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As a working parent, life has always been a juggling act… during this crisis I’m dropping a few balls and I feel totally out of control. I have always been an organised person. When I say organised, I mean that the kids get to school, I get to work, dinner is cooked, clothes are fresh, the house is clean, and we have time for fun. The last few days our worlds have turned upside down. The kids don’t go to school, my work is not what I know anymore and I’m too scared to go, dinners are not the usual (we had spam fritters and tinned potatoes last night), clothes are boiled washed, the house stinks of bleach and we can't go out. We shall get used to this new normal, I know that we all need to find a routine that will comfort us, even if that is making up new house rules or putting up a timetable for the kids (that went in the bin after 48 hours). I’m getting used to being a bit of a crap mother at the moment. I’m getting a bit shouty, more than usual and I don’t like it. We are eating weird stuff I have found in the back of the freezer as I am limiting the amount of time I go out; I don’t recommend a frankfurter curry… bit salty. I'm trying to home-school the kids as the school will only take the boys when I’m at the hospital – this is to make sure everyone can get to work. If anything, this is what is going to send me over the edge first! The boys are fighting, they refuse to do the work set by the school, I try and help but I can’t understand it, they ask for snacks constantly, they want to go out with friends and, what with everyone online, the internet is slow. It’s been 48 hours of lockdown and I think I shall have an 'inset' day tomorrow. I know in my last blog I spoke of my husband and his business going a bit t***s up, it’s the least of the worries at the moment. The government has set out lots of support for him and his employees. He will be ok, his employees will be ok, we will be ok. This was a huge part of the stress we were under last week, but things have changed. I have been doing extra shifts at the hospital to cover sickness. Many of our outreach team are in self-isolation due to family members being unwell or they are unwell. During these shifts I have witnessed the very best of our NHS and the Trust I work in, so why am I dreading my next shift? Fear. Never have I felt that my life is at risk during my 24-year nursing career. I have worked all over the world. Working in a refugee camp, being the only blonde, white woman, you would have thought I would feel scared or threatened. No, I was welcomed and respected. I have been driven at high speed in taxi in South Africa, racing away from armed car jackers when I was a repatriation nurse (admittedly this was a brown trouser moment), but it was one isolated incident. Being fearful of a job I love is so upsetting. The medical admission unit is filling up with ‘red’ patients (COVID positive) and the ITU is starting to see its first patients. As an outreach nurse we are seeing the sick patients. They cough all over me. I have no idea if they have the virus or not. I am not wearing scrubs; I wear my outreach uniform which I launder at home, but I do have access to surgical masks, aprons and gloves. A sick patient who is positive needs to go to the ITU. It’s my job to transfer them. I turn up with the ward nurse in an apron, gloves and surgical mask. They are wearing powerhoods or the N95 masks, scrubs, full plastic covering from head to foot, they have access to a shower after work and they have support from intensive care doctors. I feel totally underdressed and ill equipped. The nurses on the ward have been caring for this patient while wearing a surgical mask, apron and gloves. This patient was not receiving aerosoled treatment and the personal protective equipment (PPE) guidance is being followed, but I can’t help thinking that the wards are getting a raw deal. They are working in a 'soup of droplets'. I caught a glimpse of one of the cleaning staff changing the curtains of the COVID positive patient who had left the ward to go to the ITU. He also had just a surgical mask and his normal uniform. I felt sad. I can’t help thinking that this isn’t right. I don’t think we have the right protective equipment. Surely, we should not be wearing and laundering our own uniforms? We get told by our management, who get guidance from the Public Health England, so should we just accept it? If it feels wrong, it usually is wrong. Would they come and work a shift here in their clothes and be happy washing it at home? Probably not. There are not any showers for nurses at work. We bring this virus in to our homes on our uniforms, risking our children, our family and friends, not to mention ourselves. I feel filthy. I rush upstairs to shower while the uniform is boiling in the washing machine. Scrubs are at a premium. There are not enough to go around. I am upset over many things; I feel I can't do anything properly and feel useless. Everything we have ever known is different. I would like to end this blog on a high note… The sun is shining, just in time for lockdown.

This document is also attached for download.

