Keeping elective care going during Covid-19

Amid news coverage about rising elective waiting lists and concerns about how the NHS is coping, it is important to remember that a huge amount is being achieved at the moment by the organisations and the people that are part of the NHS; and that those efforts are making a big difference.

Since the start of the pandemic, staff have been working tirelessly to make a difference to patients’ lives and this has resulted in some great achievements by individual hospitals and Trusts, something which is also reflected in the most recent figures on diagnostic activity and waiting times in England, released last week.

Official NHS figures indicated signs of real recovery in endoscopy activity in October, and the latest figures show that recovery was sustained in November - despite the rise in Covid-19 cases. While activity remains below last year, it had reached 86% of last November’s level and was broadly in line with December 2019. What’s more, the number of patients seen within the 6-week target has increased markedly month-on-month and the total waiting list for endoscopy actually contracted in both October and November.

Although waiting lists remain at historical highs, waiting times for patients would have been even longer without the efforts of hospitals and Trusts taking decisive action to keep essential elective care going. By very quickly adapting the use of both internal and external space in order to minimise any disruption to non-urgent care during the pandemic, they have helped prevent an even bigger crisis.

In particular, the dedication and the extraordinary resilience of the clinical staff that are working through very difficult conditions throughout the pandemic to deliver vital patient care warrants more than a passing mention. From a Vanguard perspective, all of our clinical staff have had to adapt to new conditions, while some have taken on completely different roles during Covid-19, or joined host hospitals’ teams to provide support elsewhere on the site.

We are honoured to have worked with a number of Trusts who have taken positive action to ensure the continuation of elective surgery and diagnostic procedures as far as possible, despite stretched resources and a need to accommodate Covid-19 patients within the hospital.

A flexible resource

An example of how flexible healthcare facilities can be adapted as circumstances change is provided at our bespoke ophthalmic hub situated at Royal Preston Hospital. Initially installed to add capacity for cataract surgery, the use of the unit was flexed during Covid-19.

The hub, which incorporated two Vanguard laminar flow theatres, was in daily use before Covid-19 struck, helping to reduce waiting lists for conditions such as glaucoma, ocular plastics, cancers of the eye and cataracts. In one of the theatres, the team had carried out more than 100 cataract procedures in just two weeks.

When all work on the unit was halted as elective surgery was cancelled back in April, the hospital realised that the hub, which provided a self-contained environment in a location away from the main hospital site, was ideal for use for emergency surgeries and smaller plastic surgeries. It also aided overall patient flow, as patients could be assessed and admitted directly onto the hub, via a separate pathway to the main hospital admission area.

The Vanguard staff team increased from five to eight, to allow for new procedures and additional PPE changes without slowing lists down. Staff were also sometimes brought in to supplement the Trust’s staffing teams on the main theatres within the hospital.

Dr Shveta Bansal, Consultant Ophthalmologist at Lancashire Teaching Hospitals NHS Foundation Trust and Clinical Lead for the project, said at the time:

“Having the Vanguard unit as a standalone facility separate from the hospital was a huge asset during the early stages of Covid-19. The hub had been extremely busy prior to the pandemic, and remained busy and extremely effective throughout, supporting us to continue surgery outside of the main hospital theatres.

Continuing elective work

At the Shrewsbury and Telford Hospital NHS Trust, a mobile operating theatre and ward had been set up at the Princess Royal Hospital in Telford in 2019, supported by a team of four Vanguard staff members. Specialist oral surgery, ENT and urology patients accounted for the majority of the work on the unit, which was focused on procedures with long waiting lists, and prior to the pandemic, the unit saw between 8 and 10 patients a day on average.

Since the start of Covid-19, the unit has been successfully operating as a ‘cold’ site for the Trust, allowing key procedures to continue. The unit is completely separate from the main hospital and the staff are a designated team, not working elsewhere within the hospital.

Neil Rogers, Assistant Chief Operating Officer – Scheduled Care at The Shrewsbury and Telford Hospital NHS Trust, said:

“During Covid-19 we didn’t want to let it go – the unit was due to go back at Easter -but we have extended the contract so we can use it as a ‘cold’ site through to the beginning of 2020/21.

“This is a safe environment to continue with the skin cancer work and we are looking to add non-urgent cancer work too. Having the unit separate to the hospital is key for patient safety and the patients have been very happy to attend because of that separation and the ring-fenced group of staff. We’ve been extremely pleased that the Vanguard unit will continue to add to our capacity through into the restoration and recovery phase of responding to, and living with Covid-19.

“The team have been really helpful, they are really part of our collective team and it has been great to have that additional resource and expertise on site. Even when the unit was on downtime, we knew we could turn to them if they were needed.”

Improving patient flow

Another hospital that quickly adapted to the new circumstances was the Royal Infirmary of Edinburgh. In 2019, a temporary minor injuries unit, using a combination of a mobile laminar flow operating theatre and a number of modular buildings, was set up at the site to improve patient flow in the A&E department.

But with fewer people presenting to A&E during the pandemic, fewer people were also being directed to the MIU, while at the same time, additional space was urgently needed in other parts of the hospital. The facility was adapted to RIE’s changing infrastructure requirements within a very short timescale.

Being accessible from the existing A&E department, and having its own reception and waiting area, the MIU facility has proved versatile. It has been repurposed twice during the course of the pandemic, first as a surgical admissions ward, and later, for use as an emergency department observation area, also bringing a change of role for Vanguard’s staff on the unit.

