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Okay, So could you just start by saying your name and what your role is until Friday?

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So. So my name is Sam Foster. I'm the chief nursing officer at Oxford University Hospitals NHS Trust.

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That's great. And without going into an enormous amount of detail,

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would you like to just tell me how you first got interested in nursing and what the main kind of headlines have been in your career to date so far?

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Sure. So I never remember not wanting to be a nurse.

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So. So I'm not sure whether it all started. I mean, my mom's a children's nurse, but.

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And I spent time as a child. Most Christmases onwards.

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Because that was the way that you would be with your mum. So I just grew up around.

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Around healthcare. And it was something I always wanted to do.

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But first I purchased my first Brownie patch, and St John's Ambulance was something that I did as soon as I could as well.

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So I always wanted to do it. I undertook my nurse training.

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I worked in medical wards, I worked in intensive care units, and then I developed a real interest for training in education.

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So I had a couple of training roles.

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I had some dual roles with universities and in senior nursing posts within critical care kind of experience.

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And then I took more corporate roles. So in in always in acute provider trust.

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So I took corporate education and practice development roles, and then I took a deputy chief nurse role,

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which I did in two separate trust, one extremely highly performing trust and one extremely challenged organisation.

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So I learned an awful lot from both. And then I've been a chief nurse in two big provider trust again,

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one that was fairly challenged and was then subject to a merger by acquisition by another large trust.

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And then latterly for the last five and a half years in the you h.

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Mm hmm. And what was it that drew you to take on a more management role?

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So I think I think things have changed over the years in that actually, unlike medicine,

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you have to you had to decide quite early whether you were going to progress,

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have clinical leadership groups or more of a corporate managerial role, although,

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you know, still clinical leadership, you'll see I've got my uniform on. I've always wore my uniform.

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So, you know, I'm really proud to be a nurse.

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But latterly, you know, times have changed. I did a master's degree in advancing clinical practice.

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And actually, as I as I move on to the Nursing Midwifery Council as of next week, interestingly,

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one of the first objectives is to work with colleagues to consider regulating advanced clinical practice.

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So that's something that's really evolved over the last decade in that now there are really tangible routes to progress your career,

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continuing to be very clinical but succeed in terms of career progression clinically much more than that ever was before.

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So I often reflect that. How do I, you know, how do I have my time again now?

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I might have chosen a more clinical role because it was where my heart was.

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And I loved clinical practice. You know, going into a corporate role, I've learnt that you can influence clinical practice on a much larger scale,

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but I'm really pleased that professionally now there are two clear avenues and one of them you can

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maintain a high degree of clinical practice with some management and research opportunities as well.

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But it's there's a credible clinical career progression route in nursing and midwifery now.

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So what are just above what sounds like a very simple question. What does a chief nursing officer do?

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So I've got a slightly unique role.

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But the core chief nursing officer role is the professional leadership of nurses, midwives and allied health professionals.

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And in Oxford we have around 5000 nurses and midwives and around 2000 allied health professionals.

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So it's the board, the statutory board registrant representing the voice of nurses,

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midwives and HPC within the functions of nursing and midwifery peace.

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There's a large workforce function.

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So looking at career pathways, career progression, professional regulation, rostering, workforce planning, international recruitment.

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So there's a workforce function and I have a fantastic team who undertake all of that work.

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There is an education function,

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so we have the line management and in setting the strategy for professional education and interfaces with the AIS and the providers.

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There is the research function,

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so that's something I've been really proud of over the last few years that we've been developing capability and capacity of non-medical research.

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I hate the term non-medical, but it's what it's called. And so, so bringing demystify and bringing research to life and having nurses,

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midwives and AHP as researchers rather than assisting with research, but undertaking research into professional issues.

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I have the patient experience portfolio, so I have the complaints team who manage operationally manage our complaints responses,

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and I sign all of our complaint letters and the patient experience team that respond to our patient feedback and

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undertake quality improvement so that they are kind of the key functions as well as safeguarding adults and children.

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So the statutory responsibility for ensuring that we work in partnership with with, you know, education, police,

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other health organisations and deliver all legal responsibilities over safeguarding adults and children and indeed date staff.

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What's slightly unique to my role is I lead urgent care for Oxfordshire,

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so I work as a system leader with adult social care and other health organisations to to,

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you know, chair and oversee the development programs around improving pathways for urgent care with the ambulance service, with GPS.

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And you know, the work, a lot of work that we do there. But I also have the estates and capital and PFI portfolio.

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So the director of estates reports in to me and that function includes all of our estates trust buildings, property,

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car, parking, security, poaching, catering, cleaning, you know, the whole kind of gambit and the PFI contract.

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So in Oxford University hospitals we have three PFI contracts.

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Lots of our estate is privately financed, so we have huge contracts to manage those buildings.

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And we also subcontract a lot of our coaching, catering and security.

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And I'm also responsible for the Trust's capital programme, which is a capital allocation that we receive to buy medical equipment,

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digital equipment and manage our capital programmes and buildings.

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You'd have no idea that you would be doing that kind of thing.

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I have always said our health and safety portfolio is the board lead.

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Now that sounds a lot and it is,

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but there is a fantastic infrastructure of people that work with me on that and the reason that I have that extended portfolio.

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My chief executive, Bruno, asked me to bring a clinical synergy to that portfolio.

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So. We've we've looked at the infrastructure of how, for example, the PFI was a very contractual relationship that we had.

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You know, we have a building and we pay rent and we ask permission when we want to make changes in the building.

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You know, it was very contractual. We have moved that significantly to ensuring that the buildings meet the needs of our patients

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and ensuring that the contracts that we have for food production are patient focussed.

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Coaching services are around patients and patient experience.

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So we've developed the relationships with a much more patient focus when things go wrong.

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So for example, we had death of one of the patients from Legionella pneumonia, which is a bug found in water.

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And I think traditionally we would have had a very legal relationship with the PFI who provide the building that provide the water.

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But we we worked very closely with the with the co-driver that a patient had died

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and their family needed to understand how we were going to investigate and learn.

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So we did that together rather than contractually and people worrying about liabilities.

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We did that with the focus of the patient. There was obviously a need for the legal teams to be involved,

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but the driver and the relationship was very much with the patient at the centre of that.

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So just a couple of examples.

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But yeah, having and obviously I haven't mentioned the pandemic yet, but I will get to that, don't worry, I'm going to get you to get to it just yet.

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So I mean, I talked to make Independent and she talked about quality improvement, which was one of the things that you listed.

