So if you'd like to just begin by saying your name and your current position.
Yeah. Thank you. My name is Meghan Pandit.
I am a professor. Am I going to Pandit? And I'm the chief medical officer at Oxford University Hospitals, NHS Foundation Trust.
Thank you very much. And without giving me your entire life history, but starting from when you first got interested in medicine,
can you just give me a sort of account of what brought you to where you are now?
Gosh, yes. It seems such, such a long time that it's, you know, medical training, etc. goes on for.
So I. My first consulting job was at a district general hospital that's too far away from me to go back a bit further than that.
Oh, you want me to go back there? Just that. What got you interested in that?
In medicine? Oh, well, what got interested in medicine is the human side of it.
I wanted to help people.
I wanted to be sure that the health care that was delivered to people was focussed around them, that they were the main stakeholders, as it were.
And I was very taken by and those early days surgery.
I wanted to use my hands to make people better.
And that's what I wanted to do. And I did.
I became a gynaecologist and an obstetrician, which was also a very nice mix because it has surgery and it has some medicine, as it were.
So and the joy of delivering babies and actually the thrill and excitement of doing that when I was doing obstetrics,
although, you know, there are some very hairy moments.
It was it was about doing the right thing for the woman in front of me.
And I think that was really important. And latterly I then took an interest in URO Gynaecology, which is very much focussed on women's health,
the sort of incontinence and prolapse aspects which really, you know, many women feel that they can't speak up about it and don't seek treatment.
And those, you know, back in the sort of late nineties when I started preparing to be a gynaecologist again, the focus in my mind was about women,
about what impact childbirth has on women with regard to incontinence and prolapse, and how we can how we can improve women's women's quality of life.
And I was very influenced by Professor John Delancy, who I worked with in Ann Arbour, Michigan, as his visiting lecturer.
For a year. He has described the continents mechanism in women, and it was a fabulous opportunity to work with him and to understand the concerns,
mechanisms and theories that underpinned his findings.
So I was very much intrigued by that.
And then I was a year ago an ecologist and an obstetrician in a district general hospital in England for nine years.
But during that time I felt that we weren't really as a unit doing what I intended for women to have
and for the satisfaction that patients should receive from a service that's being offered in the NHS.
I also felt that we could do more to improve staff morale and also the outcomes for both from the point of view of clinical service,
but also the education and training that we were offering. So I was brave.
I put my hand up, said I wanted to lead the unit, and a very wise person said to me,
Well, you haven't been consulting for long, so you should go and get some training.
So all that was, was a week long course at the King's Fund.
But nevertheless, I was with like minded people that was hospital management or that was on that was on leadership.
And it just leadership how to be a clinical director was what it was called then I think it was in 2006 or seven, I can't remember exactly.
And then I was interviewed and appointed as clinical director, and being a clinical director for a unit is a, you know, a relatively small budget.
You are responsible for a smaller number of people as compared to what my current job is, obviously.
But I was very fortunate to work with a newly appointed head of midwifery and a general manager for that unit.
And we worked, you know, we just had the same aim, it turns out.
And we worked very hard together as a team. We got lots of people on board and the outcomes and everything turned around gradually.
So in three years time, I. I was no longer standing in front of the television apologising for some unfortunate mishap and sad case.
And, you know, we were instead celebrating the wins that we were demonstrating, and that was really fulfilling.
We're talking just after the report. The Ockenden report. Yes, yes.
Yes, yes. So so that that was and then I was asked if I would be a divisional director for Women's and Children's.
So that was a bigger budget, more people, more patients, a different scope.
And I really enjoyed that. So this was alongside clinical work of course, and I just thought this is something that really motivates and inspires me.
And I decided that I would undertake an MBA, which was again,
not not a not very easy thing to have done because when I applied to the program at Oxford Brookes,
they said, well, there haven't been many, hardly any doctors at all wanting to study and do an MBA.
So and you are so busy as a divisional director with clinical practice, we are really worried that you may not be able to complete it.
So you were doing it side by side? Yes. Yes. And I managed to convince them and I said, no, no, I really want to do this.
And they accepted that. And within six months of that,
I saw an advert in the journal Medical Journal for a Chief Medical Officer position at University Hospitals in Coventry, Coventry and Warwickshire.
And I thought, okay, so this is really where I want my career to go as a medical leader.
And, you know, and I'm a person that actually changes pathways, changes care for the better.
And I applied and I got that job.
And that was for me, it was like hitting a lottery because that was exactly what I wanted to do.
I was travelling from Oxford, but. Or just outside from Oxford but or just outside Oxford.
But it was it was something that I was passionate about.
And, you know, when I started that role, there was a very steep learning curve,
but I was surrounded by two or three individuals who really supported me and took me through that first,
first year to understand what being a board director means.
You know, how do you what is the governance and, you know, the interactions with with external agencies, regulators?
Because by then and this is 2012, the role of the medical director had changed considerably from being a senior doctor
who gives trust boards opinions about medical matters to being a very regulatory one,
one that is responsible not just for the quality of care that's offered, but there was also a new regulation about appraisal and revalidation,
and it was about being a responsible officer for the number of doctors.
