President’s Blog: Covid19 – up close and personal!
Look, let’s get the “u” words out of the way first of all –unique, unprecedented, united, unswerving, unbelievable – utterly brilliant healthcare scientists! Are you not all bowled over by the brilliant responses our Healthcare Scientist teams/colleagues have delivered fighting COVID19; pulling together, reformatting services and duties, re-training, re-purposing and becoming central in the NHS family fighting COVID19?
Many of us have moved far from our “comfort zones” of routine clinical care, daily diagnostics, standard treatments, research, procurement, national professional duties and usual training programmes. However, we have all found in the depths of our experience, training and professionalism that have transcended the “normal” and are enabling up to achieve incredibly rapid change and new roles.
I was actually on ward ventilation duty at QEHB on a Thursday night when the 8pm “Clap for Carers” applause was apparently taking place. With full PPE, including ventilated hood, we were settling in our first CPAP/Oxygen patient on our new Level 2 area within our respiratory ward – we were oblivious to the public applause. Nevertheless, our wards are covered in hundreds of (laminated) rainbow pictures from schoolkids and others. The out-pouring of public appreciation is very kind and almost shocking, since much of the last decade it feels like the NHS has just taken for granted. It’s many decades since I’ve worked nights in hospital, but how my own hospital QEHB runs at night is truly amazing. The donning & doffing routines, the patient monitoring and care are all done with generally plenty of staff and PPE available.
Spending hours with a sick, scared and lonely patient, who is struggling to come to terms with their predicament, brings out our innate humanity, caring, empathy and humour, all of which is fundamentally essential for their very well-being. What has made this particularly rewarding was that our patient was herself a patient-carer and had probably contracted COVID19 from her workplace. What a privilege to be able to help her – one of the truly unsung heroes. This has all made me reflect on how we have got to this point in the COVID19 story.
There have been many phases of this COVID19 pandemic; the early days of planning, stepping routine services down, training and general preparation for something which was sometimes enormous and unmanageable, and at others achievable when done a bit at a time.
Next was the uncontrollable increase in ICU patients and wards filling with actual and suspected COVID19 patients. When would it stop? The No 10 briefings, the Trust bulletins, the media tsunami of information, comments, statistics and endless graphs all made us feel we were all playing a small part in a blockbuster disaster movie! What has been hard to handle has been the constantly changing expectations, setting and re-setting the new realities of what we’ll be doing.
However in recent weeks, the changes; the empty hospital atria, the silent wards and corridors, the air of calm serenity and trickle of healthcare staff belie the frenzy that continues on ICU units and selected respiratory wards. Rainbows, food treats, gloves, gowns, FFP3 masks and aprons have become our new normality. Elsewhere, labs are beavering away crunching thousands of swab samples, other immunology, microbiology and biochemistry and skeleton crews deliver routine care often in new ways to ensure patients can be seen remotely/virtually as the lockdown continues.
Some HCS are quarantined at home, shielding family or working from home where this is possible. Not travelling to the hospital is supporting the “Stay at Home, Protect the NHS, Save Lives” government campaign. Contributing to saving lives – just look at the “change in the curves” as evidence of stopping/slowing the spread of the virus! We all play different parts in this war on COVID19, but the fact that we do this together as professionals, citizens and neighbours, makes the joint effort all the more amazing.
Working in the hospital each day, as you meet colleagues, or staff who you’ve smiled at before, but never really spoke to, you begin to pick up the human stories, the reality of this dreadful pandemic and how it changes and wrecks people’s lives, but also makes us be achieve the amazing too.
There is the cleaner whose wife had COVID19 and was poorly and on oxygen as he worked on the opposite ward each day. How must that feel?
There is the husband who has been “tubed” on ITU for 2 weeks who doesn’t know that his wife has died – when do the clinical team break that news to him?
Then there’s been pregnant consultant who was intubated for >20 days, but who has just delivered 2 healthy but premature babies and is now weaned off the ventilator.
The doctor in his 30’s, who said goodbye to his children and wife on Skype on a tablet before being sedated and ventilated on ICU. Fortunately, he has now also been weaned off the ventilator.)
There is the story of the woman who was put on CPAP/oxygen treatment as her ceiling of care by an intensivist. She was looked after by physiotherapist/physiologist ventilation team for 24 hours. When the team approached the then on-call intensivists the next day regarding her care plan, that intensivist insisted that the treatment be stopped immediately as it wasn’t clinically appropriate. This is a tough message to take on board, but especially when sadly, she died 3 days later. Rationalising the right clinical decisions with how you feel can be really difficult.
I have been lucky and helped to set up ventilation on several patients on the COVID19 wards, but fortunately, although most only had suspected COVID19, and turned out to be negative. Both have gone home, safe and reasonably well. How they must have felt with two physiologists dressed like something out of a sci-fi film, mumbling through our masks/hoods/visors! Patient resilience is itself inspiring and drives us all on to do our best from them.
How many of us have experienced the range of personal emotions, sometimes within the same day from “oh we’re just doing our jobs” through “well I need to take care here”, “God, I wonder what we’re going to witness”, and up to, “Grief I’m going to catch COVID19 and end up intubated!” We have a much distorted picture of the worst COVID19 can do – remember 80% of the public get this, and then have 1-2 weeks laid low and then gradually recover.
