IBMS Chief Executive David Wells was NHS England’s Head of Pathology when COVID struck. He explains what lessons he learned and how they can help the profession. We then hear from a range of IBMS members and scientists on their biggest lessons and takeaways from the pandemic.
When David Wells was Director of Operations at Viapath, one of the UK’s largest networked pathology services, he decided that his team in Guy’s and St Thomas’ Hospital in London would take part in a multi-agency disaster recovery exercise. The premise was that a tower block could collapse onto Waterloo Station and the Underground. Whole trains were mocked up and actors played people needing urgent care, and leaders at St Thomas’ decided to keep the hospital open and run the preparedness “live”, so it remained open.
“We were given an option in pathology to just be observers or take part fully. I decided if the hospital is doing it fully then we would do it fully,” David says. “So we ran our disaster recovery plan live. Everything was all planned, in place and our labs were still fully open.”
The team’s involvement in the exercise was relatively low – involving blood transfusions in the main – but it meant the team and all the systems had been tested and the processes were in place for a real disaster. “But also we saw how we plugged into the system, how we were involved in all the reporting cascades and conversations,” David adds.
About a year later, the Westminster Bridge terror attack happened right outside St Thomas’ Hospital. “When we were put on major incident for that my boss asked if we were ready; the answer was ‘yes’. We knew who we would call, and who we would be dealing with,” David says.
Unknown circumstances
It was an invaluable lesson for David in February 2020 when, as Head of Pathology Transformation at NHS England, he received a phone call from the incident management team leader from Public Health England (PHE) explaining that NHS England would need to build up testing capacity for COVID-19.
“The most important aspect of my role was bringing all the laboratory leaders together to make sure that we had a coherent response to the demands for testing within the NHS,” he says. “And making sure we had a really clear view of what was happening, where it was happening, what the problems were, what the constraints were and how we as a team of 29 leaders could pass any messages up or down, depending on what we were doing. It was very much a team effort across the entire country.”
Prior to the pandemic, David had been Head of Pathology Transformation in NHS England, responsible for bringing the 120 or so separate pathology services that operated in England into a structure of 29 networks. “If we hadn’t done that work independently my job [during the pandemic] would have been impossible. Because of the progress we made prior to the pandemic, we could talk to 29 groups of people and be assured that messages would get to other lab services. We could coalesce around a smaller cohort of people and my daily phone calls were with a manageable number of people.”
But David and his team were working in uncharted territory during the pandemic. “When I got that phone call, it was a case of ‘how do I make this happen, who do I talk to, how do I fit into the right systems?’,” he says. “The problem statement was quite clear, we needed to have as much testing for COVID-19 as possible. Even though we were in very uncertain circumstances, we knew we needed to work out how we would ensure that the NHS had enough testing to match the government’s requirements.”
At the time there were far more visible challenges in the NHS – such as having enough PPE, ventilators and ICU beds. “So we were able to get on and do what we needed to do and build the relationships to set up our system with a limited amount of interference. Once we got to the point where people were interested in what we were doing, we were set up and scheduled and we knew what we were doing.
“Even though we were working in unknown circumstances, we built confidence around what we were doing and we delivered time and again on what we were asked to do,” David adds.
Relentlessness
David was the only biomedical scientist working full time on the project at a senior level, and he still had “the day job” to get on with. The team still had to keep the pathology network progressing, and then in October 2020 another major incident happened in the world of pathology, which didn’t get a huge amount of attention at the time.
“A major supplier of pathology equipment into the UK had a massive failure in their logistics chain. This meant more than half the GPs in the country could not order blood tests,” David said. This affected testing patients for cancer, heart attacks, renal failure, “the bread and butter – everything else that’s not COVID”. “I had to lead another major incident alongside COVID during October and November while we dealt with this,” David adds.
We built confidence and we delivered time and again on what we were asked to do
“Thanks to the pathology networks we were able to move vital stocks from hospital to hospital, just in time. We had situations where people had nine tests for a critical test ED left in one part of the country and we had to get a courier or taxi to move them across.”
Lessons learned
Despite his planning experience in dealing with unknowns and disaster recovery, it was the “relentlessness” of the situation that was the hardest part of the job. At the start of the pandemic, David was working seven days a week for at least 12 hours a day, for two months. “As the country slowly went into lockdown, I was still travelling into London every day on empty trains, and having conference calls as I was walking down the street because it was so quiet.”
The uncertainty was extremely difficult too. “We could be working on one approach up until 3pm on one day. At 3.01pm we would be told by ministers to completely change our focus,” he says. Teams that had been “moving heaven and earth to get to one position” would have to switch to another from that evening on.
“That’s where the emotion would come through. People would have spent days working on independent projects and then be told to stop.” A calm and pragmatic approach to leadership was crucial.
“Leaders need to set the vision and where they want to get to, but they shouldn’t tell people what to do,” David says, adding that the people he worked with are experts in their field. “One thing we never shifted from was our aim: to build high-quality testing capability for our patients, whether it was traditional tests, rapid tests or antibody tests. We kept that vision clear, concise and tight.” This message applies in quieter times, too. “Disaster or no disaster, leaders should say ‘this is where I want to get to’, and then turn to the experts – local, subject matter – to deliver on that vision,” David says.
