Julian Hartley calls it “ingenuity in a crisis”. The chief executive of Leeds Teaching hospitals NHS trust is referring to the creative thinking that many parts of the health service displayed in spring, as it coped with the huge disruption and risk – for staff, patients and the provision of care – from Covid-19.
These include the creation of the seven Nightingale hospitals to GPs’ and hospitals’ almost overnight switch to routine telephone and video appointments, to the expansion of critical care to help the most seriously ill and the repurposing of thousands of staff to work there. But Hartley is also talking about less well-publicised innovation that occurred on a more local level in the NHS in England.
A report by NHS Providers out on Wednesday concludes that some local changes have transformed the NHS for the better. It also shows that ministerial perceptions that NHS management is “slow and inward-looking”, as reported by the former NHS chief executive Sir David Nicholson in the Health Service Journal, is misplaced.
“The NHS entered the Covid-19 pandemic with 100,000 vacancies, a growing waiting list for elective care, increasing demand for mental health, community and ambulance services, and a social care system in a fragile state,” the report states. “This makes the achievements trusts, and their local system partners, have delivered to transform care within the first weeks of the coronavirus outbreak all the more remarkable.”
The report cites eight examples of resourceful ways of tackling the pandemic’s many new challenges, like the shortages of personal protective equipment and ventilators and the difficulty patients had accessing help when hospitals either suspended normal, non-Covid care or because the risk of infection meant they were too risky to visit.
The Northumbria Healthcare trust, faced with an imminent danger of running out of full-length surgical gowns at the height of the onslaught in March and April, took the novel step of setting up a factory to produce its own. It was in what the finance director, Paul Dunn, describes as “dire straits” about how it could guarantee a reliable supply of personal protective equipment (PPE), when Sarah Rose, a 27-year veteran of the clothes manufacturing industry, offered to help.
“We embarked on this initiative because we weren’t getting enough PPE in a timely way,” Dunn says. “At the height of the crisis we only had 30 gowns in our central stores and as a trust we were using around 400 isolation gowns per day. There were no gowns provided through the central drop and we had to resort to making our own gowns.”
“We were also experiencing considerable concerns regarding [the] quality [of gowns it received, almost entirely made overseas].”
Drawing on Rose’s knowhow and contacts, the trust set up a network of 35 factories, including those run by Barbour and John Lewis. She helped to find machinists and the raw materials needed to make a range of PPE, which included scrubs, theatre hoods and gowns.
In May, the trust established its own factory in Cramlington, a small town north-west of Newcastle, to ensure a reliable long-term supply. Ex-machinists dusted down their old skills to volunteer, as well as locals who had been furloughed or lost their job. With growing demand, the factory recently moved to Seaton Delaval in the Blyth Valley and will expand its workforce to 60, plus 10 apprenticeships for local people in an area of high unemployment.
NHS England and NHS Improvement contributed £13.2m to help start an initiative that means Northumbria has already made 2.2m gowns and supplies dozens of other trusts in the north-east. What was conceived of as a temporary, emergency response has become a permanent facility.
Clinicians were heavily involved in the development of the gowns, and Dunn says the feedback from staff has been fantastic. It also helped reassure workers that the trust took PPE seriously.
“We needed to guarantee a supply locally and across the region, but also demonstrate to staff that we were doing everything possible to source the items they would need and that we wouldn’t run out. Of course it was also important to support the local economy at a time of crisis while harnessing the manufacturing expertise that exists in the north-east.”
A different shortage – of ventilators – prompted Hartley’s Leeds trust to embark on a similar partnership with outside experts. Prof David Brettle, then head of its medical physics team, suggested converting Nippy 3 machines, which are usually used to treat sleep apnoea, into makeshift ventilators to treat Covid-positive patients whose impaired breathing placed them at serious risk. Leeds University’s mechanical engineering department helped with the process and 20 patients were put on to a ventilator they might not otherwise have had access to.
Like Northumbria’s foray into PPE, others in the NHS benefited too. “We were also sharing our equipment, literally putting it in taxis and sending it over to neighbouring hospitals who had immediate problems,” says Brettle.
The London ambulance service (LAS) set up multiple collaborations to help it deal with what its chief executive calls the “tsunami of demand” that arrived suddenly in March. Needing more of everything to cope with the sheer number of 999 calls it was receiving when the capital was the first city to be badly hit by Covid, it used furloughed British Airways and Virgin Airlines staff as call handlers.
Needing to almost double its usual stock of 350 ambulances to 650, it bought 60 new ones, overhauled 50 more and refitted some non-emergency transport vehicles, with 170 mechanics from the AA making the running of its newly expanded fleet possible.
Although retired LAS staff and third-year paramedic students helped temporarily boost its workforce to ensure it had enough crew for all these extra vehicles, a partnership with the London fire brigade (LFB) led to more than 300 firefighters filling the gap. They knew the city well, were blue-light trained and already adept in emergency care response techniques and basic life support, so were an ideal fit, says the LAS chief executive, Garrett Emmerson. “It was slightly controversial at the start, but very quickly staff at all levels in our organisation and from the LFB found it a really positive experience,” he says.
The Royal Surrey NHS foundation trust was able to free beds, and give patients a calm environment as they neared the end of their life, when it agreed a deal with the Mount Alvernia private hospital in Guildford to look after 12 patients receiving end-of-life care. Its staff trained their counterparts at Mount Alvernia, who were used to dealing with people recovering from surgery. The patients involved were each given their own room, which meant that – unlike in NHS hospitals at the time – one of their relatives was able to visit.
The report finds that involving staff led to some of the most successful innovations. Bradford District care NHS foundation trust set up a Covid-19 home-visiting service in just three days, while Leicestershire Partnership trust created an urgent mental health hub so people in crisis, including those who had self-harmed or taken an overdose, did not need to go to A&E.
The report does not quantify how many pounds or lives have been saved by these innovations. But as the NHS Providers deputy chief executive, Saffron Cordery, explains, with a second wave of Covid looming large, local ingenuity has helped “embed a new culture of understanding and collaboration between different staff groups and organisations. Valuable lessons have been learned for the long term.”