COVID-19: working together in the NHS

I’m not meant to be here in London today; I shouldn’t be packing away my FRCS revision and receiving refunds from cancelled courses. I run past closed restaurants, pubs and gyms. I turn on the news, I turn it off. The cancellations, postponements and restructuring are all part of preparing for a global pandemic. My plans are now insignificant.

The COVID-19 virus is a monumental challenge we must face. Yet it is in moments of order amongst chaos, of organisation and ingenuity that we stand together. I have seen changes to the organisational structure of our A&E department. I have seen ambulances be met by staff wearing masks. I have been part of a surgical team reorganising their theatre lists, switching clinics to virtual telephone clinics and restructuring the on-call rota. Every hospital is doing the same; everyone is working to reduce footfall to hospitals, to prioritise cancer and urgent surgery and redeploying personnel to other teams in need. Evidence of teamwork is aplenty.

Concerns have been made public of inadequate availability of Personal Protective Equipment (PPE), simple surgical masks and the correct fitting of masks (and when to use them). There is mixed information regarding the testing of exposed and potentially infected healthcare workers. Confusion also arises over 7-day isolation recommendations for healthcare workers, compared to the 14-day isolation given to the public.

The fear of exposure is real – healthcare workers want to work, but also to stay safe – and a lack of consistent information fuels more concerns. We fear exposing family members and those they share accommodation with, and the dilemma of keeping those that are pregnant safe is justifiable. All trainees face a pause on training and progression: exams, courses and Specialty Training interviews are postponed and ARCPs are under review. However, we accept these changes with grace and composure; we trust in the Colleges and trainee representative groups that will support us. Working in the NHS is rarely easy, but we hear of support, thanks, special shopping hours and discount codes quicker than the virus can spread.

Social media has become an increasing source of connection and entertainment during #socialdistancing and #selfisolation. Notable examples include the memes and messages promising Wembley-sized lasagnes, videos of hand-washing dance routines and hundreds of singing jelly babies. There’s been a surge in downloads of virtual meet up Apps such as ‘Houseparty’ and ‘Zoom’ as the public are told to do their part; to self-care, stay at home and forgo their right to party. Staying in is quite literally the new going out. Sadly, there’s news of queues, empty shelves and fights over toilet rolls, but we’ve also seen kindness and community goodwill (for example, the ‘Mutual Aid UK’ community group flyers that facilitate offers of help to those that need it). Foodbanks have had a surge in demand; but initiatives such as Fareshare have been working hard to reallocate surplus foods from now-closed restaurants to those in need.

Important lessons are being shared between from doctors in countries worse affected by COVID-19 via Twitter. Treatment plans, models and assessment tools from different institutions are made public; this is quality improvement without the audit cycle. Lessons are being learnt quickly. This virus knows no borders and it doesn’t discriminate; the elderly and co-morbid are most at risk, but no one is immune. Learning from colleagues and sharing ideas are key.

Everyone will be affected economically, professionally and personally. Yet it is in this difficult time and times of change that we see the best in people. The evidence is in the selfless attitudes and mobilisation of the NHS workforce working together to deliver care, containment and treatment. We won’t see specialists, individuals or any one person more important than the other in the fight against this pandemic: in human terms there is no ‘I’ in COVID.

Comments (8) Add yours ↓
  1. Roger Kirby Professor of Urology

    Goodness!
    Boris Johnson says coronavirus is “biggest threat [UK] has faced for decades”
    New curbs on movement include shopping only for basic goods and a ban on gatherings
    Police will be given powers to enforce restrictions, including by fines
    The coronavirus pandemic is “accelerating”, the World Health Organization warns
    350,000 confirmed cases worldwide, with nearly 15,000 deaths and almost 100,000 people recovering
    335 people with the virus have died in the UK
    Italy deaths drop for second day in a row as it enters tougher lockdown
    Death toll in Spain passes 2,000
    Aaaargh!

    March 23, 2020 Reply
  2. Louise de Winter TUF

    Very well put Sophie. This is a far greater test than many of us have ever faced in our lifetimes. The country is now in ‘lockdown’ with legislation to force us to stay in our homes, if necessary, only days away. I hope that everyone does what is asked of them. A few weeks of enforced isolation must surely be worth it if it means we can knock this virus on the head. We must trust the experts and have faith that they are doing their best in a fast changing situation.
    Those of us who are not medics are full of admiration for each and every member of our health service. You are putting yourselves on the frontline for all our sakes. I can only say thank you, thank you, for what you are doing. Back at TUF we are busy thinking about and discussing (virtually) what we might be able to do to offer some support to our urology professionals during these difficult times, no matter how small. If anyone has any suggestions, please do share them with us.