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And, and, and Chip, I mean, you must you and she must have arrived not very far apart.

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Is that is that right? It was at about the same time, I think it's sort of less than a year really, but that's not a long time in the world.

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So it feels like we kind of came together. We came together.

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I'd done a bit of diagnostics and we we very much came together on a leading quality together.

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And what did that entail, from your point of view? So I think it was it was very much role modelling.

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You know, they. The ambition, the accountability, the multi professional working that the human factors,

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the Kiwi and the culture so very much around just culture, you know,

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and ensuring that the direction of travel from the NHS was operationalised so that it was a culture of learning and improvement rather than blame.

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So. And and just really keeping it very alive.

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So, for example, we brought the Patient Safety Response Team Colon,

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which is a daily call of senior colleagues from every division that we have to look at all harms

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with a moderate rating or above in the last 24 hours so that we all know what's happening.

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Have we had any harm incidents? Is there anything we need to do immediately?

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Are there staff that need to support other families that need talking to?

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Do we need to make any immediate changes? So that type of thing, you know, making it very real, bringing safety huddles and having conversations,

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which we've then sort of bought into much wider corporate conversations and ones I've used in really difficult conversations,

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just what's going well, what's not going so well? Where are the opportunities to do something differently to make it better?

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And it's a framework that. Yeah.

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I've used in, you know, I've used corporately in difficult situations with partners as well as just standing in a ward saying what's going okay today,

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what's not okay, what do we need to do to make it feel safe?

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So, you know, just bringing bringing a tool kit in, really,

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so that it feels that we're together and that we all are here genuinely to make improvements for patients and staff.

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So that must have been a very good preparation when the pandemic finally arrived.

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So when I mean, this is a question I'm asking everybody. Can you remember when you first heard that something was going on in China and

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how long it was before you realised that that was going to impact on the trust?

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Well, I mean, I've been skiing and I've just come back.

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And then there was. So that was what, February. What was it?

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Yeah, February. After my pin escape came back.

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A friend of a friend had a child on a ski trip in Italy, and there was a bit of a pull that kind of sending everybody back.

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There's this pandemic thing going on and we we talked about it at work and everybody said it's not going to affect us.

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It's in China. So, you know, there was a few people saying, I'm a bit worried about this,

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but the majority of people that we were looking to saying get to worry about, it's not going to affect us.

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It's happening over there. And and my daughter's birthday is March the 20th, and by March the 20th, we were in full lockdown.

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It was its 28th. Always thought it was the 23rd. But anyway, yes, it was around that.

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That was that weekend when we had warning. You remember it was the last weekend a bit mad.

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So we were that was that was the weekend that we were all that was the last time we were going to be able to be together.

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And that's how it felt. Yeah. And had by that time had the hospital already started making provision for the

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fact that you might have an influx of patients with a severe respiratory disease.

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You we started looking at you know, that started to be lots of data requests.

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We started to bring together, you know, our command structure or response, if you like.

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But we you know, I don't remember being particularly frightened at that early stage.

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It was more, you know, we've got to count things in.

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But then our medical staff particularly were starting to get involved in more international, you know, sort of informal WhatsApp groups.

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And things were starting to come back that were saying, you know, it's this is quite real and it will impact us.

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And, you know, the modelling and the forecasting was starting to come through.

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So, yeah, we were we were starting our preparations and there was just multiple instructions coming through from NHC and I,

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and we were just starting to get ourselves together and, and mount our response, if you like.

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And I've heard the expression task force used in relation to the staffing at the hospital and that.

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What point did that come in? So we've got you know, the NHS has got an emergency preparedness response,

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you know, a systematic approach anyway, so that that kind of bottom was pushed,

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which then pushes you into the kind of control and command structure and various sub groups that need to consider what our response looks like.

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So for this, you know, we would have infection prevention, procurement, workforce, you know,

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bring our gangs together to consider what the response needs to look like and

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what the recommendations and approvals need to be up the line so that we can,

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you know, communicate, make decisions and start to respond.

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So yeah, what workforce was going to be key and, you know, some of, you know,

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workforce and activity really looking at what we were going to be able to continue to do and what we wouldn't be able to do,

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therefore, what staff that released, what the impact would be.

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So yes, it's a bit of a blur at that time, but we were just, you know,

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still working as normal, which is busy enough whilst in parallel planning a response.

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And often, you know, with major incidents and other responses where we run a command structure, it's for a very defined period.

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You know, there's been a big accident and everybody stops what they're doing for a couple of days and then we debrief.

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So we were kind of in that mode where we were all prioritising what we thought

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the response might need to look like whilst carrying on with the day job.

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Because the day job is, you know, at that point the day job was continuing.

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And when did that change? At some point, obviously, elective procedures.

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But I mean, I remember I remember we were asked to be a designated.

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So we have a a regional responsibility around infectious diseases.

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We have an infectious diseases unit, but we're not one of the national you know, we're a more spoke to hub.

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So I remember the first cases coming into the you know, being going on the news in the UK.

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And I remember as they were, those units were starting to fear there was a kind of your next Oxford discussion.

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And if you know how it went, it went from first case in UK to ten, 20, 34.

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You know, suddenly it overwhelmed the capacity of the specialist infectious diseases units.

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And we initially started with our infectious diseases ward of having that as a COVID ward.

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And then, you know, we were in touch with and learning lots from Italy predominantly.

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And then we had to start preparing our, you know, these these patients were deteriorating rapidly.

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So very rapidly the critical care response needed to kick in.

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And we were having our conversations about. We have five intensive care units, one Nero, one cardiac, one children's,

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one adult and another adult and another side which predominately looks after our cancer services.

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And we were looking at scaling up. We were then told we needed to double and double again our capacity.

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And, and those are the days I remember very vividly because I'm in intensive care.

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And so I took quite a lead role in working through how we were going to do that and had probably some of the most difficult

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conversations that I've ever had with colleagues around what we were being asked to do and what we were then not going to do.

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So for example, as a tertiary cardiac centre to sit with.

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Our experts and talk through the likelihood of doubling and doubling again in the first instance.

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So crowding, physically crowding departments and doubling nursing capacity remits because intensive care nursing is a 1 to 1 profession.

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So to be thinking through how would we go from, you know,

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experts to wipe pets with the same staff with this unknown disease which which had a high mortality rate and.

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You know, with PPE orders filling up, um, and not then doing the cardiac work.