It was about responsibility for medical education and training and also for research and development alongside the whole of quality,
which at that time I radzi had said, had to be sort of what was really about three domains.
It's about safety, effectiveness, outcomes and patient experience.
So I worked with again with the chief nurse and that's a very close relationship has to work well.
And you know, I was a newcomer to that organisation in 2012, but when I left in December 2018, I very much felt like I was leaving home.
It became a relationship where the organisation grew and changed.
I grew,
I learnt a lot and during that time I did several things like starting a master's course at Warwick University on health care operational management,
because I felt that as doctors, nurses, pharmacists, physiotherapists, middle managers,
we need to understand the theory that underpins everything we try to do.
So this is having completed my MBA,
I had learned so much that I felt it really is essential for people who manage health care to understand the basics of their of their practice.
And then Warwick University agreed and that course started and I still teach on it, which is fantastic.
And I am a chair. I have a chair at Warwick linked to that.
I was also made a senior founding fellow of the Faculty of Medical Leadership and Management,
and I did various other things linked to my role as Chief Medical Officer.
And one of the other things that really influenced me was and my career was the partnership with Virginia Mason Institute and Medical Centre.
This was something the previous Secretary of State for Health, Jeremy Hunt, did.
He he created, he released some funding for five organisations in in the UK to learn.
From Virginia Mason Medical Centre about how to improve quality.
Yes. So what is the Virginia? It's a hospital. It's a it's in Seattle.
It's a small hospital in Seattle. But what they did about 15 years ago now is they went to Toyota motor industry in Japan, learned about lean.
And more importantly, they have demonstrated how to deliver lean in health care.
What is lean?
So lean management is about removing waste from everything and they have shown how removal of waste and there are several types of waste,
how removal of waste improves efficiency and productivity, but it's also underpinned with the core principle underpinning this is respect for people.
So it's the people on the shop floor who know the best way to improve and change the work so that we benefit patients.
Those are all stakeholders. It might be somebody buying a car for Toyota.
And and and we learned and while I was Coventry, we were one of those five trusts to partner with Virginia Mason Institute.
So we learned from them and did several things.
And, you know, I'll cut it short, but several workstreams and one of them was on safety in the work we did.
And that allowed us to develop things like creating a patient safety response team, which we now do at Oxford as well.
And that's about responding to harm incidents that may happen and in responding very regularly.
Every 24 hours there are harm incidents recorded on systems and we are top you a team of five, six people, governance practitioners, nurses, doctors.
We meet every morning at 8:00 and we go through those incidents and decide what level of investigation we should do.
We make sure that duty of candour, which is apology, is offered to the patient and relatives and we make sure the area is safe.
And we also support our staff so that people understand it's not about blame, it's not punitive.
So those is just that's just one example. So that's I mean, that's an example of something that's reactive.
Yeah, but it does it also does the method also introduce introduces sort of proactive.
Absolutely. Because everybody is now aware of that,
that there will be the chief medical officer or chief nurse or their team tomorrow morning that I can speak to.
I'm really worried about this. People are not afraid of reporting.
They are reporting every incident, you know, whatever the incident is.
And there is a lot of learning. There is learning on the spot.
There's learning on the day. And and that learning is disseminated more widely by use of safety huddles, for instance.
So so there are a lot of changes that we were able to make and I was able to learn.
And then in January 2019, I came to Oxford as chief medical officer, and a lot of work had to be done.
That was very clear. And again, it's about being in a team, it's about being in a team to get the basics right.
And this is a very big yes. So you're your chief medical officer across all the Oxford University Hospital?
That's correct. That's correct. So we have how many hospitals, health care staff?
Yeah. So Oxford University hospitals, it has a turnover of 1.3 billion.
We have four hospital sites, we have circa 14,000 staff.
And we, as you know, conduct services ranging from basic health care for people of Oxford,
share if they fall ill or come to any to, you know, kidney and intestinal transplants.
We have a very busy maternity unit of we deliver almost 7000 babies.
We do complex neurosurgery, heart surgery. You know, anything other than a heart transplant or a liver transplant is done here.
And we have the expertise,
absolute expertise and commitment in this in this organisation and the partnership that we have in this organisation with universities in Oxford,
Oxford University,
Oxford Brookes University is something that we really have developed over the last few years and that has really stood us in very good stead.
So, so yeah. So I'm here and my role is again, it involves patient safety, effectiveness of outcomes,
medicines management, end of life care, research and development and medical, postgraduate training.
And also that responsibility to make sure that the medical staff of it to practice so so all of that but also as I've said,
the role has changed so much. So now it's changed further since I was first appointed to 2012 and CMO was the chief medical officer.
So that will mean when you're previous. Yeah. Yeah. So I've been a CMO now for ten years.
So in that ten years, it has changed. So, you know, I now work very much alongside other executives.
So it's it's about being an executive director and providing assurance and accountable to the board.
Yes. And the that is a chief executive. There is a chief executive.
That's it. Next in line. So the chief executive has a team and that's how the work happens.
That's how the organisation is run.
So, you know, I work on productivity with with the chief operating officer, I work with the Chief People Officer in terms of workforce planning,
in terms of personnel matters, I work with the Chief Financial Officer in terms of how do we allocate capital?
