Andrew Watterson says unions must be part of the post-crisis economic and social reconstruction
Pandemics cannot be avoided but COVID-19 has shown that Britain could and should have done a lot better to protect its workforce, protect the public and, hence, protect the economy too. April saw the Society of Occupational Medicine along with a range of professional bodies issue a belated but very welcome statement calling for zero workplace fatalities in health and social care due to COVID-19. This should have been the starting point for the Westminster and Holyrood governments, through testing, preventing transmission and protecting all groups of workers at risk from COVID immediately. Such a strategy would have reduced the number of COVID cases, hence, reducing the threat to health workers and other workers of contracting the disease. This, in turn, would have ensured health workers were available to treat what should then have been a much smaller number of COVID cases.
Corona viruses have been around a long time. Some but not all had little effect on humans: not so new COVID-19. Nevertheless, there have been warnings for months about the pandemic threats from this virus. For years, Westminster and devolved governments had been warned to plan for pandemics too using World Health Organisation (WHO), International Labour Organisation (ILO) and other international pandemic guides and manuals. Such planning, including storing basic PPE for health and other workers, often does not require rocket science. Yet, here we are four months after the Chinese COVID-19 outbreak and still our health workers, care workers, service workers remain at risk and PPE – supply, suitability and replacement – continues to be problematic to say the least.
At the same time, we have Westminster – and sometimes Scottish – government ministers and civil servants ironically telling us not to be complacent and to act responsibly in the face of the pandemic. It is clear who has been complacent and who has been irresponsible in pandemic planning and protecting workers. It is not the public or workers themselves, their unions and non-governmental organisations (NGOs) who have been far more active flagging up the risks of COVID and precautions needed than many politicians and regulators? Why is this?
Occupational health and safety, a reserved matter, has been a Cinderella in the funding and staffing policies and practices of successive Westminster governments over decades. Neither Scottish workers nor the Scottish Government have control over either the Health and Safety Executive (HSE) regulator or health and safety laws (Scottish local authorities will enforce some Westminster health and safety laws mainly in smaller workplaces). Worse than that, the HSE has been a specific target in the last decades for those wishing to cut red tape through deregulation, so-called ‘better regulation’ or ‘smarter regulation’. Such policies have damaged inspections, monitoring, information and advice and enforcement on workplace risks. This probably meant that HSE checks on the health and safety aspects of pandemic planning in hospitals and social care either did not occur or at best were limited. Prior to COVID-19, many workers in Scotland were already dying from occupational diseases and large numbers had been made ill by work each year.
Running parallel with these cuts and ideological attacks came significant budget and staffing cuts in the NHS and public health: most pronounced in England, less so in Scotland. Juxtaposing these two elements with the possibility of a pandemic which could take out key workers in acute, primary and social care, and also from key parts of our economy, and a perfect storm looms. The Scottish Government at times appears to be guided by ideologically driven Westminster politicians, UK NHS medical advisors and Public Health England (PHE) leaders. Westminster initially ignored WHO advice, global experts on pandemics and the most recent experience of COVID-19 in China, South Korea, Germany and Denmark, delaying early and extensive lock down measures and testing. Scotland’s government tended on occasions to follow this lead. Key testing epidemiology principles were ignored and this may have resulted in more workers exposed to COVID-19 than elsewhere in Europe. PHE at the beginning did not address the PPE needs of non-health workers faced with COVID exposure either quickly enough or at all in some cases. Non-health workers fell through the PPE gap and the HSE effectively remained passive on COVID.
Additionally, PPE advice from these government bodies has been constantly changing. Westminster and Holyrood governments may have considered there could be no circumstances whereby health and safety cuts would ever be immediately and publicly visible in a pandemic. They were wrong. The continuing lack of effective PPE for doctors, nurses, paramedics, other health and emergency workers, shop workers, call centre and transport workers, construction workers, care workers, prison police and fire officers – who face COVID-19 risks – appears daily in our newspapers, on TV and radio. PPE failures have repercussions for both pandemic patient treatment and the workers themselves. Health staff shortages through COVID and self-isolation put additional pressures on remaining staff in terms of fatigue and stress. So testing, tracing, isolation and lockdown policy failures damaged the NHS workforce directly and indirectly adding to hazardous and risky NHS and social care working conditions.
