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It's been a busy few months to say the least. Preparing for the pandemic, sourcing correct personal protective equipment (PPE), redeploying staff, acquiring new staff, making ventilators, redesigning how we work around the constraints, writing new policies, new guidance, surge plans, and then the complex part… caring for patients. If I am honest, when this all started it felt exciting. Adrenaline was high, motivation was high, we felt somewhat ready. There was a sense of real comradeship. It felt like we were all working for one purpose; to safely care for any patient that presented to us in hospital. We were a little behind London by about 2–3 weeks, so we could watch from afar on how they were coping, what they were seeing and adapting our plans as they changed theirs. Communication through the ITU networks was crucial. Clinical work has been difficult at times. The initial confusion on what the right PPE to wear for each area added to the stress of hearing that our colleagues in other places were dying through lack of PPE. The early days for me were emotionally draining. However, this new way of dressing and level of precaution is now a way of life for us. I have come to terms that I am working in a high-risk area and I may become unwell, but following guidance and being fastidious with donning and doffing helps with ‘controlling’ my anxieties in catching the virus. Some parts of the hospital remained quiet. Staff had been redeployed, elective surgery cancelled and the flow of patients in the emergency department (ED) almost stopped. I remember walking through ED and thinking: where are the people who have had strokes? Have people stopped having heart attacks? Are perforated bowels not happening anymore? The corridor in ED is usually full. Ambulances queuing up outside, but for a good few weeks the ambulance bays were deserted. The news says over and over again "we must not overwhelm the NHS". I always have a chuckle to myself as the NHS has been overwhelmed for years, and each year it gets more overwhelmed but little is done to prevent winter surges, although it's not just winter. The surge is like a huge tidal wave that we almost meet the crest of, but never get there, and emerge out the other side. I sit in the early morning ITU meeting. We discuss any problems overnight, clinical issues, staffing and beds. We have seen a steady decline in the number of ITU patients with COVID over the last week or so. The number of beds free for COVID patients were plentiful. We have enough ventilators and staff for them. This is encouraging news. I take a sigh, thinking we may have overcome the peak. In the next breath, the consultant states that we don’t have any non COVID ITU beds. We have already spread over four different areas and are utilising over 50 staff to man these beds (usually we have 25 staff). So that’s where the perforated bowels, heart attacks and strokes are. The patients we are caring for had stayed at home too long. So long, that they now have poorer outcomes and complications from their initial complaint. These patients are sick. Some of the nurses who are looking after them are redeployed from other areas; these nurses have ITU experience, but have moved to other roles within the hospital. This wasn’t what they had signed up for. They were signed up for the surge of COVID positive patients. I’m not sure how they feel about this. As the hospital is ‘quiet’ and surgical beds are left empty, there is a mention of starting some elective surgery. This would be great. It would improve patient outcomes, patients wouldn’t have to wait too long, so long that they might die as a consequence. However, we don’t have the capacity. We have no high dependency/ITU beds or nurses to recover them. We would also have to give back the nurses and the doctors we have borrowed from the surgical wards and outpatients to staff ‘work as normal’, depleting our staff numbers further. Add to the fact that lockdown has been lifted ever so slightly, the public are confused, I’m confused. With confusion will come complacency, with complacency will come transmission of the virus and we will end up with a second peak. If we end up with a second peak on top of an already stretched ITU and reduced staffing due to the secondary impact on non COVID care, the NHS will be overwhelmed. This time we will topple off that tidal wave. It’s a viscious cycle that I’m not sure how we can reverse. My plea, however, is to ensure we transition out of this weird world we have found ourselves in together. We usually look for guidance from NHS England/Improvement, but no one knows how best to do this. The people who will figure this out is you. If your Trust is doing something that is working to get out of this difficult situation, please tell others. We are all riding the same storm but in different boats. I would say that I am looking forward to ‘business as usual’ – but I can’t bare that expression. Now would be a great time to redesign our services to meet demand, to involve patients and families in the redesign – to suit their needs. We have closer relationships now with community care, social care and primary care, we have an engaged public all wanting to play their part. Surely now is the time we can plan for what the future could look like together? The Government has announced that Ministers are to set up a ‘dedicated team’ to aid NHS recovery. We need to ensure that patient and staff safety is a core purpose of that team’s remit and the redesign of health and social care. Would you be interested in being on our panel for our next Patient Safety Learning webinar on transitioning into the new normal? If so, please leave a comment below.

Watch the video or access the link below for more information about PatientAider.