I have also met so many healthcare staff that I would never usually meet. The problem is if I ever had to identify them in a photo-fit exercise they’d all look the same (apart from height, eye colour and shape) – FFP3 mask, visor, apron, gloves. Other distinguishing features……….er scrubs? It amuses me the process for getting donned according to social media – gown, gloves, FFP3 mask, visor, obligatory photo with option video dance!
The press and media highlight the negative parts – the lack of PPE, lack of testing, lack of vaccine and medication, but you have to push all this low-level angst deep down, because otherwise you’ll not be able to do your job as easily. That’s not to say we don’t all have an occasional “wobble”, lose our composure, get into a tizzy and (as in my case) go on a pointless, unkind and unfair social media rant late at night. This may be at colleagues, politicians, family or even friends. We are all human, we can and do make mistakes, but it is in learning from those mistakes, reflecting, considering, realising and correcting them that we become better people and better professionals. We may not feel proud of our behaviour/actions after them, but we need to pick ourselves up, dust ourselves down, and get back to it. One lost battle in a war of promoting our wonderful professions with kindness and measure.
The nature of the severest manifestations COVID19 is such that, there is sudden catastrophic hypoxaemic events where patients go from unwell/stable to critically ill and in need of intubation in 30 minutes. (These patients probably die from a pulmonary embolus.) It is a traumatic and shocking event to witness and something that may affect staff for possibly years afterwards. It is really important to talk with colleagues, mentors, family, friends or professionals or anyone you feel comfortable with about what you’re seeing and experiencing. We have all joked in the past about the “touchy feely” aspects of healthcare, but this COVID19 situation has brought out how important it is to be confident to display our humanity and vulnerabilities. This is the “care” of the healthcare scientist which we should nurture, develop and improve to be better professionals. Learning from our nursing, allied health professionals and medical colleagues, who have enormous experience of these aspects of healthcare is a unique and fantastic opportunity for us all.
Low levels of stress over many months, changes sensibilities, drains emotions, triggers an underlying fatigue and is perhaps an element of PTSD (outside my scope of practice here!) and needs to be addressed in all staff whether they’re on the COVID19 frontline or not.
Add to this, the shock of hearing of the death of a family member, friend, colleague or well known personality, it all chips away at our life confidence and security. Remember, we wear “scrubs” not lycra! We’re not super-heroes/heroines, but ordinary people who chose to work in public service, as part of the NHS, in a collective of like-minded carers, who generally speaking love their jobs and working for patients. Just as we look after our bodies through exercise and healthy diet, so too we need to look after our minds.
Regarding working in extraordinary ways, the Nightingale Hospitals are a case in point. Oh, how we marvelled as hundreds of Chinese diggers threw together a prefabricated hospital in 2 weeks! Did we believe then, what we know now – that we could transform our large exhibition centres in purpose made hospital extensions with capacity for thousands of patients?
NHS Nightingale Hospital London at ExCeL London
NHS Nightingale Hospital Birmingham, at Birmingham’s National Exhibition Centre
NHS Nightingale Hospital North West at Manchester Central Convention Complex,
NHS Nightingale Hospital Bristol, University of the West of England
NHS Nightingale Hospital Exeter at Westpoint Arena near Clyst St Mary,
NHS Nightingale Hospital Yorkshire and the Humber, Harrogate Convention Centre.
NHS Nightingale Hospital North East at the CESAM, in Washington, Tyne & Wear
Each one of these “pop-up” hospitals has required the input of healthcare scientists in designing and planning of each facility. HCS in Medical Physics and Bioengineering , Life Sciences and Physiological sciences have either been delivering their own expertise, or re-training and supporting nursing and medical staff to deliver the care required. I totally admire and must thank all those HCS involved in these astronomical ventures. The NHS has made an exhibition of itself – in the best possible way, by working with the military and private companies to provide this essential safety net for this unknown contagious enemy. Whilst they have not yet been used in large numbers, we have a long way to go with COVID19 and to have such an important “safety net” for our population is absolutely right and proper. The willingness of people to cooperate and make this all happen restores faith in humankind.
Please carry on being brave, brilliant and the best. Whilst the curve may be flattening, COVID19 will become a long “slow burn” in our health system until we can get the vaccine and medications in place to reduce its ferocity and its indiscriminate selection of patients. We will soon turn to “living with COVID19” and begin to return to our previous work – but by no means “back to normal”. We have learned so much about who we all are (and can be) in the NHS now. So we may be HCS, but we are also a part of the NHS Family. COVID19 may produce a lot more positives than the doom laden media are trying to make us believe. Finally, don’t “take care” (I hate that phrase now!), but “take risks carefully” by using PPE, hand-washing and support for each other.
As stated before, the pandemic has changed the way the NHS can work and can make bold/radical changes to the services we have known for decades. In that respect the pandemic has acted like a catalyst, for change. Central to that change will be the HCS teams. What we have all learned is how to be flexible, hot to adapt, “think outside the box” and deliver new ways of working so that after COVID19 we won’t return to “normal” but to a new world of innovative services. Virtual clinics, reducing hospital footfall and treating patients remotely will be the new norm. We look forward to the stories of innovation which we can share with one another to inspire others both within and across our professions.
Most importantly will be our ability again to support the wards and patient facing services by working alongside our nursing, medical and AHPs colleagues when “winter pressures” or other “pinch points” happen in healthcare. It’s not just COVID19 that has become “up close and personal”, it’s what healthcare scientists have done and continue to do across the UK.