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And the ethics around admitting COVID patients with a high mortality versus continuing with

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our cardiac work with young patients with a chance of survival higher than the you know,

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they were really difficult times. So there was lots of, you know, lots of differing responses.

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People were very frightened. People were very cross. You know, some people found it personally very frightening.

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People's home circumstances impacted on, you know, the vulnerabilities of their own families, the impact on their children.

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You know, there was so much to contend with, wasn't there? You know, we I had I have three children and Keyworkers school was available to me.

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And I used that. And I mean my husband's military.

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So we kind of saw this as a, you know, the command and control space, and this was the duty that we had.

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So we made provision for parents to move up and key workers school so that we could be,

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you know, pretty much deployed back to work to to do this leadership piece.

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So for a short time at the beginning once once we got all right you set up,

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the national team asked me whether I would be part of a team to scope a potential south

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east Nightingale centre because by this time they were caring for patients in the streets.

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If you remember, in Italy, the hospitals had filled up,

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so they built and were building the Nightingale in the Excel at London and the modelling appeared to look like we needed more.

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So I was seconded from Oxford for three weeks in the end for a lot longer, but three weeks away from home with.

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A group of other NHS colleagues who'd been asked to join,

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and I was asked on the Thursday night and by the Friday morning I was at Heathrow Airport with

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the military and with these colleagues scoping Terminal five for a potential nightingale.

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I saw that, Yes, yes. So we scoped that and we went back to our hangar and there were some calls with senior

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government officials and they couldn't negotiate the right terms and conditions.

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So we were then taken in a convoy to. To a airport, to Farnborough Airport, where we stayed for three weeks and progressed.

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Operationalising, a nightingale south east, and it was felt to be the right location.

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They had got the Farnborough Air Show planned. They had hotels, they had accommodation, they had an aeroplane hangar,

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and and we worked up with the military and we went and visited the Nightingale Centre of

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Excellence and we worked for several weeks to plan to open a nightingale in Farnborough Airport.

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And and how I mean, over the course I've always had a question about the Nightingale that a lot of people have is that.

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There are only so many nurses in the country who are all deployed in hospitals and only so many ventilators which are all deployed in hospitals.

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So how were they going to staff and equip the Nightingale? So I think we've got to remember what was known at the time.

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And you know what? The do nothing was not an option.

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You know, what was known at the time was there was this escalating demand for ventilated beds.

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And we had colleagues in Europe with patients on the street.

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So being behind that curve, what what what were the options?

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Now, when. So I worked in intensive care as a nurse during COVID as well.

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So, you know, the the end of that story was that the modelling then suddenly dramatically changed and the whole thing got pulled.

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And I returned to Oxford, and during that time I worked in intensive care four day a week actually, for sanity.

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I really that you went to intensive care for a rest.

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What would you say? Well, I went for multiple reasons, being being an executive during the pandemic and.

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Running a gold command. It's really difficult and two of my colleagues were very unwell with COVID and off sick,

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so not all the team were fit to work and, you know, making decisions.

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You know, and in a pandemic around clinical care staff, safety is really stressful.

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And being an ICU nurse, it was a great opportunity for me to go and work for a long day, week one, to really understand what it was like.

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But two, it gave me space to.

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Work clinically and just think through what we were doing. And it gave me a purpose to.

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You know, to be contributing appropriately as a nurse.

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There was there's I came so much more than any of them did, I think, because of my rusty skills.

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But, um, but I could test we took we had to take so many risks and I could test it as a nurse and I could test it in the coffee room.

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So we couldn't talk very much because if you remember, we were pretty masked up.

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Um, but when we, when we had our breaks, we could, we could talk about what was worrying people,

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the decisions that I'd been part of making, it got the impact of those.

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So it was just a perfect opportunity to test things, to feel it.

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Um, yeah. And to just. Just think about things and not be in that gold command for new pieces of information have come through from the government.

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You've got to do the return an hour ago, you know, type stuff.

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It just just made me stop and think about what was real, you know, what the focus was, which was predominantly about critical care capacity.

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And so. And that was with me.

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Did your capacity turn out to be adequate for the demand that was placed on you in this area?

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No, we had we had some really, really difficult times when we were.

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You know that we did double and triple again. So and the other difficulty was we were spread across different locations.

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So, you know, at our peak, we were we were, you know, in an extreme is really.

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But back to the how many nurses we moved to team nursing.

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So what's interesting about all COVID patients is they all had the same management plan.

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So that enables you to do something differently.

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So if I was in intensive care pre-COVID looking after a patient, you know, it might be a patient who needed a range of things due to their conditions.

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And the patient in the next bed might have very different requirements during COVID.

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We had. 20 or 30 people that had the same management plan, the same drug regime, the same the same needs.

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So actually it became very task orientated, very systematic.

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What we did at ten, 12 to 4, six and eight. So we were able to form teams and draft in teams of nurses that had never worked

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in intensive care and work in what we called nurse one a nurse two teams.

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So Nurse one was an intensive care trained nurse and nurse two with a nurse who could perform other nursing duties.

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So important things eye care, mouth care, catheter care, feeding drugs.

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So actually, nasties could do that.

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Nurse One would do the complex ventilation changes. We also brought in Proning team.

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So if you remember, we used to put we might not do it, but we used to ventilate these on their tummies.

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Yes. And and then it takes about six or eight people to to turn up a patient onto

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that time because of the complexity of everything that's attached to them.

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So. We started to get teams of people,

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so we stopped doing elective orthopaedic surgery and our orthopaedic doctors and other

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colleagues became Proning teams and they would come and that job was to turn ten patients over.

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You know, because it takes about it, it could take 40 minutes.

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But if a Proning team was turning your patient and you're the ICU nurse, you might take a block as before per person medication, you know,

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talk to the family and you come back in the patient's patient and then you carry on so that the tasks were delegated out to the appropriate teams.

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We had family liaison teams, we had medical students in our donning and doffing shirts to support us with putting our kit on and taking a kit off.

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So, you know, the capacity of intensive care,

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you had to really think what is the what's the delivery of care that really needs an ICU nurse and doctor and and who can support us with the rest?

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And that's where the teams of, you know, reservists and volunteers and where we you know, we we closed several wards,

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our orthopaedic centre and brought the whole team across as one which was important because they came across as one,

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which gave them a lot of psychological safety, but they then expanded non-invasive ventilation wards in medicine.

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So cardiac, you know, our non-invasive ventilation capacity was probably times five of what it was commissioned for.

