Innovation through partnerships

Photo of Ronan Fenton, Medical Director Designate for the MSE ICS When Covid struck, Medical Director Designate for the MSE ICS Dr Ronan Fenton was tasked with helping develop a coordinated response to the pandemic. What emerged will lead to lasting change.

I’d been away on secondment, but when the pandemic hit I was called back to Essex, to help organise the response. The merger between our three hospitals was imminent, but it hadn’t happened yet, so we needed to find ways to pull together and collaborate. Together, we held vast resources: staff, equipment and expertise, so it made sense for us to join forces.

The intensive care units (ICUs) would be hardest hit. At the time, I was Interim Medical Director for the Health and Care Partnership and my first task was to start ringing round our three hospitals, to find out their plans. Their preparations were impressive, but each had its own systems and practices. None of us knew what the pandemic might look like, but it was clear that to meet this challenge, we’d need to align our approaches. This wasn’t just the case across the three hospitals: we would also need to connect with our partners across the wider health and care system.

Sharing staff and equipment

Our initial plan for the ICUs was to transfer staff and equipment, such as ventilators, between sites to wherever there was the greatest need. Initially, some sites were hesitant to let go of important equipment, but they were reassured when they saw that every site was getting what it needed. The estate teams would send a truck to one hospital, transport five ventilators to another hospital, and then test them in the new site. The process needed managing carefully, but the teams became extremely efficient.

Moving staff was less straightforward. Staff in the ICUs were facing devastating situations every day. To cope with that, they wanted to be in their usual teams, where everybody worked to the same processes, and knew each other well, to provide emotional support. But the situation quickly became untenable. By Good Friday 2020, Basildon ICU had 48 patients – four times the usual number – and despite the extra equipment, the staff were working beyond their limits. Something had to give.

Transferring vulnerable patients

We moved to the only remaining option: moving the patients. Moving ICU patients is generally avoided as it carries risks, and it hadn’t been done before with Covid patients. The decision was deemed controversial and there was a lot of scrutiny. But keeping things as they were carried risks, too. Our patients needed to be in an ICU with a safer staffing ratio.

I managed the first transfer myself, with a paramedic from the East of England Ambulance Service. At 8pm one evening, we walked in to Basildon ICU, dressed as spacemen – as we all were at that time – and together we moved the first patient across to Broomfield Hospital. It went well. And that was the start of our new road vehicle transfer service, which carried us through the pandemic, linking with the British Red Cross.

The sites were only 10–15 miles apart, but even transferring two patients per day was a very heavy day’s work. Three was the maximum we could do. But the team quickly became extremely skilled and moving the patients decompressed the ICU load. This had an impressive psychological effect on staff, and the patients received better care.

Once we’d proved the concept, a lot of other organisations started doing it, too. I’d already worked with Essex and Herts Air Ambulance and they began flying ICU patients, for the regional critical care service. When we opened a new Covid ICU unit in Basildon for Wave 2, in early 2021, these skills enabled us to move people to the place with the best care facilities.

Joining up with community services

While all this was happening inside our trust, collaboration was also taking place at pace across the local system. My role changed to medical director for the local health care partnership, and suddenly, I was having Zoom calls with community health teams, frailty teams, GPs, NHS 111 and colleagues in social care and ambulance trusts.

My role was to improve patient care across that entire system, and that meant building and leveraging relationships to make things happen. I set up a rapid clinical governance group for all the medical directors in hospitals and primary care, and we would convene and make collective decisions, all working virtually.

Building virtual wards

We were all worried about how to meet capacity for patients during Wave 3, so at the end of 2020, between Christmas Eve and New Year’s day, we managed to set up a 280-bed virtual hospital. This meant some patients could leave hospital a little earlier and have community care coming in to the home up to four times a day. Some patients had electronic systems that transmitted data to the hospital about measurements such as oxygen saturation, so staff could monitor any changes.

For the patient, virtual treatment means you can be in your own bed, rather than in hospital, which most people prefer. If your condition deteriorates, you are fast-tracked back into the hospital rather than going via A&E.

Since then, NHS England has announced that they want to see 40 virtual ward beds per 100,000 population, so things are moving in this direction nationally, too. It makes sense because – especially for older patients, because for people aged 80 or over, each hospital stay is likely to result in their losing an activity of daily life.

The value of relationships

I learned so much during the pandemic. There are many different ways to get the outcomes you want, and not everything works first time. But in everything we’ve done, the common thread has been strong relationships. The experience emphasised the importance of building trust and respecting one another’s differences.

Covid pushed us into making some very difficult decisions, but in the long term they have all led to change for the better. The new ICU at Basildon has the latest techniques and equipment and is attracting excellent new staff. We continue to have virtual wards in place – not just for Covid, but for respiratory disease and cardiology patients. And Zoom helped us build relationships with lots of people very quickly – leading to a stronger system all round and better integrated care. Without Covid, we’d be years behind where we are now. It was the hardest of times, but a lot of good came out of it.