Daghni's story

“I have a lot of family in South East Asia so I was aware of what was coming early on. I saw the need to redeploy staff and Simon Steddon (Medical Director) had his hands full. I stepped into the breach.

We redeployed 640 doctors altogether. I got senior clinicians from critical care, the emergency department and COVID-19 wards round the table and appointed a project manager. We had 2 daily huddles, 7 days a week to review what was needed. What did we need to provide, what did we need to change, how should we adapt? We had to cope with uncertainty.

We needed to deploy doctors in waves as capacity increased. We had to identify the gaps and design training packages. We went for junior doctors first – those who had mastered the core tasks and could be upskilled quickly.

If you are a senior surgeon in, say, orthopaedics, you don’t spend time listening to the heart and lungs, it will be something you have not done for a long time, and you will take longer to upskill. It sounds very logical in retrospect (to choose junior doctors) but it took working out with everyone chasing their tails. We designed a skills questionnaire which will probably be a legacy of COVID-19 – helping us deploy in a second wave.

We started on 9 March and it took us 6-9 days to launch the training packages. It was a real challenge to help the experts who were under huge pressure to come up with them. 

Did we have enough volunteers? It depends what you mean by volunteers. All staff were told that because this was a national emergency and they worked for the NHS, they were required to work where they were needed. But 2 weeks into the crisis people did volunteer. We set up an email address to co-ordinate them.

We talked to clinical directors, told them we needed 10 or 20 staff and asked who they could release and where from. We selected the doctors, allocated them and provided training, education and simulation. The same was done for nurses. No member of staff went to work in a new area without some form of training.

A lot of staff had concerns. Half my job was dealing with their concerns. On the shopfloor, there was no concern about PPE but staff were worried about catching COVID-19 on the wards or travelling in and out.

Staff also worried about the patients they felt they should be treating and were not [because wards had been cleared for COVID-19]. And for the first time they faced the hugely difficult task of deciding which patients with COVID-19 should be ventilated. Those were really hard decisions. It’s true we never ran short of ventilators because we were very good at deciding who should go on a ventilator. Not every sick patient who came in was appropriate for one. We were also careful to arrange DNR (Do Not Resuscitate) orders where appropriate.

I was very aware colleagues were practising in ways that could have exposed them to difficulties. It will be vital that we reflect on and learn from this. We made the best decisions we could at the time given with the information we had.  

We are a large risk-averse organisation and there were several points where I feel we weren’t brave enough. COVID-19 divided my world into two groups – those who were opportunity focused and those who were risk focused. You absolutely have to be prepared to be flexible. Seniority doesn’t always give you that innately. Those who were uncomfortable with it were really stressed by it. It’s not a criticism it’s an observation.

We over-deployed in the early weeks. When clinical leaders said what they needed, we responded. We didn’t question it. If you get togged up in full PPE and then spend the day twiddling your thumbs it is not ideal.

My view was I will do the best I can with the data I have. If I am wrong I am really sorry. For the first 3 or 4 weeks I was saying sorry a lot. People were quite accepting. Over-providing was better than under-providing.

We did amazing things as an organisation. But we know we could have communicated better with staff. We weren’t always timely, and we weren’t able to say ‘we don’t know’. My frustration was we weren’t always able to share the real issues. I co-ordinated 3 events early on to let staff talk about their worries. But we couldn’t do that later because of the rules on social distancing.

Colleagues were anxious and when you can’t deal with that it's not good. They couldn’t share their experiences. There was no downtime, they couldn’t go for a drink after work.

I would say I am a resilient person and I can normally switch off after work. But when I had my first 3 days at home (in June) I found it difficult to sit still. My brain was just going. If I felt like that, I suspect a lot of others did too. The impact of the experience on families, friendships, work is only now coming to the fore.

I have arthritis and am on therapy that makes me susceptible to infection. I stopped my clinical work but I was able to work a step away from my normal job. A lot of staff who were shielding felt bad because they couldn’t help.

I am extremely proud as a home-grown St Thomas’ doctor – I was a student here – of our response. One thing that sticks in my mind is an email I got from a renal transplant surgeon redeployed to critical care thanking me and my group for the work we had done. That touched me.

So did the first NHS clap. I was standing on Westminster Bridge, people were clapping and everything turned NHS blue. In my 36 years as a doctor it was the first public acknowledgment of the work we all do. I was taken aback by how much it affected me. Then I cycled home through an empty London. It was a very special moment.”

The photographs in this story were taken at different stages of the COVID-19 response with varying guidance for personal protective equipment (PPE) and social distancing.