of expensive sandwiches, would also close in the early evening. When an unfortunate junior left their prepped meal in the fridge at home or didn’t find the time to throw food together before an on-call shift, as is often the case, the only options were vending machine crisps. In the general surgery department, where, due to the crisis, I have been working for almost a full year, the FY1 workspaces were less than ideal. A handful of computers and chairs were squeezed into cramped alcoves on the wards. In terms of rest facilities, while I have heard tell of a doctors’ mess, this is located on the opposite side of the campus, and not a practical place for a surgical FY to retreat with a pager. My medical colleagues tell me that I’m not missing anything, that the mess is a small room with a couch. In place of a mess, in surgery we only had a few small break rooms shared between nurses, healthcare assistants, catering staff, and doctors. These spaces, inevitably, became crammed at peak times.
While I have heard of and been placed on sites with superior facilities, having recently engaged in a Scottish Junior Doctors Committee (SJDC) discussion about improving break facilities across Scotland, I also know that our situation was far from extraordinary.
Looking After Staff
As rotas changed and new staff appeared on the wards, it became clear that the cramped nooks and crannies of old were not pandemic-ready; social distancing was impossible. It did not take long for management and the facilities department to take note and act. The surgical secretaries migrated from the spacious offices adjacent to the wards to the relative safety of the University’s academic building. With the blessing of management, their vacant workspaces were seized by the FY1s. These were our first offices: rooms with good IT equipment and plenty of space to distance. Here we could discuss complex cases and write discharge letters in a position both far enough from the ward to instil an atmosphere of calm but close enough for nursing staff to reach us in seconds when required.
Other changes swept across the hospital. The canteen started to open for a night-time slot. Fish and chips at midnight! Even better, local businesses and Celtic Football Club began to donate food – at the peak of the pandemic we were provided with a free high-quality hot dinner every night.
Rest & Recuperation
The centrepiece of the innovations, however, was the “R&R Area”. Break areas bearing this title were implemented across NHS Greater Glasgow & Clyde overnight. In the Royal Infirmary, this took the shape of a spacious area in the academic building manned with redeployed NHS staff and volunteer flight attendants and pilots from “Project Wingman”. It is furnished with soft seats and stocked with tea, coffee, and snacks. The space allows for social distancing, even during the mealtime rushes. In the R&R, we are not segregated by profession; everyone from porters to Advanced Nurse Practitioners has a space to relax and sip coffee alongside consultants, cleaners, and HCAs. At their peak, NHS R&R areas also provided 24 Hour, in-person psychological support and featured food and goodies donated by the public to boost staff morale. At GRI, for a time, there was even a free gym in a repurposed lecture theatre, with exercise equipment and fitness classes.
After several weeks on my new Covid rota, I was sitting in the R&R with two colleagues during a night shift. We got to speaking about how, despite the tone of discourse suggesting that we were making a sacrifice for the country, many things at work were better than they had ever been. We were adequately fed and well-rested. We felt looked-after. In my time as a BMA Hospital Representative (on the Local Negotiating Committee) , I had never dreamed that we could demand such comprehensive services, especially with regards to the new mental health support. We noticed that night that they had already started stripping equipment from the new staff gym. Sensing that further rollbacks were imminent, I started to feel strongly that we should fight to keep as many of our new facilities as possible.
Trade Unions can Defend Improvements
That week, I sent around emails via BMA listserver (a group email list) and put out messages on various WhatsApp groups. Employment Advisors and more senior colleagues in the BMA agreed with the sentiment of my demands . Everyone felt from their own workplaces that support services, staff facilities, and catering were all drastically improved. I was assured that this would be taken to the next Local Negotiating Committee meeting to raise with management. However, several colleagues were sceptical about the feasibility of the demands; in the Royal Infirmary, for instance, the University would need its academic space back, the restaurants and football club would eventually stop donating food, and the airline staff would have to return to the skies. I was aware of these points, but I felt that, since the pandemic had demonstrated that these amenities are possible, we should take a hard line – we should view them as essential.
I also saw that this could be a campaign which would help us to recruit and organise doctors into the BMA. If we worked with other unions, we could increase union representation for all workers in the hospital.
Unite with Other Workers
I have been a member of Unite for a year or so now. Until recently, I had never engaged with them directly on workplace issues. However, before Covid I had been in talks with the secretary of my local Unite branch, a consultant psychiatrist and union organiser, about establishing a Doctors in Unite Glasgow division. Furthermore, in the Winter I had been elected as health rep to the Scotland Unite Youth Committee. Having seen that Unite had recently won several victories for facilities and catering staff in my hospital, I thought it could be worth tentatively reaching out.
I sent an email detailing my thoughts. Two days later, I walked into the R&R Area in the middle of the night for a break. On the walls and scattered across every table were dozens of Unite posters demanding the retention of our new services and a post-Covid 20% discount for staff at onsite catering facilities, along with leaflets seeking to recruit new members. I texted the phone numbers on the poster. Shortly after I got home that morning, I received a phone call – it was an enthusiastic Unite organiser. He was delighted that I had reached out and thanked me for raising the issue. The branch representative had already started working on such a campaign, and my email served as impetus to put a poster together and kick things into action. The organiser strongly encouraged me to get involved with the campaign and with the grassroots work going on in the branch.
I was taken aback with the warmth and passion of this reception. A few days later, I received another phone call, this time from the branch representative, who works in one of the hospital labs. As well as thanking me for reaching out and encouraging further participation, he informed me that most of the airline staff looking after the R&R Area were Unite members. In solidarity, they had assisted in the distribution of the campaign and recruitment fliers. The rep proceeded to give me a link to a survey on staff food and rest facilities, which I promptly shared on all my FY1 networks.
The BMA had never considered such an approach.
The campaign is ongoing. NHS Greater Glasgow & Clyde, my local health board, has promised that the spirit of the R&R Areas will continue after the pandemic. This is not a concrete win – many of our gains will disappear as students, academics and administration staff return to the hospital site. However, having shown that at times of crisis, Glasgow can do better for health workers, it is important that we retain, or have new, facilities for rest and recuperation. We will hold this commitment in hand when negotiating in the months ahead.
This experience has taught me that, as workers, we can achieve more together than we can as individuals. The new facilities at my hospital are used by everyone, not just by doctors, and we should defend them together. We all have a stake in our workplaces and our communities; doctors could learn a lot by engaging with the wider trade union movement and striving for better conditions with a united front.
The case of the R&R Areas is one example of how workers have come together to weather the Covid-19 storm. In hospitals and other clinical settings across the UK, as well as in shops and factories, on doorsteps, and on the streets, the same thing is happening every day. It has become abundantly clear that workers on the frontline, including local managers, know how to make the NHS work best for our patients and colleagues. We made rapid and excellent changes to our workplaces when free to do so, whilst national leaders and government dithered. Together, we should run the NHS all the time.