The National Health Service (NHS) in England is a tax funded institution. However, due to the severe lack of funding there has been an increase in the struggles to cope with a growing demand on NHS services, especially since the COVID-19 pandemic. Attempts have been made within volunteering schemes or encouraging public donations as ways of helping the NHS manage throughout the pandemic. However, this has repositioned institutions as charity cases, shifting responsibility from governmental concern to a public one. The neoliberal mindset that has infiltrated the discourse around public healthcare in the United Kingdom shifts moral responsibility from the institution to that of the individual. This is reflected in the demands put upon the public to donate or volunteer due to the overworked NHS workforce. Relevant here is what the anthropologist Anne-Meike Fechter (2016) calls moral labour, the ‘unpaid’ labour involving questions of morality when navigating complex or impossible situations (2016: 230). As a result of growing pressures on the NHS, particularly in the wake of the COVID-19 pandemic, health workers appear to be facing a moment of moral reasoning: a result of conflict between the impossible aims set and the mental ability to fulfil them. The public, including the NHS workforce, are now saddled with the ‘moral responsibility’ to help. But it is the government who should be correcting the fundamental issue of an underfunded healthcare service.

A number of sources are provided for NHS staff encouraging self-care. For example, in this guidance video regarding compassion fatigue provided to healthcare workers by the Staff Support St George’s, they appear to encourage staff to seek, support, and perform self-care.

Additionally, in a guide provided by an NHS trust, doctors are encouraged to ’treat yourself as you would treat a good friend’ (Sherwood Forest Hospitals, n.d.), taking moral responsibility to care for oneself as well as patients. Neoliberalism can be identified as the source of this issue, instilling the idea that individuals must be resilient. The encouragement to care for the self as well as others results in increased pressure on NHS staff performing an impossible task. NHS staff are met with the ethical challenge of balancing their wellbeing with the role of a health-care worker, particularly during the pandemic. It seems as though the government and higher powers in the NHS responsible for the stress and overworking of staff are playing the onus on doctors to ensure that they are fit for work. Staff then begin to perform moral labour when met with this conflict between the responsibilities undertaken in their roles as health workers and as individuals responsible for their own mental resilience.

The COVID-19 pandemic has demonstrated more than ever this moral responsibility of the people, which is expressed through virtuous actions the public. The idolisation of Captain Tom and the money he raised for the NHS (Ainsworth, 2020) was a discourse perpetuated by the government itself that he is a ‘national hero’. This fails to consider that an elderly and vulnerable man performed physical labour in order to be a moral agent, shifting the responsibility away from those who have been elected and paid to support the prosperity of the NHS. There is little acknowledgement of this failure.

The movement from the NHS as a government-subsidised healthcare institution towards that of a ‘charity’ reliant on public donation is insidious when it becomes reliant on moral performativity and volunteers that are susceptible to compassion fatigue. By fostering an image of healthcare workers, volunteers and donors alike as ‘heroes’ it is possible to argue that actions above and beyond what should be required of each is being reflected not through practical governmental action such as pay rises (Watson, 2021), extra support or donations, but through performative discourse and actions like ‘clap for the NHS’.

All the evidence points to the NHS becoming part of the unsustainable model of neoliberalism. The pressure put on NHS staff contributes to what is known as ‘compassion fatigue’: staff burning out as they become overworked due to understaffing and long hours (Campbell, 2020). The rapid spread of COVID-19 reflected in part the political choices of the UK government to prioritise economic growth over the collective population ‘after four decades of neoliberalism had depleted state capacities in the name of the “superior efficiency” of the market’ (Saad-Filho, 2020: 478) Neoliberalism in this context refers to the increasing privatisation of state capacities, such as the NHS which reduced the abilities of such resources (Saad-Filho, 2020). So when the time came, the onus was placed on the individual to care for themselves, and more widely support the NHS. Saad-Filho’s (2020) article provides an important way of situating the NHS within a neoliberal context in which the government advocated for a herd-immunity strategy with little thought about the impacts on the NHS. So what does all this mean for the future? Scientists warned that a new disease (COVID-19) was on the horizon, yet nothing was done in the face of this warning (Saad-Filho, 2020: 478). It is clear there needs to be less pressure put on the NHS workers and the only way to do this is to reverse the neoliberal discourse that the NHS has become embedded in. This means paying attention to the warnings that are emerging in society today and, more widely, to implement greater structural changes to value the essential resources we have available.

The COVID-19 pandemic has demonstrated the failure of the government to prioritise the well-being of NHS staff and patients alike, shifting the responsibility to individuals to perform moral acts. As the responsibility is increasingly put on the public, the idea that the NHS is a charity becomes prevalent and people act to support the NHS, furthering this neoliberal discourse. By inferring that it is the duty of NHS workers themselves to support their own mental wellbeing in adverse conditions, the government is freed of the responsibility to ameliorate conditions and provide better help to mitigate compassion fatigue.

Bibliography

Campbell, D. (2020). ‘Third of UK doctors report burnout and compassion fatigue’, The Guardian, 27 Jan [Online]. Available at: https://www.theguardian.com/society/2020/jan/27/third-of-uk-doctors-report-burnout-and-compassion-fatigue (Accessed 12 April 2021).

David, A. (2020). 'Giving Is Good – But We Should Never Forget That the NHS Is Not a Charity', The Guardian, 22 April [Online]. Available at: http://www.theguardian.com/commentisfree/2020/apr/22/giving-nhs-charity-fundraising-coronavirus-state-taxes (Accessed 12 April 2021).

Fechter, A-M. (2016) ‘Aid work as moral labour’, Critique of Anthropology, 36(3), pp. 228–243

Saad-Filho, A. (2020). ‘From COVID-19 to the End of Neoliberalism’, Critical Sociology, 46(4-5), pp.477-485.

Sherwood Forest Hospitals, (n.d.). 'Guide to Self Compassion', [Online] Available at: <https://www.sfh-tr.nhs.uk/media/10136/od-guide-to-self-compassion-2.pdf> [Accessed 5th April 2021]

Staff Support St George's (2021). Compassion fatigue Am I OK? [YouTube]. Available at: <https://www.youtube.com/watch?v=9C4clL9BHk8> (Accessed 12 April 2021).

Watson, I. (2021). 'NHS 1% pay rise is "as much as we can give" - Boris Johnson', BBC News, 7 March [Online]. Available at: https://www.bbc.co.uk/news/uk-56313199 (Accessed 12 April 2021).