When visiting a critical care unit some months ago, I saw a ventilated patient, unconscious surrounded by photos of their friends and family. A dedicated team of staff worked quietly and efficiently monitoring their blood pressure, temperature, and oxygen levels. Day after day, colleagues cleaned this person’s teeth, fed them through a tube and provided sedation and pain relief. Underneath the PPE, I could see the eyes of the members of staff – focused, concentrated but drained. This was the reality of Covid-19. The figures can seem abstract – number of hospital admissions, number of critical care beds and number of deaths. There is a person behind every statistic – that’s why it’s been, and continues to be, so important that we get this right. Every decision we make has a real, human impact.

As well as being chief executive of Wigan, Wrightington and Leigh NHS Foundation Trust (WWL), I chair the Greater Manchester Gold Command Group, set up early in the Covid-19 outbreak. This brings together heads of all NHS trust providers in Greater Manchester, including hospitals, mental health and community services, to plan and respond in a coordinated way. By working together, we can operate more strategically and provide mutual aid if areas come under increased pressure. We aim to ensure that every patient can receive the care they need and there is the workforce and resources on hand to provide it.

In a way, this is simply an extension of how we usually do things in Greater Manchester, but Covid-19 has certainly taken it a step further. There has been fantastic teamwork across lots of different organisations from the NHS, police, universities, wider public sector and beyond – everyone has really risen to the challenge in a way I’ve never seen before. I want to bottle the ‘in it together attitude’, the collegiate spirit and hold on to it. I feel closer to NHS commissioning colleagues and partners in local authorities, which is absolutely the way it should be. One example is the increased dialogue between hospitals and social care as we worked together to speed up hospital discharge for those patients who were well enough. The two sectors work in very different ways and to different timescales – that’s just the nature of what we do. Covid-19 has provided the impetus to have valuable conversations around managing expectations, identifying gaps, and agreeing future ways of working.

In this way, I think our response to the pandemic has really strengthened the argument for devolving decision making and funding for health and social care. A more local, joined up approach allows us to respond better to the needs of local populations and tackle the specific challenges we face. One size doesn’t always fit all.

It’s also shown that we can make decisions, adapt, and innovate – fast. Something, I think it would be fair to say the NHS isn’t always known for.  It’s refreshing. We have seen digitisation, the creation of new apps, widespread rapid clinical trials, and changes to clinical pathways to get patients through diagnostics more quickly and into treatment. All things we must keep hold of as we move forward.

It’s been challenging too. In the early days we had to move rapidly yet we were dealing with so many unknowns. Some of the hardest things to manage were PPE supply chains and concerns over mortuary capacity across Greater Manchester. A sobering insight into what was to come.

Covid-19 has shone a light on inequalities in our city region, with those in some ethnic minority groups or lower pay impacted more than others. Greater Manchester’s much celebrated diversity yet higher levels of deprivation has sadly meant we have been more affected than some other parts of the country.  It pains me to say it, but this does reflect poorly on what went before. Tackling inequalities has greater focus now and we must ensure it remains so as we move forward.

Many of our NHS staff have done, and continue to do, an incredible job over the past 12 months, often with little time to recharge and recover. That’s why the whole system has invested heavily in psychological support – whether that’s counselling, safe spaces, or break outs to destress – all ensuring rapid access for staff whose need is greatest. I really value the work of the Greater Manchester Resilience Hub, which provides psychological and emotional wellbeing support to all health and care staff and their families. Some members of staff who contracted Covid-19 are now experiencing ongoing symptoms and they will need specific care and support.

It has been humbling to see frontline teams step up to the plate. Like many colleagues, I have now been working intensely for over a year and it’s exhausting. However, I must admit that there have been moments of exhilaration too – when we have got things moving quickly, mobilised extra resources and brought in more support. I’ve found reserves of energy and determination I didn’t know I had – somehow, I’ve been able to keep motivating others and keep going. I think the experience has made me a better leader, helping me to strike a balance between focused, serious, and personal. You achieve more with kindness and humour – we need it, even at the darkest of times. It’s always a juggling act between my role as Gold Command chair and WWL. I’ve leant heavily on the team at the trust to keep things running on the ‘homefront’ with colleagues stepping up to take on more of the day-to-day coordinating. There have been moments where I wonder whether I’ve made the right decisions – after all this is new territory for us all. You can have all the right people in the room but sometimes a judgement call is still needed. We’ve learnt from each wave, so we know more about what works now.

Sometimes, it’s not until you stop, that you can reflect and let it all sink in. Then the enormity of what we are dealing with hits you. I’m fortunate to have a strong network of family and friends to help me to step back and relax. I’ve had my first vaccine and looking forward to my second. This is our hope – our reason for optimism. I encourage everyone to get theirs when their turn comes.

My priority right now is getting planned services back up and running, and this is already happening to some degree. It’s vital we do this in a controlled measured way, partly to protect our workforce.

Science tells us that Covid-19 isn’t going away. It’s natural to worry about what this will look like. It calls to mind those who didn’t make it – the lives robbed by this virus. Sadly, we can never turn the clock back, but I believe we are in a very much stronger position than this time last year. The number of patients with Covid-19 in our hospitals continues to fall. We have the vaccine and current lockdown restrictions to thank for this.  We know more about this virus – it is not the entirely unknown entity it once was. We know more about treating it, caring for those who have it and managing its impact in our communities. And perhaps our strongest assets for the future? Our incredible dedicated workforce and the ever-stronger ethos of partnership working.

After all, this is Greater Manchester – we do things differently here.



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