Some have argued no pandemic could have been foreseen or foreseen on the scale that COVID-19 has (so far) affected the world. Others argue all the planning necessary for a pandemic had been done and no country could have done more to protect the health and safety of its health care professional related workforce. They are wrong. Coronaviruses were first identified in animals in the 1930s, then in humans in the 1960s. The new COVID-19 emerged in 2019 but the possible pandemic effects of such viruses had been flagged repeatedly in 2005, 2009, 2015, 2019 and early 2020 by WHO and other organisations. In 2005, the International Health Regulations bound every country to prioritise and dedicate domestic resources and recurrent spending for pandemic preparedness. PPE availability problems were noted internationally in pandemic planning assessments and specifically flagged in Britain throughout the 2010s. Ignoring these warnings demonstrated ‘wilful ignorance’ on the part of some British government and scientific civil servants.
In Scotland, it was apparent early on that not all workers at risk from COVID-19 – for example, those in social and home care settings, emergency workers such as firefighters, the police and paramedics – had been recognised in pandemic planning or operationalisation. Problems then emerged with suitable and sufficient PPE supply in hospitals, GP practices, residential homes, social care, transport and other service and emergency settings services. Even basic requirements such as hand sanitisers were not being met. In April, over three months after COVID19 was confirmed in China, RCN Scotland still expressed concerns about whether staff had the PPE they needed not just in the NHS – in the communities, in the care homes, in the hospices, wherever care is being provided. BMA raised similar PPE concerns for medical staff.
Many Scottish workers also faced the double jeopardy of either losing their jobs or carrying on working in what might be hazardous employment. The ILO and international union organisations in their pandemic planning publications in the 2000s indicated the need to protect all workers economically during a pandemic, especially those in precarious employment and in the gig economy.
In contrast to these governmental, agency and sometimes employer pandemic planning and action failures, the unions and their representatives along with NGOs like the UK Hazards Campaign acted. They quickly identified hitherto neglected ‘at risk’ workers and pressed for effective policing of workplace social distancing, closure of non-essential work, early lockdowns – topics on which the Scottish Government led the UK government – and PPE. The TUC, STUC, hazards groups, unions including the GMB, UNITE, UNISON, FBU, POA, Police Federation, RCN and BMA, and professional bodies all provided good health and safety information on COVID and mooted immediate solutions for their members along with the need for economic support and job security. Unions use a precautionary approach to risks from hazards. The precautionary public health principle geared to prevention should have been adopted by governments throughout Britain to tackle the pandemic at the beginning. It is difficult to envisage a public health threat that could have warranted a more precautionary approach than a pandemic. Yet the Westminster government did not act.
We are still in the pandemic. So, there is little justification for not now taking even greater steps to protect our health, emergency social care and key employees in ways that will not hinder or disrupt their work. This irony is not recognised by our Government. Good health and safety practices will safeguard these health workers who safeguard the public who safeguard our economy. The three elements are closely intertwined. HSE now states it wants to be ‘flexible and proportionate’ in dealing with COVD-19. Yet the HSE appeared to go missing in inaction for weeks and months when the pandemic started and is still barely visible. It is also difficult to envisage how a proportionate response by HSE to major failings for protecting doctors, nurses and social care workers could have been anything less than rapid interventions requiring immediate health and safety improvements.
Early regulatory interventions in workplaces through inspections, monitoring, advice and support were needed. PPE provision, adequate staffing levels, testing, action on the position of vulnerable workers outside healthcare should all be considered health and safety matters. Ministers, regulators and others should provide details and timetables on PPE provision; ensure proper consultation with workforces on pandemic planning; and update the public, unions and the media regularly on how many health and other workers have been made ill or died from COVID caused or related illnesses. A HSE COVID health and safety phone hotline should operate.
When the pandemic is over, there will need to be a fundamental review of the many COVID-19 failures to protect worker health and safety not just in health and social care settings but in all Scottish workplaces. This should include an examination of the HSE’s and local authority health and safety regulatory roles and functions, and the impact of PHE and Health Protection Scotland (HPS) on both public health and occupational health and safety policies in a pandemic. It should, however, go wider and include questions about how workplace health and safety generally is dealt with in Scotland. Unions have been some of the most effective analysts and problem-solvers in the COVID crisis on prevention of workplace illnesses and supply of PPE along with the Hazards Campaign and Hazards magazine. There should be a key role for unions post-pandemic on taking forward Scotland’s economic and social recovery recognising the need for decent working conditions including health and safety and tying in with existing work on just transitions and green new deal approaches relevant to the even bigger public health threat of climate change that is looming.
Andrew Watterson is Emeritus Professor of Health in the Public Health and Population Health Group at the University of Stirling
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