Pandemic shines spotlight on grassroots healthcare activists
At the start of the pandemic, trainee GP Kaveri Jalundhwala was working on a hospital placement. By the end of March, she had become infected with Covid-19, which then developed into long Covid and forced her to pause her training.
With stories emerging of how healthcare workers in makeshift masks and gowns — and sometimes no protection at all — were paying for failures to provide adequate personal protective equipment (PPE) with their health, Jalundhwala looked for a way to support her colleagues.
She joined Doctors’ Association UK (DAUK), a grassroots lobbying group. And rather than “just get angry at home”, Jalundhwala got involved with their “Protect the frontline” campaign. Its aims include to inform the public about conditions in the fight against Covid and press the government to give healthcare workers appropriate PPE and support.
DAUK is among a number of grassroots organisations for medical professionals — including EveryDoctor and Nurses United — that the pandemic has pitched into the spotlight.
Created by doctors and nurses, who check in with each other from iPhones and laptops between hospital shifts and GP surgeries, such organisations give healthcare professionals a community in which to share concerns, find a collective voice and campaign for change.
The DAUK grew from doctors joining together to support a junior paediatrician, Hadiza Bawa-Garba. In 2015, Bawa-Garba was convicted of manslaughter by gross negligence after the death of six-year-old patient and was then struck off by the General Medical Council.
But many medical professionals did not see a doctor who had failed, rather an overstretched colleague who was put in an unsafe situation and scapegoated. “Any one of us could be Bawa-Garba,” says Jalundhwala.
It often feels that doctors are “a faceless number on a rota where [our] individual voice does not matter to the people who make decisions,” she adds.
Bawa-Garba has since returned to medical practice, while the DAUK developed its “Learn not blame” campaign to improve the culture of the NHS so it can learn from mistakes “in a constructive and fair manner”.
When the pandemic hit, DAUK started its “Protect the frontline” campaign. As part of this, it broke the story of NHS staff being warned not to discuss PPE problems on social media or speak to the press. It also created an app that enables doctors and GPs to report on PPE supplies.
In April 2020, DAUK also led calls for an independent public inquiry into healthcare worker deaths and PPE supplies, with its petition gathering more than 100,000 signatures. When this received no formal response from government, DAUK started legal proceedings with the Good Law Project.
“When something needs doing, we do not sit on it,” says Pushpo Hossain, who joined DAUK to amplify the voice of doctors working in the UK who qualified abroad. With the large medical unions “there’s often a lot of bureaucracy involved,” she says. “It is hard getting heard.”
The networks and personal ties binding grassroots organisations are helpful when a fast response is required. For example in May, when a DAUK member heard about a plan to upload all NHS patients’ medical records to a central database that could be shared with third parties, the organisation joined forces with Foxglove, a digital rights campaign group, to help force a delay.
“In less than a week we had decided to take legal action [later paused],” says Rosie Shire, a GP who led DAUK’s response to the plans. The scheme has now been postponed to allow time for more consultation with no new date for implementation.
DAUK is “not against data collection for research purposes,” Shire says. But it wants “reassurance” that all patients have been fully informed about who would have access to the data and for what purposes, and that everyone has the opportunity to opt out, she adds.
Grassroots campaigns also bring a sense of urgency that some doctors see as lacking elsewhere. Most of the conversations on the EveryDoctor platform, another grassroots campaign group, reflected the preoccupations of more junior colleagues when Maria Corretge, an NHS consultant in Edinburgh, stumbled across it. But, she says, part of the reason she joined was because the medical unions “were not out there making enough noise”.
Julia Patterson paused her psychiatry training to start EveryDoctor in 2019. She describes the organisation as a place that “listens to what doctors are saying” and uses “softer methods of democracy”, such as online polls, to decide which issues to campaign on.
“If we get five or 10 messages, that pricks up our ears that there is a problem we need to talk to our membership about,” she says.
EveryDoctor also runs an encrypted email account allowing doctors to raise concerns in confidence. It was through this channel that it received a copy of a management email from within the Royal London Hospital in late December last year. The note informed staff it was in “disaster medicine mode” and could no longer provide a high standard of critical care.
“We broke that story via Twitter, and it got a lot of media coverage and reaction,” Patterson says. Days later the government announced the country was going into lockdown. “We felt we were instrumental in that,” she adds.
Grassroots groups are not trade unions. They lack unions’ large memberships and the legal standing to negotiate on pay.
But by grounding their campaigns in the confidences of doctors and nurses who band together in Facebook forums and WhatsApp groups, they are meeting a need, says Roger Kline, a research fellow at Middlesex University who designed NHS England’s workforce race equality standard.
Unions have bought into an HR model that is deaf to collective experience and fails to probe the root causes of problems, he argues. When a whistleblower or victim of discrimination comes forward the response is to individualise the complaint, rather than ask if it has happened to anyone else, says Kline.
Indeed, mental health nurse Rachel Ambrose joined Nurses United, a grassroots group that encourages and teaches the profession to be activists, because she liked the idea of belonging to a community that “was discussing the things I’m passionate about”. She used the training she was given to start the Nurses of Colour Network, which leads Nurses United’s work against racism.
A return to grassroots principles might help unions reconnect with their members. In 2018, the Royal College of Nursing’s (RCN) entire council stood down after losing a no-confidence vote — for which less than 4 per cent of its members turned out.
By upending itself, the RCN now hopes to unlock its sleeping strength. The idea is to move from a model that looks to union officials to “do things for nurses” to one that puts power into the hands of nurses to do things for themselves, says Patricia Marquis, acting director of RCN England.
Tackling the “massive issues” in nursing — including understaffing and the lack of a meaningful pay rise — will “take more than our policy people and a few of our members pulling together the evidence,” Marquis says. “It is going to take nurses speaking together in a very strong, very loud, collective voice.”