Speaking exclusively to The Leaders Council of Great Britain & Northern Ireland in the first segment of a two-part interview, Dr David Fluck, Medical Director and Executive Lead for R&D at the Ashford & St Peter's Hospitals NHS Foundation Trust, reflects on the impact that the first two waves of the Covid-19 virus has had on the health service and discusses how healthcare sector leadership has had to be proactive in offering support to its staff.
In a week where retail giant Arcadia entered administration to become one of the latest economic victims of the Covid-19 crisis, a vaccine was approved for use in the UK, and England emerged from its full autumn lockdown and into a tougher tiered restrictions framework, prime minister Boris Johnson issued a stark warning that the NHS “remains under pressure” and urged citizens to avoid complacency and adhere to the new restrictions to ensure it does not become overwhelmed.
To better understand the challenges that the pandemic has thrust upon the healthcare sector, The Leaders Council of Great Britain & Northern Ireland has been in conversation with a number of NHS leaders, garnering their views on how the pandemic has affected the health service so far throughout the first two waves of Covid and what the long-term effects of the crisis are likely to be.
In the latest of these features, we spoke to Dr David Fluck, Medical Director and Executive Lead for R&D at the Ashford & St Peter's Hospitals NHS Foundation Trust. Dr Fluck first joined Ashford & St Peter’s in 1996 as a Consultant Cardiologist before becoming the Clinical Director for Medicine in 2006. He was elevated to the position of Deputy Medical Director in 2010, before being appointed to his current role of Medical Director in 2012.
Adapting quickly and upping capacity
As the Covid-19 pandemic began to take hold in the early part of 2020 and a feeling set in that the scale of the challenge could overwhelm the health service, Dr Fluck recalled that the NHS had to make changes to capacity and infrastructure in order to be ready for a large-scale cohort of vulnerable Covid-19 patients.
He said: “When we knew the pandemic was arriving, we felt the scale of what we were facing was going to overwhelm us and we set about getting ready to cope with vulnerable people coming through our doors in large numbers.
“Firstly, we increased the intensive care capacity. During this time, our staff were absolutely magnificent in the way they adapted and changed, and that was not only down our staff but also staff working outside the hospitals and elsewhere within the healthcare system who were working to try and get people home as quickly, and as safely, as possible.”
Furthermore, NHS Trusts found themselves having to change their working infrastructure to enable more staff to work from home and reduce the amount of footfall within hospitals, thereby cutting down the likelihood of the disease being transmitted.
Dr Fluck explained: “We had to reorganise ourselves very quickly. We knew this was an infectious disease, so we had to quickly enable as many people as possible to work from home as well as significantly limiting visiting within our hospital. We knew that the virus was most likely to be transmitted within hospital, so these steps were paramount. We saw the number of patients increasing quickly and we increased our level 3 critical care capacity to match. Usually, we would have eight level three critical care beds, but we increased capacity to cater for 26 people on ventilators. Our staff then had to adapt to work under these new conditions, which they managed very well.
“Within the first wave, the other thing we saw was the halting of most other health services that were not dealing with the pandemic in order to free up more capacity on the frontline. So, elective care and much of the normal care we delivered was greatly reduced, and elective surgery was stopped. Meanwhile, outpatient care was switch to virtual consultations via telephone or video to reduce traffic in hospitals.”
While a much quieter summer period was sandwiched between the two waves of the virus, Dr Fluck explained that much of the summer months were spent preparing for the second wave, which has been greatly differed to the first wave seen in the earlier part of the year.
“When the lockdown came in March, the first wave began to flatten off and it became quiet as it tailed off in the summer and we started to prepare for a second wave of the virus. The difference in the first wave was that attendances in A&E dropped dramatically and our inpatient load with non-Covid related conditions also dropped because people were concerned about coming to hospital because of the risks associated with the pandemic.
“We have worked very hard to maintain the safety of patients when they arrive in hospital even with the prevalence of Covid in the community and we needed to reassure people that the NHS would be there for them when they needed help with anything else. In this second wave, the levels of non-Covid related patients are more like what we would expect them to be, and we are having to balance that with the latest cohort of Covid-related attendees.”
Research changes direction
While the onset of the pandemic also saw the pause button pressed on much pre-pandemic R&D, Dr Fluck believes there are some positives that came from that setback in that capacity was increased in other areas of research which accelerated affairs in the battle against the virus.
Dr Fluck elaborated: “The pauses in R&D elsewhere made room for us to focus our research efforts more on Covid. Our R&D teams put their energy into recruiting people into Covid related studies that were ongoing, and we contributed to ongoing national studies. It was not just our Trust doing this either, we were seeing this across the whole NHS. This redirecting of research helped us quickly understand Covid in more detail and treat people more effectively than at the start in the first wave.
