The intensive care accountant (#DoingOurBit)

Mrs Foster (pictured) is a business accountant heading a small team supporting the trust’s surgery division. But when the trust asked for volunteers from its 700-strong non-clinical workforce, she was quick to put her hand up.

An experienced accountant, with a background in the commercial sector and local government before joining the NHS in 2017, she was asked to help identify volunteers for the new ‘yellow army’ – the band of volunteers would wear bright yellow T-shirts to distinguish them from clinical colleagues. ‘I couldn’t ask others to get involved if I wasn’t happy to do it myself,’ she said.

With most children expected to have asymptomatic or mild cases of Covid-19, Alder Hey was not experiencing significant numbers of paediatric admissions relating to the virus. However, it did have to enhance its infection control precautions while treating all children and the intensive care unit isolation pods enabled children showing symptoms to be segregated from other patients.

But in a first for the trust, the children’s hospital opened an adult intensive care ward to ease the pressure on local acute trusts during the pandemic’s peak and this was where Mrs Foster chose to be based.

After some initial training, she spent some weeks working three 12-hour shifts a week, fitting in her finance responsibilities in the remaining days.

A day would start by changing into scrubs and Crocs – with Mrs Foster admitting it did not take long for her to decide that comfort was more important than fashion – before attending a daily co-ordination session where she would be allocated her responsibilities for the day ahead.

She would then typically start by filling stock cupboards across each of the sections – also known as pods – that make up the intensive care unit. As part of this initial task, she would ensure each nurse’s trolley was fully stocked. She would also fill-up hand sanitiser and glove dispensers around the wards and help with the constant challenge of ensuring surfaces were regularly wiped clean.

As ward rounds started, from around 8:30, involving a range of clinicians including consultants, anaesthetists and physiotherapists among others, she would often be assigned to help the clinicians don and doff PPE as they entered the pod. ‘In the donning area, we would work in pairs to prep the clinicians, making sure they left personal items at the door and put on sterilised footwear and then follow a methodical way of ensuring PPE was put on correctly,’ she says.

What goes on must come off, so the follow-up role at the end of rounds was to ensure that all PPE was taken off and disposed of safely in the doffing area. Disposal of consumables was itself a major undertaking involving double bagging, tagging, disinfectant labelling and then letting it rest in a secure area before it could be sent to general waste.

Mrs Foster spent long periods inside the pod herself both in terms of keeping stores stocked and supporting clinical staff. One activity she was asked to help with on occasion was to reposition patients to improve their blood oxygen saturation. This proning and de-proning of patients was a complicated business given patients were sedated and connected to various lines and the all-important endotracheal tube – often up to seven people were needed to turn a single patient.

The unit ended up looking after 11 patients. No further admissions were needed beyond this as, with a reduction in region wide admissions, there was sufficient capacity to cope within the general acute sector.

Mrs Foster said the work in the pod was hot and physical and made more difficult by having to wear full PPE. And with PPE scarce, once you were inside, it was good to stay inside for some time to minimise the times you would have to change,’ she says.

However, she said she felt protected and confident at all times. Any anxiety she had up front was addressed during training. ‘I felt comfortable that I wasn’t in danger and I was blown away by how calm and methodical the nurses and clinicians were on the wards,’ she says.

Reflecting on her time in the ICU, she says she is really grateful for the experience. The whole team worked effectively together and with good humour despite the very serious context.

‘Seeing the team in action was very humbling and I was proud to be a part of it,’ she says.

However, she also points out that lots of people in finance have stepped up, taking on extra roles to support procurement, undertake daily stock takes or deliver PPE training.

Critical care is an area supported by Mrs Foster’s surgery division and she says it was really informative to get an inside view into their daily pressures.

‘Walking in the shoes of someone else gives you an understanding of what we support,’ she says. On the back of this, the finance department will soon be launching a volunteering programme, where each member of the team will pick an area in the hospital that has meaning to them and volunteer for up to five days’ work throughout the year on the selected ward or with the service.

Mrs Foster says that she has gained a better appreciation of the work of the frontline, made a contribution she is proud of, and developed relationships that will improve engagement between finance and clinicians in the years to come.