    March 24, 2020 Reply
  3. Bill Dunsmuir Consultant

    Thank you Sophie for this articulate summary. Whilst we are almost too scared to think what we might be doing in 2,3, 6 weeks time – many of my Urology Consultant colleagues are having the same two conversations:

    [1]. How many of us will need to rapidly retrain to ‘ventilate’ patients and, when we do, will there be PPE for us? Are we urologists waiting to ‘go over the top’?

    [2]. When this is over, how will the NHS be re-shaped? Many of us are ‘assessing’ our 2 week rule (and other) referrals and rapidly dismissing so much. Are we are just doing what we have secretly ‘wanted’ to do for years? Could this be a ‘reset’ for how British Urology services work?

    Finally, in the aftermath, how can TUF become a force in driving re-focused clinical education for a re-structured NHS? Should / could TUF become The Aftermath Foundation (TAF)? The infra structure exists already to reshape a foundation that could be really relevant in providing supplementary education for a reborn healthcare system…

    March 24, 2020 Reply
  4. Roger Kirby Professor of Urology

    Italy has just reported a jump of 743 deaths in the past day – 141 more than Monday
    While the number of deaths has risen, the number of new infections appears to be slowing down
    Health Secretary Matt Hancock says a temporary hospital will be set up in London with military help
    Based at the Excel exhibition centre, it will consist of two wards and hold up to 4,000 patients
    Britain is also looking for 250,000 “NHS volunteers” to help national health service employees
    India has become the latest country to order a total lockdown
    The Olympics, due to begin in July, are moved to next year
    Confirmed cases approach 400,000, deaths near 17,000, more than 100,000 recoveries

    March 24, 2020 Reply
  5. Catherine Lovegrove Academic Clinical Fellow- Urology

    An enormous time of change:

    Changing our social responsibility; how we spend our time has a tangible effect on the health of others and this is clearly seen in current circumstances. Never before has this been quite as explicit. Passive smoking, vaccine uptake etc have been miniscule by comparison and now the impetus is on the public to act to reduce not only personal risk but risk to family, friends, strangers as a means of damage limitation.

    Changing roles in healthcare; adaptability is an essential skill for all healthcare professionals, yet here we see it brought to a new level. Re-allocation of roles, cessation of formal training & teaching, utilisation of existing skills in unfamiliar settings. This will call for strong leadership in all teams, communication and situational awareness of patients but also how colleagues are coping.

    Changing pressures on the system; the NHS has struggled in managing the burden of non-communicable disease in recent history but now faces the added burden of communicable COVID-19. This doesn’t replace the needs of patients with existing chronic health conditions but creates motivation to streamline services to offer greatest efficiency with resources including personnel, beds, time, medication etc. How we navigate this has potential to result in a large-scale restructuring of how care is delivered in future.

    Changing interpersonal dynamics; this is a time of change for everyone. It is a most non-discriminatory event that leaves nobody unaffected. In light of this we must be more mindful than ever of the personal burdens of colleagues and neighbours. Social isolation and lockdow present challenges to a species that live in community. While we continue to live in community, how we navigate these relationships is in a state of flux and finding a new “normal” during COVID19 will take time but is of utmost importance.

    A community-wide response to a community-wide problem is to be embraced, whether that’s the global community, national, regional, NHS trust or simply the street we live on.

    March 25, 2020 Reply
  6. Roger Kirby Professor of Urology

    People across the UK joined in last night a mass round of applause from their doorsteps to thank NHS staff like Sophie working through the coronavirus crisis.
    The national “Clap for our Carers” event was coordinated to show appreciation to healthcare workers risking their own lives in treating those infected by COVID-19. Well done all of them!

    March 27, 2020 Reply
  7. Holly Ni Raghallaigh Research fellow

    Lovely insight and I echo your thoughts Sophie. Any worries I had weeks ago about my research, career, training or…anything now seem so pointless in comparison to what our colleagues and patients are facing every day. The speed and effort with which our departments have mounted a response is astounding and this is what keeps me cheerful and optimistic. We will learn so much from this.

    March 28, 2020 Reply
  8. Alastair Dick Orthopaedic Surgeon

    I have been incredibly impressed with the massive and rapid changes seen in the NHS as it focusses its resources on dealing with the pandemic. The rate of change is unprecedented. In weeks our orthopaedic department has evolved from offering a broad elective service to one focussed solely on trauma as well as providing more and more surgeons to help look after MSK patients presenting to the ED and UCC. Surgeons are increasingly managing some fractures using the classic closed techniques described by Sir John Charnley in the 1950s. Teams are rapidly acclimatising to operating in PPE. There is a feeling of being part of a huge team trying to optimise patient flow and free as many resources to look after patients with Covid19.

    The NHS is stepping up to this huge challenge in an incredible fashion; it is brilliant to see such wonderful team working allowing change that would previously have taken months or years happening in days.

    March 31, 2020 Reply

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