By Adam Doggett 
Healthcare systems around the world have been pushed to their limits by the fluctuating demands of the coronavirus pandemic, this on top of the day-to-day pressures and concerns of the healthcare professionals (HCPs) that operate within the system, creates a cacophony or working challenges. With healthcare operations paramount to nations’ successful navigation through the pandemic, it is no surprise that the relative capacity of health systems influences national policy.
Even beyond the pandemic, the UK government has introduced a number of measures in recent years aimed at increasing efficiency and capacity, whilst decreasing costs. Some have been met with HCP disdain, public criticism and staff protests. While such demonstrations require a lot of forethought and organisation, HCPs express their opinions online, providing real-time insight into the needs and concerns of those on the ground. In 2020, using its unique HCP dataset, CREATION.co reported how social media conversations can inform policy decisions. Now we take a fresh look at pressure points within the NHS from the point of view of HCPs and consider the areas of healthcare where they want to see policy reform and we consider why policy makers should be listening to online HCPs.
HCPs address NHS policy
HCP online conversations between June 2020 – May 2021 have revealed six key areas of concern relating to healthcare practice. Pensions and pay, PPE, work/life balance and referrals and patient care were key issues discussed with news of nurses’ 1% pay causing a spike in conversation.
The level of conversation surrounding these topics, averaging almost 1,700 HCP posts per day demonstrates the extent of HCP concern. However, while these issues may be stimulating conversation, a much smaller group of HCPs are using their online presence to discuss these issues in the context of addressing policy and looking for change. Some HCP role types are vocal in looking to bring change in all six areas of concern, whereas others compartmentalise and prioritise. Nurses, allied health professionals and general practitioners contribute the most posts addressing NHS policy with nurses discussing hospital visiting policies more than any other group. General practitioners had a relatively higher post volume related to data protection, along with psychiatrists and public health doctors.
HCPs were quick to respond to changing policy and circumstances, spikes in PPE and pensions conversation came in July 2020 and March 2021, respectively. However, HCP reactions towards their work life balance presents a picture of ongoing concern. Rather than a sudden increase and equally sharp decline in HCP posts, the work life balance conversation permeated the entire study period as HCPs attempt to drive policy change.
GPs look for policy to support work balance
The stresses of the working environment and home-life balance is a constant threat to HCP mental health, as reported by CREATION, and prompted passionate reactions online in relation to NHS policies. GP Marie-Estella McVeigh described feeling ‘emotionally blackmailed’ as GPs look for better support and protection from policy makers. Similar concerns around the lack of support are arising from the GP workforce with Richard Van Mellaerts and Ed Allens discussing new regulations which cause ‘more stress and more work for GPs and practices’.
What happened to the “unlimited funds” promised by @RishiSunak ?
Now Drs emotionally blackmailed to work for free in their “spare time” with no regard for the safety of breaching hours regulations etc.
Promised TOIL adding up to what… entire NHS closes for staff holiday in Aug? pic.twitter.com/Qy8RVhOVDl— Marie-Estella McVeigh (@DrMariMcV) January 26, 2021
By what contractual levers do CCGs believe that they are able to enforce non-GMS regulations? NHSE refusal to withdraw and bin this SOP sows division, causes more work and more stress for GPs and practices. Offensive disregard for the pressures we work under.
— Richard Van Mellaerts 💙 (@vanmellaerts) May 21, 2021
They can’t, but it was nice to have a supportive message from our CCG to distance themselves from the NHSE SOP and to provide a general message of thanks for what we’re doing
— Ed Allen (@edallen41) May 21, 2021
Vaccination centre mask policy does more harm than good?
PPE has been a multifaceted and contentious issue since the pandemic started. In June the conversation turned to the use of masks in vaccination centres, with HCPs arguing that NHS policy is having a negative effect. David Tomlinson joined a conversation in which members of the public shared their experiences with vaccination centres. Tomlinson suggested that it was NHS policy to remove better fitting masks in favour of lower quality alternatives and that this contributed to an increase in infection rates.
💙 Regarding whether it is #NHS policy to remove better fitting masks from those being vaccinated and/or attending hospital: it certainly seems this way, doesn’t it?
As you know it’s a consequence of opting for the lowest common denominator PPE, rather than #BetterMasks 4 all. https://t.co/bQ2YBLFpSk
— David R Tomlinson 🇺🇦💙 (@DRTomlinsonEP) June 13, 2021
I’d have been more impressed with our vaccination centre if they hadn’t insisted on us changing out of our own properly fitting masks into their ill fitting flimsy, ‘help yourself’ out of the open boxes on the table in the sealed doorway! The most vulnerable I’d felt in a year!
— Kathryn Butler (@QuaysideKat) June 11, 2021
Elsewhere, Dave Jones believes that unnecessary policy may prevent health staff from carrying out their work efficiently.
“We need an in-hospital referral policy pathway proforma”
“How about: Two (or more) highly trained adults have a professional discussion and come to a sensible and pragmatic conclusion that does not include any preconceptions or biases about the others’ abilities or work ethic?”
— Dave Jones (@WelshGasDoc) June 8, 2021
Health workers want equal standards
Healthworkers, who are put under such pressure by the system in which they work, want fair and safe policies which allow them to care for patients effectively and be rewarded for their work. In an attempt to open a discussion on policy equality, healthcare stakeholders and members of the public joined with Rachel Clarke as they looked to hold government officials to account over a perceived lack of probity.
If I ‘technically’ breached my GMC duties as a doctor, it would matter, & be taken extremely seriously, because those rules are there for a reason. Why is ministerial probity any different? https://t.co/1wMue28zX0
— Dr Rachel Clarke (@doctor_oxford) May 28, 2021
Listening to online conversations of the healthcare workforce on the ground allows us to gain real-time insight into what is practically working and what may need addressing in order to bring the most benefits to patient care and HCPs.
For those in a position to be making decisions and influencing policy, the power of social media for communication and connection provides the opportunity to digest feedback in real-time. HCP online voices can and should be allowed to shape the practices which affect them most.
To understand more about what HCPs are saying, sign up for the CREATION Knowledge monthly eJournal.
