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See ITV NHS Staff survey below.

If, in a life or death struggle, your front line workers are feeling like this, even though they are putting on the bravest face they can manage, you have a serious problem that you need to address.

Since warfare is the lowest common metaphor for any struggle, it should be noted that it is a commonplace of military strategy that a successful offensive – or defence come to that – is dependent not simply on soldiers being well trained and equipped, with plenty of back up in reserve and a plan flexible enough to innovate under the impact of opposition and the unexpected; it also, crucially and decisively, depends on the state of the soldiers themselves. What is their morale? How far do they trust their leaders? Have they been fed? How long have they been fighting? Have they slept. How exhausted are they? How are they coping with the deaths they have seen. How many have shot their nerves, are shell shocked, have PTSD? How worn out are they?

Its not just where they stand, what their strength is on paper. Its whether they have any strength left. This is particularly crucial if the struggle is projected to go on for a long time.

On Friday, Boris Johnson held up the UK as a positive example to other countries because our Health Service has not been overwhelmed by Coronavirus. This took some Chutzpah because on Friday 9 (and still today) the UK’s daily death rate was second only to the USA; so we are no example to anyone.

More to the point, Johnson was assuming that staff in the front line are in a position to cope for the prolonged period of partial lockdown and ‘living with the virus” that too many factions in the UK government and – worryingly, the opposition too – envisage as the “next stage’ – possibly starting as early as May 18th. A shorter, sharper campaign to eliminate the virus; with the lockdown tightened until new infections were well down and deaths in single figures took China 6 weeks across the whole country and 11 in Wuhan before there were cautious steps taken to ease off. The problem here is that our infections per capita – thanks to the complete failure to prepare and get a grip in February and early March -are massively above the worst peak in China, so even this will take us longer.

Instead, the entire debate is about how much and how fast things can be relaxed. That will mean that there is a danger of the virus rebounding. Germany – which has a much more effective testing and tracing system than anything in the UK relaxed restrictions last Monday when death rates were down to just over 1000 a day. Every day since the number of new infections rose. It had reached just over 1400 by Friday. What happens in Spain and other countries with even higher infection rates, let alone the US States that are determined to “reopen” with no safety net at all will be even more instructive.

The  pressure this will put NHS staff under will be intense. it cannot be taken for granted that the line will hold. A survey of NHS staff carried out by ITV last week came up with some alarming results. Just under 6 out of every 10 workers reported feeling stressed beyond a point they could cope with (57%). 1 in 10 reported having suicidal thoughts (11%). One in 30 reported self harming (3.4%). Half report that there has been insufficient support. (1)

What this means is that NHS workers need more than claps and badges. They need PPE, respect and support from managers (and no gagging orders on telling it like it is to protect official myths); and above all a clear strategy from government to eliminate the virus, not the prospect of continual ongoing “management” of it.

(1) https://www.itv.com/news/2020-04-30/more-than-half-of-frontline-nhs-workers-unable-to-cope-with-stress-brought-on-by-coronavirus-itv-news-survey-finds/