It is now used to help keep beds in the emergency department next door for patients needing more urgent care, while those not in need of one-to-one nursing can be supported in the former MIU.

‘Cold sites’ for elective care

New, stand-alone, so called ‘cold’ sites for surgery – or for safely undertaking diagnostic procedures such as endoscopy - have also been set up at many sites using modular infrastructure during the pandemic. A combination of an operating theatre and a hospital ward can create a visiting hospital, which provides a complete clinical environment including an anaesthetic room, scrub and recovery areas, clean and dirty utility areas, a reception/nurse station, waiting room, ward and WC.

At one hospital in the Midlands, a mobile operating theatre was set up to provide additional capacity connected to the hospital’s existing green zone, to ensure elective surgery would be able to continue throughout the winter period, despite the need to retain Covid-19 capacity within the hospital.

The unit is used as a flexible resource that can be adapted to the hospital’s needs as they change during the course of the pandemic. The theatre has laminar airflow, making it particularly suitable for orthopaedic surgery such as joint replacements, but a mix of patients needing different types of surgery are treated in the unit.

Vanguard’s mobile theatre forms part of a wider plan by the Trust to add surgical capacity and bed spaces to tackle waiting lists, and a modular ward facility has also been put in place ahead of the winter season. Having been open to patients since mid-September, the theatre is due to remain in place through the winter, allowing the hospital to continue with routine surgery, improve patient flow and reduce waiting times for patients. 

Reassuring patients

Modular and mobile wards are also being used during the pandemic not only to supply additional hospital bed spaces, but also to provide additional reassurance for patients. This was the case at Kettering General Hospital in the UK, which commissioned a modular ward at the start of the pandemic to provide a Covid-free zone.

A bed modelling exercise at the start of the pandemic suggested the hospital may need additional bed capacity to deal with the crisis effectively, and the Trust decided to commission a modular ward to create another ‘green’ zone, away from Covid-19 areas, where at-risk patients could be safely cared for.

As well as providing the hospital with temporary additional bed capacity for non-Covid patients, its position on site offers reassurance for those who may be worried about attending hospital during the pandemic. The plan has allowed the Trust to retain additional Covid-19 capacity within the hospital for the second wave, which was the intention at the start.

A KGH spokesman said: “The new block housing the 18-bed ward was installed as a contingency measure to support the safe management and flow of non-Covid patients, as we continue to care for Covid-19 patients at the hospital.

“Having the additional bed capacity at our disposal at this critical time has been extremely valuable, and the fact that it’s situated away from the main hospital building has provided reassurance for patients who may have been worried about the risks of attending hospital.”

The modules were built off-site by Young Medical, Vanguard’s specialist modular subsidiary, and the stand-alone ward facility was completed within a period of just five weeks, despite the restrictions imposed by the lockdown protocol that was in place at the time.

Dedication and commitment

Covid-19 has brought extensive challenges to our colleagues right across the NHS, and Vanguard is honoured to have been able to contribute to their efforts to deliver essential patient care in any way possible. NHS staff have shown exceptional resilience as they have adapted to new conditions at very short notice and continued to put patients first.

That goes for Vanguard’s own teams too. Many of our staff members have suddenly found themselves working in a different facility, at a different hospital or location, with different working hours, learned new skill sets, and in many cases have been given new responsibilities or have moved from elective to emergency care.

Even before Covid-19, Vanguard’s teams were known for their adaptability, solutions-focused approaches and ’can-do’ attitude, and throughout the crisis, they have shown repeatedly how that reputation for doing all they can to support customer is justified.=

Some of our team members work away for long periods of time, and in addition to work-related changes, they have also faced additional challenges during the pandemic, such as their hotels closing down and not being able to see their families during breaks due to the risk of spreading the virus. They have made huge sacrifices in order to keep supporting hospitals.

Maria Rickards, Clinical Contracts Manager at Vanguard, said:

“There’s been so much change as a result of Covid-19 for our teams working at host hospitals. Some units and individuals are extremely busy, working under really challenging circumstances, and many staff have gone from working relatively predictable hours to perhaps working several long days or night shifts.

“The changes, the unpredictability and even the unexpected downtime all have a physical and mental impact, and our teams really do need to be highly praised for everything they’re doing. No matter what they are being asked to do, they’re just getting on with it. They are flexible and willing to help however they can; whether that’s working in ICU or supporting in a respiratory assessment unit, or basically just helping wherever they can.

“When the use of our units changes radically with little notice, that places additional pressure on team members. Aside from getting used to new procedures and processes, this makes it extremely difficult to predict exactly what supplies or equipment might be needed on the unit, which can be unsettling for a usually well-rehearsed and prepared team.”

Their efforts, and those of our colleagues across the NHS are making a huge difference to individual patients’ lives, and are keeping rising lists at bay as far as possible, even if the results are not always obvious when looking at performance data.

Finally, Vanguard’s non-clinical staff have also overcome many additional challenges during the pandemic. Setting up a new healthcare facility requires site surveys, testing and assessments to be undertaken, units or modules to be refitted and transported, and in some cases construction or enabling works to be completed – all of which has been much more challenging due to restrictions during the pandemic.

Our staff continue to work incredibly hard to make safe, deliver and install facilities to provide extra capacity at hospital sites across the UK, mainland Europe and in Australia during the pandemic, and we are incredibly grateful for their dedication.