A third open letter from Tracy Taylor, Chief Executive at Nottingham University Hospitals.
It has been eight weeks since I last wrote to share my thoughts about the pandemic, and it felt appropriate in the week that the NHS turns 72, to reach out to you and share what we are doing at Nottingham University Hospitals to bring our services back online whilst we are still facing the challenges posed by Covid-19.
2020 has to have been the most challenging year since the NHS was formed, and I suspect, it has marked a pivotal turning point in the NHS’ history.
I, like many other NHS leaders, have been, and remain, incredibly proud of the way staff have handled the challenge this pandemic has presented us. I am humbled and inspired by the desire of my staff to provide the best care knowing that they could be putting themselves at risk; Their determination to work differently so we can continue to see as many patients as we safely can; Their commitment to each other, to holding each other up and making each other smile, and their pride in what they do and in our hospitals.
Data suggests that we are through the worst, and whilst prepared for a second spike and what that might mean, we have been planning how we can begin to return our services to normal.
Normal is an interesting word. I think we can all agree that the impact of Covid-19 has been significant. It has changed how we live, work and interact so very dramatically in such a short space of time, it’s unimaginable to think we might ever return to the normal we know.
Things we used to do, we will do once more, but probably not in the way we remember them. This week we see the lockdown restrictions eased further with pubs and restaurants reopening. Like you, that’s something I’ve been looking forward to, especially the thought of spending time with friends and family.
However the reality of what it will be like will be very different to our memories of it. Social distancing remains in place and we still can’t meet all of our friends together in one go. You won’t be able to walk up to the bar and order a drink, chatting to the person stood next to you waiting to place their order. This is our new way of life, our ‘new normal’; at least for now. Covid is amongst us. We can’t see it, but we have to be mindful that it is there and that we can catch it, or worse still, pass it onto others. We now have to learn to live and work in a world where Covid lives alongside us.
And it is no different in hospitals. For us it means delivering care in a way completely differently than we have ever known before, as well as using the space we work in differently. With social distancing and the need for personal protective equipment it will simply not be possible in many services to deliver as much care as would have been done in the past.
Restoring normal services may be the biggest challenge the NHS has ever faced, and it could take a while. I know that will not be what many of you will want to hear. You are probably already frustrated, and may even be experiencing pain whilst you are waiting for your planned operation or treatment. For this I am very sorry, but please be assured that we are doing our best to bring our services back as safely and as quickly as possible.
We have put extra planning and protection in place for people who are at highest risk from Covid-19. Where possible, we have used technology, such as video or phone calls, to carry out appointments to avoid patients travelling in to hospital. Around 1,500 outpatient appointments now take place each week, and half of those take place virtually.
During the pandemic we have continued to carry out urgent and cancer surgeries with the help of our partners in the independent sector, with almost 1,800 surgeries done to date.
Restarting services is much, much harder than making the decision to stop them, given the challenges we are now working within. I know that there are people who have been patiently waiting for their planned operation whilst we dealt with patients suffering from Covid. To ensure our patients come into a safe environment there are a number of questions that we need to ask ourselves, so we are assured that a service can start to bring patients back safely into our hospitals….
How will social distancing affect the way we deliver care? If you have been to our hospitals recently you will have seen signage reminding you about social distancing; no different than you have been used to in supermarkets. The unseen impact of social distancing is the beds that we have had to remove to keep patients further away from each other. Less beds means we will treat less patients. Or the changes of personal protective equipment needed between patients which means we can see less people than we would have previously.
Do we have enough personal protective equipment to care for these patients? Whilst the availability of personal protective equipment is less of an issue than it was back in March, we need a significant amount for our staff to care for patients in our hospitals. Making sure we have access to the right level of personal protective equipment to care for our patients and protect our staff remains a priority.
Can we create areas dedicated to treating elective patients only? Before we operate on a patient we need to know if they have Covid or not. That affects the way we deliver their care, the PPE required and which area in the hospital they will go to. We are creating elective only areas, but even before a patient comes to hospital for their operation they will have to do something that they have never done before – they, and those in their household, will be asked to self-isolate for 14 days. These changes will help keep our other patients, and you, safe.