Greater visibility
During the pandemic he was meeting with ministers and very senior policymakers regularly. “You have to learn very quickly how to get people to understand what you’re saying and why it’s important, or what the key messages aren’t. I learned loads in that time.”
Now that he’s Chief Executive of the IBMS, keeping the visibility of the biomedical science profession high is a top priority. “We want to push things like advanced clinical practice and the visibility of our scientists and how important scientists are in diagnostics. If you don’t tell people that, and tell enough people, they won’t know. For example, we’re vital to the effort in clearing backlogs, in response to how the NHS will survive for another 75 years.”
David believes biomedical scientists should appreciate the importance of what they do, not be afraid to speak up and take every opportunity presented to them with gusto. “I think traditionally as a profession we hide behind the lab door, we’re not involved in some of the complex conversations,” he says.
“We’ve got all the right education frameworks in place, our statutory regulation as a profession is very good and supportive of us doing more. We just need to get out there and do more and be more visible.”
What is the biggest lesson or takeaway from the pandemic?
Members and scientists respond
Zoe Andrews
Trainee Biomedical Scientist, Guernsey
My own health must come first before my job. I learned the hard way and had to have an operation due to repetitive injuries from COVID testing, which led to time off work, a lot of pain, inability to drive and complete day-to-day tasks we take for granted.
Rakhee Surti
Point of Care Project Manager, Milton Keynes University Hospital NHS Foundation Trust
It has given me the opportunity to push for innovative and transformative ways of working in POCT. Without the pandemic, I believe that POCT would never have had the spotlight and funding it has had during and post-pandemic, which it deserves.
Nicki Lawrence
Principal Biomedical Scientist Advanced Practitioner in Morphology, University Hospitals of North Midlands, Stoke-on-Trent
I think the impact the pandemic has had on people working in healthcare has been underestimated. There is an increase in post-pandemic mental, physical and emotional fatigue that if not addressed will lead to more staff leaving the NHS. This will further stress a service that is already under severe pressure.
Chloe Knowles
EMEA Laboratory Workflow Optimization Consultant, Leica Biosystems
The importance of technology for collaboration. Laboratories were heavily relied upon to provide consistently high standards when the pathology service was under extreme pressure. Utilising emerging technology, such as digital pathology, reduced the burden and allowed laboratories to maintain a clinical service and deliver results to patients during testing times.
Peter Smith
Principal Clinical Scientist, Royal Liverpool University Hospital
I’d say that my biggest lesson from the pandemic is that, contrary to popular opinion, the NHS is capable of rapid change. It just needs everyone to be appropriately motivated to introduce it.
Francis Yongblah
Laboratory Manager, HSST, Clinical Scientist Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children NHS FT
The importance of teamwork. During the pandemic, myself and a number of different scientists, clinicians and managers had to work together to ensure that we could set up an in-house COVID PCR testing service. The work that we did was impressive and we had a COVID PCR service set up within a very small timeframe. This could not have happened without teamwork and recognising everyone’s contribution to this project.
Tony Cambridge
Lead Biomedical Scientist, University Hospitals Plymouth NHS Trust
Pandemic preparedness. Public and commercial organisations have been busy writing business continuity plans to include the response to public health crises, such as pandemics – everything from protecting staff through innovative working patterns to alternative supply chains to avoid service interruption. Many manufacturers rapidly increased production of essential products to support patient care, whilst maintaining quality and sound logistics. The lessons learned must inform how future responses are quickly mobilised.
Mark Cioni
Senior Lecturer in Biomedical Science, Nottingham Trent University
Be adaptable – you never know when you will again have to drastically alter the ways you work. Think about alternative ways in which you could fulfil your role and be prepared to implement these methods with very little notice.
Dr Christopher Ring
Visiting Lecturer in Infectious Diseases, Various universities
SARS-CoV-2 has been able to mutate and evolve much more rapidly than we initially believed it could, allowing it to continue disseminating around the globe, and to evade the immune responses triggered by previous exposures to the virus and vaccines, and also to resist neutralisation by prophylactic monoclonal antibodies.
Lee Peters
Blood science service manager, Hywel Dda University Health Board
I think the biggest takeaway is the importance of our pathology teams and how our training allows us to adapt to different situations. It also shone a light on the need to invest in these teams to develop to support the health service.
Rosebud Rusike
Histology Quality Lead, Cellular Pathology, Maidstone Hospital
My biggest takeaway was “do not underestimate the value of kindness”. From neighbours who would check in and offer food and resources, to work colleagues who took on extra shifts or cancelled plans to help cover for others.
Richard Wardle
Pathology Manager, South Yorkshire and Bassetlaw Pathology
My biggest takeaway from the COVID-19 pandemic was, given the opportunity, how agile and innovate pathology services are to meet the needs of users and patients. With the freedom and support to act, we have the people, skills and ideas to really make a difference.