Prof Brendan G Cooper
2nd May 2020
COVIDeo-conferencing: Healthcare scientists and working differently
Prof Brendan Cooper
Consultant Clinical Scientist, UHBNHSFT
COVID19 (SARS-CoV-2, Coronavirus, CV19, etc.) has been (knowingly) in the UK for over 6 weeks now, with the country in effective lockdown for nearly 3 weeks so far. Whilst there are suggestions that the expected “surge” may be less than expected, it cannot be argued that COVID19 has wreaked devastation on patients, families, the healthcare system and the country as a whole. However, it has also triggered some amazing responses in all our healthcare staff and systems, and produced some wonderful examples of innovation, teamwork, redeployment, re-skilling and an outpouring of cooperation and support for all in the NHS.
As AHCS President, I have along with CSOs in the four nations, the National School for Healthcare Science and all HCS professional bodies been not just promoting healthcare scientists, but showcasing examples of why we are an integral part of the healthcare family in fighting COVID. The biggest gain in the NHS may not be that healthcare scientists have been on the front line; it’s that we’ve been able to share our skills, staff, experience and leadership with our frontline clinical colleagues.
How have I seen this? Every morning, one of our lung function team joins the respiratory medicine “huddle” (all 1 metre a part!) on the 5th Floor and participate in a briefing about the respiratory wards. The consultants, ward sisters, physiotherapists and lung function physiologists all share overnight developments, issues, problems, information and updates on our services. We hear about the number of transfers to ITU, deaths, PPE supplies, staffing levels, redeployments and problems such as patient’s relatives phoning the ward all day. Collectively, we share our thoughts, suggestions, advice and understanding and offer things that we can do to help. There is an air of cooperation, openness and constructive challenging of suggestions from all in the team. We are one team.
The lung function team then holds its own “COVID Briefing” where we disseminate the information, check who’s absent/available, sort out our work streams and training for the day and feedback on where we are required to support the rest of the hospital’s respiratory team. Communication is absolutely key to maintaining engagement, staff morale and focus on what we’re doing in these unique times.
One large piece of work done with several UK lung function departments has been investigating the use of nasal continuous positive airways pressure (CPAP) with entrained oxygen as a treatment for COVID19 to be used prior to ICU admission and intubation.
This work has been able to advise respiratory physicians up and down the UK, who do not have enough ventilators to support COVID19 patients currently, to deliver this treatment on the ward. We have collectively figured out that home ventilators set to CPAP mode on 10-15 cm H2O pressure and 10-15 L/min oxygen can deliver inspired oxygen concentrations at the mask of between 50-90%. This is enough (according to the latest NHSE guidance) to treat patients effectively in the early stages of the virus. We have discovered that the point of oxygen entry, the mode of ventilation and the type of machine used, makes a huge difference to oxygen delivery. Indeed, NIHR are about to start a clinical trial of CPAP versus high flow nasal oxygen vs standard treatment to answer the question of which is the most effective treatment. The vigour, enthusiasm and professionalism shown by my respiratory physiology colleagues is humbling.
This use of healthcare science skills is helping the frontline teams making clinical decisions in treating COVID19 has been epic. Healthcare scientists are integrated into the frontline, even though some have limited access to delivering measurements and treatments to COVID 19 patients directly, many other departments are very much involved on the frontline.
I am aware of healthcare scientists stepping up to the plate helping nurses on the wards, within ICU and at the NHS Nightingale Hospitals delivering frontline patient care. This is of course as well as delivering the usual support services including all aspects of biochemistry, microbiology, COVID19 testing in life sciences. Medical engineering staff has been delivering incredible devotion by procuring/preparing the thousands of new ventilators (traditional and recently developed), the infusion pumps, and other essential equipment to ICUs up and down the UK.
All of us have had to work differently be it, changing shifts to cover 24/7 rotas, working from home doing virtual clinics using VPN, or forming new multi-disciplinary teams to deliver patient facing services. As part of the social-distancing priority we are all now using “Covideo-conferencing” or virtually meeting using speaker phones to conduct (shorter than usual) management meetings. Lots of time that was spent on targets, waiting times and budgets, is now replaced with working more effectively to conquer COVID19, supporting patients, protecting colleagues or finding new methods of treatment.
In my own department, we have struggled for years to establish IT clearance to set up remote monitoring of our patients on CPAP (for obstructive sleep apnoea) or NIV but as part of the “clearing the decks” for COVID out-patient work, we are now using this remote monitoring very effectively and without any IT issues. It just shows that much of the “command and control” beaurocracy that is followed with such zeal is actually fairly futile in times of emergency. As organisations, we need to learn from this going forward post-Covid19.
Physically we’ve changed how we look too. Most staff who work on the wards are switching to “scrubs” and often donning PPE and look very much the same as our medical and nursing colleagues to the patients. I suspect we are seen differently by our nursing/medical colleagues too, so perhaps this is a barrier we overcome moving forwards too. Even within my own team, I now wear scrubs and I feel more part of the team (although may be they just think I missed the alarm and slept in!)
When I wrote my first piece about our “unsung heroes”, we were at the beginning of an epic journey into the world of COVID19. What I have found very difficult to adjust to is the unsettling patterns of change.