Do we have enough staff? We have a number of staff off sick, shielding or self-isolating. This is something we are continuously monitoring, but the guidance around self-isolation and shielding is clear and we have to follow it just like you. Many of our staff have specialist skills or training so we cannot simply move staff from other areas to fill gaps. Of course where we can, we do, but working in theatres or in an intensive care unit for example requires specialist skills, and without enough staff for these areas we will not be able to carry out as many operations.
These are just some of the things that we need to consider to run our services in this new post-Covid world.
There is a lot that we have done over the last few months that we can be proud of. I am going to share just a few examples of how our teams have adapted.
Our sexual health team designed, set-up and tested a fully-electronic system to test our staff for Covid-19. The reconfiguration of the Sexual Health system took just one day to complete and is now playing a pivotal role in the way we manage and contain the virus, whilst supporting the wider community with staff and household contacts testing. The team carry out around 120 tests a day and turn the results around in less than 48 hours. This has meant that staff have been able to return to work quickly if they have a negative result. I would like to praise the team for their adaptability and continued efforts to deliver this vital service.
The majority of patients admitted to intensive care units with Covid-19 have needed long periods of invasive ventilation along with many other treatments to help save their lives. It became clear that, as an increasing number of patients left intensive care, they would need a significant amount of rehabilitation and medical input before they were able to go home. To help these patients, our Intensive Care team created a critical care step down unit to provide specialised support to those patients who have been on intensive care. As with other forms of critical illness, recovery from severe Covid-19 involves far more than surviving and going home. Most of these patients have needed lengthy periods of advanced respiratory support, using muscle relaxant drugs and keeping them heavily sedated. Unsurprisingly there is also a significant psychological impact for these patients, waking up after being so ill from such a highly publicised disease and not being able to see their family and loved ones. The work done by our teams to save and rehabilitate these patients is exceptional.
We are aware that patients with cancer have been concerned about coming into hospital, and have been seeking advice from one of our specialist nursing teams. So lead cancer nurse, Ellie Robinson, and her team created a video to reassure patients and show them how we have adapted our environment to make it safer for them.
These last four months have been challenging, and we have made a lot of changes at pace. Our teams are being supported, using a tried and tested quality improvement approach, to embed those innovative changes that they made to their services quickly when Covid arrived. We have learnt a lot in 2020, and as a result are committed to driving through changes and improvements so that we come out of this having made our services and hospitals better.
We are, and remain, incredibly grateful for the countless examples of support and numerous donations we have received from across the community. Alongside these generous donations Nottingham Hospitals Charity has raised nearly £300,000 and along with grants from NHS Charities Together the total comes to over £400,000. So thank you, the money you have raised and gifts you have donated have significantly helped.
Let’s keep going…
Changing behaviour is never easy. Research says that it takes 66 days to develop a habit, but behaviour change is a little more challenging. Changing a behaviour can take between one and five years, and most people don’t succeed. We, as a nation, have been asked in a very short time to make some significant behaviour changes to the way we live and conduct ourselves, without necessarily always seeing a direct benefit. We have been asked to stand two metres away from people, so we can no longer hug our wider family or friends; and we have been asked to wear face masks which limits our ability to communicate in ways we would have previously relied on without knowing. None of this has been easy - for anyone.
However, it is important that whilst we learn more about this virus we recognise we all have a role in preventing its spread. We will continually remind you, and our staff, to observe the two metre rule, which remains in our hospitals, and to wear a facemask in line with the national guidance. I recognise it isn’t easy and thank you for your efforts to continue to try and do what is right, not just for you but for our wider community.
Before I end, I would ask that you please take a moment to reflect on what the NHS has done for you in your lifetime. Thank those NHS staff who have impacted your life, whether silently in your prayers or screaming your praise from the rooftops along with the rest of the country at 5pm on 5 July with the biggest, loudest and final ‘clap for carers and key workers’. It is an opportunity to thank those who have done so much to keep us going - the carers, teachers, supermarket staff, bus drivers and countless other key workers. I will be clapping alongside you to thank the NHS for 72 years of care it has provided for our country.
I know that we all wish this was over; but it isn’t. My thoughts go out to our friends and neighbours in Leicester who have this week gone into a localised lockdown. We’ve talked about, and expect, a second spike, and we should prepare for that. In the meantime we can all play our part by observing social distancing, not travelling unless necessary, wearing facemasks and good hand hygiene. Hopefully that will be enough.
Take care and stay safe.
Tracy Taylor, Chief Executive
Nottingham University Hospitals