You know, what do we procure? Is this the right thing?
So there are so many different aspects to the role of a chief medical officer, and that's just internal.
There's also the external work. So we now part of an integrated care system.
The structure of the NHS has changed and so we belong to this system, integrated system that includes Buckinghamshire, Berkshire and Oxfordshire.
So it's very much about working in collaboration rather than in competition.
So, so that that is one. And then there are several external regulators on there.
There's the Sikh, you see the NHS, England, there's, you know, several.
So, so the work is endless, but it's actually the joy and the core of the work is, you know, why am I doing it?
Well, I'm doing it for the patients. And if I keep that in mind every single time, then actually things are very clear.
Mm hmm. So I'm just reading a little bit about what you've been doing.
The phrase quality improvement come comes up, and you also just throw away,
as we were talking earlier, that when you came to Oxford, there was a lot that needed doing.
Can you give me some examples of the kinds of things, the kinds of changes that you've brought in, in the direction of quality improvement?
Yes. So again, the key thing that I realised I needed to do was to work very closely with the chief nurse and be really be taught alike.
And that's what that's what we did.
So one of the first things we had to I was asked by the board and chief executive and the board is to reduce the number of never events.
So never events harm incidents that should never happen because there are mechanisms in place to prevent them from happening on an average.
You know, the whole hospital this size with this kind of complexity, you would expect maybe three or four and in a year.
Classic examples. Yes, in a year. Classic examples of never events are the most commonly occurring in this country,
are retained foreign body and something left behind after a corrective or a procedure and wrong site or wrong side surgery.
And and there are others, you know, there are seven or eight types of environments, but those two are the most commonly occurring in in this country.
And they continue to happen. So, you know, okay, so I was I was I was told that that is one of your objectives in the first year.
And when I looked at when I looked at the the the picture in front of me,
there had been eight I think the year or the year 18, 19, no years, 17, 18 and 18, 19,
because that came before the end of the financial year 1819 there were 11 and a
majority of them were one of these two region foreign body alongside procedure surgery.
And then when, when I looked at, so what is the most important mitigating sort of factor to prevent that risk and that sort of event happening?
It's compliance with the W.H.O. safe surgical checklist.
This is a checklist rather like in the airline industry when the pilot sits in the in the
cockpit and introduces himself to the team because they're all a new team every day,
they're not the same team. Flying the same planes starts with who you are, what's your name?
But it goes through very rigorously whether all the controls are in place.
So that's very that's what the safe surgical checklist is.
It goes through, you know, is this the right patient?
Have you checked the name Ban? Does the patient need any blood after surgery?
Have you got the right equipment? All these sort of things. And compliance really needs to be 100%.
And it wasn't. It was approximately 95%.
So the checklist was in use, but not effectively. Not 100%.
It was. You could argue whether it was effective or not when it was 95%.
So you don't need a rocket scientist there to work out what needed to improve.
So so, you know, we set about making it doing a few things.
We started the patient safety response team, did it as a pilot initially because, you know,
what I didn't want to do was, oh, here comes the new CMO, and she's just imposed a new process on us.
So I convinced the the clinical leaders just to sort of try a pilot.
And that's why there's a screen behind you, because until COVID hit, so from January 19, until COVID hit, that that meeting used to happen here.
And I did it every single day unless I was away.
And if I was away, people came in here, had that access to my office and they did it.
And that was the commitment that had to be created. So the pilot went through and people really appreciated especially the support
for staff because when we review these things we visit the ward and people said,
yes, we really want to do it. So we started that. We started sending our safety messages.
So every week we would send out a safety message on a Tuesday without fail.
It has gone on every single day to the whole trust.
And I'm just remind you, it's about learning a killer thing or saying this happened and if we've done this.
It's about it's about a learning point from whatever has happened.
Right. And not just. Bad things, good things as well.
So it's about positive things as well as learning from home.
And that's since we started sending that out.
We created the notion of safety huddles, which became slightly later, but that's as a package of things around safety.
And people started noticing this. People started what a safety huddle is,
because I think I would come to that and people started noticing this and people started being open about reporting.
Our reporting rates went up, our number of home incidents came down.
And now, three years on, there is mostly 100% compliance with the checklist.
And when there isn't, people are held to account because it's not a new thing, a safety huddle.
We introduced safety huddles during COVID. Actually, we would be meeting to introduce them, but COVID gave us a perfect platform.
It's about a multidisciplinary team.
So a doctor, nurse, business student, you know, whoever a pharmacist on the ward coming together every morning to ask for basic questions.
What went well yesterday? What did not go so well? What can we learn from it and do differently today to avoid it happening today?
And are there any current risks in the environment in which we work that we need to take note of and mitigate?
So that allows people to very quickly get the support for things if something is going wrong, and to identify good practice and celebrate it.
And also if there is a negative thing to report it and look into it.
So so that's a safety huddle. And it also is used to cascade information so that we don't people don't work in silos.
So that's what we did. And, you know, all of this meant that there's a clear and obvious reduction in never events.
The following year there were seven and the year after that there were two.
But also we can demonstrate in our staff survey, the NHS staff survey, which happens every year.
