Recovery and restoration

Here's me (top) and
Nihal Fernando (bottom)

Boris is expected to deliver an address to the nation this Sunday to unveil a ‘roadmap’ setting out how the government will "unlock the various parts of the UK economy".

In line with this, we have started working on our own roadmap. Not a roadmap taking us back to where we were before this dramatic detour, but a new roadmap. Yes, the ultimate destination is the same, as our vision and big ambitions have not changed, but this is a route we could never have quite imagined eight weeks ago.

We’re framing this road map as having four phases over the next 18 months or so.

The first phase of ‘Escalation’ was our immediate response to coronavirus as the virus rapidly tore through our nation; this is just finishing as we appear to be over the peak of the pandemic. However, we will need to be mindful that we may need to move back into escalation at any point, if we start to see the virus spreading in a significant way.

We’re now entering the first phase of recovery which is being calling ‘Restore’. This phase over the next six to eight weeks is about restoring critical NHS services that may have been temporarily stepped down at the height of the crisis.  Our acute colleagues have been impacted by this more than us, as we’ve managed to keep our mental health and learning disability services going, albeit in different ways.

But what is important for us during this phase is planning for the increased demand in mental health services we’re anticipating, as the lockdown measures are eased. Plus, we also need to plan during this time for the next phase of recovery - ‘Living with Covid’. Whilst some of the measures will be eased, we won’t be able to return to how things were before, so will need to take social distancing and infection prevention guidelines into account for some time to come.

During the ‘Restore’ phase, we are also intending on undertaking an ‘appreciative enquiry’ with staff and patients about people’s experience over the last few months and how our learning should inform what changes we want to retain going forwards. We want to understand how it’s been for people. What have been the pros and cons for those of you working from home?  What has it been like delivering services in different ways? And how have our service users felt about receiving these services in different ways?

Then, from about July, having done some of this planning in the context of the government’s roadmap, we move into the third phase - ‘Living with Covid’ - which is likely to last right up until the end of this financial year, March 2021. This is about how things stay up and running again whilst keeping people safe and not risking a second peak. So, for example, how do we use Trust HQ during this time? How do we configure our inpatient wards in the context of our plans for single sex accommodation? It’s hard to see how we could run a dormitory-style ward and still meet social distancing measures. And, how should we provide community mental health services and still keep people safe?

The final phase is being called ‘Building Back Better’, which perfectly describes the positive opportunity that this negative crisis has given us. So, from next April, this is about advancing big developments around our use of technology and buildings for example, alongside different ways of working. It will also include our role in the big stuff, such as kick starting the economy and climate change.

So as we enter this next phase, we will be looking at what has worked well and what we might therefore want to ‘lock in’ as our new normal. We’re setting up a recovery group to oversee this work, and they will support other groups, such as the mental health programme board and our corporate leadership group, to lead this work. We will also be working closely with our partners, as it’s essential that there is a consistent approach to recovery.

But this is not just about organisational recovery and restoration. We need to do this as individuals.

It’s essential that we all find ways of restoring our energy. The last few months have been shattering. People have been working really hard. There is an immense psychological impact from this pandemic that will have affected all of us in different ways.

Clinical psychologist Rachel Chin and her team have done some great work on the psychological impact of coronavirus, recognising that people are being affected differently and creating a diagram which explains what people might be feeling. You can see this diagram here.

We all need to find ways of taking a proper break from work to really relax, rather than simply to pause. That means taking annual leave sooner rather than later, even though we can’t go anywhere, as well as any overtime that you may have accrued. Hopping on a plane for a week by the beach feels like a lifetime away, and I appreciate many are therefore reluctant to take time off with so many restrictions in place, but it’s vital to avoid burnout.

And I know this has been really difficult, but when you are working, please take regular breaks. I know this is especially hard for our clinical staff as it has been so full on. I also know lots of people working from home are having back-to-back meetings on Microsoft teams and other digital platforms, which can be exhausting.  The screen freezes. There’s a weird echo. Heads stare at each other. It’s harder to relax into the conversation naturally as you constantly have to remember to switch yourself onto and off mute! No wonder people talk about ‘Zoom fatigue’.

I’ve noticed my migraines have ramped up since I’ve been using Microsoft Teams and Zoom most of the day (and then more of the same to connect with family and friends in the evening). After a weekend of migraines, I took a day off earlier this week and didn’t look at any screens all day. No migraine!

So, please look after yourselves. We will need all of our energy for recovery and should adopt the ‘Building Back Better’ approach for ourselves, as well as our organisation.

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I’ve asked Nihal Fernando, our deputy medical director to say a few words for the guest blog this week. Nihal has experienced this pandemic as a clinical and senior leader. He also spoke at the BAME forum event we held this week, which over 100 staff joined to discuss their experiences, feelings and views on the impact of the coronavirus pandemic. Unfortunately I was unable to attend the forum in the end, which I was really disappointed about, but I’ve been so heartened to hear the positive feedback.