The Health and Social Care Select Committee is currently holding an inquiry to consider the preparedness of the UK to deal with the coronavirus pandemic. MPs will focus their discussion on measures to safeguard public health, options for containing the virus and how well prepared the NHS is to deal with a major outbreak. At Patient Safety Learning we are gathering #safetystories from both staff and patients to highlight the challenges for safety in healthcare that are resulting from the pandemic. Ahead of the Committee’s next oral evidence session we have raised several urgent safety issues with the Chair, Jeremy Hunt MP. The Committee should seek answers and actions from NHS leaders and politicians on the issues identified to ensure the safety of staff and patients. Below is a summary of our submission to the Committee, a full copy of which can be found here. Personal Protective Equipment (PPE) for staff There has been an increasing number of concerns raised by staff through the media over the past week around problems accessing appropriate PPE. While at a senior level there has been assurances about the availability of appropriate PPE for NHS staff, we are concerned that this is not being borne out by their experiences on the front-line, undermining trust and confidence that staff safety is being treated as a priority. In our submission we’ve cited several issues raised by healthcare workers in this regard, such as discrepancies in the amount of PPE available to staff in some roles (e.g. ambulances) as opposed to others (e.g. emergency departments). There have also been concerns about the guidance provided on what PPE is required. We’ve been advised of incidents where this has been downgraded to reflect the availability of supplies; this is clearly highly risky and does not reflect a science-based response to the pandemic. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What is being done to ensure all ‘at risk’ staff have access to PPE, not only in the Intensive Treatment Units (ITUs) but Emergency Departments, Wards, Ambulances, in the community, everywhere? Who is in charge in every organisation to ensure that PPE is available and in use, according to robust guidelines? How do staff report concerns and to whom? What assurances are there that the safety of staff is paramount and that the cost of PPE is not preventing staff from having access to life-saving protection? How is the NHS supply chain communicating with trusts over likely lead times for PPE and availability of supplies? Is there transparency in this so that trusts can plan effectively how to use the stocks they have left? Testing There has been a number of reports about how the UK’s approach to testing differs from World Health Organization guidance and we’ve had concerns raised directly with us by staff who are genuinely fearful that they are infected and spreading the virus to their friends, family and the general public without knowing. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What is the policy for testing and tracing patients for Covid-19 in the UK? What are the requirements for test production and testing capacity in this country? What are the plans and timescales to deliver this? We think that the scale of testing is compromising our ability to track the spread of the virus and isolate those that are infected. Non Covid-19 care Understandably the healthcare system is focusing its attention on the deadly effects of the coronavirus and we believe that we need to pay attention to patient safety now more important than ever. We are hearing stories of patients whose planned tests, elective operations, diagnostic procedures are being postponed or delayed while the health care system focuses on responding to the pandemic. It is important to assess the impact the coronavirus will have on other areas of care and ensure it does not magnify or exacerbate existing patient safety issues. We’re asking patients to share their safety stories with us to highlight weaknesses or safety issues that need to be addressed and share solutions that are working, so we can seek to close the close the gaps that might emerge as a result of the pandemic. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What arrangements are being put in place to inform patients and families of any changes in non Covid-19 care during the pandemic? How are UK patients and families being informed about any such changes in their care? What should patients do if they notice new signs and symptoms? References [1] UK Parliament, Health and Social Care Committee: Preparations for Coronavirus, Last Accessed 25 March 2020. [2] HSJ, Staff in ‘near revolt’ over protective gear crisis, Last Accessed 25 March 2020.

Today I was nursing a patient on the ward who was very unwell. The test result came back as positive for COVID-19 and the patient needed to be transferred to the intensive care unit (ICU). I was concerned that the masks and other personal protective equipment (PPE) being used on the wards are not adequate for such specialist nursing tasks. I consider (and it is the Trust's good practice guidance) that the mask that specialist outreach nurses should be using are the ones that ICU staff use. Specialist masks are needed for aerosoled treatment. So I use the specialist mask as the patient was going straight to ICU for aerosol treatment. When donning this specialist mask, one of the managers on the ward (someone who has budget responsibilities) said to me "you shouldn't be using that mask as it costs 8 quid." I have been 'covered by COVID-19 all day' and feels like it is just a matter of time before I succumb to the disease. Coming home last night I was convinced that the disease has been transferred to my husband and young sons. I asked my manager if, when the PPE runs out, will we be expected to nurse without a mask and protective clothing. My manager said that it wouldn't come to that. But I don't trust that. If there is not adequate PPE, I don't want to work and I believe that no one should be expected to. I am angry that nursing staff are being put in danger and that this will escalate in the coming weeks. Despite the assurance of the Deputy Chief Medical Office that the UK has "perfectly adequate" supply of PPE, my brother (a paramedic) has bough his own supply of masks as he’s sure that they will run out. It would be gruesome enough to be insufficiently protected if there weren’t enough masks to go around, and there are at the moment, but to be denied the essential equipment on cost grounds is disgraceful. The government are rightly saying ‘whatever it takes.’ Matt Hancock and the Cabinet need to know that their commitment is not being honoured. This is just my experience of course, but it’s clearly symptomatic of a culture that isn’t protecting staff and where trust is breaking down. If there are no staff, there will be no patient care. The sea near the hospital is calm this morning. But it’s like its going to drag back slowly. We know the tsunami is coming and we’re all terrified.

Today I was both humbled and deeply moved. The Royal Free Trust (RFT) continue to take the health and well-being of it's staff seriously. I’m proud to say I’m one of them. In response to COVID-19, a multidisciplinary group have been tasked to specifically look at how staff can be supported through the pandemic. It recognises that the support will need to be multi-faceted and my role as the founder of SISOS (Safety Incident Supporting Our Staff) and present SISOS lead will be to help provide emotional peer-led support for our staff alongside chaplaincy and varied mental health professionals. Released from my clinical role (scrub nurse) for the foreseeable future, I will be able to focus on, and will endeavour to promote and support, the emotional safety of my colleagues Trust wide. The mental health first aid training I undertook in preparation for my SISOS role will surely be put to the test. None of us know what obstacles and challenges we will have to face, both in our private and professional lives, as we race off track, gathering speed and moving towards an unknown destination. By and large, I envisage the peer support SISOS provides will be achieved remotely: telephone, WhatsApp, Facetime, text, emails. The experience we have gained allows us some insight into how this support will be received and I feel positive. Who could possibly have predicted two years ago when SISOS first evolved the events of the last few weeks. Implementing, embedding and sustaining a peer support initiative has thrown up many challenges but we are reassured that our colleagues can be confident of genuine emotional support from peers who are guided and supported by professionals within a Trust which cares. SISOS: caring is our passion Human being is our highest banding Read my other blogs on the SISOS journey: Part one Part two Part three Part four