We can demonstrate a rise in response to questions such as Does your trust take your concerns about safety seriously?
Are you given feedback? If you reported incidents, are you confident that your trust will investigate problems and learn from it?
Which demonstrates objectively that that there has been a change in culture of safety in this organisation?
And that's just one of the things we're going to talk about quality in such in terms of quality improvement.
We set up a couple of consultants, approached me early on in 2019, spring of 2019,
saying they're very keen to introduce learning across the organisation and quality improvement.
And quality improvement is about the three domains of quality and how we improve them and there are tools and methods, so the methods might be asked.
The five whys ask the question why? You know, somebody fell over.
Why did they fall over? Well, they fell over because they slipped or why did they slip?
You know, there was a patch on the floor. Well, why was there right back on the floor was a leaky tap.
Why is there a leaky tub? You know, why has not been fixed.
So you get to the root cause of why the patient fell by simply we're asking five boys and that's just one basic example.
But so I along with a colleague who doesn't work here anymore, director of improvement, he was we said, yes, we would very much support you.
So they started the key hub back in 2019, summer of 2019.
And we've now taken a large cohort of staff through that QE hub.
They've undertaken several projects,
but it's really about being consistent in the messaging and making sure that all these projects are not just projects that tick a box,
they actually lead to improvement and that improvement is spread across the organisation on a big scale.
And one example is AQI project which has created a change is a flood water bus where there's a bus now goes
along in Oxfordshire to to do phlebotomy blood tests for patients so they don't have to queue up here.
So, you know, that's an example. But also I think the main thing that that I,
I said during when COVID hit was I was asked the question because everything suddenly went to remote working.
I was asked the question whether really we should continue patient safety response team at 8:00 in the morning.
And I said, absolutely, yes. Absolutely, yes.
Because that is the prime purpose. And there has to be a relentless focus on safety for patients and support for staff and.
Did not stop.
Which which, you know, which makes which gets people to understand that there might be a, you know, a storm outside or storm about to come inside.
But we will still carry on doing the core business that we are meant to be here for.
No, I mean, I think that's that's very interesting that what you've introduced is opportunities to reflect on practice.
Yes. Which is often the first thing that goes out the window if you're very, very busy.
That's right. But then that has negative. That's right.
Yes. Yes. So you've mentioned it. You've brought Kogut up. So a question I'm just asking everybody is,
can you remember when you first heard about the COVID pandemic and when you first realised
this was actually going to be something that would be a major part of your role for a while?
Yes, very much so. It was mid-February, late February.
And the I think it was that first case that that that individual had returned from a skiing holiday.
And we knew the first U.K. case.
Yes. So you knew when you asked me, you know, because until then, I think we were all in oblivion,
including some very senior people, that it's not going to come here.
It's in China or it's in Italy. But but we knew when it was in Italy that it's going to be a matter of days, that it's going to be in England.
But in those days, you know, we thought, okay, you know, two months, six weeks, how long is this going to last?
And I work I'm responsible for infection prevention and control.
And so I work with, you know, extraordinary people who are extremely clever and vigilant and have their own networks.
And the director of Infection Prevention Control, who works very closely with me, said to me, this is coming here,
and I'm getting a lot of questions from US staff as to what this is about and what will change and how have what sort of impact will it have on them?
And I, I remember it was early March.
We had a we used to have staff briefing in the lecture theatre, which is not too far away from here,
but the CEO would lead that and about I think it has a capacity of around 150.
And it used to be full and people would come forward and see things and ask questions, etc.
And we had this staff briefing and and it was when the first came the cases in England had had come about and it
was full and we needed to use both lecture theatres with a with a broadcast on All in one and live in the other.
And there were many questions then that we did not have answers to.
Did we have PPE? Yes. But, you know, there was this overwhelming concern that particularly a surgical colleague who said,
I'm not going to operate, I'm simply not going to operate.
You need to tell me how I'm going to protect myself and my colleagues.
And, you know, it was not just that. It was this this was this dilemma of, okay, so very, very rapidly.
We have to change our pathways. We have to change our front door, which is any we've got to care for COVID patients.
We don't know how many there will be. So we've got to do we have to empty the John Ratcliffe building?
Do we have to, you know, stop doing orthopaedic surgery at the Nuffield Orthopaedic Centre?
What do we do with cancer surgery of the Churchill? What will happen at the Horton?
What? It's a much smaller hospital. How are we going to make sure the resources are right?
And what about those people who don't have COVID? You know, what about the people who have a heart attack?
What about the people who have a poly trauma in a road traffic accident?
How are we going to look after that? And at that point, we were told that the projections from NHS England,
because NHS England went into a command and control structure and then it just England.
And there were these suddenly there was a completely different meeting structure.
There was a mushroom of meetings. It was it was just like, you know, some something overwhelming.
And I was asked to be the chair of a COVID steering group for the organisation, and we had to come up with a plan.
And the modelling from NHS England said that we'd have to double and double our ICU capacity and we have, we have,
you know, we have adult critical care, we have neuro critical care, cardiac critical care and paediatric critical care.
But you know, the numbers of beds that we had had to be doubled and doubled.