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And so so yeah, so we looked very much at Pathway task orientation, the focus of what an expert had to do,

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the rest of the care and who that kid who needed training, where it could be delegated to and and just.

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Carried on and learned and shared and had also WhatsApp groups and shared things.

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And. And then you'd come in the next day and someone said, I've just had another idea and another,

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you know, I mean, you know, the talent in the NHS and the drive to make things better.

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And the innovation was, was immense. And of course most of the bureaucracy was, was gone as well.

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And then, you know, you could liken it to the vaccine hubs because we set up Hub.

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I gave the first AstraZeneca out of trial drug in the UK in the world.

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I was going to come to that because if you think about, you know, in my head professionally, I couldn't cope.

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It's not nurse who's giving injections, but you know, you've seen it.

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We would have never rolled out the vaccine programme. All of the people in the country that that stepped up.

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And what happened there is that the statutory requirement of our medicines was delivered by nurses,

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but the actual injection was delivered by air hostesses and all sorts of different,

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you know, all sorts of people that came forward and said, I want to be a volunteer.

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Whether they directed in the car park or gave the vaccine,

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that that clinical piece was looked at the top of licence piece that needs a nurse to assess a patient, prepare a medication, draw it up.

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The actual giving of the vaccine was not, you know, not deemed to be requiring a registrant and the productivity gain by splitting that into,

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you know, doubled the capacity to be able to deliver the vaccine by bringing two people in to do one task.

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So that's a similar thing in the ICU. You know, and what's such a shift in the ICU would be, what, 12 hours?

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Yeah. Yeah. Mm hmm. And what we did, there was a lot of burn out.

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And it was really uncomfortable wearing that cap.

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And what we did is we did the nurse one and two very early on, and we drafted in a significant amount of reservists and non-icu people.

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And we did 2 hours on, 2 hours off, which sounds like a lot, but you're 2 hours off by the time you go off to care.

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It took that was ten, 15 minutes, got a drink,

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and then you would do your documentation work and then you would go to the medicine hub

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with your shopping list for the medicines that you needed to take back in with you.

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So it was 2 hours chilling out and a coffee, but it was time.

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So I'm without the time to have a conversation face to face, without a mask on with the medical teams,

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time to update the family liaison team that were going to ring the relatives for you on what was happening.

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Time to collect the equipment you needed to take the cleaning equipment you needed to

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take back into ICU with you for the the next 2 hours of care for your patient at time.

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Time to have a look at what the donations of the day had been in terms of food and drink and pizzas.

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And yeah, and so we did a two on two off and then talk to each other and not every where in the country did that.

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But we found that that. Felt quite a healthy way of.

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Of nursing. Hmm. And do you think has anybody looked at rates of burnout among nurses?

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And do you think that was that was a. But they have that.

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They have an A. I think some of us are a little worried about that.

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There was some there was a lot of research starting at the time and.

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We have a psychological medicine service in the air. They are truly phenomenal.

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They're integrated into many of our clinical services.

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But during COVID, they took up a pivotal role in the support for staff psych med support for staff.

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So when we were looking at some of the research opportunities that were coming about,

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we went to them for some expertise and they were they were quite worried about some

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of the claims around PTSD and burnout being quite extreme and unlikely in that.

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I remember one of them said to me, if you had PTSD, you wouldn't be able to drive to the hospital.

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So you can't function as an ICU nurse with PTSD. You can't be in a bed space with PTSD.

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About COVID looking after a patient competently. It's just not possible.

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Was one of their views to me. So we did.

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We just focussed on the wellbeing support based on what the psychological medicine team were hearing and seeing.

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Now, that doesn't mean that there weren't people that, you know, whose wellbeing wasn't affected.

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So there was individual support for individuals,

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but there was a core wellbeing offer that was advised by our psych met team that we felt and we had feedback,

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you know, was was absolutely critical to the wellbeing of staff.

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And what did that consist of? Apart from the 2 hours, one and 2 hours of shift patterns.

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So subtle things like safety, huddles, debriefing before we left the unit from training.

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We've got a small Ministry of Defence Hospital unit with us in Oxford.

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So we looked at how the military were supporting their staff when they go through.

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You know, difficult operations, difficult times.

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So we learned a lot from the military.

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So there was, you know, individual offers on the day, offers after event offers, you know, because it was it was just tailored to what was required.

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And then post-COVID, there was more offers in response to, you know, how people were feeling.

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So there was a whole suite, a whole toolbox that they had dependent on what was facing them.

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You know, So, for example, we we cared for our own colleagues in our own unit.

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So, you know, there was a there was a wrap around for.

331
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Four colleagues who were very close to her were, you know, just just all of the the emotions that went with that.

332
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Um. You know, we we livestreamed one of our nurses funerals and we all attended that in the lecture theatre.

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And we had lots of support, just, you know, so, so, so many examples.

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We have this amazing book called Beyond Words, which is just a picture book of everything that happened.

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So, you know, you'd be here all night if I gave you one of the examples, but lots of site support for,

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you know, to support different levels of stuff, just dependent on the scenarios that were happening then.

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And also lots of site med support for our relatives.

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How could we support the fact that we weren't allowing visiting? How could we support the fact that.

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People's loved ones were unconscious with us and they might never see them again.

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So lots of work around how we could support video calls.

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Just amazing, you know, how we could liaise with relatives so that they knew that we cared.

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You know, amazing bed space, bunting of photographs and pictures.

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And like I say, when you had your 2 hours off, you would update the liaison team so that they could phone.

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And then often when you had your break, they might say.

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The relatives have sent in an iPod with a playlist or or they would say they've sent an iPhone and can went when a patient was more awake.

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And can you show them some videos from their family? And we had video conferences with families in Australia.

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You know, just there was a lot about wellbeing and psychological support for patients and relatives.

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It was amazing. Well, that's that's probably the most detailed account I've had so far of what it was really like in intensive care.

349
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But you also mentioned research. So I mean, I've talked to loads of people who are,

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but most clinician researchers and research even researchers who didn't have clinical

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qualifications and looking at things like antibody levels of T cells and all that kind of thing.

352
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And so from your perspective, how did you participate in the research that was going on to look at the, I suppose,

353
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the evolution of the disease and try to understand it as a as a new a new phenomenon where as a teaching hospital,

354
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you know, the research is active in all of our clinical settings.

355
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So there were a number of trials going on in the intensive care unit in our respiratory unit.

356
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So so it would be a matter you know, it was it's part of our clinical work.

