Tackling COVID-19: The Inside View

The Boardroom View

Dr Peter Reading has decades of experience working for the National Health Service, 18 of which have been spent as chief executive at various Trusts.

Yet nothing over those three decades could have prepared him for the challenges facing him and his staff in March.

“I have been working in the health service for 36 years. In some ways I have been challenged more in the last six months than I had previously”, Dr Reading told me.

“Many have had to work in circumstances that have been really, really difficult. Lots of practical circumstances like wearing PPE, different rules and regulations to reduce infection have made it more challenging.”

“The lack of precedent meant that we had to move at considerable pace. In the first month I, and many other leaders, were extremely worried about whether we were providing adequate protection for our staff. ”

“Circumstances changed daily in the first few weeks. The guidance coming out from government which we tried to work at all times was also changing.”

“We would be pointing one direction, the guidance would change, often with very good reason, and we would have to change to another direction.”

“Sometimes the notice we have had for that has been very, very late. So we have had to be very agile.”

This is the reality of how the pandemic turned NHS Trusts upside down, almost overnight.

Even at the very top of the organisation, they were having to work it out as they went along. A relentless challenge, the like of which they had never seen before.

How Did Intensive Care Cope?

By mid-March, the number of patients requiring treatment for Covid-19 was already rising rapidly in hospitals across the country.

Intensive care units across the UK were bracing for impact. NLAG was no exception.

The issue of personal protective equipment (PPE) raged throughout that time. Demand was vastly outstripping supply.

The concerns of those in the boardroom were being realised.

At NLAG they, mercifully, were able to get on top of the situation relatively quickly.

“I think many of us in leadership positions felt that we needed to be using PPE much more, thankfully the guidance then came out to match it”, said Reading

“The lack of supplies have been a big factor in the way things have played out.”

For Hannah, even her previous experience could not prepare her for what was to come;

“We always had people with infectious diseases before, so are kind of used to PPE, but not to that extent. It was just mental.”

“It was pretty well managed initially. The issue arrived around May time, we were running out of gowns so some had to be stockpiled just in case, they could be rewashed.”

“I don’t think we ever got to a stage where that was done, but at one point the hospital thought there was going to be national shortage, so we started to save them.”

But those involved at all levels know that despite adapting to such a difficult way of working, the issue of PPE has not gone away entirely. Instead it now sits in the background.

“Things have improved now”, affirms Dr Reading.

“As we go into the winter and possibly a second wave, we are using PPE in ways we never did before. I am nervous about having further problems with it in a few months’ time.”

Clearly no-one is taking the issue for granted.

Nurse Becky Conway worked at NLAG’s Grimsby hospital during those difficult months in the intensive therapy unit, and found adapting to the high level PPE equipment difficult.

“I don’t think you really can ever get used to wearing PPE, because it’s frightening for every patient that was involved. Even if you are familiar with the strain of wearing it”, said Conway.

“It was really, just physically draining to wear for long periods. My face ached all the time.”

“Just simply checking the oxygen levels becomes so much more difficult. At the end of my shifts I felt like I had been in a fight.”

By early-April the two intensive care wards across both hospitals were full to capacity.

For Hannah, the main difficulties was around carrying out the most primary task of all in healthcare, reassuring the patients.

“For them it must have been awful, particularly for the confused ones, because we were all terrified”, she said.

“The mask sucked into your face, after two hours with it on you would get a pressure sore.”

“It did make me feel safe though, in fact I never really considered that I was putting myself at risk. In terms of the level of staff that were infected, our ward was actually one of the lowest in the hospital.”

The response had to be a team effort, perhaps because the alternative was unthinkable. A choice emerged of pulling together or letting the disease overwhelm key areas.

A common theme to emerge was the spirit amongst those on the shop floor. In the face of death, and personal risk the only thing getting the frontliners through the ordeal was each other.

“Morale from the team was so much better than it has ever been before”, said Hannah.

“It was survival mode and the team were so close.”

“It just felt weird, maybe that’s because you were in PPE as well. As soon as you went through that door it was like another world.”

“I’m glad I was doing what I was. I’m a bit of a control freak at the best of times, so I would have struggled with just being at home.”

The struggle particularly hit hard when other members of staff required treatment for the virus.  

“The lowest point was when we were looking after a really senior member of our staff. That was when things got a bit real”, said Hannah.

“I think at one point just slightly less than half the beds on our unit were staff members.”

“That was touch and go that day it was awful, I didn’t know how to deal with it. It was difficult to disconnect your personal feelings when you know them.”

The sacrifices made by those working within clinical areas were certainly not underestimated by those at the top.

Chief-executive Dr Reading said, “The risk of looking after COVID-19 positive patients obviously carries potentially serious risk to our staff and I would like to praise the courage of those staff as well as their dedication.”

“I think people have risen to the challenges very well. We have learnt from it, stuck together and supported each other.”