In late January, national NHS leaders declared coronavirus as a level four incident. Since that moment, trusts have been at the forefront of the response to the virus, balancing Covid and non Covid care to keep people safe. The pressures were felt beyond the acute sector, including in community services, which played a huge role in supporting the safe discharge of medically fit patients from hospital; mental health providers, that developed new 24/7 emergency services and supported more patients in the community; and in ambulance services, which adapted quickly and effectively to the increased demands posed by the pandemic.
Trust leaders recognise the disruption and distress for many patients caused by the need to focus on Covid-19 at the height of the pandemic. However, it is important to recognise just what was achieved in this period.
The case studies in our new report Providers Deliver: Resilient and resourceful through Covid-19 are a reminder of the extraordinary and daunting challenges posed by Covid-19 as the number of cases rose earlier this year, testing the resilience, resolve and ingenuity of staff across a wide range of roles in the NHS. They also offer a valuable insight into the skills, compassion, and sheer determination to be found in NHS trusts that helped to overcome the difficulties they faced.
One of the strongest themes to emerge is the value of staff empowerment, where trust leaders show support for ideas and approaches developed within their workforce. This helps to nurture swift, effective innovation, as we see with Bradford District Care NHS Foundation Trust’s success in setting up a Covid-19 home visiting team in three days, and the trust-wide medical roster at Countess of Chester Hospital NHS Foundation Trust. At Leeds Teaching Hospitals NHS Trust, staff were encouraged to be part of the “ingenuity in a crisis”, which resulted in a scheme to adapt respiratory equipment used in sleep apnoea to treat people with Covid-19, which could be of benefit to patients around the world.
The response by Northumbria Healthcare NHS Foundation Trust to severe shortages of isolation gowns is a further great example of innovation to confront one of the biggest challenges posed by the virus – shortages of personal protective equipment – and a notable collaboration with industry experts and major textiles manufacturers. That same problem-solving spirit is evident in the approach taken by University Hospitals of North Midlands NHS Trust to persuade people that it was safe to come to hospital. The deployment of thermal imaging cameras has offered reassurance to patients and staff. But it required boldness to alter governance and decision-making arrangements for the project to be implemented at pace.
Another strong denominator in these case studies is a willingness to look outside the organisation and work with partners across systems. At Leicestershire Partnership NHS Trust the team set up an urgent mental health care hub which took advice from patients to create an environment that was as safe and comfortable as possible. They also worked closely with acute and ambulance trusts, social care and housing teams in order to provide a holistic approach.
London Ambulance Service NHS Trust turned to Virgin Airlines and British Airways staff to support call handling operations, harnessing the skills of AA mechanics to keep the ambulance fleet on the road, turning to neighbouring ambulance services to help them through the peak in demand, and using firefighters to work alongside their clinicians, and so increase the number of ambulances they could deploy. Royal Surrey NHS Foundation Trust worked with a private hospital to increase bed capacity for end of life care – providing specialist advice for staff who were used to looking after surgical patients rather than those at the end of life. This provided a quiet and peaceful environment for patients, and care that would not have been available in a Covid site.
Looking ahead, it is striking how many of these changes, borne of necessity, have helped to embed a new culture of understanding and collaboration between different staff groups and organisations. Valuable lessons have been learned for the long term. But as we move to a second peak and winter pressures, the threat from Covid-19 has not gone, and we will need more great innovations like these to ensure the NHS, once again, rises to the challenge.