A month ago I wrote to the people of Nottinghamshire, and also my staff at Nottingham University Hospitals to share my thoughts about the pandemic and our reaction to it. I wanted to reach out to you again, in the sixth week of lockdown.
There is no getting around it; life at the moment feels very different; at work; at home; even in the language we use. The impact of COVID-19 has been significant. Some of my staff have seen and dealt with things we never expected to, and these will leave indelible marks on our hearts and minds.
But in this strange new world, where we can’t shake the hands of people we meet or hug our friends, I wanted us to stop, and pause and recognise the good we have done, what we have achieved at Nottingham University Hospitals in this extraordinary and worrying time, and of course recognise how it is making us feel.
Grateful and proud are just two of the many words I could use to describe how I feel about being the Chief Executive at Nottingham University Hospitals. I remain amazed at the continued kindness, resilience, resourcefulness, sacrifices and dedication of my staff, which is witnessed on a daily basis in the far reaching corners of our organisation, and in the dining rooms and kitchen tables of those working from home.
We have been galvanised and united in our response to this challenge, and staff will play a crucial part in how we can begin to navigate through it to what will become our “new normal”; working in a world where COVID exists and we deliver the care that all of our patients need, but in a slightly different way than we have known before.
At pace, we were asked, and needed, to make some big changes to the way we worked and delivered care. Team NUH stepped up to the plate and were hugely innovative about it too.
The way we use technology has changed. Six weeks ago, there were, on average, between 15 and 30 staff working from home on any given day; on a single day last week, between 6am and 6pm there were 1,300 staff logged on at home, with around 200 staff still logging on after 6pm, supporting those staff who want to work flexibly to suit their personal circumstances. And to help them work in this new way, our Digital Services team has delivered over 3,000 devices to help them work away from our hospitals.
Six weeks ago, we had not used MS Teams; yet last week it helped us hold over 3,000 meetings and have more than 40,000 chats - it has now become a regular feature of our daily lives.
NerveCentre, one of the clinical systems we use, has also adapted to meet our growing need for more accurate data about our patients. Our doctors and nurses have worked with another clinical system, Dr Doctor, to hold virtual clinics with patients. These technological strides forward are definitely not ones to lose, although I for one will welcome sitting around a table with my colleagues again instead of staring endlessly at my laptop!
As we came out of winter we had, on any given day, over 200 patients that no longer needed to be in our hospitals – we call this medically safe to be discharged. The ask of us was to get those patients home or to another care provider so that we could begin to create enough empty beds for the numbers of COVID patients we were expected to see. Over the last month we have worked tirelessly with colleagues in the community to get those patients home with packages of care, into rehabilitation or a care home, leaving between 20 and 40 of these patients in our beds on any given day. If you had told me that this was possible in January I would never have believed you; but it has proven to me that when we work together we can make a huge impact.
Throughout this, it has remained important to us that we treat those of our patients that need urgent care, treatment or cancer surgery. The only way this has happened is through the commitment and efforts of our surgical and anaesthetic teams working with our partners in the Independent Sector. Together we have been able to give around 500 patients over the past five weeks, the surgery they need for them to be able to fight their cancer. Our surgeons, anaesthetists and operational staff will continue to meet regularly over the coming months to make sure that we have the critical care beds we need to treat some of our most vulnerable of patients. In the coming weeks we will work on our plans to create additional protected capacity to treat more cancer patients, and in time, that will extend to carry out more routine surgical procedures for those patients who have been patiently waiting whilst we manage this pandemic.
Since the start of the pandemic, there has been a drop in cancer referrals, and we are only seeing around 60 per cent of the patients we would normally see in our Emergency Department at this time of the year. This is not unique to Nottingham, and is something that is being seen across the country. People are scared to come to hospital and we understand that. It’s our job to reassure them. It’s our job to create environments where patients feel safe to seek the help; particularly if they need urgent care or have symptoms that may be cancer.
Of course, there are hundreds of other examples of changes we have made, that have made a positive impact. With the help of my staff we will make sure that we keep what works, and discard what doesn’t.