So we were looking at something like creating a capacity for something like 100 over 120 ICU beds that were ventilated.
Now, you know, we don't have that that many beds. And what that meant is I had to get people around me and we had to go through this
rigorous mapping of which wards we would clear who would have to move from the building?
Where would they go? Where would gastroenterology go? Where would, you know, cystic fibrosis services go?
And and undoubtedly, you know, there has been a not such a good impact on some of the services that we had to move during COVID.
We now know that there's an iceberg of of people that weren't treated, who didn't come forward for treatment at the time.
We don't know where they are and who they are. That's in addition to the waiting list of people who are waiting for surgery.
So so this was all very reactive. But, you know, the board took a very, very calm and measured approach to this.
Everything went to remote working. We continued having our board meetings, the COVID steering group that I chaired met every day.
We had the chief operating officer on and chief nursing officer on it, Chief People Officer on it,
because we had to do a whole new piece of something we'd never done in this country, which is redeployment.
So so we had to redeploy research staff and nurses.
We had to redeploy junior doctors from one speciality to another because the need,
the overwhelming need was in general medicine, in chest medicine, that's respiratory medicine and ICU.
And the anaesthetists, they created a rota, a new rota to intubate patients with COVID and PPE.
I mean, procurement of PPE. So we had several strands in the steering group.
We had the clinical strand, of course, for COVID patients, for Non-covid patients, we had the infection prevention and control policies.
We had the support for our own people, and we had procurement, which is PPE, we had medicines management, and we also had oxygen in that.
So remember, there was a fear that we'd run out of oxygen at some point and we had to look at all of that.
So looking back at it, you know, those days, one after the next one after the next, they just carried on and we worked really well together.
And in the background we knew that there was a vaccine being developed not far away from this hospital.
So what we had is we had 14,000 people with hope.
We had 14,000 people who worked as a team. We had support from our partners, the charities, the universities, the other hospitals in the system.
There was mutual aid and and we had no shortage of PPE in this organisation, not throughout the whole.
Yeah, yeah. We've in fact offered mutual aid to all the other places.
So. So it was from my personal point of view, if this had happened, if COVID had happened in February 2019,
when it was a month since I'd arrived in this hospital as the CMO, I think that would have been not as effective.
My, my, my steering and my presence as a CMO would have been less effective than it was because I'd been here for a year,
just over a year, and people knew me. People knew my approach to things.
People knew and had started to understand my decision making.
And and, you know, I think that helped.
And the safety culture. Correct. Being developed. Correct. And the consistency in that.
So I think all of that meant that we were in there.
I was certainly in a much better place.
I didn't have a book in that cabinet which said Open page 65 and you will know how to manage a COVID pandemic, you know.
No. So it was it was working and teamwork.
It was about gathering and being surrounded by experts.
There is no shortage of experts in this organisation.
There's an expert in every clinical field and it was sitting with them and looking at the various guidance that came out from the centre,
looking at whether we need to adopt or adapted, looking at what what you know,
their opinion might be about any particular thing, for instance, resuscitation, etc.
But the interesting how did you feel about the guidance that you were getting?
Was it was it good on the whole? Like how flexible could you be in responding to it?
So we couldn't be flexible initially.
But I have to say that being the organisation that we are and being also part of the Shelford group, we could do a lot of influencing.
We could do a lot of what influencing by listening to our people.
So the Shelford group is a group of the ten biggest hospitals in the country and we had regular meetings.
We still do have regular meetings with the national directors.
So so that was a good forum. But the thing I was going to say was that being surrounded by experts was fantastic.
And it meant that I.
Could gather the information I needed from these experts to be able to make the holistic decision in a very logical and rational manner.
So this was a very symbiotic relationship because was they were experts in their field.
They had not necessarily made decisions for a whole huge groups of people populations.
And I had the expertise from them to be able to make that decision because I was more used to making decisions.
So so it worked really well.
And, you know, we constantly maintain communication channels, not just within the organisation, but also across Oxfordshire.
And we did lots of new things that were very important and done very well, like starting the COVID care at home service.
And this and that has been a sequential change and improvement because, you know,
we didn't in the end need those doubled and doubled bed capacity for COVID in the first wave.
Because, you know, we were we were looking at we there was a ventilator sort of it was allocation from the centre.
So depending on our beds, we were given numbers of ventilators.
But you know, we were we were looking at prospects of actually ventilating COVID patients in theatres and recovery areas,
which is not good in the end. We did use one recovery area in the second peak, but we didn't need to in the first week.
We also had we developed Oxford developed the ethics proposal, the ethics guidance for for this for COVID during call that we use during COVID,
which is certainly regional, if not national, nationally adopted.
So a lot of things happened in that time.
But I can tell you that working through the first peak was was almost thrilling, was almost coming out of it,
was almost a sort of feeling of exhilaration where you felt, well, you're never going to experience that again in your life.
And, you know, to do that in a way that has had a positive impact on people and we've done as best we can as a team to help our patients.
And our staff was was very good.
But it was the second peak which was in the which came in the December, January, February of 2021, which was far worse because people were then tired.
And and we just saw this coming and thought, I cannot believe this is happening again.
