Paran's story

Paran Govender, Director of Operations in Integrated Care

“I was in a meeting with Public Health in April and the first data was coming through correlating COVID-19 hospitalisations and deaths with ethnicity. I put my hand up and asked: "Are my staff going to be safe? Am I going to be safe?”

We are the most diverse directorate in the Trust – 57% of our 2,500 staff have an ethnic background. We manage the transfer of patients from hospital to home (or rehabilitation unit or care home), for Guy’s and St Thomas’ and King's, and we also provide an @home service for patients needing home based nursing care referred by GPs. 

No one would answer the question. I said if you are going to put this out there you have got to take responsibility, you have got to give me something to work with. I wanted to know what was the answer if staff asked me this? They would be looking to me for reassurance - and I didn’t have it myself. 

I still don’t have it. But we had bigger fish to fry – keeping our patients safe.

We did worry about sending COVID-19 into care homes. Initially there was no requirement to test on discharge. When the guidance changed we immediately complied. Even so, I am not aware there were any cases of COVID-19 caused by our patients – and we had multiple conversations with the institutions to which we transferred them.

We had to keep staff safe. They were going from home to home and had to carry their PPE with them. It was not just a question of supply. They had to know what to wear, when to wear it, how to take it on or off. They had to have a clean bag for the unused PPE and another for the used PPE. They couldn’t just go to the cupboard, like their hospital colleagues. It was a logistics and planning challenge. 

Then, when you look at the PPE it doesn’t exactly scream out 'protection'. People wondered, is this flimsy apron enough? There was a lot of fear. And frustration too over the lack of clarity in the guidance. A nurse could be wearing a long sleeve gown next to a social care colleague working without it. So is it required or not? How does having a different employer alter the rules?

Much of our workload comes through emergencies, and attendance at A&E declined. But as time went on we were dealing with more recovered COVID-19 patients discharged from critical care. Many were scared, deconditioned, and didn’t understand what had happened to them. There was a lot of need for psychological support. 

I am proudest of the fact that we delivered high quality care to our most vulnerable patients in a situation no one had dreamt of. The biggest pressure was ensuring we had the right numbers of staff with the right skills supported in the right space. Many were redeployed to us and needed training.  

People were energised and happy in the moment. They were able to see beyond their own fears and put patients first. Even those who weren’t able to come in because they were shielding supported us by working from home. Having that feeling of being a little bit in control is so important when you are dealing with an enemy you can’t see. 

The hardest thing was seeing demand rising and not knowing when or where it was going to stop. Every day there were more and more patients. We never knew how many staff we were gong to need. Normally we can predict demand but this was on a scale and rising at a speed we had not seen before. We couldn’t just shut the door and say we had reached capacity. 

I was disappointed by the way the guidance kept changing – and the changes always came on a Friday afternoon so we knew that we would struggle to implement it over the weekend. We were on our knees. I know it was difficult, with an evolving situation, but there was a huge sense of frustration.

There have definitely been good things that have come out of this. Instead of 5 professionals visiting a patient’s home we have 1, for infection control. That means the one professional provides more holistic care and we have staff working to the top of their ability.

In March, the government issued new hospital discharge standards which established 'flow hubs' to place patients. We had talked for many years about this but COVID-19 was the spur that made it happen. 

Personally I think it's more efficient. You let the flow hub know your patient is ready and they organise the placement. A ward nurse may have patients from 6 boroughs and can’t know the differences between all their offers. 

The discussion became a needs-based, patient centred conversation rather than a supply-based conversation. It’s about getting the right patients to the right place to get the best care.

Some staff found it difficult. Change is always difficult. But love it or hate it, it gave staff a clear steer. What you do is important. But how you do it is the hallmark of leading organisations.

Patients in turn are being taught to self-manage. Before COVID-19 there were worries – was this safe?  Now it’s – this is how you do it, call me if you get into difficulties. That is continuing. This is sustainable.

This period has reinforced for me how important it is to take people with you, to see things through their eyes, whether it is a member of staff, a patient or family member. Humility is vital.”