Like nothing we’ve ever experienced (#DoingOurBit)

by Steve Brown

07 May 2020

It was Thursday 12 March when things started to feel different at Sandwell and West Birmingham NHS Trust. ‘There was a change in mood nationally and in the government’s response. Along with clinical and operational colleagues, we could see this was going to be really big for us and was going to dominate what we did for the foreseeable future,’ says Dinah McLannahan, the trust’s chief finance officer.

And that is exactly how things turned out. Health services across the whole country have moved rapidly from business as usual to emergency management as part of a rapid response to the Covid-19 pandemic, with the West Midlands one of the major early hotspots outside of London.D Mclannahan p

‘I look after procurement in my remit and we very early on realised that getting hold of personal protective equipment (PPE) was going to be really important to us,’ says Ms McLannahan (pictured). ‘We have worked very hard to source PPE and to be as clear and supportive as possible of staff in ensuring they understand the PPE guidance. In the early days, there was a huge surge in demand and there were well-publicised difficulties in distributing PPE across all trusts. We felt the threat of that on the frontline.’

It was hard work and stressful, but Ms McLannahan says with some pride that the trust has not run out of anything to date.

On the evening that the country went into formal lockdown, Ms McLannahan was quick to respond. She wrote to the finance team the same evening to instigate home working arrangements and set six areas to prioritise as the team looked to support frontline operations:

  • Ensuring continuity of supply stock and PPE
  • Paying staff
  • Paying suppliers
  • Invoicing and receipting of cash
  • Oversight of Covid-19 expenditure
  • Preparing the annual accounts

The subsequent announcement of a temporary financial regime, with block contract arrangements in place for the first four months of the year, helped Ms McLannahan to devote a much greater, but necessary, amount of her time to procurement issues. ‘For the first third of 2020/21, we’ve effectively got two sources of income and two pots of expenditure – which should deliver breakeven,’ she says. ‘It is a clever but simple approach that has enabled me to focus about 80% of my time on PPE.’

PPE distribution hubs have been set up on two hospital sites – City Hospital in Birmingham and Sandwell General Hospital in West Bromwich, and there are community hubs at the Lyng Centre in West Bromwich, and at the Rowley Regis Community Hospital. Deliveries are made daily to ‘red’ Covid areas, but wards can also call in to a shop arrangement directly if they are running low on anything. The trust has also taken it on itself to support local care homes, hospices and housing associations, where PPE supply lines were not in place for the quantities of equipment needed, or where fit testing for FFP3 masks was required.

PPE has had to be sourced directly as well as receiving central supplies. With significant offers locally from suppliers, two homeworking staff have taken on the vetting of suppliers – one for masks and hoods and one focused on gowns, which have been the trust’s two main areas of concern.

‘We’ve also created a procurement dashboard with all categories of PPE and we do a daily stock take of where it all is and what our burn rate is,’ she says. This detailed oversight has been instrumental in ensuring the trust didn’t run out of important kit and got early warnings of where problems might be about to arise. The trust has tried to use six days supply as the trigger point for getting concerned about key items such as masks.

On one occasion, the regional sales manager for a supplier hand delivered from Manchester a few boxes of masks ahead of a scheduled delivery to ensure the trust didn’t run out – an example of how suppliers have worked hand-in-hand with local health services. Supplies and fit testing capacity have also been sourced from local companies.

If masks have been one of the main problems, there were also challenges with ensuring they fit their users properly. With many of the trust’s trained mask fitters now preoccupied with delivering clinical services, the trust needed to expand its existing fit testing team. And again, Ms McLannahan stepped in alongside another finance colleague and a group of second year medical students.

‘I wanted to do my bit clinically and it is really important for me to be doing something that contributes directly to the frontline effort,’ says the former nurse turned accountant. The fit testing also provides her with a chance to talk to clinicians about current concerns or local pressure points with PPE.

Fit testing is a major issue – with all staff that need enhanced respiratory protection having to be assessed to ensure masks fit properly. Getting through all staff working in, or being redeployed to, Covid areas would be challenging enough but to ensure staff were appropriately fitted for the different masks being delivered meant that some staff had to be re-fit tested for replacement masks.

Testers first conduct a fit check to decide if the mask fits well enough to undertake a full fit test. The test itself then takes around 15 minutes with the wearer taken through a series of exercises and movements to replicate activities encountered in patient care while monitoring how well the mask keeps spray particles out. At times, certain masks haven’t been able to fit specific users, and in those cases hoods have to be used.

With a daily clinic running from 8am until 10pm and managed by the patient access team, the trust has stayed on top of the demand for fit testing.

Ms McLannahan says it has been a real team effort. Most procurement, stores and materials management staff are still on site and have been since day one. ‘They have been amazing – coming in at weekends and over the bank holiday – and supporting the setting up of two extra intensive care units.’ She says the finance team too have also just got on and made things work. Most of the 60-odd finance staff are homeworking, with some staff (accounts payable and payroll) coming in on a shift basis to pick up paperwork or access the network when necessary.

‘It has been like nothing we’ve ever experienced,’ she says, although she says activity has settled down in the last couple of weeks, in line with the national trend. It has been traumatic at times, but there have also been good things that have emerged and that will help improve services going forward.

‘The camaraderie has been one of the best things,’ she says. ‘It has been such a team bonding experience across all disciplines in the organisation. People have really pulled together and the public support – especially in those first few weeks when I was doing 14-hour days under constant stress – kindness and teamwork really made a difference.’