If we are at war, why have healthcare staff not received danger payments?

Let's reserve war metaphors for warfighters.

Dear readers,

I originally pitched this article to a few outlets including BMJ Opinion, ANZ Journal of Public Health and also the magazines Quilette and Areo. I received some kind rejections. Such is the life of a writer!

My loss is your gain, and I now release this article early for your eyes only. I hope it provokes and prompts some thoughts.


Since the beginning of the COVID-19 pandemic, government officials across the globe have waxed poetic that we are at war with an invisible enemy. Indeed, aside from the genuine instances of martial engagement over the last few decades, of which there are many, including the War on Terror, we have also witnessed the War on Drugs, the countless battles against cancer, wars on numerous infectious diseases, including HIV, the war on crime and poverty and even a war waged in vain against artificial polymers. Warmongering politicians use passioned orations to convey an image of strong leadership and action. Such talk may help garner confidence in the Government, instil a sense of national pride, and appeal to the jingoists of the populace. Still, conflict peppered diction is not particularly well-suited to public health matters, nor does it do those on the battlefield any favours.

In the United Kingdom, during the embryonic stages of the pandemic, it became customary to “Clap for carers” as weary healthcare workers trundled home in the dark hours. These “front-line” operators were still trying to ascertain the complexities of the situation in which they found themselves and dealing with a health system quickly flanked from all sides. Naturally, this collective display of gratitude was no doubt appreciated by Boris Johnson’s NHS comrades - but one wonders if they might have preferred more appropriate Personal Protective Equipment (PPE) instead, and for the Government to have put its money where its mouth is.

British healthcare staff found themselves amid a crisis for which the National Health Service was not adequately prepared —leading to many staff undertaking additional shifts and working extended hours without extra pay and forgoing annual leave, all the while working in circumstances that increased their chances of contracting a novel and dangerous virus. Many staff reported feeling overburdened, overworked and unsafe.

Irrespective of the martial parlance used throughout the pandemic, those on the front lines have not been remunerated in kind. This is in stark contrast to military personnel who conduct hazardous work, such as Mine Clearance Divers or Bomb Disposal Experts, who receive extra allowances corresponding to the increased dangers they face. It is widely accepted that such remittance is standard practice, not just for military personnel but for those in other dangerous occupations, such as miners or those who regularly work in treacherous weather conditions.

Furthermore, regardless of risk, all military members who serve on any deployment can expect to receive an extra daily payment culminating in a tax-free lump sum per tour. However, for all the hyperbolic talk of being at war, there has been no mention from the UK Government of a parallel payment for those serving in the nation’s domestic defence.

The UK government, after much avoidance, has reluctantly offered NHS staff in England and Wales a pay increase of 3%, their Scottish counterparts receiving a backdated 4% raise and a one-time “COVID payment” of £500. However, this does not equate to providing staff with the appropriate daily payments that sufficiently recognise the threats they have faced in an ever-changing and purportedly hostile environment.

Perhaps the government’s reluctance to monetarily recognise healthcare workers’ services performed for the country stems from the fact that they don’t honestly believe that we are at war at all. For all the embellished talk of doctors and nurses being “in the trenches”, there have yet to be any cases of trench foot or gangrenous body parts developed from long shifts on Nightingale wards. Initially, PPE was lacking, but health professionals were not asked to share a rifle between two whilst defending the Eastern Front. In this war, the aggressor is not conjuring up vile and vicious new methods to mutilate and destroy, nor is it allied with others with similar ideologies. No. This “war” is one fought against a biological entity that lacks an agenda other than to survive, selected by nature with no ulterior motive or purpose. It is crass to compare the situation that healthcare workers find themselves embroiled in – one that could have been well prepared for given a chance by a functioning bureaucracy – to those who have fought and died on battlefields throughout history in treacherous conditions.

Regardless of historical precedent, politicians, the public, and even scientists have used military metaphors throughout the pandemic without restraint. The emotional reaction by the public towards the services of healthcare workers has been palpable. The British public desires to show their gratitude to healthcare workers, and the Government is adamant that they are serving the citizenry as wartime leaders. Accordingly, it would be appropriate to properly acknowledge those who have served in theatre with rewards in line with the services performed. If politicians use fighting talk, they should understand that war metaphors are only applicable when warfighters are treated as such.