And we, you know, we just about got the people who had moved from the job market building back into the building,
but now they were all spread in the wrong place and having to say to them, were you going to have to move again?
So we were asking a lot from of of people. And, you know, it was hard.
But I think people understood the rules.
People understood why things were happening as they were.
And we did it. But I remember one one afternoon, I mean, the executives met every day led by the chief executive.
And I remember one one day on a call the executive called, I said, I am waking up at two in the morning worrying about things like oxygen.
How will you know, patient on bed six on such and such a ward, will they get the oxygen?
Because where are we going to put our next patient? And nobody said anything.
So I thought I said, you know, I pushed that.
I said, so is that not happening to anyone else?
And the chief executive said, You're very brave.
You said, what people most people I think felt and worried about but perhaps didn't want to say it.
And that was a good thing because it's demonstrating humility.
It's actually something that, you know, is best discussed.
So I literally was waking up at two in the morning worrying about it.
But but since then, obviously, it then reduced again.
And policies have changed now. And, you know, we as we sit here today, we have over 500 staff off with COVID.
But the good thing is that the severity of the disease is lower because everybody is vaccinated as far as people have been.
And the stress on the system remains because it's a different story now that, you know, we don't have the staff.
But but we are we are getting through it.
And there is a lot of pressure on urgent and emergency care and any which you might have read in the in the press.
It's across the NHS. So things haven't, haven't gone back to whatever normal was.
It's just a different healthcare system now. And that's going to take it is going to take a long time, in my opinion.
Yeah. Yeah. So you said you got through the first pandemic reasonably, as you say, on a bit of a height, but you can't have been completely unscathed.
I mean, did you did you lose colleagues during that wave?
Yes, very sadly, we lost in during that wave.
We lost full staff.
Yeah, it was it was very sad. And, you know, we obviously have to investigate.
And we carried out a thorough investigation about all of those and, you know, have communicated as far as we were allowed to with the families.
And what were you able to do with staff who, you know,
who were presumably aware that colleagues have been either very sick or in some cases, you know, sadly died?
That must have raised their own levels of anxiety about coming. Oh, yes.
I mean, there was a whole programme of risk assessments and we didn't know very much at the beginning of COVID.
But by the summer or autumn summer, I think we pretty much knew that the risks of COVID were higher in ethnic minorities and and certain kind
of predisposing conditions or comorbidities were predisposing conditions that increase their risks.
So many people moved to homeworking they some people didn't come into who were vulnerable,
identified subsequently as extremely vulnerable, clinically, didn't coming to work for a year and a half.
And you know, so there was a whole programme of all those 14,000 people being risk assessed by their line managers.
So that was done. And that was the one thing that was the best about this organisation was the staff testing.
So we started staff testing for asymptomatic staff in May, one of the first hospitals to start staff testing.
And that staff testing programme allowed us to develop infection prevention control policies because
we knew then we knew within the first three months which group of people were at highest risk.
So it wasn't the people in intensive care because they had the protective gear,
it was actually the people on general wards where there was the unfiltered admissions right at the beginning,
in January, February, when the testing of patients had not begun really unless they had some specific symptoms.
And those were the staff that were more exposed.
And yeah, and then we started to create our policies, we started to change the protection we offered based on where they were, etc.
So, so, so the testing programme really helped us and it still continues.
Of course, you know, we health care workers now do still have the facility to order the lateral flow tests from the government sites.
And so people have to report in twice a week into our into our systems, their test results.
And that will conduct testing of health care workers. That was a it was partly a research project as well.
It wasn't when initially started with the yes.
Data. Yes, well, that was in the latter. That was in the second wave.
So that was supposed to be for everybody in the first week of May 2020.
Yeah. So, so, so that, that was extraordinary.
And then we opened our vaccine hub, I think 7th of December and we that was not the Oxford vaccine.
That was the Pfizer that that was first released.
And and then, of course, we were we were the first we gave the first phase of the first AstraZeneca vaccine as well in the same up.
That was slightly later in in in early June.
Yeah, it was in January. Yeah. Yeah.
So I have the picture with my colleague Chief Nurse because I prescribed it to the first individual
and she administered it because in those days we certainly did a doctor to prescribe it.
So that was that was a very proud moment. This is an elderly lady was a gentleman.
Oh, it was a gentleman. The elderly lady was the first one to have it.
And my previous trust was just Coventry. Oh that's it.
Yeah. So, so yeah, that was amazing and extraordinary.
But I, unfortunately, I had COVID back then in December 2020 and that was very difficult.
I was unwell. But I mean, I was, I was that was before that before the vaccine.
And I, I had. I started to feel marginally better by day seven or eight, but still very, very tired and muzzy headed.
And on day ten I because in those days the isolation period was ten days.
On day ten, I was communicating with my deputy and I said, Well, how's it going?
Is everything all right? And she basically said to me that her words is sort of going slightly round and round in circles.
And I thought, Ooh, I don't know what she means by that. And I brought myself into work on day 11.
And, you know, I just thought, it's best I'm part of it.
I wanted to be part of it. I wanted to help. I wanted to relieve the pressure on colleagues who had not had a break.
And, yeah, just just dived straight back.
