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A manager’s account

A manager's account

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As a healthcare manager, one gets the chance to work with several different clinical teams during a career. Each department brings its own opportunities to meet new people, learn a new clinical language, new processes and procedures. However, nothing could have prepared me for what was to come when I started as Deputy General Manager in Theatres, Anaesthetics and Perioperative medicine (TAP) on the 27 January 2020. TAP is a large directorate with around 800 people and, under normal circumstances, I would only ever have worked with a minority of staff, but COVID-19 would quickly change this.

The reality of COVID-19 set in when the Trust called all directorate management teams to an emergency briefing. A line that stuck was “80% of our local population will get COVID-19, 35% will need some sort of healthcare contact, 10-12% will need ICU care and 1-2% will die, so there are 100+ people in this room which means some won’t be here at the end of this.” A chilling call to action. What this meant for me, and the directorate, evolved over the next few days. I quickly learnt that our workforce’s skillset meant that they would be the first in line to become part of the wider critical care team. Anaesthetists and theatre nurses have always been in high demand, with surgical services requesting ever more theatre time. Now they were critical to the COVID-19 crisis. Along with the clinical director for TAP, it was my job to articulate the urgent need for surgery to wind down in order to free up the anaesthetic team, so that they could undertake training to ensure their safety when they were deployed to critical care.

The organisation stated that we had to wind down theatre lists at a pace of 25% per week; no small feat when you deliver 600+ lists. This was rapidly challenged by the anaesthetic up-skilling training, and a careful balance had to be struck between freeing up anaesthetists and completing life-saving surgery at the request of surgeons who were understandably and quite rightly campaigning for their own patients.

As the straightforward elective work was cancelled, the daily conversations became harder as urgent operations had to be cancelled. It was painful being part of the board making these decisions. Of course it wasn’t just me, but at the end of each day, as I sat drafting the email which would confirm all the lists that would be cancelled the following day, the colossal impact of what we were doing hit home in a way that nothing at work has ever done before. As a non-clinical person, I don’t have lives in my hands in the literal way that clinicians do, but this certainly felt very close to it and was arguably the most difficult set of conversations and decision-making of which I’ve been a part.

As well as managing what was happening at work, I was seeing scenes on the news of hospitals in Europe. I realised that the teams that I work with might face the same challenges as our European colleagues. Various anaesthetists stepped up to take leading roles in the crisis, including setting up training programmes, developing standards of care documents, designing new rotas and looking out for staff wellbeing. The Clinical Director asked that we made arrangements to start stockpiling food in the department in case staff could not go home.

I had never heard of the organisation doing this previously, so I started my own donation drive. With the help of my husband and two friends who fielded calls and made collections during the day when I was at work, we ended up with eight carloads of donations. After work at 21:00 each evening, my friends would drive to the hospital with the donations, I would meet them, and we would unload and start delivering food to various areas in the department. Through social media, companies offering care packages, hot meals and other food started getting in touch asking what they could do. In hindsight, I think that part of the reason we received so many donations from large companies was that I started the donation drive before others realised it would be necessary. Quick thinking and acting on one’s gut instinct in these situations are key.

The hours that I have worked so far throughout this crisis, including my daily responsibilities as well as coordinating the donations, have been long and on some days hard. However, the current sense of purpose that health care workers have is strong and unwavering, which gives me and others in the NHS, clinical and non-clinical, the focus and energy to continue.

Sonia London
Deputy General Manager
Theatres, Anaesthetics and Perioperative Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London