“Covid research has been an incredible success and the research going into a vaccine has seen a huge amount of incredible work done at an amazing pace. It is sad that people have had to pause other things of course, but within our Trust, we are taking trials and studies back online now and most things we were doing before Covid will be on track in roughly six months’ time. There was a change in direction for research during the first wave, because it was necessary at that time. The biggest change in our focus was taking time to sit back and reflect on how the health service coped with the initial onset of the crisis and how we can learn from the innovation and transformation that went on in such a short space of time.”
A beleaguered healthcare workforce
Although the NHS has triumphed so much throughout the course of the pandemic, it has not come without cost and as the UK tiptoes toward the traditional winter period of January to March, NHS leaders are becoming more and more concerned about the effect that the ongoing battle against the virus is having on staff fatigue and morale.
Yet, what Dr Fluck believes the NHS and its staff have been able to count on throughout is an immense amount of goodwill and moral support from local communities.
He highlighted: “Looking back at the first wave, our staff have recognised that an immense amount of support was given by the community, and they have been hugely appreciative of the NHS and healthcare workers despite the fact that they were experiencing sadness, loneliness, anxiety and economic strain. For hospital staff it has been a hugely stressful time, yet this level of support from around them has been overwhelming and so supportive.
“Clinicians have also had to deal with setbacks in morale since many patients have not done as well as the staff would have liked, so mentally they have been feeling the strain and it has had a huge effect on mental health and wellbeing. It has not just been clinicians putting in such an immense effort during this time either, but also lots of human resources staff who have been organising workforce flexibility and staggered shift patterns, IT staff working on communication and infrastructure for clinicians coming in and out of hospital and having to work remotely, and an incredible amount of work has been done by our housekeeping staff with all of the new cleaning regimes.”
Yet, despite the after effects from the arduous task of having to reorganise the health service at such short notice, Dr Fluck believes that the altered regime helped the NHS ready itself to respond quickly when the second wave of the virus began to appear.
“A lot of things changed quickly in the first wave and we made sure these were ongoing changes so that we would be ready to look after Covid patients and those with non-Covid related conditions in a subsequent wave. We kept busy changing the infrastructure and staffing at our Ashford site to ensure we could focus on elective work there and on delivering outpatient services out in the community rather than within a hospital setting.
“In the second wave, we have tried to keep the whole healthcare system working rather than focusing solely on Covid, and as we have learned more about the virus our treatments have changed and become more effective.
“Our staff are going through this second wave more tired and fatigued than in the first wave, and we are seeing the community becoming more tired in facing this for a second time. With the weather not being as good this time around as we have come through the autumn lockdown, it is harder for people to get out and enjoy exercise which helped keep morale up before, and the economic impact of prolonged restrictions is causing distress to many more families and businesses.”
Supporting staff
To combat mental health struggles among NHS personnel that have come about as a result of the pandemic, Dr Fluck discussed how health leadership has had to be forthcoming with psychological support.
“We have put a lot of local effort into providing health and wellbeing support for our staff, especially psychological support. You do have to be proactive with that because staff will try their best to carry on as normal whatever their struggles are and leadership must therefore be forthcoming with support, offer it to staff and actively be looking after them. Evidence indicates that people can suffer with the after-effects of trauma for a long-time and that is something we need to be aware of.
“There is also a huge increase in mental health issues within the community and we are seeing more patients suffering in this way coming into our facilities, owing to loneliness and other psychological troubles arising from lockdown. It is difficult with everything going on not to feel lonely and affected and we anticipate that additional mental health support is going to be needed over the coming year.”
Staff are also aware of the community. There is a huge increase in mental health problems in patients coming into our facilities and there is a lot of loneliness arising from lockdown and it is difficult not to be affected. Mental health in the community will need additional support in the coming year too.
Managing loss
When Dr Fluck first arrived at Ashford and St Peter’s as Consultant Cardiologist in the 1990s, he was instrumental in developing services such as the Rapid Access Chest Pain Clinics and trans-oesophageal echocardiography. Like many in the field of cardiology, he was saddened to learn of the passing of esteemed cardiologist and clinician Anthony Gershlick from the University of Leicester, who died with Covid-19 at the age of 69.
Paying tribute to Gershlick, Dr Fluck said: “Anthony Gershlick was an amazing clinician, and it is incredibly sad that he has passed away. When your colleagues die it is incredibly hard to come to terms with.”
Highlighting the difficulties staff across the NHS have faced when they have lost colleagues of their own to the virus, Dr Fluck added: “For the first time in a long-time from the first wave of Covid onwards, there was a real acknowledgement within the health service that staff knew they were at risk, and when members of staff then started to come in unwell and needed to be looked after by their colleagues, it was an incredibly difficult thing to have to go through.
“We have had three members of staff die during the pandemic and there is no other time that I can think of where staff have felt as vulnerable as they have now, especially so when they are seeing their own colleagues become ill”.
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