Covid-19: “Steady the front line! There is no retreat from here”

As an ex-army surgeon and a military historian, we have previously felt uneasy about healthcare workers being described as “frontline staff.”1 The front line suggests to us a tangible risk of harm or death at work. No longer. NHS staff are dying of covid-19 acquired from patients.

Many UK health workers have said that they lack protection. Some have died: whether inadequate personal protective equipment (PPE) was linked, we do not yet know. But overseas data indicate that good PPE might reduce risk.

During and after the 2003 Gulf war, British soldiers thought that they were deployed with inadequate equipment. Worries over body armour and communications were widespread. It was generally thought that the chancellor, Gordon Brown, had blocked funding equipment, a claim repeated by senior officers2 but roundly denied by Brown.

Many soldiers and their families thought that deaths occurred because of penny pinching; for example, in the 2003 slaughter of military policemen in Basra.3 Many soldiers thought that the “military covenant” was broken by the Blair-Brown government.

Soldiers might go to war, but they won’t accept avoidable injury or death without good reason. The NHS risks similar perceptions with covid-19.

NHS staff accept the difficulties but worry about PPE and testing. Speedy diagnosis for politicians is in contrast with how clinicians are being treated. PPE provision seems haphazard—many healthcare staff are buying their own masks. Health boards contradict intercollegiate advice on PPE. The Royal College of Nursing seems to suggest withholding care if nurses are worried.

Soldiers will put themselves in danger, because they believe that the cause is just and that their commanders are honest and share their fate. Good training, good kit, motivation, and discipline are essentials. The NHS should show it protects and values its staff in such crises.

The title of our letter misquotes Colin Campbell who commanded the 93rd regiment (Sutherland Highlanders) at the battle of Balaklava. In 1854, when the original Thin Red Line of soldiers faced an overwhelming cavalry charge, Campbell said to his men: “Needs be you must die where you stand.” They replied: “Aye, Sir Colin. If needs be, we’ll do that.” Many died; the battle was won.

Leadership and a shared sense of purpose can make humans endure the impossible: the NHS should be stronger in many ways after covid-19. We hope that those in charge will listen to those who risk their lives and improve trust and cohesion.