Healthcare scientists may feel they are having a “roller-coaster” of emotions regarding the expectations and the realities of what HCS roles will be to contribute beating COVID19 which has frequently changed. For a workforce who enjoys order, standards and evidence, it has been an unsettling experience, but one which has led to significant adaptation and utilisation of fundamental leadership skills described above. This has been an experience of frustrations, flexibility, listening, fears, and personals circumstances for all.
For example, reading then details of managing COVID19 patients on ventilators/ICU and reading/watching the accounts of clinical colleagues develops exaggerated fears of COVID19, even though our rational mind shows that 80% of the population who catch it will have mild symptoms. Because we work at the forefront of the illness and see the “worst case scenarios” and hear the dreadful personal tragedies, we can often become deeply affected by that experience.
In that way, we again become closer to our other clinical colleagues who face this reality daily and begin to expand our understanding of what healthCARE actually means. It is the sick, scared, lonely patient, cut off from their family, in strange surroundings, surrounded by gowned people in hoods, visors and gloves that we now help to care for. We become their link with humanity……….. their carer…… their attachment to family and friends. How privileged we are to be working in that role. I believe all healthcare scientists will be changed forever post-COVID19 through these career-changing experiences. How wonderful for our STPs experiencing a lot of this close up as they are re-deployed to the NHS Nightingale Hospitals.
It is essential in this National Emergency that organisations (Trusts, divisions, clinical teams) communicate clearly to all staff and that this is delivered by local HCS leaders to all their teams. Even if the plans change, at least the workforce can manage their expectations and provide innovative input into any proposed plans. Communication needs to be clearer, although, to be fair to most Trusts and organisations, the plans are often changing hourly but there is also the need for some national standardisation (e.g. the PHE, NHSE guidance) based on best evidence, often gathered at pace, of how we deliver the right care in the right way.
Staff and particularly leaders, shouldn’t be afraid to seek support from professionals such as counsellors or psychologists, but can often confide in other healthcare colleagues to help manage some of the difficult raw emotions staff can experience during this national emergency. Sudden unexpected death, young people in deep trouble and people stories can tear at our emotions.
I hope you are coping well with the changing work and life situation, the bizarre lifestyles (the difficulty in reading anything but COVID19 information), the travelling to work on near empty roads, the pockets of human kindness and decency that is so often lost in our hitherto “normal world”. Your sleep isn’t normal and refreshing (waking up at 5am, reaching for that mobile phone?) , your diet has gone to pot (convenience food, poor appetite, etc.) and your brain is a “mush” unable to easily focus on big tasks. And there’s months more of this to go!”
I am immensely impressed with the stories, tweets, messages and testimony of the tremendous work that healthcare scientists continue to do in this relentless pandemic. You are amazing people, with huge talent, great innovation and most importantly humble humanity. You should be immensely proud of all that you are doing/have done to get the NHS into shape to be able to tackle COVID19. You should (no doubt very embarrassed) accept the 8pm clapping on Thursday nights – you deserve it! On behalf of the AHCS, thanks so much for being so brilliant.
Prof Brendan Cooper
The Unsung Heroes – now roaring out the COVID19 Chorus across the UK
COVID19 is developing into the greatest healthcare pandemic in terms of its healthcare and economic impact that’s ever been experienced in the modern world. Not since the 1918 Spanish Flu Epidemic has our world been stopped in its tracks like we’re seeing across most countries of the world today. Words like “unique”, “unprecedented”, “unfathomable” barely capture the enormity of our world almost stopping spinning on its axis! Commerce is standing still, leisure and travel is frozen and sport is side-lined like never ever before – not even in war has this ever happened.
Naturally, much of the world’s media focuses on the army of doctors and nurses (mainly in hospitals) who are seen as the frontline healthcare force brilliantly and bravely facing patients on ICU, Admissions, respiratory wards and in Primary Care. However, an “underground resistance” movement against COVID19 has from Day 0, have been influencing this war against this contagious coronavirus, that has swept from the Orient, across Eurasia, and across all other continents.
Without a vaccine, or some smart immunological intervention or an unexpected drug effect, our only defences are testing people for the virus, isolating them from getting the virus (if vulnerable) , self-isolating when they get the virus and treating those with the consequent pneumonia using both invasive and non-invasive ventilation and related respiratory support.
I am in a unique position, firstly as President of the Academy for Healthcare Science (AHCS) and secondly as a Consultant Clinical Scientist in Respiratory Physiology at the largest UK acute Trust, University Hospitals Birmingham. I am experienced in a variety of therapeutic techniques including non-invasive ventilation, oxygen management and many aspects of acute respiratory services. I am also an academic with responsibility for co-writing national and global standards in lung function and sleep physiology testing and treatments. The Academy of Healthcare Science is the over-arching professional organisation that represents over 53,000 healthcare scientists (7-10% of the NHS workforce) delivering over 80% of all NHS diagnostics.
In my role as AHCS President, I am witnessing battalions of healthcare scientists from most of the 52 healthcare science professions (readers wouldn’t know many of these by name!) working sometimes in the “background” and often on the “frontline” delivering care and services that will determine the eradication of COVID19 and save lives. Rarely will the public see the kinds of roles HCS are taking on and delivering in spades. I have a belief that for every doctor a patient (or pre-patient) sees, there are at least 10 healthcare scientists who have done the work to enable the doctor to reach a diagnosis or deliver a treatment plan. But let’s look at a few examples or how HCS have risen to the challenge of the COVID19 Pandemic.
