County Durham and Darlington leading medical director reflects on a Covid year like no other

“As the impending situation became clear in February 2020, we moved at pace to ensure we had the facilities and teams in place to give the very best care to the many patients we expected to be admitted with Covid-19. This included creating two emergency care departments at Darlington Memorial Hospital to segregate Covid and non-Covid patients and increasing ITU and critical care capacity. We also reluctantly reduced non-urgent outpatient activity and non-urgent surgical procedures, meaning we could redeploy our skilled teams to where they were most needed and this shift in focus was mirrored at University Hospital of North Durham.

“Throughout the spring of 2020 we admitted increasing numbers of patients very ill with Covid-19, many needing intensive care and some of whom, very sadly, didn’t survive. It was impossible to predict how long we would continue seeing increasing numbers of admissions, and our staff, regardless of their role, showed remarkable commitment and worked as a team – our frontline staff focusing on giving patients the best possible care, supported by others, such as porters, and often forgotten specialists such as our clinical engineers who make sure all the equipment is working well. In addition to continuing to ensure our patients across all our sites were well fed, our catering team at our two main sites, Durham and Darlington, gave a free two-course hot meal to every member of staff, every day. These were supplemented by deliveries of pizza, curries and sweet treats from businesses keen to show their solidarity with us – so humbling given how many of them have suffered enormous financial losses themselves – but incredibly welcome.

 

“Behind the scenes, our corporate teams ensured everything was planned and in place – changing and adapting rapidly as situations moved. Our procurement team ensured we never ran out of PPE.

“As the number of inpatients with Covid-19 fell following the first wave, we reintroduced services as soon as we were able. Again, this was only possible thanks to the hard work and flexibility of our fantastic teams, many of whom have learnt new skills, worked in different roles and teams, and out of their comfort zones – always putting patients first. Some of our office-based staff went to work on wards, supporting the administrative aspect of patient care, liaising with our pharmacy and laboratories, plus helping keep in contact with families. Everyone simply focusing on doing what needed to be done.

“Our cancer services have continued and we have also undertaken thousands of surgeries and outpatient appointments – recognising the real difference these interventions make to lives.

“We’ve been using ground-breaking digital technology for several years, meaning we were able to introduce remote, digital appointments, quickly. Over 350,000 outpatient consultations took place in 2020 – many of them without patients leaving the safety of their home. This is optional and not always appropriate but feedback from patients is very positive – around convenience and not needing to travel to hospital – so it’s a change we’re likely to retain.

“Our community teams have been vital in ensuring our most vulnerable patients continued to receive care in their own homes and our community midwives have done the same. The additional patient capacity provided by Bishop Auckland Hospital and our five community hospitals has also been invaluable. Patients no longer needing acute care are often transferred to our community hospitals.

A year has passed since the World Health Organisation declared a global pandemic after 121,500 cases of Covid-19 were confirmed across the world. That figure has increased by nearly a million times in just 365 days. Jeremy Cundall, inset

“The safety of everyone coming into our hospitals and other sites is an absolute priority, with sanitising stations at all entrances, mandatory masks introduced long before they were required in other public buildings and social distancing procedures – such as keeping left in corridors and allowing a maximum of two people in lifts.

“The decision to restrict visitors to all our sites was a difficult one because we know how much patients depend on relatives and other visitors. We’re grateful to all our communities for understanding that this decision has the safety of everyone at its heart.

“We’ve introduced a number of services helping keep families connected. An application to NHS Charities Together secured over 80 tablets so families can ‘visit’ remotely. Families can also drop off belongings at our reception, which are taken to patients within a few hours.

“We also introduced ‘Stay in Touch’, where families can send a letter by email which is printed, and delivered to the patient, by hand, on the same day. Almost 500 of these have been distributed. One family wrote to us after their relative sadly died, saying, “As a family we would like to send a huge ‘thank you’ to everyone involved in the contact system. At a very difficult time it has been comforting to have this contact.”

“While our attention over the last year has understandably been on patients with Covid-19, we have continued to identify and introduce improvements to our services overall with, for example, the introduction of a team focused on those in our care who are particularly frail recognising that physiotherapy, occupational therapy, a look at their diet and other interventions, can, at the very least, improve their quality of life. We have also opened two additional wards and increased our endoscopy capacity at Bishop Auckland Hospital.

“We’re particularly excited to be undertaking building work to introduce a service within our emergency departments, identifying those patients who, with speedy diagnosis and treatment, can avoid admission and go home on the same day they’re admitted.

“Supporting our patients and communities is always our priority as you continue to support us and keep yourselves and others safe, by following national guidance. As spring emerges we know there are brighter times ahead.”