Covid update 7 @SWBHnhs

March 27, 2020

Dear colleague,

As we enter the weekend, it is very clear that locally the number of unwell people admitted with confirmed or strongly suspected Covid-19 is rising steeply.  It is impossible to know if that rise will continue day on day or whether we have a few more days to be ready.  In either circumstance this latest update from me outlines the steps that are happening and are imminent to help us to cope.  In writing I want to reiterate that discussions about opening beds, or capacity, and moving colleagues into new roles, or staffing, are a language that can seem cold and inhumane.  Each person who dies in our care, is looked after by us, or works alongside us, has their own story, needs and fears right now, and nothing in this message is intended to gloss over that.  I continue to be daunted and inspired by the work individuals and teams are doing to try and manage.

Hopefully you are increasingly acquainted with the red and blue colour scheme by which we are now trying to clearly indicate areas, be they wards, theatres, lifts and so on, that are largely or wholly Covid-19 positive areas.  Blue areas are not the same, but we all recognise that in those areas there remains infection risk, even if it is lower.  The scale of red areas will of course reflect admissions.  But crucially it will also reflect discharge volume.  The next three or four days will see a sustained press here, and elsewhere, to move those patients who can be cared for safely elsewhere to that place.  Discharges will determine our ability to remain within our bed base and to see to sustain staffing ratios that we are all more comfortable with.  You will appreciate that professional bodies are working on revised risk based staffing levels for all professions and so our modelling of staffing, and beds, reflects both our current practice and emerging guidance for this unique situation.

I am fully aware that alongside our red and blue designations we have posted the current PPE guidance.  Our PPE guidance to date has been slightly more than PHE guidance.  The PHE guidance is probably about to change, and over the next few days we expect that that guidance, and we, will support surgical mask use in blue areas as well.  Supply chain discussions are taking place to ensure that the move to that arrangement is stock supported and making the change will not denude our highest risk colleagues of supply.  When (or if) we change our guidance, we will change the posters and confirm the change in our e-bulletin.    Presently we are recommended that staff wholly or largely based in the following areas can have access to scrubs: Critical care, theatres level environments, delivery suite, and where you choose in our red areas  The 3.5-fold increase in scrub demand is putting real strain on our supply but we are working very hard to catch that up.  In truth it will be Monday or Tuesday before we can be confident we have scrub supply to match our recently adapted local guidance.  Whilst scrub use may be preferred, it is not a mandated part of our PPE arrangements.  For the next few days only choose scrubs if you truly must.

I want to begin here to outline the staffing changes that are happening around you.  In doing that, I will provoke questions.  But I think it is better you understand the direction of travel, even as the details and personal implications are worked through by local leaders and individual discussions take place this weekend and early next week.  Six key points are set out below.

• Critical care capacity will expand into D16 and then into (OPAU) Newton 1.  Re-organised medical teams drawn from intensivists and from anaesthetics will run those facilities.  Nick Sherwood is best placed to answer questions on that model.  Nurse and HCA staffing for those wards has been devised and, recognising a 43 hour week, and allowance for leave and acknowledgement of absence, will mean that we ask around 160 colleagues to join that team.  Our first phase are drawn from theatres, but individuals are also going to be asked to move from areas like some of our wards, and speciality roles.  Training will take place across eight days from Monday.
• At the same time, and at the same pace, we need to implement revised medical rotas across our assessment and ward areas.  At this stage those involved have typically been involved during higher level training, or in recent practice, in such work.  A second phase of deployment may be needed drawn from surgical and less acute medical specialties.  Whilst training will be provided first on the immediate phase, those outside that should begin to consider how you would equip yourself for a role in this response to surge.  Chetan Varma and Sarb Clare are best placed to advise you on the details involved.  David Carruthers has already issued guidance on the training and support offer being provided.
• With extra wards open, and some ward nurses and HCAs needed in critical care, we will be asking some staff not currently in ward based practice to move into our wards, either in our community beds or acute.  Again a training programme is in place through Helen Cope.  We would expect, with the beds we can foresee, and with again a high rate sickness, and some civilised allowance for leave, that at least 100 colleagues in the first instance will be asked to take on these new roles.  It is unlikely that those involved have yet been contacted and those discussions will take place in coming days.
• There is a detailed set of options for therapy support to the above model, and a recognition that in other roles such as ward clerks and ward service officers we will need to expand numbers and make some new hires too.  That is happening at pace.  Remember we are also assisted by having 150 people on a wait list to join us in various roles, especially HCA roles.  Frieza Mahmood will be working alongside local managers to coordinate some of these individuals joining us in the next ten days.
• Where colleagues are asked to be moved, we will be matching the higher of your current or equivalent new salary.  We will work with personal circumstances around hours, home and life balance, and other reasonable adjustments.  You can opt to work different hour patterns, including some shifts, where you have not before.  We would be grateful for anyone able to do that, so that we have local flexibility over creating rotas and building teams.  Where we are redeploying people from an area that is not ward based to a ward based environment, we will, based on feedback, seek, like Noah’s Ark, to move pairs of colleagues from current teams to new teams.  Finally, we are looking to change from Wednesday 1^st some of our bank rates and will be paying more, with a specific premium still for those booking five or more shifts.  Doing that lets us plan, and that plan lets someone else grab a break.
• The changes outlined above, whilst presented on a rather hospitalist basis, operate on a fully integrated basis.  We have colleagues moving into hospital work from community settings, both at FY2 and nursing roles.  And we will continue to regard primary care, including the newly opened Hot Covid-19 Centres at Parsonage Street and Aston pride as part of our system and will work to support their care, PPE and staffing.

Clearly this fundamentally different set of clinical services and of roles asked of you is a huge change.  By providing training, not just once, but on an going basis, and by providing coaching and counselling, we are looking to mitigate some of the impacts we would all want to avoid.  It would be foolish for me to pretend that this is easy or will have no unintended harms.  But acting now and gearing up this weekend and next week gives us, and those we serve, the best change of the best response possible.

The scale of adjustment, and our ability to sustain that adjustment over time, will be critically impacted by returns from sick leave or isolation.  Further sickness or isolation will be effected by how quickly staff testing can be re-introduced here, and by how many of our now 800 high-end hotel rooms are taken up by you choosing to move away from friends and loved ones for the next phases of this pandemic.  I am grateful to colleague from FY1 through senior consultants for you taking up those options, and for the positive feedback received to date.

If you are reading this at home, we will be working with you to get you back to work if you can and we need you here.  It will be a week or more before we can usefully use large scale volunteers, medical students, or those from backbone functions moved into clinical areas.  But worth mentioning here so that you know you will be called up, and so that those facing clinical work this weekend understand that everyone is going to be in this fight together in the days ahead.

In contrast to some of my other updates the above is rather a lot of information sent your way.  I wanted you to read it directly from me on behalf of the executive, and after today’s Board reviews.  I want to offer a clear note of thanks to those clinical and managerial leaders working flat out to construct scale-able, humane, and least-bad options in the face of the pandemic.  When the plans are communicated here or locally, there will be misunderstandings and difficulties.  I urge you to voice your concerns but in doing so to recognise that those creating these plans share your passion for the patients we serve and share your commitment to workforce safety.  Mistakes may be made without intent, working together we minimise those chances.  Supporting one another we give ourselves the best chance.  As always it is kindness that must lie at the heart of our response.

PS … and the fight for staff swabbing goes on.

Every best wish,

Toby

Chief Executive

Sandwell and West Birmingham NHS Trust