In the early phases of the pandemic, it was biomedical/clinical scientists who were able to identify the COVID19 virus, map its genetic code and develop techniques to detect antibodies to it in the blood. As if that wasn’t enough, they have then geared up analysis “tracks” in hospitals throughout the planet to analyse swab samples from patients/suspected patients on an incredible scale to provide the intelligence on the spread of the virus for epidemiologists. Remember, it is as important to test someone as definitely negative as it is to confirm the test positive to not release people back into the population with the virus. The public won’t be aware that these staff are on-call or work shifts running samples 24 hours a day on a colossal scale. Many have worked long hours into the night and over weekends to get their testing system up and running to beat COVID19. These unsung heroes don’t feature in the final verse lyrics of the public’s COVID19 overture. Why would they, they’re quiet, hardworking, highly trained and skilled “lab rats” (jokey but insulting term for such brilliance!) who are the back bone of our Life Science services.
As the pandemic continued, the public heard and saw the rows and rows of patients in Wuhan (and later in Italy) all on ventilators, fighting their pneumonias. Oh yes, the Intensive Care doctors and nurses have been amazing setting up and monitoring patients on those ventilators. But take a step back. Who procured, tested, checked, internally cleaned and scheduled servicing for those ventilators ready for use? That’ll be electrical and biomedical engineers – who too, are healthcare scientists. Oh, they would also have tested and checked every point of care analyser used in Admissions and ICU, each blood gas machine, every single infusion pump (for antibiotics, fluids or other liquid medications) and every oximeter, probe and ECG machine. And you still haven’t “heard” of them?
Pandemic People 1: Malcom is a HCS from Point of Care Testing QEHB who turned up and informed us that he’d sorted an IT point, upgraded the analyser software, and found a space on the respiratory ward for our blood gas machine! Incidentally, all of that was with a laugh & joke (one of the many “loo roll” parodies doing the social media rounds!). This mix of grafting, thoroughness and humour is a trademark the healthcare scientist family during the pandemic. Priceless!
Healthcare scientists are baffled why we don’t appear in every episode Holby City & Casualty! But then perhaps the storyline doesn’t run to some “geeks” getting excited about a new piece of kit that will save lives or diagnose thousands of disorders in hours! The bioengineering/medical scientist are the “baritones” of the chorus – giving depth, richness and solidity to the heroics.
And now we’re moving to the third phase of COVID19, where those 20% of the population who haven’t shrugged off feeling lousy, achy, “fluey” and that persistent cough. Some members of the public, often but not exclusively, have longstanding medical conditions, succumb to the virus and need hospital admission and intensive care, usually involving a ventilator to take over breathing whilst the pneumonia tears through the lungs. And this is predominantly my own profession – respiratory physiologists and scientists. Never heard of them? Know anybody with a diagnosis of asthma, chronic obstructive pulmonary disease (COPD) or obstructive sleep apnoea? They will have heard of us, because they are diagnosed and on the correct treatment because of the respiratory physiology team getting both diagnosis and often the treatment right.
And what’s our role in COVID? In the last 2 weeks I have been working with physiotherapists, doctors and managers to plan how we will be on the frontline delivering ventilation to very sick patients. We won’t look very different from the doctors in our gowns, protective hoods and gloves. We too have families at home (or hopefully in school as key professionals!) and possible underlying asthma, diabetes or other risks. We too will be putting our health on the line just like the doctors and nurses. We won’t be recognised by the media for carrying out these roles, because they don’t know we even exist! Nevertheless, we will carry on doing this life-saving work, with the stresses, strains and pains whilst carrying our own burden of loved ones at risk from this potentially aggressive pandemic. We chose to work in the NHS, not for the glory (there’s been little), not for the money (there’s been little) and not for the fun of it (although there can be lots of that!). We care about health and we like the scientific life.
Are we a bit scared? Yes. We’re on the wards performing blood gases on COVID19 positive patients. We’re also setting patients up on acute non-invasive ventilation (this is ventilation via a face mask rather than being intubated), and will probably before the peak of COVID19 is reached, may have some of us helping to run intensive care ventilators. However, we too will only have the personal protective equipment used by ITU doctors and nurses in Wuhan, Italy and Spain – that’s of course if we ever get it in time! We too will be at high risk from aerosolised virus, but we’ll be standing shoulder to shoulder with our brilliant doctor and nurses colleagues (without the luxury of being a metre apart at the bedside!)
I spent 10 years leading/running an acute non-invasive ventilator service in Nottingham City Hospital, getting up in the night, working on Intensive Care, as well as delivering ventilation clinics and home visits. We once famously discharged a patient from 3 months on ITU to his “hospital at home” in Lincolnshire on a large ICU invasive ventilator. We excel at the unusual – safely. I have colleagues running a similar healthcare scientist led acute ventilation at Walsgrave Hospital in Coventry. Joanna Shakespeare, (yes most healthcare scientists in physiology are women!) has been ventilating suspected COVID19 patients for the last fortnight. No it wasn’t on the front page of the tabloids – why would it be? It didn’t fit the convenient stereotype of the health service that only contains doctors and nurses (which is all Boris Johnson refers to in his deliberations to the country! Grr!), and it isn’t understood by the public, so why write about it. This is one of the main drives for this piece – to raise the profile of the “unsung heroes” of the COVID19 Pandemic who don’t even get a mention and yet collectively are responsible for saving just as many lives as the doctors and nurses.
