The idea of moral injury is perhaps best known in the health sector, naming the longterm stress that impacts on dedicated staff who are unable to respond to the distress of people they meet because of a poverty of resources.

But we are now seeing moral injury across many public services:
– schools arranging counselling for teachers no longer able to refer vulnerable children to social services;
– police officers attending serious incidents involving people and addresses where warning signs have previously had to be skipped over;
– housing officers unable to find a home anywhere for a family, even with young children.

Some right-wing politicians talk about the merits of the small state. This is usually linked to lectures about productivity in the public sector.

Productivity here isn’t what it usually means – companies buying the latest equipment so that people can do their best work – instead of investment these politicians are talking in code about fewer staff and lower wages.

In economics, reducing the revenue available, not increasing the capital invested. All to make room for tax cuts for wealthier people.

Where does this road lead to? I’d suggest it leads to burnout, followed by workforce exodus, leading to service collapse, and usually a public scandal but blaming an individual (usually a female manager, especially in the tabloids) instead of questioning the paymasters.

As with the breakthrough scandal of the Post Office, we paradoxically need more public scandals to save public services.

The conflicted world of medical and social care:

It seems the use of “PA” for Personal Assistant may become a source of confusion as medics are increasingly using PA now for Physician Associate, for example in social media posts.

Interestingly, office workplaces have already started to use “EA” and Executive Assistant instead of PA to avoid confusion in recruiting staff.

I guess the pressure will be to rename PAs as Care Assistants; probably accompanied by pressure to align CAs with Health Care Assistants, HCAs in hospitals. Or maybe SCAs, Social Care Assistants, as a parallel career to HCAs.

Disabled people with Personal Health Budgets are already seeing their PAs being tasked as if they were community-based HCAs, with all the medicalisation that implies.