We had been preparing for the pandemic for some time to make sure we were as ready as possible for what was to come. From January our senior leaders established a strategic group, it is in this group that our strategic objectives were agreed.
These were developed over time and focussed on reducing mortality, both from COVID-19 and from disruption of other services (save), and protecting our staff (protect). Some of the things we have done include:
Creating bed capacity
To prepare for the anticipated numbers of patients we were expecting, work took place across hospital sites to swiftly build additional bed capacity. By reducing our services and working with partners to discharge patients who were medically fit, we were able to free up more than 200 beds across the two acute sites in Carlisle and Whitehaven in preparation for COVID-19 patients.
We developed designated areas and pathways for patients with confirmed coronavirus, patients with suspected coronavirus and patients with other conditions within our two main hospitals and we had COVID-19 pathways in our community hospitals.
This has made sure that our patients and our staff have bee kept as safe as possible during the pandemic.
Further partnership working also took place between the NHS, local councils and the military to build additional capacity in leisure centres including in Carlisle and Whitehaven should this have been needed.
Increasing clinical capacity
We also needed to ensure that as many clinical staff as possible were available to help support the expected higher demand of in-patient care due to COVID-19.
In line with national guidance we looked at what hospital activity was essential during this time and which we were able to temporarily pause. This included standing down elective surgeries, some outpatient appointments and introducing telephone appointments for a range of services. The MSK Physiotherapy team in west Cumbria switched more than 700 face to face appointments to telephone appointments.
Paul Counter the clinical director of head and neck services, made a number of changes in his service including introducing telephone triage and a novel way of holding team meetings on the lawn area at Cumberland Infirmary.
A remote consultation package which was already in place in 16 of the Trusts’ services was able to be rolled out to a further 46 services. Altogether 60 services across the trust now benefit from the remote consultation package ‘Attend Anywhere.’
Our Children’s Occupational Therapists have also adapted their service and have been carrying out telephone assessments, followed by an email to parents with personalised information, advice and resources to help the child reach their identified goals. Therapists have provided home programmes for families of children already known to them and have kept in regular contact by telephone to monitor and adjust programmes as required.
Looking at ways to support our staff and teams has been paramount. Teams have adapted and changed the way they work to support the situation.
By making changes to services we were able redeploy more than 300 people. Included in this was Angela Wannop who returned to front line nursing after two and a half years away to help patients affected by COVID-19. Alyson Ritchie and Dr Jennifer Chilman also returned to the front line after their careers changed paths into medical education and some staff even postponed their retirement to support the effort.
A workforce hub was set up to provide support to essential services by re-purposing the work of staff to where it is most needed. Within this a medical hub made sure that junior doctors were deployed on a daily basis to where they were needed the most.
The Trust arranged to offer staff affected by the 14 day isolation the voluntary option of staying in NHS-reimbursed hotel accommodation while they continued to work.
The Trust gained the skills and input from more than 50 final year nurses and 21 junior doctors over two months some of whom we hope will stay with the Trust.
175 volunteers have come forward to directly support on-site activities for the NHS in North Cumbria. Of these, the majority (137) signed up to be patient facing in COVID areas if necessary.
Volunteer Joseph Dean, has been volunteering for the last month at the medical workforce staffing hub at the West Cumberland Hospital.
We are keeping in touch with our volunteers on a weekly basis now and hope to have a bank of ‘reserves’ in the weeks and months who can support us if needed.
We know that the incident has been difficult for most staff and upsetting for some. That is why the Trust very quickly ensured that support was available if and when they needed it. A Wellbeing hub was developed including a helpline for staff to call. Staff feedback for this service was very positive.
I found the service friendly, reassuring and helpful. I was given loads of information, apps and advice to help me. It was nice to know I could discuss concerns with someone who wasn’t a family member.
Since accessing the service I would have no qualms in using it again. It was a great aid, helping me stay at work and feel more confident in my daily life.
The wellbeing team made sure that staff were aware of a range online resources that were available to them including a new employee assistance programme called VIVUP. Regular updates about the services that staff could access were included in the daily staff briefing Our staff health and wellbeing pages on our staff website which has recorded almost 6000 page views during April and almost 3000 in May.
The chaplaincy team developed ‘Walls of Hope’ across all the Trusts hospitals which showed drawings sent in from local children to support staff. They also sourced and developed pause for thought spaces where staff of faith or no faith could go for a quiet moment on their own or for a chat to one of the chaplaincy team.
Keeping people informed
Since the government introduced the Stay at Home measures in March, we have issued a daily bulletin to all of our staff to make sure they are kept informed of the latest information and updates, so far this totals 69 bulletins.
We developed a dedicated staff web page to host all the information in relation to the incident relevant for staff called the “coronavirus hub”. This enabled us to put all the pertinent information in one place and make it as simple as possible for staff to stay updated.
We regularly shared COVID-19 news stories. As of the end of May we have posted 331 posts on Facebook, reaching 2,451,874 people, 221 Tweets, reaching 577,791 people and have shared 196 staff stories relating to coronavirus as well 63 news stories on our public website.
Occupational Health support
Teams and departments have had to quickly adapt across NCIC to new ways of working and guidance. The Occupational Health team based at the Cumberland Infirmary and West Cumberland Hospital are no exception.
They have been working closely with health and safety leads, infection prevention and health protection teams, HR, health psychology team and Microbiology. Together they have carried out over 800 staff swabs and swabs of 100 staff household members. They have received over 4000 COVID-19 queries via a dedicated email inbox. They are reporting data on a daily basis to local intelligence teams and NHS England. They supported a national clinical trial by swabbing 350 asymptomatic staff over 3 days.
The team extended their opening hours during peak weeks to provide a 7 day service. In addition to routine work they have been working with Salute the NHS, to support our colleagues who have contracted COVID-19 to provide food packs.
They have also provided increased proactive support and guidance to managers and staff including supporting staff who may be more vulnerable to COVID-19. As well providing reassurance and risk assessments, and support for staff where concerns are having an impact on an employee’s mental health.
Personal Protective Equipment
A key part of protecting our staff has been ensuring that we have the appropriate personal protective equipment.
As with all NHS Trusts, PPE is not something new and has always been used. However the response to the pandemic meant that we had to very rapidly scale up our supply and distribution of PPE, using up to four times as much PPE as normal and frequently updating our guidance as the national guidance changed. We took a decision ahead of the national guidance to provide basic PPE for all clinical staff with patient contact based on the position locally and in order to provide maximum protection for our staff.
Whilst in the COVID-19 pandemic PPE has been a hot topic and this has been challenging for everyone. Across the Trust, multiple teams pulled together to did a remarkable job to ensure we could co-ordinate stock from the national supply chain and implement a frequently changing position to a large staff group. The same teams developed detail contingency plans to understand what to do if any item ran out, however it should be noted that due to the incredible effort to coordinate and monitor stocks, while we ran very low at times, we never ran out of any PPE.
We have provided frequent updates to our staff on which PPE they are required to use and have also held regular fit test sessions to make sure specific masks are worn correctly. We have even had local communities helping us out by making protective visors which is very much appreciated.