Staffing is the issue keeping NHS leaders awake at night — and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence

I was shocked to read about nurses working in the private sector being threatened with disciplinary action if they refused to treat covid-19 patients, as revealed by my colleague Rebecca Thomas this week.

A staff member at a Nuffield Health facility in Cheltenham said nurses had objected to working without the right personal protective equipment, although the provider said it could “categorically state” there was a full supply of PPE.

HSJ has previously reported staff working at NHS trusts were refusing to see patients due to concerns over PPE. 

The issue has continued to dominate England’s covid-19 experience. A few weeks ago, HSJ’s survey of chief executives cemented it as the top concern. We have since reported on fears over a shortage of gowns, with disposable coveralls being shipped to trusts as an alternative.

Despite clarifications from Public Health England on PPE guidance, healthcare professionals still do not feel safe at work.

This is highlighted again by new research from the Institute for Public Policy Research think tank and YouGov; three-quarters of 1,000 healthcare workers polled in the UK said the government had not done enough to prevent them from getting ill. In London, those agreeing too little had been done to protect them was as high as 80 per cent.

Perhaps unsurprisingly, one in three said the pandemic has had a detrimental impact on their health.

Many will be concerned following new reports from the BBC, in which a leaked PHE document revealed there is still a reduced ability to supply PPE and discussions around some elements of PPE being reused. I had heard rumours a few weeks ago from staff working at a London trust there were plans to reuse PPE, with suggestions of washing and reusing visors, but nothing more concrete.

Rates of staff sickness are still somewhat of a mystery. Although trusts are reporting daily figures to the centre, NHS England is not making the data publicly available or even sharing it with unions. The reasoning behind this is unclear.

At the end of March, a Royal College of Physicians survey suggested 14 per cent of doctors was off sick due to coronavirus. According to internal NHS England data, seen by HSJ, one in 10 nurses is currently off sick because of the virus and more than 8 per cent of staff overall are absent due to covid-19.

In response to the story, one commenter suggested these figures seemed low, but when speaking to another senior doctor at a major teaching trust, they suggested staff sickness was not as bad as originally feared. Every trust will have its own experience, but what they should have in common is how they respond to staff concerns.

It is notable that, in recent days, unions have taken a tougher line on staff health and wellbeing.

In a message to Royal College of Nursing members, chief executive and general secretary Dame Donna Kinnair alerted them to new guidance about what to do when deciding if the PPE provided is appropriate and what to do if it is not.

“This include[s] refusal to treat,” Dame Donna said. “This will go against every instinct you have, but your safety must not be compromised.”

The Nursing and Midwifery Council has also recently published guidance for staff on what to do when faced with PPE shortages. It is clear staff should not feel they have to place themselves or others at risk.

The British Medical Association is also clear it will defend its members’ right to refuse treatment if they do not have adequate PPE.

It is remarkable that thousands of staff have chosen to rejoin the NHS — the latest figures suggest nearly 5,000 have been deployed this week, with around 10,000 having completed pre-employment checks.

But their sense of duty must be met with a duty of care from their employer, NHS England and the government. Ensuring all staff have access to PPE is essential but employers must also understand refusing treatment is the very last resort, and a decision any staff member would take reluctantly.

As Dame Donna said to RCN members: “We trained to save lives, not to forfeit our own.”