Coronavirus: How Great Western Hospital prepares to fight the pandemic

Great Western Hospital’s acting chief executive Kevin McNamara says the crisis is one of the biggest challenges anyone working in the NHS has ever faced.

When he spoke to the Adver earlier this week, around 60 patients – a sixth of the hospital’s overall capacity – were awaiting coronavirus test results.

Three people who tested positive for the virus have died at GWH, all had underlying health conditions.

Confirmed coronavirus COVID-19 cases in Wiltshire & Swindon:

Find out more: UK cases of coronavirus area-by-area

Mr McNamara, 39, says bosses are block booking hotel rooms for staff unable to return home to self-isolating family members.

“I think it’s one of the biggest challenges that anybody that’s worked in the NHS has ever faced,” he says of the virus.

“We have people here who have worked in the NHS for 40 years. They say they’ve never experienced anything like this.

“It’s a big challenge and in many respects a step into the unknown."

Praising “remarkable” staff, he says he's impressed about how quickly the hospital has been remodelled in order to care for an influx of patients experiencing coronavirus symptoms.

“We’ve done massively quickly things that ordinarily would have got caught up in decision making and meetings,” he says.

“That singular focus, that national priority, I think has really focussed the mind in terms of what we need to get done.”

Bracing for a health crisis

Planning began weeks ago. The hospital has axed its private ward, the Shalbourne, and converted it into a kind of triage centre for patients suspected of having contracted the virus and sent to hospital upon the advice of NHS professionals.

The aim is to keep coronavirus patients out of A&E.

Inside the hospital, three wards have been converted and used to house Covid-19 patients as they await the outcome of their test results.

“That’s something that’s under constant review," the CEO says.

"Obviously, as cases increase that number of wards would increase. Part of our planning is looking at what ward would we use next.”

All non-urgent operations were cancelled last week in order to free up space in operating theatres to care for Covid patients.

Staff across the hospitals are being retrained to use ventilators.

Before the crisis began, GWH had just eight of these life-saving pieces of kit on its intensive care unit.

Now, they are hoping to quadruple that figure – dependent upon getting the equipment from NHS bosses in London.

Amazing work by team ITU @GWH_NHS ...
Preparing extra bed capacity ready for influx of #COVID19 patients pic.twitter.com/rAgDP5wIKX

— Mark (@MarkCJuniper) March 25, 2020

It’s possible ventilators designed by Wiltshire-based vacuum cleaner firm Dyson could help critically ill patients in Swindon within a few months.

While across the NHS concerns have been raised about the lack of personal protective equipment, Mr McNamara says PPE stock levels at his hospital were good.

They had had a large delivery within the last 24 hours and stock levels are kept under constant review.

Mental health support for hospital staff has been stepped up.

“I absolutely understand it is a stressful time," he says. "My message to staff is it’s okay not to be okay in these situations.”

The chief spends time everyday answering questions emailed by doctors, nurses and other staff – often prompted by the government’s daily briefings.

“Staff are having their commitment to the NHS tested like never before,” he adds.

The healthcare shake-up 

The entire workforce faces long days. Mr McNamara starts early in the morning, checking emails and ringing in to teleconferences at which the pressure on the hospital was discussed in detail.

"First thing when I come in I’ll go straight to our control room, which is in the Trust's boardroom now, to see what updates we’ve had overnight, any additional confirmed cases and any issues that have come up."

A teleconference call repeats at lunchtime, with a final call between the on-duty members of the executive team at 10.30pm every evening.

Rules around visiting the hospital were tightened-up, allowing only one “essential visitor” a single hour-long visit a day.

Visits to the intensive care unit have stopped.

Coronavirus' effect on A&E admissions 

Meanwhile, A&E admissions were down by more than 1,000 last month.

The data, published by the NHS, reveal that 5,222 attended the Swindon emergency department in February 2020 compared to 6,285 in the same month last year as people stayed away.

Roughly the same number of people were admitted to the wards; around 2,000. 

McNamara's theory is that the coronavirus crisis has helped focus minds across the NHS and social care system.

As well as seeing a drop in A&E figures, as people opt to stay at home rather than head to hospital with minor injuries, bed-blocking delays have spiralled downwards too.

In the current climate, authorities are desperate to clear hospital beds in anticipation of an influx of coronavirus patients requiring treatment in the coming weeks.

Mr McNamara says: “There’s still further to go, because we have to get those stranded patients down to an absolute minimum to make sure we don’t have any medically fit patients waiting in the hospital.”

Read more on this: Number of A&E admissions drops amid coronavirus outbreak

Keeping one eye to the future is key to avoiding a crisis later in the year, Mr McNamara says. 

Non-urgent operations have been cancelled while outpatients' appointments have either been delayed or moved to video calls.

These measures were put in place as the hospital ramps up efforts to tackle the virus.

If not managed that could present difficulties in the future when the pandemic dies down. 

“At some point we know that this will pass, although it might not feel like that at the moment, and we’ll have to recover this sort of activity," says Mr McNamara.

“We’ll have to get patients booked back in and we’ll have to get the hospital back to normal as best we can and as quickly as we can.

“We are trying to keep one eye on the here and now - have we got enough equipment, have we got enough supplies, are our staff supported - but another eye on what’s happening two, three or four weeks down the road and then several months down the road.”

The NHS' plea for a community effort

Mr McNamara called on people to stay at home to prevent the spread of the virus.

“For me, all we have to do is look to the images in Spain and Italy to bring home why we need to act quickly, why the national announcement was made on Monday.

“If anybody was in any doubt as to how serious this is that announcement brought it home to us.

“We have colleagues at the moment who are self-isolating away from their families. They have family members who were unwell, so they’re self-isolating at work so they can carry on providing lifesaving care.

Read more: Swindon comes out in full force to show support for NHS workers 

“The least we can do as a country and as an individual - even if we’re not impacted by it and we’re safe and warm at home - is to stay at home because every time we go out, make contact with other people we’re increasing that knock on effect and demand to health services. Ultimately, that increases the risk to staff.

“When we talk in this country about the NHS being the thing we’re most proud of we can prove that by following the instructions, staying at home and saving lives.”