357
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So, you know, it may well be that there was a sample that you had, you know, there would be a research protocol and when you cared for a patient,

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part of their care would include a sample or a piece of data that was required or I mean,

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the research was so life during that time because of the need and the removal of lots of bureaucracy,

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that there was you know, there was lots of communications.

361
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So if I think about the clinical lead for intensive care, had a blog that he was writing and updating us continuously and you know,

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you might read it on one day and then the next day it would say the latest evidence is telling us,

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you know, to phone patients for 6 hours, not for, you know, it would just be so life.

364
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There would be a you would go in for the shift and the handover would say, we're now using X drug.

365
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Can you all read the protocol and sign it? You know, so it was it was just a very.

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Rapid, exciting time, full of hope that new things were becoming evident.

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And, you know, and of course, the vaccine was the absolute pinnacle of something is something's going to.

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Stop this from continuing. So yeah, it's a very research active organisation, as you know.

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So from a clinical perspective it was just being part of whatever clinical care the patients needed because the best evidence was saying this.

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And so how did you come to be the first person to deliver a coded chaddock?

371
00:42:27,690 --> 00:42:35,820
I cannot remember the whole of it. But the Oxford vaccine in in January 4th, I think it was 2020.

372
00:42:35,830 --> 00:42:38,940
Yes. Yes. So we obviously had.

373
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The VAX before AstraZeneca was the name got out of my head.

374
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What was the first vaccine? Oh, the Pfizer five.

375
00:42:50,790 --> 00:42:54,140
Yes, there was Pfizer in December, I think was about 30.

376
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So in December, we, you know.

377
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Gold Command was we have now got authorisation in the UK to deliver Pfizer.

378
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So we're asking all hospitals to set up vaccine hubs.

379
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We're going to vaccinate frontline staff that allow for, you know, action.

380
00:43:16,940 --> 00:43:25,940
Who's setting up the vaccine hub? So so obviously we then start scoping everything from the space.

381
00:43:26,420 --> 00:43:31,190
So we have a quick taskforce. You know, we need pharmacy, we need procurement, we need nurses, we need.

382
00:43:32,390 --> 00:43:35,690
So how do you operationalise we don't have a vaccine hub.

383
00:43:35,960 --> 00:43:42,260
We need one. What do we need for that? Everything from, you know, chairs and computer systems and booking systems, comms.

384
00:43:42,860 --> 00:43:47,030
So, you know, we responded by you got there, everybody, you work out the job in hand,

385
00:43:47,030 --> 00:43:54,740
we split it up, and then we find a space and then we pop up a vaccine hub and.

386
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And. Had received a delivery.

387
00:44:02,040 --> 00:44:06,690
I called it like the Coca-Cola advert was like, Pfizer is coming, you know, we knew.

388
00:44:07,620 --> 00:44:12,929
Yeah. So we set we set it up. We, we put a quick training programme on.

389
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It was a really complicated drug to prepare and give.

390
00:44:17,340 --> 00:44:28,620
So I remember myself and the chief pharmacist making a video of how to prepare the drug so that we could use that as a training aid.

391
00:44:28,800 --> 00:44:30,930
And it was really complicated.

392
00:44:30,930 --> 00:44:38,210
You had, you know, you had 2.4 of a meal into the vial and then you had to rotate it X amount of times and then you had that.

393
00:44:38,820 --> 00:44:42,149
So we made a video and and, you know,

394
00:44:42,150 --> 00:44:49,799
we got the got the nurses in and we waster patient group directive for governance through our Medicines Management committee.

395
00:44:49,800 --> 00:44:51,370
And, you know, and you know,

396
00:44:51,390 --> 00:44:59,580
we had a log of things we had to do and we progressed through that and we set up a vaccine hub and it was an amazing place to work.

397
00:44:59,580 --> 00:45:01,170
I spent a lot of time working in that.

398
00:45:02,130 --> 00:45:10,520
So I and we opened our vaccine hub as part of a system for health and social care quality service for there was a kind of a.

399
00:45:12,280 --> 00:45:18,340
Prioritisation list for, you know, COVID exposed clinical staff initially,

400
00:45:19,960 --> 00:45:24,580
and we vaccinate colleagues from care homes, social workers, ambulance crews.

401
00:45:25,480 --> 00:45:31,360
So we set up this busing vaccine hub that was just packed from day to night.

402
00:45:31,780 --> 00:45:37,329
And it was amazing because it was still happening and there was still the pandemic running,

403
00:45:37,330 --> 00:45:45,370
but it was this passive somewhere where people were just dying to come and get protected and there was hope.

404
00:45:45,880 --> 00:45:49,690
And, you know, you'd spend not very long with people,

405
00:45:49,690 --> 00:45:56,679
but you just interacted with 50 to 80 people personally a day to consent them and get their vaccine.

406
00:45:56,680 --> 00:46:01,360
And they all had a story about what it meant to them. And it was just amazing.

407
00:46:01,870 --> 00:46:12,829
So we did the Pfizer and then. Obviously, AstraZeneca was developed in Oxford and the vaccine hub was in a building called OCTA,

408
00:46:12,830 --> 00:46:19,340
which is opposite to where Andy Pollard and colleagues developed the vaccine.

409
00:46:19,340 --> 00:46:25,170
And yeah, they. They they said, would you give the first.

410
00:46:26,010 --> 00:46:30,809
They asked me the night before and said, would you give the first one? You know, I'd been working in the hub.

411
00:46:30,810 --> 00:46:34,800
I've given hundreds and hundreds of vaccines. They said, We want you to give our first one.

412
00:46:35,790 --> 00:46:41,070
And it's very excited about that. And then I was like, this kind of media.

413
00:46:41,120 --> 00:46:45,540
I mean, they were quite savvy about media all the way through.

414
00:46:45,540 --> 00:46:52,290
I think when they the vaccine development team, they knew they wanted to make this very much a public thing.

415
00:46:52,830 --> 00:46:56,010
Was that did you have a lot of exposure to the media personally?

416
00:46:58,020 --> 00:47:06,390
Absolutely massive. And I just hadn't thought about it because in the vial you could give 8 to 10 doses.

417
00:47:06,900 --> 00:47:13,530
And once you've opened your vial, I mean, they were precious vials. You know, you were responsible for that vial and you got you signed it out.

418
00:47:13,890 --> 00:47:16,890
You signed it back in. You had to say how many doses you got out.

419
00:47:16,920 --> 00:47:22,770
It was so regulated. So I gave I gave the vaccine to the.

