The Ward Round: The virtual frontline

This week the government triumphantly announced the launch of its test and trace programme, which was set to go live on Thursday.

The service, according to the Department of Health and Social Care, will include 25,000 dedicated contact tracing staff, working with Public Health England, who will have the capacity to trace the contacts of 10,000 people who test positive for covid-19 a day and can be “scaled up if needed”.

The other week Matt Hancock also announced 7,500 of the contact tracing staff would be clinical contract tracers and according to the job advert on NHS Professionals this involves using existing clinical skills to join the “virtual frontline”.

The role, according to the advert, needs clinicians qualified at band 6 or above and is suitable for nurses, doctors, pharmacists, vets, those working in community healthcare and many others.

This comes with a lot of responsibility – duties include performing initial public health risk assessments of covid-19 cases – but it remains unclear how many clinical tracers have so far been recruited and how many have started work.

This role, which has pay of £16.97 to £27.15 an hour, will play an important part in ensuring the success of the scheme, but with workforce shortages in much of its recruitment pool, 7,500 feels like an ambitious target to hit.

The new contact tracing app also presents a challenge for healthcare staff in terms of when to use it at work. In an interview with HSJ last week, Isle of Wight Trust chief executive John Metcalfe said staff need to ensure they disable the app before going into work environments to prevent it from registering a high-risk contact with covid-19 patients.

“Who has time to switch apps on and off?”, questioned one HSJ reader. You can imagine how easy it would be to forget to do this before starting a long shift. But with the onus on employers and individuals to ensure the app isn’t misused, its success among healthcare staff will surely be patchy.

International recruitment challenges

In this week’s HSJ Health Check Podcast we discuss the things that have gone “under the radar” during covid-19, and part of my suggestion were the aims of the People Plan and whether the target of 50,000 more nurses by 2024 would be scuppered by the pandemic.

HSJ dug into this last week, as senior sources warned the first year of the workforce plan may have to be “written off” and later years backloaded in order to meet the government’s manifesto promise.

Other sources suggested the plan was always intended to be flexible, but if the NHS has not seen substantial growth in nurse numbers over the next four years, the gap between supply and demand will be even bigger, services more stretched and the government facing embarrassing questions.

As perhaps expected, figures provided to HSJ by the General Medical Council, have shown the number of international medical graduates granted registration to work in the UK fell from 1,663 in March to 778 in April and down to 441 as of 20 May.

GMC chief executive and registrar Charlie Massey said as safety measures and travel bans have impacted the flow of medics from abroad it is “crucial” the workforce already working in the NHS is supported.

Supporting the current workforce of course links to retention – another major part of the People Plan. Retaining staff members who re-joined the health service during the pandemic will be incredibly challenging, but they will be needed more than ever, considering the lower numbers of international and European staff able or willing to work in the NHS.

More than surviving

As any healthcare professional reading this will know, a patient’s recovery from coronavirus continues long after they are taken off ventilation or high-flow oxygen and involves the whole of the multidisciplinary team.

A new service developed by Nottingham University Hospitals Trust has emphasised quite how work intense the recovery process is and just how many different members of staff are needed to make the service happen.

The acute trust in the East Midlands has created critical care step down units for patients who have been on intensive care with covid and are suffering from post-intensive care syndrome.

Steve Gill, critical care consultant at NUH, stressed recovery from severe covid-19 involves far more than surviving and going home.

“Reaching the best possible level of recovery needs early and prolonged interventions to help patients recover their physical strength and coordination, improve their speech and swallowing, optimise their nutrition, as well as managing the cognitive and psychological consequences of being on intensive care,” Dr Gill explained.

The multidisciplinary team involved in the new step-down recovery units are made up of rehabilitation medicine, respiratory and acute medicine consultants, physiotherapists, nurses, occupational therapists, neuropsychologists, speech and language therapists, pharmacists and dieticians.

This case study at NUH highlights how the coronavirus pandemic has required the NHS to change and how the workforce is deployed in a very short space of time. It will be interesting to see whether this pocket of creativity will endure in the health service after the pandemic has eventually passed.