I recognise that the concerns about personal protective equipment (PPE) have not gone away since my last letter; concerns mostly fuelled by media coverage, changes in national guidance, and of course a personal fear that many staff have had about accessing the right PPE to prevent them contracting the virus whilst at work. We have had some challenges getting PPE - as you would imagine with every other Trust in the country, and in fact most hospitals across the globe trying to buy stock – however, we have been able to ensure that we have always had enough. I have been able to personally escalate concerns to NHS England when we have needed to. We have also had some very gracious donations from individuals making scrub, to Sky and Rolls Royce making visors for us. And behind all of these efforts has been our, quite frankly, fantastic Procurement Team who have moved heaven and earth to get the stock our staff need to help them carry out their job. Challenges will continue, but I remain confident that if the stock is available, and we need it, then we will be able to get it.
Everyone has been asked to play their part in social distancing and staying at home to help “flatten the curve”. As a result we are beginning to see numbers of positive cases in the community slowly decline and the numbers in our Intensive Care Units and wards are too very slowly declining. This is giving us some headroom to start thinking about how we begin to bring those services we stopped or slowed down, back on line. This planning won’t be easy. We now know that this virus will change the way we work and care for patients. COVID-19 will be around for some time and we will have to adapt the way we live, work and care for people, whether they have the virus or not. This is influencing how we approach the conversations we are having about how we return to a new “business as usual” and begin to treat those patients that have had their care or treatment postponed.
We expect to hear soon whether some of the lockdown measures and restrictions on daily life are loosened a little. I know that this will be met with cautious relief by many. I am acutely aware that on top of working every day and dealing with the challenges my staff are presented with, they also have commitments outside of work that need their attention. You too will have these same challenges, balancing your home and working life. It might be home-schooling your children, or caring for older relatives and collecting their food shopping as well as your own. You may have loved ones who are vulnerable and you are concerned about whether they will contract the virus; you might worry more that you are the cause of them getting the virus.
You are not alone in these worries. We will all, to some extent, be thinking about what we are doing, whether we are doing enough, or if this virus might impact our own worlds more than we would ever wish. I have these concerns. With this in mind, it has been, and remains a priority for me that we support the well-being of our staff through this.
I am so pleased with the support we have put in place for staff, including mental health support programmes, psychological support, as well as practical support. We have opened two Wellbeing Centres (and are looking to open a third), one at each hospital site, open 7 days a week from 8am – 8pm. Over 3,000 staff have now visited these flexible and safe spaces where they can rest, recuperate, talk and be supported. Of course we can do more, and as part of the recovery planning we will be looking at which of these interventions staff want us to keep, and how we can support that.
I also recognise the significant concerns our BAME (black, Asian, and minority ethnic) colleagues have. Their concerns are my concerns. We have almost 2,800 BAME staff who make up around 17 per cent of our workforce and last week I wrote to them to set out the support we have put in place. Since then we have done more. We have a well-established BAME council that is heavily involved in our response to COVID and the protection of our BAME colleagues, and we have set up a network which will meet weekly to raise and resolve issues raised by our BAME staff. We will continue to talk with them and involve them in decisions about what we can do to provide further support and to protect them, as much as we can, from any potential risks.
When I wrote my last letter a month ago Nottingham Hospitals Charity's had launched their 'Help your Hospital Heroes' appeal, which had already raised £20,000. Just over a month after being launched the appeal has now raised £100,000 and some of that money has already been spent and is bringing a benefit to our staff. This, along with the countless gifts and donations we have received, not just from local people, but from further afield has been eye-watering. The support from our community seems unwavering and endless, and for that I am incredibly grateful.
Finally, I have said this before, but I genuinely believe that I am the luckiest Chief Executive in the country. I am filled with pride to lead Team NUH, now more than ever. Thank you for all that you are doing to stay at home and protect the NHS. Be kind to each other, take care and stay safe, Tracy
Tracy Taylor, Chief Executive
Nottingham University Hospitals