Rostering in a pandemic: Sustainability is key

Mental health and wellbeing

The mental health and wellbeing of healthcare professionals is at significant risk during and after the COVID-19 pandemic: acute stress, burnout, bereavement reactions, anxiety, depression, moral distress and post-traumatic stress disorder have all been predicted.^2–4 It is important to prioritise wellbeing and mental health, and indeed prevention is at the heart of guidance.⁵ Sustainable working patterns – including adequate periods of rest during and between shifts⁶ – are fundamental to preserving the wellbeing of the workforce through the pandemic,⁷ and can be supplemented by development of a team ethos and adequate provision of facilities, including places to rest during shifts.⁸ This needs to be balanced with providing a functioning service to deal with the COVID-19 pandemic. Reinstitution of previous educational and mentoring leadership roles, such as royal/associate college tutors, may help with this.

Rest and recuperation: annual and study leave

Short-term blanket cancellation of leave to deal with the COVID-19 pandemic crisis may have been an appropriate emergency step in some organisations, but is not sustainable moving forward. While cancellation may be lawful,⁹ and national rules have been relaxed to allow staff to roll over annual leave,¹⁰ no national body is advocating for preventing leave entirely. As services resume, so should taking leave. Though the most common reasons for taking annual leave – such as travel and attending gatherings – are currently limited, healthcare workers still need meaningful time away from work to prevent negative effects on their wellbeing, performance and outcomes. Staff who have worked intensive surge rotas or were redeployed to high acuity areas may benefit from additional leave to allow for recovery and processing of difficult experiences.

Annual leave allocations should, as far as possible, be facilitated, though perhaps with more frequent, shorter periods to allow individuals to rest at home. The experience of taking leave is not necessarily the same for everyone: for example, some will be able to spend time with their family during this worrying time, while others may be unable to do so due to the need to isolate or follow social distancing rules. Many workers, whether due to a sense of duty or because they are socially isolated away from work, may be reluctant to take leave. Supervisors need to understand and consider individual circumstances, and on occasion may need to actively encourage staff to take time off. Annual leave should only be cancelled in the future if absolutely necessary, and only for a short period of time (less than a month). It is likely that staff will be unable to take accrued leave and hence must be compensated for untaken leave. Ideally, decisions regarding leave cancellation should be made at a high level, and in consultation with the affected workforce to ensure staff do not feel devalued by the decision.

Professional and study leave have been uniformly cancelled so as not to impair healthcare provision and to allow social distancing, leading to the loss of local training, regional and national meetings. Continued professional development and leadership roles will be as important as ever during the coming months, particularly given that knowledge will help combat the fear of the unknown. Therefore, some provision for professional and study leave needs to be allowed if possible, perhaps to enable the delivery of updates and training around the COVID-19 pandemic itself, now and as services recover. There are many examples of ‘side-skilling’ in the physician workforce, be it intensive care working, frontline and palliative care, and new ways of working (eg telephone clinics). These skills will be utilised both for ongoing learning and to provide flexibility in the future, enabling the healthcare system to re-adapt if future pandemic peaks occur.

Sick leave and compassionate leave will have to remain available and accounted for in rota planning, at higher levels than normal. Many health care professionals and their loved ones will be infected with COVID-19 themselves, with a range of consequences inevitably affecting sustainable workforce planning. Even in the face of uncertainty regarding the magnitude of the pandemic, we need to empower colleagues to take ownership of providing a sustainable, kind and safe work environment. After all, beyond COVID-19, we need a healthcare workforce that has the capacity to go on, perhaps bruised but unbroken.