In the second and concluding part of a feature on Dr Andrew Stradling of the Medway NHS Foundation Trust, the discussion focusses more closely on the digital agenda of the NHS, the importance of an open-door leadership model, and what can be expected from the health service in 2021.
Reflecting on the uptick in remote appointments and consultations, Dr Stradling believes that the increased use of technology within the health service has been years in the making.
He said: “I do hope the digital agenda is here to stay. It has been a long time coming and other countries I think have executed it better than we have, for whatever reason. I think the NHS has not been as good as it could have been in adopting IT prior to now, and we have a real opportunity to do so at this point.
“For certain things such as immediate consultations, primary care and outpatient work, remote consultations are ideal. For larger collaborative meetings, particularly academic, I feel it is less effective, but we may well get better at that.”
The disadvantages of digital interaction
Following on from those remarks, Dr Stradling went on to discuss another key disadvantage of the increased use of digital communication, in that it removes much of the non-verbal social interaction which healthcare staff thrive on as a coping mechanism.
“While we have had to have physical distancing, the remote working has come with huge advantages, including less commuting and less travelling, as well as giving us more time in the working day to be productive. But all of the soft social stuff, such as the non-verbal interaction, those other ways of communicating and socialising with each other as professionals, these have been lost to us.
“It is difficult to quantify the issue, but it does slow things down and affect us. I find that when we meet remotely, decision-making generally becomes slower. People are more cautious, people queue up to talk rather than engaging in free and open conversation where anyone feels they can chip in at any one time. This is a problem and hopefully it is something we can work on, or alleviate once we are able to hold physical meetings again.”
A magic bullet?
While the positive news about vaccines comes as a real hope that an exit route from the pandemic may be in sight, Dr Stradling warned against being drawn into expectation that it could act as a magic bullet which will revert life to pre-pandemic norms.
“I think the combination of understanding the disease and having a testing system which allows for a quick turnaround in results and repeat testing, alongside a vaccine, means that we should now be in a position to deal with Covid like we would any other disease. The biggest healthcare workers’ scare in many of our living memories was HIV, which was initially seen as a death sentence, but now people can live a full lifespan on medication despite being HIV positive and it almost becomes a background condition that people can live with. It may well be that illnesses like Covid end up going the same way.
“We are still in very early days with regards to a vaccine, and I do not think we will know until the spring whether we genuinely have an effective one.”
Dr Stradling also found himself in agreement with the remarks of the University of Oxford’s Prof Adrian Banning, in that for the first time since the emergence of HIV, the Covid-19 pandemic had left healthcare workers very aware of their own mortality and feeling at risk in attending work for the first time in a generation.
Dr Stradling explained: “I think staff have been very self-aware during this time, more so than we have seen since those early years of HIV, and for the first time over the last ten days, we actually had our first member of staff succumb to Covid. That really hits it home and changes the atmosphere but things like this re-focus us and remind us why we do what we do.”
The need to adapt
Looking back on the early days of the pandemic, Dr Stradling recalled that what the crisis had done is forced a number of more senior medical professionals to administer care and make decisions that they had not previously been accustomed to; a learning which he feels will help make the NHS workforce more robust and resilient in future.
“Early on, we were very much talking about Covid as a ‘major incident’ which has a clear NHS definition as being ‘any incident which overwhelms the available healthcare resource’. In these cases one typically things of major disasters where patient numbers become substantial in a very short period of time, which causes difficulties for the ambulance service, emergency departments, and operating theatres. While I do believe that the pandemic has been like a major incident, a lot of the patients coming into our care have already been subject to routine elderly care provision or medication, and typically clinicians have never been used to adapting to addressing large scores of patients like this at one time, nor forced to make key decisions on who gets what type of treatment.
“To expand on that, we were effectively having to ration some treatments because we cannot ventilate every single patient that may well need such attention. So, some patients are receiving ICU treatment, and some are not, but even some of my more senior colleagues have not been put in the position where they have had to make these decisions. The experience of this, I feel, will help to galvanise them.”
What Dr Stradling does want to see in future is an appreciation of the psychological effects that being forced to make such decisions is likely to have on medical staff, and urged leaders in the sector to recognise that the NHS workforce will need support to overcome the mental health challenges that will arise as a result.
“Helping our colleagues deal with this new set of responsibilities and come to terms with the decisions that they have made is important. So often, clinicians have been protected from having to make these decisions and it is a terrifying scenario for them to be in now. We cannot just forget the fact that healthcare staff are not just healthcare staff who are thick-skinned enough not to suffer as a result of their experiences. These people are parents and children and carers who all have to eat, commute and look after themselves as well as others. We would do well to remember this.”
A flattened hierarchy
Of course, charting a course through a health crisis inevitably takes its toll on the NHS workforce, and while there will be many psychological consequences of this both through the remainder of the pandemic and post-Covid, Dr Stradling explained that an open door policy of leadership had been instrumental in helping provide his team with the guidance and support they have needed to navigate Covid-19 thus far.
Paying tribute to his staff, Dr Stradling began: “I have been really luck in that I am Clinical Director and have been for a while now at the best emergency department I know of. Lord Carter actually visited us some months ago and also said the same thing. It is a fantastic department with incredible staff, and it is easy for me to be proud of them which makes it easy to lead.”
He continued: “Throughout Covid, people here have been scared and had their own individual difficulties to contend with, but we have an open flattened hierarchy and a very open way of working to ensure effective communication. I have an open office and am entirely approachable and available whenever anyone needs support and that is the way we have tried to do things. I am an advocate of the need of trust and believe that having mutual trust is the only way you can work with people. I work hard at instilling that and making sure my staff know they can trust me just as much as I know I can trust my staff.”
For all of the lessons that Covid-19 has brought as well as its many challenges, Dr Stradling did not feel that his leadership approach had changed as a result of his more recent experiences.
“I do not feel I have changed my leadership approach as a result of Covid, but I may well ask my staff if they think I have changed!”
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