420
00:47:23,190 --> 00:47:26,639
So we were asked to find a couple of patients that were happy to be in the media.

421
00:47:26,640 --> 00:47:32,190
And so I gave a vaccine to. Patient called Brian.

422
00:47:32,190 --> 00:47:35,340
And then I gave I vaccinated Andy Pollard.

423
00:47:36,780 --> 00:47:41,390
And there was some there was one pressed team in the vaccine hub with us.

424
00:47:41,820 --> 00:47:51,540
And then I thought, Oh, that's that them. So I, I got my tray and I started to wander back to the, the base to finish using my vial.

425
00:47:51,540 --> 00:47:56,330
And the comms team said, no you need to come outside now to do the press. And I said, What press?

426
00:47:56,340 --> 00:47:59,819
I think I thought we'd done it. And they said, No, no, they're all outside.

427
00:47:59,820 --> 00:48:03,780
And I was like, No, I need to. I need to use my vial. I've got to use my vial.

428
00:48:04,350 --> 00:48:08,390
And and they said, No, no, you've got to come outside.

429
00:48:08,400 --> 00:48:11,610
So I had to sign my violin to another nurse to give.

430
00:48:12,210 --> 00:48:15,420
And it was a freezing cold day. And I didn't have a cardigan to remember.

431
00:48:15,420 --> 00:48:18,629
And I went outside and there literally the world's media outside,

432
00:48:18,630 --> 00:48:25,350
and they gave me a piece of paper and they said Sky News and then BBC and then Lorraine.

433
00:48:25,350 --> 00:48:30,540
And I just just couldn't believe it. It was it was surreal.

434
00:48:31,800 --> 00:48:36,480
So I did. You done? Had you done any media before or just things like local, local radio?

435
00:48:37,560 --> 00:48:41,700
See, Oxford, of course.

436
00:48:42,150 --> 00:48:46,889
You know, it wasn't a controversial. It was. How did it feel to give the first vaccine?

437
00:48:46,890 --> 00:48:49,240
How does it feel? It wasn't anything.

438
00:48:49,860 --> 00:48:55,259
And of course, I could just tell how I felt because I'd just given the first, you know, it was really proud to have given the first one.

439
00:48:55,260 --> 00:49:00,100
I was really proud to be an Oxford chief nurse working alongside, you know,

440
00:49:00,150 --> 00:49:04,680
because because I think people think that the researchers just sit in the labs.

441
00:49:04,710 --> 00:49:08,970
But of course, the researchers are doctors and nurses in our hospital, so.

442
00:49:09,930 --> 00:49:13,920
Yes, I was really proud to share it with them. It was a little bit overwhelming.

443
00:49:15,540 --> 00:49:18,929
They didn't you know, they didn't try and trip me up. So it was actually fine.

444
00:49:18,930 --> 00:49:28,889
I was just freezing cold. I didn't anticipate I didn't tell anybody because I didn't tell any of my friends because I didn't have any time.

445
00:49:28,890 --> 00:49:32,140
But of course, all of my friends are just at home bored, watching TV.

446
00:49:32,160 --> 00:49:36,959
You know, nobody was at work, were they? So my phone was just going ballistic.

447
00:49:36,960 --> 00:49:40,780
And my brother said, I've just seen you on telly. They're not joking.

448
00:49:40,780 --> 00:49:44,819
So I've just seen your backside on the television because I was going to stand and give the injection.

449
00:49:44,820 --> 00:49:48,030
And then the patient said to me, I've got a renal fistula, you can't vaccinate that arm.

450
00:49:48,030 --> 00:49:55,980
So I had to turn round. So the, the picture was the back end of me rather than lots of groups about that.

451
00:49:56,790 --> 00:49:59,249
Yeah. I was really proud to give it.

452
00:49:59,250 --> 00:50:08,459
And it was, it was a time when I never forget the first day we opened the hub, our respiratory team came en masse.

453
00:50:08,460 --> 00:50:14,750
It was so loud. They were so they were they'd been so frightened about what they were taking home.

454
00:50:14,760 --> 00:50:20,900
You know, I remember we used to shower, you know, you literally just wanted to scrub yourself in case you took something home.

455
00:50:21,210 --> 00:50:27,240
So I particularly member of the respiratory team coming up for their vaccines and the atmosphere was just amazing.

456
00:50:27,240 --> 00:50:31,800
So, yeah, so there was you know, there's plenty to say because it was a really amazing time.

457
00:50:32,550 --> 00:50:38,250
When and how threatened did you personally feel by the possibility of catching the virus?

458
00:50:42,660 --> 00:50:45,870
I think initially I found it really frightening.

459
00:50:47,220 --> 00:50:51,870
But I think part of overcoming that was working clinically, you know, and.

460
00:50:54,460 --> 00:50:59,650
How can I how can I send out memos about which mask we're now going to wear?

461
00:50:59,890 --> 00:51:09,330
If I wasn't prepared to put one on because when I walked into work, you know, I was walking past the doors that said Danger do not enter covered area.

462
00:51:09,340 --> 00:51:15,300
So when walking through the corridors. As it as a nurse,

463
00:51:15,660 --> 00:51:18,840
I've got to be able to put that mask on and be behind the other side of the doors

464
00:51:18,840 --> 00:51:22,919
to be able to send a note to say because the mask wearing was a rapid change.

465
00:51:22,920 --> 00:51:30,410
And what we did as an organisation in our decision making is went ahead of national guidance to further protect,

466
00:51:30,420 --> 00:51:34,110
you know, in anticipation for what was about to come. So.

467
00:51:36,060 --> 00:51:46,200
We we had a procurement so that were probably life saving for us actually, because we never run out of anything.

468
00:51:46,590 --> 00:51:49,500
And we provided mutual aid for many colleagues.

469
00:51:49,950 --> 00:51:59,700
So I can recall being on conference calls at the weekend where we counted gowns because colleagues were going to run out of gowns over the weekend

470
00:52:00,420 --> 00:52:08,580
and we needed to give mutual aid to other health and social care providers because they didn't have sufficient PPE to get them through the weekend.

471
00:52:09,360 --> 00:52:16,349
And we never faced that. I remember in the coffee when one day someone telling me that her colleague worked in another

472
00:52:16,350 --> 00:52:21,140
hospital and they were they were hanging up their PPE for their rest breaks and putting it back on.

473
00:52:22,830 --> 00:52:27,370
And we were doffing in a shed everything we had on leaving.