And it’s not just the current hospital HCS employees who are working hard to fight COVID19.
Pandemic People 2: Alan is a retired but incredibly experienced & well connected respiratory HCS. He worked on ITU ventilators and a respiratory physiology service for 40 years until his retirement 3 years ago. We were approached by Dr (Lieutenant Colonel) Andy Johnson, RCDM an ITU/military Consultant colleague who was asked nationally to source an artificial lung for the UK F1 Ventilator companies to test their newly built ventilators on. Within 3 hours Alan had got 4 such “lungs” sourced from manufacturers and on route to UK F1 makers Red Bull & McLaren. Brilliant work from a healthcare scientist who is allegedly retired!
Many of the healthcare scientists/physiologists in cardiology will be performing thousands of ECGs and echocardiographs on patients who will be drifting into cardiac failure on ICU. Wearing basic PPE, they will spend many hours on the front line in close contact with very sick COVID19 patients. Supporting the nurses and providing vital information to the multi-disciplinary team of doctors, anaesthetists and allied health professions fighting to save people’s lives.
The training programme for healthcare scientists now runs from assistant grade, through graduate practitioner training, master’s level scientific training and finally to higher scientific doctorate training to reach consultant level after about 12-15 years from leaving school. Consultant clinical scientists lead scientific services in the four branches of healthcare science; Life sciences, Medical Physics and Bioengineering sciences, Physiological sciences and Bioinformatics. Schoolchildren really need to consider some of the amazing career opportunities available as a healthcare scientist in the NHS.
Consultant clinical scientists often advise medical and surgical consultant colleagues and develop and procure new technology and innovation through research and development. Life science colleagues will continue to review the scientific data on the genetics and immunology of COVID19 to eventually understand how and why it is so contagious. The research phase of this COVID19 pandemic will inform global healthcare about the next pandemic whenever that may be. Careful, controlled, meticulous analysis and working to high quality standards by healthcare scientists reduces the “noise” of clinical data to understand the underlying patterns of the spread of the virus through vulnerable populations.
Whether patient facing, laboratory based or workshop testing healthcare scientists will hopefully no longer be the unsung heroes of the NHS – but will be recognised with the public for roaring out the COVID19 Chorus as we to help defeat this pandemic across the UK.
Professor Brendan G Cooper B.Sc. (Hons.), M.Sc. Ph.D., C.Biol, FRSB, FERS
20th March 2020
President’s COVID-19 Blog
My God, I have never been so busy in my career! Covid19 has been so consuming as we prepare my respiratory physiology team to be supporting ventilation and oxygen care directly to patients on the frontline! The task ahead is daunting, sometimes overwhelming for not just my juniors, but my nursing, AHP & doctor colleagues but everyone who is involved cleaners ,porters, managers too.
The anticipated stresses, inevitable patients deaths and emotional burden is challenging but I believe all of my team will cope. They have been magnificent so far – truly heroes.
Both Julie my wife & I are ready for NIV ser-ups all day probably next week. We are wrecked each evening watching any old TV programmes to block out the reality – and the onslaught hasn’t begun.
We may struggle to attend the Professional Body teleconference if things kick off next week, & the blog and messages I’d hoped to write I will struggle to find the capacity to write. I need help from AHCS on this. If someone could capture my Covid19 tweets & messages I will try and edit it each day. I’m regularly writing “Pandemic People” and will start “HCS Heroes” tweets soon which could be used to develop blogs. Can you help? of course I know you will. l do want to make sure that we are acknowledging the care and compassion of our colleagues.
I never thought I would be doing this role(s) – we’ve stopped/cancelled appointments & rebooked lots as tele-consults, we’ve retrained all staff in PPE, ward observations, ward blood gas services, cancelling tests into the summer. I’ve been co-writing ARTP Covid Guidelines, getting PPE supplies for staff using the “Prof” clout! The list goes on.
Have to go in now, have to drive to avoid people on trains then deliver daily brief to team. Will continue this later. So proud to be a HCS Lead. Best job ever, with the best team ever!
IQIPS Accreditation – Official Statement
Please click here to read the official position statements from the Association for Respiratory Technology and Physiology (ARTP) and Association of Gastro-Intestinal Physiologists (AGIP).
21st May 2018
Once upon a time, there was a big banquet held in London when the HRH Princess Royal was introduced to all the clever healthcare scientists across the (Eng)land to discuss how clever we all are and what a difference we make to the subjects across the land!
Well, we all knew we would all be introduced to HRH before the dinner, and it’s hard to know exactly what you could say to have any meaningful conversation in such a brief encounter. In point of fact the Princess Royal spent over an hour speaking with every healthcare scientist she met with kindness, interest and patience. Because I was in the last group it was all very rushed and I just managed a handshake and “Your Royal Highness” as advised, before she moved on. Doh!
As the last group on table 14, we assumed we’d be at the back of the room, relaxing & enjoying the awards. We were escorted behind Sue Hill, CSO & HRH into the room of standing guests, when it dawned on us we were on the top table! Imagine my surprise (& I might add mild panic), when I saw my place name next to HRH! Sue Hill was sat on her other side.
What would I say, how would I behave, how could I speak to this powerful, famous and influential member of the Royal Family. Was this real? Very quickly CSO & HRH took to the stage for 45 mins of awards! I discretely texted my wife at home; “Sat next to HRH. Help!”
