Ian's story

Professor Ian Abbs
Chief Executive

“The first time I thought, crikey, this is going to be big was when we admitted the first patients [with COVID-19] to the High Consequence Infectious Diseases (HCID) unit [in February]. When you are dealing with an unknown pathogen with unknown consequences, there is always a moment of uncertainty, anxiety and a little bit of fear.

The care of those first patients was actually pretty straightforward. I became more concerned when we heard what was happening in Italy, with so many patients presenting to hospitals, needing critical care, and dying.

Across London, normal capacity is 700 patients on ventilators – and we were facing a potential demand for 7,000. By mid-to late February we were looking at a tsunami – the health system in London potentially being overwhelmed. 

I always had confidence that Guy’s and St Thomas’ would respond well. We have dealt with many crises over the years. In the July 2005 bombings, we were told to expect hundreds of casualties and we got the hospital turned around in a morning. We dealt with the Westminster and London Bridge terrorist attacks too.

There were so many uncertainties in the early days. We knew something big was coming but we were still uncertain of the infection risk, the demand for critical care, the demand for ventilators. We didn’t have prescient vision but we were able to make decisions in advance of the curve. We ramped down our elective surgery earlier than others, so we had anaesthetists and others training to look after COVID-19 patients alongside critical care staff. We got ahead on PPE – we didn’t get it right all the time but we did protect our staff.  

The biggest challenge was around the supply chain. One Thursday evening we were down to a few hours supply of FFP3 face masks, having scoured the world to source them. We called an emergency meeting of our top leaders and agreed if we ran out we would have to ask the staff to work in high risk areas in surgical masks alone.

That was probably the most worrisome day – potentially having to ask our staff to work with inadequate protection. There was already anxiety among staff that the changes in PPE guidance nationally were being driven more by supply issues than by the science. In the end we scraped by. A new consignment [of FFP3 masks] arrived on the Friday.

Maintaining the confidence of staff was most difficult. It wasn’t commitment but confidence that was fragile. There were many anxieties – in the community, on the wards and in critical care – and there still are. Being seen and talking to people is very important in managing that.

On 22 March, I developed symptoms of COVID-19. Compared to many I was incredibly fortunate. I was unwell for 72 hours, including a grim 24 hours when I was really quite unwell. I was off for 7 days, feeling washed out, but I was able to stay in touch by telephone and manage some difficult issues with colleagues.

Yes, the Nightingale Hospital did cause tension. But London was facing difficult choices – if there hadn’t been a potential escape valve there could have been a very poor outcome. We did send them staff but it’s a zero sum game. You have only got the number of staff you have. It did cause some robust discussions across London about how to make the best use of staff at the time. 

Many of our staff – clinical and non-clinical – had a very intense experience. They were energised by COVID-19 in a way that had not happened for a decade. The engagement and enthusiasm in looking after patients and working together as a team were extraordinary.

You are a team, bonded by a single purpose, looking out for each other and climbing towards a single goal. It gave people autonomy and let them act. A lot of the reflection since has been about the energising power of that autonomy.

The more difficult time is when you hit the peak and come down the other side. You are tired and your goals change and become more diffuse. That’s when you can fall off – it’s a riskier time. Two of our staff died of COVID-19, though there is nothing to suggest they caught the virus in the hospital.

There is also guilt – among those staff who felt they should be there [working on COVID-19] but couldn’t be. It’s a curious mix of envy and anxiety. We need to counsel them they have nothing to feel guilty about. Then there is guilt among staff who lived away from their families to avoid transmitting the virus to people they love, and felt they were depriving them of support at a difficult time.

We underestimate the emotional toll of working in healthcare at the best of times – and certainly during COVID-19. And the physical toll. We developed a wellbeing package – from free food to putting everyone in scrubs, which created camaraderie as well as improving infection control. Clothing is hierarchical. That helped break down the hierarchy – we had nurses giving instructions on proning patients to senior surgeons. That is not people’s usual experience. Traditional expectations just fell away. The overwhelming response from staff was not “You’re asking too much,” but “Can I do more?”

Did I lose sleep? Because I have confidence in the skills of the people at the Trust I have never lost a moment’s sleep in any of my leadership roles. I am sad that we could not help more patients than we did – even though with a 70% discharge rate from critical care our outcomes were above the national average.

People talk a lot about organisations. But there is no such thing as an organisation. There are people. The family we have at Guy’s and St Thomas’ is endlessly resourceful, adaptable, and compassionate. When you see people running towards danger, that’s quite powerful.

Those are the qualities that come to the fore when you are dealing with this kind of emergency.”