474
00:52:28,090 --> 00:52:36,070
We built these plywood sheds out of the back of the ICU. And you'd go through a door and off your kit, and then you'd come back in with fresh kit on.

475
00:52:36,130 --> 00:52:41,380
We never, ever felt that. We never worried that there wasn't going to be PPE for us.

476
00:52:41,980 --> 00:52:46,890
Was that disposable or was it laundered? It was all disposable initially.

477
00:52:46,900 --> 00:52:48,970
And then we moved to washable gowns.

478
00:52:49,720 --> 00:53:00,130
We also invested early on in reusable FFP, so we had the gas mask, so they were personal use that were tested to us and had our names on them.

479
00:53:00,790 --> 00:53:04,750
So we moved to add to those big black masks.

480
00:53:05,050 --> 00:53:08,940
But that was another sense of safety that they've been tested to us.

481
00:53:08,950 --> 00:53:13,400
They were us. They were our responsibility to to wipe clean and then put back on.

482
00:53:13,780 --> 00:53:15,250
There was a confidence in the.

483
00:53:16,900 --> 00:53:24,040
So in some sense, I mean, I think somebody else's estimate this to me that because there was so much care taken and you had all the PPE,

484
00:53:24,280 --> 00:53:27,370
you were possibly safer in the hospital than you might be going to Sainsburys.

485
00:53:28,210 --> 00:53:31,620
Definitely. Yeah, That's how it felt in the air.

486
00:53:31,770 --> 00:53:35,480
Yeah. And yet.

487
00:53:35,530 --> 00:53:41,200
Okay, I think we might take ten, 10 minutes and.

488
00:53:44,100 --> 00:53:51,450
Yeah. So, I mean, we got to we got through the I suppose we've got through the first two waves and we've got to, we've got to the vaccination.

489
00:53:51,460 --> 00:53:55,410
So how did things pan out in the subsequent.

490
00:53:55,920 --> 00:54:02,090
Well it's two years really isn't it. 2021 and 2022 when there was still COVID around.

491
00:54:02,100 --> 00:54:06,959
But the vaccinate, the fact that we had a vaccine programme meant that the number of cases coming into

492
00:54:06,960 --> 00:54:11,610
hospital and or the number of very severely ill people was presumably in decline.

493
00:54:12,840 --> 00:54:16,620
Did that give some breathing space to the to the nursing workforce?

494
00:54:17,910 --> 00:54:25,170
Well, I mean, I think the other thing to add about the vaccine was, you know, there were obviously quite polarised views,

495
00:54:25,170 --> 00:54:34,350
so we had quite a bit of work to do as executives around wellbeing of staff who didn't want to have the vaccine.

496
00:54:34,350 --> 00:54:38,330
And you'll remember there was a consultation about mandating the vaccine for healthcare workers.

497
00:54:38,490 --> 00:54:42,330
Oh yes, which caused terrible distress to colleagues.

498
00:54:42,330 --> 00:54:50,729
So we spent a lot of time briefings and listening events and hearing staff and

499
00:54:50,730 --> 00:54:55,710
working through the preparation for what we were going to do if it was mandated,

500
00:54:55,920 --> 00:55:02,280
which would be a government mandate, but obviously was felt as a trust deliverable.

501
00:55:02,280 --> 00:55:10,680
So there was lots of lots and lots of distress by staff who didn't want the vaccine and were fear fearing losing their jobs.

502
00:55:10,690 --> 00:55:18,600
So that was a difficult time as well, working out How many of them or what percentage would you say were unwilling to be vaccinated.

503
00:55:20,980 --> 00:55:25,780
Well, we didn't ever get to measure it because it wasn't mandated.

504
00:55:27,010 --> 00:55:35,510
So. But there was there was a large corps of staff who'd written anonymously as well as joined.

505
00:55:36,130 --> 00:55:41,300
You know, when we put on listening events, there would be large groups of staff joining that very,

506
00:55:41,300 --> 00:55:50,510
very angry with us for, you know, for implementing the process, for preparation for mandatory vaccination.

507
00:55:51,350 --> 00:55:56,060
So it was not to small voices, it was large cohorts of staff.

508
00:55:57,530 --> 00:56:03,589
So that was difficult. Yes, I can imagine. And, you know, and, you know, I may be naive.

509
00:56:03,590 --> 00:56:11,030
I didn't think that giving one of the first vaccines would mean that people sent me horrible messages.

510
00:56:11,090 --> 00:56:15,500
So that was that. That was interesting. Not for too long, but.

511
00:56:17,070 --> 00:56:24,480
You know, it was a bit frightening. There was some anti-vax work that went on and there were some frightening times for colleagues in other hospitals.

512
00:56:24,490 --> 00:56:31,680
So I just hadn't thought that through. But there was yeah, I received some pretty unpleasant messages.

513
00:56:34,190 --> 00:56:37,220
Yes. And how did you feel about that outlay for the.

514
00:56:38,560 --> 00:56:42,790
I'm quite vulnerable. Yeah, just.

515
00:56:43,240 --> 00:56:47,950
Yeah, just a bit vulnerable and maybe just. Just a bit naive.

516
00:56:50,210 --> 00:56:53,640
I wouldn't have done anything different. I wasn't prepared for it. And.

517
00:56:55,480 --> 00:56:59,890
But were you aware you supported it too, to cope with that?

518
00:57:00,640 --> 00:57:08,049
Yeah. I mean, you know, the executive where we just spent our whole time, you know, we were never apart from each other.

519
00:57:08,050 --> 00:57:15,270
So, you know, we, we, there was plenty of difficult decisions that we made, but we just continuously supported each other.

520
00:57:15,280 --> 00:57:19,780
You know, it was really important not to have groupthink. We had some really difficult decisions to make.

521
00:57:19,780 --> 00:57:27,909
Some of them took longer than others. So it was part of the, you know, psychological safety that we had together.

522
00:57:27,910 --> 00:57:32,979
It was you know, it was another thing that happened, you know, that we discussed.

523
00:57:32,980 --> 00:57:36,730
So wasn't just me and I obviously as a trust, we promoted it.

524
00:57:36,730 --> 00:57:42,430
Our executive team promoted it. I gave the first vaccine and then the mandating of it.

525
00:57:42,430 --> 00:57:49,239
You know, it was a collective. I never felt, you know, as an individual, they were always unitary discussions and decisions that we were making.

526
00:57:49,240 --> 00:57:54,760
So. Mm. So now you're about to move on to the Nursing and Midwifery Council.

