Guest blog by Professor Richard Preece
It was good to read James’ blog on preparing OH support to NHS Nightingale North West Hospital (NNH). I would like to express my sincere thanks to James, Tok and all the HealthWork team, and offer a few thoughts from the other side of the partnership.
In the past four years as NHS England Medical Director in Greater Manchester I’ve not had to do much occupational medicine. In fact I’ve deliberately stayed back to avoid dabbling but there have been many moments when my prior practice has been invaluable.
The development of NNH at Manchester Central has been a remarkable project. On Tuesday 31st March I joined colleagues at a cold empty conference centre to begin work that would lead to a 648 bed hospital admitting its first patients less than two weeks later. Occupational health knowledge was invaluable in the development of NNH.
In a previous role I had led OH teams supporting DEFRA in the response to avian flu. Workers had spent long hours in PPE in challenging conditions in the field (literally in some cases). Our studies then on the value of respiratory protection and immunisation of workers has resonance in the current pandemic response.
Manchester Central is a former railway station built in the 19th century. It is not a purpose built exhibition centre with a contemporary ventilation system. Past experience of working on the design of building ventilation in pharma laboratories proved useful in considering the design of the hospital.
The aim of NNH is to offer patients the usual standard of care and support they can expect from usual hospitals in these far from usual times. It has been important to recognise the emotional challenge of supporting patients in extraordinary circumstances and the potentially distressing nature of some work when usual human contact may not be feasible. There is no doubt that many years of supporting frontline workers in health and care has been helpful in designing work arrangements, welfare support, and preparing colleagues for what might lie ahead.
Most of all it is familiarity with strategic risk management that helped the most and particularly being accustomed to explain this. If fire risk dominated considerations NNH might have had fewer beds when it was always possible that even 648 wouldn’t have been enough. (NNH has the potential for more.) If NNH was staffed by specific clinicians from across the region there would be less in the populations local hospitals but this is avoidable with innovative staffing models.
NNH provides contingency. It enables the usual hospitals to transfer patients so they can continue to deliver the most acute care. It is not straightforward explaining to volunteers stepping forward to work on the COVID-19 frontline at NNH that the greatest success is that its full capacity is not needed because our population remain well and usual hospitals are not overwhelmed. Being ready to respond immediately and save lives is critical, not needing to respond is better.
Establishing NNH drew on the field hospital experience of our military partners. Their presence has influenced NNH’s core values of Trust, Respect, and Support for each other, and taking Action – it simply would not have been possible to deliver so quickly without these. They resonate through James’ blog too. I helped set up my first medical facility – a tent in a field – as a baby Royal Navy officer in 1988. I had long since assumed that experience would not be needed again.
Professor Richard Preece
Medical Director, Greater Manchester Health and Social Care Partnership
Adviser to CMO, NHS Nightingale North West Hospital