The chairman said, you should really be at work. You should be resting.
And I said, No, I think I've got over it and I'm going to work and continue working.
So that was nice just to plunge straight back into it and work together with colleagues.
But it was it was tough. It was tough. How long was it before you really felt you were over it?
I think probably another week at most, yeah, probably another week at most.
But, you know, so many people have now had COVID.
And the sad thing is, I don't think we can predict who gets long COVID,
but there is a lot of people and it's going to take a huge amount of resources to get these people better.
We have started we started the Long-covid Clinic Long-covid service about a year ago.
Now they've just come out with a book, That Team A Guide to Long COVID called Coping With Long COVID.
And we've done some research witch trials which showed some lung changes in the lungs of people related to long COVID, too.
So that then brings me to the extraordinary efforts and research that was led by the university and hospital teams.
We recruited the first patient to the recovery trial, which showed us that steroids had a beneficial effect.
You know what a fantastic thing. In the first wave, we didn't really know that it came towards the end of the first wave.
So and that's just one trial.
But there was just been so much enthusiasm and participation and research in this organisation that we've learned and our patients, I think,
expect and accept and expect that if they come for care to Oxford University Hospitals,
they will be involved in research because involvement in research has demonstrated really improved the quality of care we offer.
And there's evidence that research active hospitals have lower mortality rates.
So that is that is a good thing. We have to stop some of the research trials that are non-covid related because, you know,
the researchers came in to do clinical work and we really could not bring patients into hospitals in
that environment when they didn't when the research was not directly related to their treatment.
So at the start of COVID, we were doing some 2000 clinical trials.
Yes. Yes. And it's only now that we have back up to about 1600, but we are registering about 40 new trials a month now.
So, you know, it is absolutely extraordinary.
But now we have a mountain of work. We have to deal with waiting lists.
We have to deal with pressures in the front door.
And we are very obviously conscious of the health inequalities that became apparent and came to the fore during COVID.
So we are working on that agenda as well in collaboration with the other providers in the system.
So one thing I wanted to ask about was medical students because they stepped up, didn't they, to to help out?
Absolutely. Fantastic effort, you know, and it makes me quite emotional because they were in their fifth year,
finally, whatever they were, wherever they were, they all came to help.
They helped with donning and doffing in ICU areas.
They helped communicate with their relatives using iPads.
You know, they helped do the testing.
The entire testing service was supported by hepatology nurses and medical students.
It was just amazing. Absolutely. Amazing. And, you know, I and what they I think they.
Yeah. I was going to say I think that's what is it. I think they learned a lot through that.
That's an experience they'll never get. They can see I was part of this but actually what they missed was the that the peer group being together,
learning on the wards, being part of a hospital, you know, normal business and I think.
And not not getting their tutorials I think that that's not that wasn't great so I but at least two years two cohorts miss.
Miss that but you know what they're going to be fantastic doctors because above all,
they they they were able to demonstrate the basic human quality that every doctor, a nurse has and needs, which is compassion.
So has the experience of of steering the hospital or hospitals through the pandemic increased your love of what you do?
Has it has it made you yearn to go back to clinical work?
No, it has. It has. Let's say I haven't been bored.
And actually I have on reflection, I have learned a lot. I've learnt a huge amount.
I've learnt how to cope with a pandemic, I've learned how to manage a response.
I've learned how to do emergency planning.
I've learned to appreciate and work in teams more than I ever did.
And and, you know, it's been extraordinary.
Absolutely extraordinary. So you think you'll be well prepared for the next pandemic?
I don't think we could ever say such a thing because we don't know what it would be.
But I hope that as a as a nation, as a nation, we are we are better prepared for it.
Yes. I had the question here. So obviously, quality improvement has been very much your watchword.
Was it able to keep that time in mind in the course of the pandemic that, as you say, was so unpredictable?
Yeah, wave after wave and then, you know, sense of full security.
And then suddenly we've got another of. Yeah, so so we were, we were absolutely constantly focussed on it.
And I think the three things that took us through this pandemic in a successful way or you know,
let's call it effective leadership and leadership by leadership, I use it in a general sense,
leadership across the entire organisation by every person who is a leader was about the culture of the organisation,
the partnership working and a clear strategic intent.
We just released a strategic framework based on our people, our populations and our patients with compassion and excellence as our vision statement.
And we knew that that was going to be a vaccine.
And I think those three things are predominantly what took us through.
And when I say culture, I think culture involves a couple of things.
One is the relentless focus on patient and staff safety communication, consistent and clear communication.
That's very important. And, you know, looking after staff, all the risk assessments, all the preparation for staff wellbeing, I think, you know,
is extremely important and that sets the tone of the organisation and that's why we were able to get through it.
Mm hmm. I wondered about your own wellbeing. Did you did you think did you feel that because you had this very clear mission that that supported
your own wellbeing at a time when there was so much uncertainty and so many things that one could.
Yeah. Made it so well. That was a difficult time.
There were very difficult times, some very difficult times. I if you want to talk about them then.
Well you know. Yeah. In terms of in terms of worrying, as I said to you, waking up at two in the morning, it's a novel thing.