DR NIHAL FERNANDO, DEPUTY MEDICAL DIRECTOR

When I started hearing about the coronavirus numbers from Italy and then Spain, I was seriously worried. I knew we needed to take it seriously and plan for the worst, whilst hoping for the best.

So, yes, I believe our nation should have responded much quicker and much swifter, but I’m sure we’ll all agree that the NHS has made truly heroic efforts within this unprecedented challenge. It’s been our biggest crisis since we were formed in 1948, so we can be forgiven for perhaps not being as co-ordinated and slick as we could have been at the start.

I’ve seen a lot of angst around PPE and felt really frustrated about the message and hold-ups.  I’ve been mindful of the clinical voice and its impact in our response. I’ve also worried about the challenges of social distancing for our staff.

Lives have been turned upside down and it’s been so pressured and fast-moving, with changes sometimes happening every hour. This has been a difficult time. A testing time. But I’ve been so incredibly impressed and proud of the way that our staff and organisation have responded and adapted. We have improved the way we communicate with our staff. It’s not always perfect but we are getting there.

Within the first week of the lockdown we started an 8 week “eMed” training programme via Zoom, set up by the medical education team and the post graduate tutors. The changes and different working practices have carried on coming thick and fast since then.

It is wonderful to see how staff have shown resilience and adaptation in not only picking these up, but also maintaining changes and supporting services for our vulnerable patient group, whilst they themselves were anxious and worried. That is professionalism at its best.

We need to carry on embracing every positive change and take every opportunity, including around recruitment. We had 76 applications for a post we recently advertised. Maybe not a surprise in this current climate, as we’re one of the few employers paying people, but let’s grab this chance to try and fill some critical vacancies.

We’ve had to change styles as well as systems, structures and processes, and so I’ve been trying to live by and share these six points at all times.

1. People are not ‘working from home’, they are at home during this crisis in order to work
2. Personal and emotional health are more important than anything else
3. Don’t over compensate for lost productivity, but accept we are working differently
4. Be kind to yourself and don’t judge yourself against how others are working
5. Be kind to others and don’t judge them against how you are coping
6. Your teams success won’t be measured in the same way as it was when things were normal

It’s not always easy, for example, I felt tired as last week came to an end and after a discussion with my manager, I took some days off to rest and recuperate.

People are getting tired and I worry about that. Not just about those of us on the frontline.

Everyone needs support at this time. Who are supporting the senior managers, including our board members? It is not always easy to appreciate that it is difficult in a different way to not be at the front line, to feel that we are contributing to the benefit of all. Stress comes in different forms in different roles. Everyone’s wellbeing is vitally important.

I know we need to talk about recovery, that’s really important, but we also need to remember that people are still dying. It would be a national scandal if a plane went down killing hundreds, and we’ve had the equivalent of several jumbo jets go down every day for some weeks now.

Recovery feels some distance away, but again it is about thinking and planning the path ahead; I see this road to recovery as a marathon, not a sprint. And I would say we’ve currently done about six miles of the 26.

This coronavirus has also shone a stark spotlight on the issues around BAME inequalities.  It’s an absolute tragedy that more BAME people are falling ill with this virus and dying as it is with any person. BAME staff have played a significant role in the NHS since its inception, and we know that these inequalities have been there from the beginning. It is our duty to look at this. This simply can’t be put on the back burner and forgotten about for another 72 years.

We had over 100 staff attend our BAME forum this week, which shows how important this issue is for our staff. It’s so upsetting and so wrong that BAME staff either don’t feel that they merit or have the same opportunities. This is not just a trust issue, it is part of a wider societal issue. We must keep on pushing forward our equality work and truly recognise the huge benefits that diversity brings; our differences are our strength. It should not be a source of division.

We are all in this together; over 100 different nationalities work in our Trust! This is a gift.

Reflecting on my experiences over the last 6 to 8 weeks, I can honestly say that our four values are being lived like never before: kindness, fairness, ingenuity and determination.

I’ve seen more acts of kindness in the last two months than I’ve seen in the last 12 years of working here. Despite the difficulties and distress, people are smiling more. You can even see their eyes smiling under the masks.

People want to be as fair as they possible can; listening, taking on board other views and sharing. I’ve seen issues being solved and barriers overcome through great innovation as ingenuity shines through. And, in terms of determination, people have just kept going when things have gone awry. They don’t need to be prompted.

Barriers have come down between professionals and people have stepped up to the plate, sometimes where I least expected it.

I truly believe that we are going to be stronger for this experience, as individuals and as a collective. This virus is destructive, but we have started to build, change and learn. This is something that should and will endure in shaping the direction and belief in ourselves and our organisation.

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Best wishes,
Claire
You can follow me on Twitter @ClaireMolloy2