The safety of non COVID-19 patients We need to keep all patients safe Healthcare professionals will be focused by this crisis with huge efforts being made into limiting the spread, protecting patients and keeping demand for health services down and to manageable levels. We must not forget about the adverse consequences this will have on others who need our services. We need to assess the impact COVID-19 (CV19) will have on patient safety as existing patient safety issues will be magnified and exacerbated with the rapid escalation of CV19, known causes of these issues such as scarcity of workforce are likely to become even more significant and as CV19 will become the main focus of a large number of healthcare care staff patient safety initiatives that have to date had traction and success may be abandoned for expediency. Patient, carers, family and friends perspective Healthcare staff will be focused on treating the person in front of them and the associated risks of CV19 to that individual. Patients see their whole care journey. They are well placed to identify gaps quickly. The concerns and experiences shared by patients and their families will help us highlight bigger system issues that need addressing quickly to prevent avoidable harm during this pandemic. We need patient stories, we need everyone's and anyone's stories. Knowledge sharing and collaboration for patient safety We are collating insights into the impact on non CV19 patients and patient safety to inform healthcare leaders and afterwards for learning. We are using Patient Safety Learning’s the hub, a dedicated knowledge-sharing platform and community for patient safety, to do this. This has a knowledge repository, communities of practice, news and invites members to share their resources and insights. There is already a dedicated section of the hub that contains resources on coronavirus and CV19: guidance, advice, tips and personal experience blogs. We have set up a separate section on our community and inviting patients, family members and staff to share their stories, highlighting weaknesses/safety issues that need to be addressed and sharing solutions that are working: Stories from patients, carers, families We are inviting people to share with us their stories and: A personal snippet of their life and personality (a photo would be great to make it personal) Where they live What part of the healthcare system they access and for how long have they been using it? What have they noticed that has been different now the crisis has started? E.g. outpatient appointments, collection of medication, GP appointments, cancellation of operations? What impact has this had on them? What are their fears about their long-term health problem in amongst the crisis? Do they feel safe? Do they feel informed? Contact details if they are happy to share. Highlight new areas of unsafe care. What have they noticed that has been different now the crisis has started, e.g. outpatient appointments, collection of medication, GP appointments, cancellation of operations? Some of the issues we’re keen to look at are: Aspects of healthcare that you previously considered safe but maybe no longer be so as a consequence of fewer staff, changes in ways of working, unclear new arrangements etc. In cases of elective intervention and/or appointment being postponed, does the patient/family know the warning signs to call for help? Is there a hotline or urgent clinic for patients to contact? Positive stories as well as negative. Has anything improved since the crisis? For example, has the use of digital/virtual interventions (accessing a GP) had a positive effect? Data and analytics if available to show current trends in safety and adherence. How we can engage with patient leaders to access patients’ stories We are actively promoting the sourcing of insight from patients, families and staff. We will be actively promoting this through the patient safety agencies, patient and family organisations, healthcare systems, social and mainstream media in. We will promote as a campaign through #SafetyStories What will we do with this insight and information? This information will be publicly available on the hub for all. We will review the content and identify themes of concern/worry and highlight as a global resource through regular updates and reports. These will highlight the ‘second victims' of the virus.

Learning objectives In this session participants will learn about: The design of the patient's journey and experience. Practical ways to introduce co-production in your setting. An overall framework that can help teams to work more effectively with patients and their families.

Key points The Commonwealth Fund surveyed 13,200 primary care physicians across 11 countries between January and June 2019. This included 1,001 general practitioners (GPs) from the UK. The Health Foundation analysed the data and reports on the findings from a UK perspective. In some aspects of care, the UK performs strongly and is an international leader. Almost all UK GPs surveyed use electronic medical records and use of data to review and improve care is relatively high. The survey also highlights areas of major concern for the NHS. Just 6% of UK GPs report feeling ‘extremely’ or ‘very satisfied’ with their workload – the lowest of any country surveyed. Only France has lower overall GP satisfaction with practising medicine. GPs in the UK also report high stress levels and feel that the quality of care that they and the wider NHS can provide is declining. A high proportion of surveyed UK GPs plan to quit or reduce their working hours in the near future. 49% of UK GP respondents plan to reduce their weekly clinical hours in the next 3 years (compared to 10% who plan to increase them). UK GPs continue to report shorter appointment lengths than the majority of their international colleagues. Just 5% of UK GPs surveyed feel ‘extremely’ or ‘very satisfied’ with the amount of time they can spend with their patients, significantly lower than the satisfaction reported by GPs in the other 10 countries surveyed. Workload pressures are growing across general practice, and UK GPs report that they are doing more of all types of patient consultations (including face-to-face, telephone triage and telephone consulting). Policymakers expect GPs to be offering video and email consultations to patients who want them in the near future but the survey suggests that this is currently a long way from happening. Only 11% of UK GPs report that their surgeries provide care through video consultation.