Al Bryant
Healthcare Accreditation Specialist, UKAS
My professional lesson learned is how reassuring accreditation can be in uncertain times. Accreditation of the private COVID testing market gave assurance about the quality of service provided by the new laboratories that stepped up to provide testing capacity.
Phillipa Burns
Consultant Clinical Scientist, Hull University Teaching Hospitals NHS Trust
Real-time, multi-centre platform research is the way to solve uncertainty and make evidence-based clinical decisions. Big studies, such as Recovery and SIREN, have set a new standard in how we generate meaningful data in a dynamic and flexible way.
Ashley Ballard
IBMS Advanced Practitioner, University Hospitals Dorset NHSFT
I think the key lesson learned from the pandemic is the need for flexibility to be built into laboratory design and operation. We all had to change how we worked during the pandemic, including remote working, rapid adoption of digital systems to aid this, and, most importantly, laboratory space to allow social distancing.
Nigel Crossland
Retired GCP Compliance Director
Daily news media pronouncements resembled gothic horror shows, while personal restrictions were a shock. Yet many examples of positivity – supply of food, essential services, healthcare and vaccine developments – were reassuring. But if there is a next time, I feel that the rapid roll-out of vaccination programmes should be more enthusiastically accepted by the public, with younger age groups not having to wait for theirs.
Hannah Keyser
Lead Biomedical Scientist and Laboratory and Quality Manager in Neuropathology, John Radcliffe Hospital, Oxford
Necessary temporary alterations to working practices allowed us to re-examine how we measure productivity. We continue to encourage a hybrid model of homeworking and lab work, which can increase efficiency for certain tasks, especially if balanced with plenty of strong teamwork and effective communication throughout.
Paul Chenery
Quality, Training & Transformation Manager (Cellular Pathology), Nottingham University Hospitals NHS Trust
The pandemic fundamentally changed how we approached every aspect of our personal and professional lives. It did highlight how resilient we are as a nation and indeed as healthcare professionals. My biggest takeaway is to truly embrace change. In an age where there are increasing pressures with fewer resources, maybe it’s time to look at things differently.
Dr Tina Joshi
Associate Professor of Molecular Microbiology, University of Plymouth
To invest in local and national surveillance of infectious diseases, including diagnostics development and training to deliver testing. We need to be pandemic-prepared and well resourced, with a future-ready workforce to tackle public healthcare challenges. This is more important than ever when considering antimicrobial resistance.
Tracey Stevenson
Consultant Biomedical Scientist,Department of Cellular Pathology, Royal Devon & Exeter Hospital
All the scientific staff were in work throughout the pandemic. The two-metre rule, desks placed side by side, wearing masks all day and taking breaks alone every day contributed to feelings of isolation, even within their own team. So, my biggest lesson is the importance of team interaction within the workplace.
Kunalini Shanmuganathan
Specialist Biomedical Scientist, Blood Sciences, St Mary’s Hospital, hosted by Imperial College Healthcare NHS Trust
Amongst numerous takeaways, the most significant lesson manifested during this unprecedented crisis is the significance of resilience and adaptability. We must remember and embrace these lessons as we tread uncertain paths, well-equipped to face future challenges with endurance, pliability and compassion.
Kinjal Patel
Senior Biomedical Scientist – Advanced Practitioner in Histological Dissection, North West London Pathology
The pandemic was a challenging yet transformative time, allowing me to re-evaluate priorities. I’ve focused on strengthening some aspects of my skill set, becoming more adaptable and resilient. Communicating with kindness and expressing gratitude have enhanced my wellbeing and have had a positive impact on my personal and professional life.
Madihah Abbas
Deputy Service Manager, University Hospitals of Leicester NHS Trust
The biggest lessons that COVID-19 has taught me is that life is too short, and you have the power to help anyone, no matter how big or small your contribution may be. As biomedical scientists we can thrive in challenging times, as has been shown by our dedicated workforce consistently coming into work and processing tests throughout the pandemic.
Tahmina Hussain
Deputy Programme Lead – Biomedical Science Apprenticeship Degree, Lecturer in Biomedical Science, University of Salford
The biggest lesson for me personally is recognising how the pandemic strengthened relationships between teams, reinforcing the importance of our profession and the important roles we play in providing patient care. Colleagues came together to support one another while adapting quickly to the challenges that changed rapidly on a daily basis.
Azuma Kalu
Laboratory Manager, Specialised Clinical Chemistry and Toxicology, Sheffield Teaching Hospitals NHS Foundation Trust
The pandemic presented immense opportunities for biomedical science to showcase expertise in knowledge and skills. It has also changed the way we collaborate and work. Sustaining the gains of the spotlights requires continuous engagement with all stakeholders.
Andrea Johnson
Cellular Pathology Manager, Wye Valley NHS Trust
The biggest lesson was managing staff expectations in a management role. I believe the feelings and opinions around the pandemic are as diverse as other topics, such as religion and politics, the COVID scale seemed a real thing amongst people including staff. As a manager, it was important to listen to staff members working through the pandemic and stay up to date with latest guidance and advice, as you are their first port of call.
Image credit | Ahoy there!_CIA