After the presentations, where again HRH spent time to speak to every winner in considerable detail, the Princess Royal sat down next to me and I launched into “Well that’s the work done, now you can relax over dinner?” to which she replied “Well that was easy, it was a pleasure to meet all of them….”
So then we proceeded to discuss an enormous range of topics, with ease
& interest (well for me, the Princess Royal may have held a different view!!). Ironically, she had flown up to Birmingham by helicopter that morning to open my university’s amazing new swimming pool. I joked if I’d known that, I’d have met her up there! She casually mentioned how she’d been flown back to “Buck House” for the CSO Awards. She smiled and then laughed. Suddenly, the panic within me melted. HRH is not only very experienced, confident & very sharp, she also has inherited an excellent sense of humour & fun. I suppose when you meet thousands of people a day, and are held in high esteem, it makes much more sense to let people relax and be themselves so conversation can flow and be easy.
Sue Hill and I went on and explained the 52 branches of HCS and the 53,000 workforce and the variances in workforce diversity within professions & specialisms. She is Patron of WISE and was interested in the role of women at different career levels. She was also interested in ethnic diversity and whether the workforce matched the populations we serve. We touched on people’s responsibility for their own health, which we all agreed was a major stumbling block that has to be overcome in our health system and globally.
We then, whilst discussing genomics and genetic diversity, moved on to the need for genetic diversity in farm stock – citing her rare pig breeds and then applying the consequences of global farm animal diversity and the importance of mixing the genetic pool to resist diseases and environmental catastrophe. She touched on her work as Patron of Save the Children and I was able to share my experiences of my recent trips to teach spirometry in Nepal. We further discussed the juxtaposition of innovation and traditional life with the mix of worlds – the ox and plough with the mobile phone and the role of solar power & mobiles changing global rural life forever. Her knowledge on these issues is highly impressive.
Her diversity of conversation also included my own pet interests – motoring and cars – as we talked about her Scimitar GTE, the demise of Land Rover Defender and the problems of getting DVLA driving licences for horse box lorries!
Her knowledge and understanding of people’s lives, her experience and knowledge of cultures, industry, agriculture, science and technology is utterly breath-taking. I’m supposed to a professor but felt like I was merely a student! I was suddenly very grateful to have gone to a school where arts, sciences, sports & humanities were high on everyone’s agenda, and I only now truly appreciate the wisdom of that philosophy.
When it became time for HRH to leave I told her that her sense of duty was inspirational to all leaders and thanked her for all she does for healthcare science and the country.
The weirdest part was at the conference the next day when Sue Hill mentioned to the audience “….as I was discussing with Princess Anne and Brendan Cooper last night over dinner….!” It seemed so unreal.
I can now honestly say, if ever you have to speak with the Princess Royal (or any other dignitaries for that matter), just be yourself, be relaxed and show you have a sense of humour and enjoy the encounter. You’ll be surprised at how much you learn and what you can say about the profession you are so proud to be a part of. I am grateful that Sue Hill gave me this opportunity and I only hope I represented all of our healthcare scientists proudly by praising your lives and work. And that’s the end of the story – they all lived happily ever after……….well until the next NHS crisis anyway!
10th January 2018
The media is alive with the current NHS winter pressures crisis – queuing ambulances, over 4hour trolley waits, increased admissions and patients at the front door – all related to the increasing respiratory admissions related to the current influenza outbreak. It has occurred to me how could this activity be impacting on our hard-working healthcare scientists who continue to support other clinical staff and patients throughout this difficult time.
Whilst the immediate winter crisis is putting added pressure on an already well organised pathology services, we have seen increasing demand on physiologists supporting ward work such as acute services like blood-gases, ECGs, non-invasive ventilation, etc. Medical Physics imaging naturally is also taking the brunt of the increased activity. Unfortunately, for the media this is out of sight, out of mind. HCS are resilient and flexible in their workloads – but chronically, these delayed operations will add to the burden further down the line as this week’s admissions become next months “follow ups”. Whilst the acute National Emergency Planning Panel can solve the startling headlines, the undercurrent of underfunded scientific services is the dark shape looming up under the surface!
July 26th 2017
I was interested to hear Dr Suzy Lishman, President of the Royal College of Pathologists being interviewed on Radio 4’s Today programme on Monday morning this week.
The BBC reported: NHS England said based on its latest data, 54% of women screened are getting their results on time. Delays are being blamed on cytology labs struggling to keep staff as the screening process is replaced with another primary HPV screening- which will need fewer staff.
Dr Suzy Lishman, president of the Royal College of Pathologists, said although less than 50% of women were not getting their results within two weeks, 83% were getting theirs within three weeks.
“The effect is mainly anxiety but it is very unlikely to have an effect on their health as cervical cancer can take decades to develop.”
One consequence of the changes will be that because of automation there is are likely to be redundancies in life scientists, but the waiting lists would come down. It has occurred to me that really the RC Path, IBMS and related professional bodies should be working with the Academy for Healthcare Science to explore ways of re-training life scientists into other areas of Healthcare Science where there are “pressure points” in the workforce. In my experience, I have met and worked with several previously trained life scientists who have become physiologists and delivered excellent patient facing Healthcare Science functions. Essentially we are all scientifically trained. We cannot easily stop the tide of innovation and change and nor should we. We have to use the scientists we have to be flexible and forward thinking and respond to change or be lost from the scientific workforce. Using Accredited Scientific Expertise mechanisms we can re-shape the workforce proactively and not lose the excellent scientists we’ve spent years training and nurturing. The same will be true for the geneticists in the reducing numbers of Genomics Centres in the UK whom we must utilise to delivery expertise in “under pressure” similar areas of Healthcare Science.