You know, I've been a CMO now for ten years. If somebody says to me, What keeps you awake at night?
The answer is nothing. Nothing keeps you awake at night. When I go to bed, I know the job I've done.
I know the job in hand. I know what's happening. It's very clear and I go to bed very happy and content.
But this kept me awake. I was waking up at two in the morning.
I've never experienced that before in my life and that meant I was very worried about something.
I was very anxious about something, and I needed to do something about it.
But the good thing was I have a lot of support.
So my husband is also a doctor and and that's family support is very important.
I have good friends and wider family who were able to, you know, just just normalise things in a different way.
They appreciated what I was doing and also being part of the team.
We came closer together as an executive team than we would ever have done.
I think. I think that was that part of the working in the pandemic and the response brought us together, um, my own wellbeing.
Therefore I think, you know, with the support I had got I've been able to look after myself and I've been looked after by my family very, very well.
And of course, you know, the chief executive was very clear that people must take their holidays, even if it means you're going to sit at home.
If you got a holiday coming up, you need to take your holidays switch off.
So so we went if there was planned leave in the calendar, we were instructed to take our planned leave and we did that and that helped a lot.
So so yes. And you know, when those when we were allowed those evenings to have up to six people in the garden, etc., I still remember, however,
freezing it was with with heaters under the chair in the garden trying to have
a socially distanced dinner for people simply because you get to sit outside,
you know, and those moments of joy are really important.
It just sort of distilled the important things in life.
And I managed to pursue the things I like doing, which is cooking, cooking, different cuisines.
I also wrote some poetry which I surprised myself, really surprised myself, but I wrote some poetry.
It's all very basic. But it was it was very inspired by the events I wrote, the poetry about gowns.
I wrote a poem about gowns. I wrote a poem about, you know, what will what will Summer look like?
I wrote that in in February or March when COVID had just started.
You know, it was very if I look back at it, it's very topical and it must have been my.
Because, you know, that was going on in the back of my head in behind all this frenzy of activity that when I was,
you know, lying in bed, I would come up with these poems.
Well, I think I hope it's forgotten. I do.
My colleagues on the project, when they listen to this, will be in touch with their very basic parts of creation picture.
Yes. What happened? Yes. Yes. Yes.
So what? When COVID is over, what do you want to do next?
What's your next aim for your role here? So my aim.
Well, you know, there's there's sort of usually the hard stuff and the soft stuff, isn't it?
So so my aim is to really increase the engagement across the piece in this organisation so that isn't whatever little there might be offer them and,
and us, you know, I want people to, people do the best, you know, 120% give their all to the patient in front of them.
And I know that that's a fact, but I want people to not just look at that,
I want people to have a sense that this is their organisation and the difference they make to the patient.
You know, what difference can they make to the organisation to make it outstanding?
It's exemplar in pockets. I want the whole thing to be outstanding.
An exemplar where people say Oxford University Hospitals is the best internationally
health care provider in the world and what are the barriers to achieving that?
And I'm partly thinking about recruitment, retention, recruitment and retention workforce is a challenge.
It's a massive challenge. And you know, I talked about our strategic framework and I talked about getting the basics right.
So it's it's about it's about all that.
It's about the pillars of great organisations are those things.
It's about engaging with your staff, it's about and that's through communication, listening to them.
It's about high qualities of research, high qualities of quality improvement in the organisation.
And it's about really good infrastructures to enable clinicians to do the work they want to do.
It's about collaborating with other centres, learning from the best, you know, without being arrogant about anything.
It's about appreciating how sometimes in a resource constrained, you know,
we don't have all the resources in the NHS when we have a constrained environment,
how do we still deliver the best we can and how can we be efficient and productive so that we
use the workforce that we have to deliver the care we have in the best possible way without,
you know, without really sort of creating a financial imbalance that is impossible to manage.
And I do think being part of an integrated care system will be helpful towards that.
With it. Oh, goodness. Yet another reorganisation that we have to deal with.
A bit of both. It is another reorganisation, but I think people are getting round to seeing that it can only be a good thing.
And I think we have to force ourselves to think differently and behave differently because it's not just about saying yes across the table,
it's actually going back to your organisation and implementing those changes.
So I think this is the last question. So has the experience of going through the pandemic changed your attitude to your
work and what has it brought up that you'd like to see change in the future?
Has it changed my attitude to work?
I think I'm probably more appreciative of different people's views and opinions, and it has reinforced the importance of working in a team.
It has also taught me how important it is to not work in a silo, not just in an office,
but in the organisation that you have to be open and honest with your partners and.
Don't. Don't worry. And don't hold back. Because when you ask for help, people are there to give you help.
I think that's really important. And supporting each other is critical.
Absolutely critical. Um, so. So, yeah.
Will it change the way I work? Well, I guess I will.
Always taking to account all of these factors. Um, and, you know, um.
I just hope that. We we are able to help people who obviously are scarred by their experiences.
It is very sad about, you know, for all those families that have lost family members to COVID at various parts of of of this pandemic.
And. You know, not not letting that happen again.
And as far as it possible, is very important. And drug drug discovery, I mean, you know, how amazing is that?
So never, never stop research. Lovely.
Thank you very much.