527
00:57:55,300 --> 00:58:02,920
Are there any particular lessons that you think you've taken from having such an important leadership

528
00:58:02,920 --> 00:58:10,300
role at a time of national emergency that that will inform what you choose to do in your new role?

529
00:58:12,100 --> 00:58:16,470
And what is. Sorry, What is your name? Actually. What's what's your what's the title?

530
00:58:17,080 --> 00:58:20,590
My role is the registered nurse on the board of the NMC.

531
00:58:20,710 --> 00:58:31,230
I see. So the key objectives are around, you know, revision of the NMC code,

532
00:58:31,620 --> 00:58:40,900
revision of and review of the process for revalidation, the responsibility of erm previous education standards.

533
00:58:41,910 --> 00:58:51,000
They work around the potential to progress, advance clinical practice onto the register as a separate part, you know, whole range of things.

534
00:58:51,990 --> 00:59:00,330
But if I, if I pick out the most pressing issue for the NMC at the moment is the backlog of registrants in fitness to practice process,

535
00:59:00,330 --> 00:59:10,200
which is in excess of 5000, 75% of those registrants won't progress on to a formal process.

536
00:59:10,770 --> 00:59:16,440
So is that because they've made some mistake or because they've taken time out to have a family or something like that?

537
00:59:17,230 --> 00:59:23,250
No, no, no. They've it will be they've been referred by either a member of the public or their employer.

538
00:59:23,730 --> 00:59:32,220
Right. Under an allegation of their fitness to practice not being, you know, them not being fit to practice, therefore be on the register.

539
00:59:32,700 --> 00:59:41,490
So it's it's a it's a devastating action because the worst case scenario is that you're struck off and you cannot.

540
00:59:42,460 --> 00:59:52,160
Cannot work as a nurse again. And I think the biggest learning for me has been around the just culture,

541
00:59:52,160 --> 00:59:58,879
compassionate leadership space and, you know, all of the work done into compassionate leadership.

542
00:59:58,880 --> 01:00:06,400
It's it's a hard it's hard. You know, consequences to not delivering compassionate leadership.

543
01:00:06,880 --> 01:00:09,880
You know, you'll know about the work around incivility saves lives.

544
01:00:10,750 --> 01:00:14,950
So there's a significant patient and staff safety impact to.

545
01:00:17,170 --> 01:00:22,150
Compassionate leadership being delivered. So I think that.

546
01:00:24,330 --> 01:00:29,280
That's the style that I want to continue.

547
01:00:30,120 --> 01:00:37,470
It's a smaller team, so I think I'll have, you know, I'm pretty spread out and I look forward to working with a smaller team of people that I can.

548
01:00:39,090 --> 01:00:51,420
Grasp a bit more neatly and to enable us to come together to ensure that the culture of the regulated regulator is compassionate.

549
01:00:52,320 --> 01:00:59,610
My friend has a saying. Compassionate in your delivery, stealth in your execution, but compassionate in your delivery.

550
01:00:59,610 --> 01:01:05,070
So it's not saying that as a regulator there won't be difficult decisions to make.

551
01:01:05,940 --> 01:01:10,540
And I've made difficult decisions. I have had to dismiss individuals.

552
01:01:10,560 --> 01:01:18,360
I have had to do some difficult stuff. But that's to that small minority of individuals.

553
01:01:18,360 --> 01:01:27,300
The majority of colleagues find themselves maybe in a in a context, in a practice environment that doesn't support them.

554
01:01:27,750 --> 01:01:33,390
So I think that ensuring that the regulator has a just culture approach and.

555
01:01:34,810 --> 01:01:38,580
There's a piece in there for me about race equality as well that I want to continue.

556
01:01:38,590 --> 01:01:43,960
So it's part of my personal development has been around exploring.

557
01:01:46,180 --> 01:01:49,630
Leadership in the race equality space.

558
01:01:49,780 --> 01:01:55,230
And I've had some personal development from an organisation called BRAC, and they've been phenomenal.

559
01:01:55,240 --> 01:02:02,080
So just having that, you know, developing my lens, developing and understanding self and actions.

560
01:02:02,560 --> 01:02:05,980
And there's a lot of high profile.

561
01:02:08,370 --> 01:02:15,280
Fitness to practice cases which are rooted in race inequality that I'm.

562
01:02:16,990 --> 01:02:21,910
Really keen to be part of the executive that works towards getting that right.

563
01:02:22,330 --> 01:02:29,560
So there's so much to take from my time. And but it's yeah,

564
01:02:29,590 --> 01:02:41,020
it's about joining a organisation that has a vision and a desire for compassionate leadership and just culture and equality and, you know,

565
01:02:41,410 --> 01:02:49,440
threading that through the regulatory processes and frameworks that we have the govern our profession and,

566
01:02:49,480 --> 01:02:53,980
and just trying to work through where some of those root causes are.

567
01:02:54,340 --> 01:03:01,180
Because I did a short talk to a group of managers last week because they could stop most of this.

568
01:03:01,180 --> 01:03:07,030
You know, by the time it gets to me as a panel chair in a trust or by the time it gets to the NMC,

569
01:03:07,360 --> 01:03:10,900
harm has already been done to individuals if there's not a case to answer.

570
01:03:11,350 --> 01:03:17,739
So how we can work professionally to guide ourselves, you know, systematically but fairly and compassionately,

571
01:03:17,740 --> 01:03:28,600
so that we support people when we make mistakes, we support people if they're not in the right context or being bullied to to practice professionally.

572
01:03:29,560 --> 01:03:36,820
And for those small group of individuals that are high profile that you still see in the news today that needs removing from the register,

573
01:03:36,820 --> 01:03:40,690
that that provision is still there. But for the vast majority of people,

574
01:03:40,690 --> 01:03:45,610
that there's a restorative element to enable them to continue to practice because the NHS

575
01:03:45,610 --> 01:03:50,850
can't afford to lose thousands of nurses who are in a process that they don't need to be in.

576
01:03:52,520 --> 01:03:53,930
And do you think that your family,

577
01:03:54,140 --> 01:04:01,940
that the pandemic brought a lot of those issues into into focus for you and has given you experience that will be relevant?

578
01:04:03,550 --> 01:04:07,660
Definitely. Yeah. That's great.

579
01:04:07,670 --> 01:04:12,940
Thank you very much. But I think I've had my extra 10 minutes just to let you go.

580
01:04:13,600 --> 01:04:17,870
But thank you so much. Lovely to talk to.

581
01:04:18,220 --> 01:04:18,790
And you.