Change can either be seen as a threat or an opportunity – and we must help our scientific staff take those opportunities.
Teaching Spirometry in Nepal – April 24th 2017
Day 1 – Taught spirometry to 20 health staff at Grande International Hospital, Kathmandu: attended ward round on ITU, handed IPEM poster to CEO of hospital, met a Nepalese researcher who is trying to publish research on lung function in healthy Nepalese people. All this in bright sunshine, crazy traffic and with amazingly inspirational people! Best regards, Brendan.
Brexit and the Academy – October 19th 2016
Dear Healthcare Scientists,
We have heard the verdict of the European Referendum and with pretty much a 50:50 split across the country we need to be sure that no matter what challenges lie ahead as the UK splits from the European Union, we have to be aware that many of your professional body members will continue to have strong professional links with Europe through European professional bodies, Royal Colleges and other scientific bodies. Personally I have just been given the Fellowship of the European Respiratory Society and plan to continue working closely with European colleagues on standards, guidelines and leadership of people in my profession. I am sure there are many more of you in the same position.
There is much legislation around health & safety and accreditation that has and will continue to have its roots in Europe, so I suspect that because of the globalised medical equipment world we live in, not much will actually change for a long time if at all. The NHS has been used as a pawn in some of the campaigning and it will be a while before we understand the full implications, perhaps good and bad, on the services we all deliver. We were always aware that the European Union was an important source of scientific research funding, which may be affected by different directions between European and UK governments. However, as scientists we have a role in ensuring that where we can, we should maintain cooperation , links and support with our European colleagues , but also be open to ideas outside of Europe as well (e.g. USA, Asia-Pacific).
I think we can all agree that the political campaign was very poor from both sides with much misinformation, ignorance, accusation, frustration and intolerance evident across the board. It seems only now in the cold light of day that the truths and impact of the decision is beginning to emerge. Fears are being replaced with realities, guesses with true implications, half plans with full consequences. It is likely that the worst scenarios painted may not actually come to fruition, but change always brings uncertainty, lack of confidence and caution. However, change also brings new opportunities, unforeseen consequences and a chance to improve some things for the better. As healthcare scientists we should not be despondent. We are used to uncertainty and exploring new ways forward – two essentials of research and innovation.
The Academy One Voice will continue to speak up for healthcare science interests, and use the change to bolster our cause with new political faces and forces. We will continue to drive forward the quality and standards agenda and hopefully influence the new political/economic situation that emerges. Now is not the time to be divisive, not the time to be negative, not the time to over-react, but to be vigilant and patient for opportunities to get the best outcomes for our patients and healthcare science services. Keep Calm and Carry On being Professional!
Dr Brendan Cooper B.SC. (Hons), M.Sc., Ph.D. C.Biol., FRSB, FERS
Healthcare Science Olympics – October 19th 2016
Well, I’m sure many of you are relieved that the Olympics is now over, not just because we have exceeded Team GB’s medal target, but that you can go to bed at a decent time for a good night’s sleep and not be lured into staying up until 2:00am watching Taekwondo, Archery on Beach Volley Ball!
Personally, I wasn’t initially interested in watching events from “halfway around the globe” in the “middle of the night”, but I have to say, partly because of the high quality coverage and editing, I became gradually more and more interested in the competitions, and especially the Olympian’s and their personalities. What makes ordinary people strive for excellence and achievement? What can Healthcare Scientists learn from the Olympics to help our day to day work?
Firstly, I was impressed by the level of collectiveness, belonging to one team and supporting each other, despite having different backgrounds and training in such a variety of sports. As healthcare scientists in at least 52 different professions, we all share some common training, but it’s in the implementation of our scientific services that we deliver excellent patient centred care, using best standards and maintaining the highest quality.
Secondly, it was refreshing to see that the apparent “barriers” of politics, race, creed and class seemed to be totally irrelevant when you are all pulling together to do the best you can as a single team – Team GB. Furthermore, our prejudices, biases and attitudes change when we see our fellow humans from all nations on the earth, aspire, achieve, fail, win, re-try and exceed expectation. These very human qualities are the same feelings we endure every working day of our lives.
We can learn from our Olympians, that striving for the best, believing in ourselves and building our self-confidence is what makes us all great. We should learn from each other and teach our juniors that being part of a team of Healthcare Scientists is worthwhile and beneficial. The long dark “winters” of training and development can be rewarded in the “summer” of an aspiring career and becoming leaders. Even more exciting is to become a leader and train the next generation of “champions in our own professions.
Now that Rio 2016 is over, I am left feeling a mix of pride, well-being, enthusiasm and encouragement for the future. In many aspects of my life I want to (just like Olympians) improve myself 10% across the board in everything – work efficiency, general fitness, body weight and take up long-abandoned hobbies and interests to improve my mental health too. The Olympics may hopefully press a “re-set” button in us all to get our scientific life back on course for Gold. It doesn’t matter if we don’t get the gold medal – it really is the “participating” to the best of our ability that makes us good healthcare scientists. To all healthcare colleagues – go and achieve your goal, aim to be the best in your profession but remember you are a member of “Scientific Team GB” too and contribute to our future through the Academy.