March 2020
Hello and welcome to H1, a newsletter named after our new hospital bus route, which is designed to make sure that you and your colleagues are kept up to date with the latest news and activities at Epsom and St Helier.
A message from our Chief Executive
Nationally the coronavirus outbreak is the biggest public health emergency in a generation. It calls for decisive action, at home and abroad, of the kind not normally seen in peacetime. This is why we are doing everything we can to tackle the pandemic and mitigate its impact.
The public has a crucial role to play in delaying the spread of the virus, making sure they stay at home if they have coronavirus symptoms or, if someone in their household does, washing their hands more regularly and pulling together at this time of emergency. Everyone will need to help to ensure people get the support they need to stay at home. 
We thought that during this very busy time for our services you would be interested to know that a huge amount of planning and work is continuing to take place to keep our patients and staff safe. We are working to national guidance but unfortunately we are seeing more cases of suspected and confirmed COVID-19 in our geographical area and therefore have had to take action earlier than some other hospitals.
World view
At the time of writing, 242,488  people have contracted COVID-19 globally and 9,885 people have died with the virus across the world. Figures show that the majority of people will recover from the virus, while the true number of people who have recovered is likely to be higher than the statistics show . We think it is really important to focus on the fact that lots of people have already recovered and are back living their normal lives.
Local update
Sadly, seven patients at Epsom and St Helier (including our community services) have died with COVID-19.  All of these patients were older and had longstanding health conditions. 
Protecting patients in our care
Anyone who arrives at hospital with pneumonia or respiratory illness is, for their protection, treated as a suspected case of COVID-19. Unfortunately, we do not have enough single rooms for all of these patients to be cared for in isolation, so we are caring for them in pre-determined wards at both Epsom and St Helier hospitals. As more patients are admitted, we are increasing the number of wards that are dedicated to caring for patients who are suspected or have confirmed COVID-19, as well as changing the internal layout of A&E and the way patients are moved through the department. We have also begun a big piece of work to create additional capacity in critical care (this includes intensive care and our high dependency unit).
To support our emergency response, we have had to make some difficult decisions regarding the planned care we provide to our patients, and have cancelled all private patient procedures usually carried out in Northey Ward.   
The privacy and dignity of all our patients remains a priority for us but in these difficult times we have had to relax the rules around mixed sex accommodation on the cohort areas.
Our hospitals and community services are very busy, and we are working closely with our partners in Sutton Health and Care and Surrey Downs Health and Care to ensure people do not stay in our hospitals for any longer than they need to. We have had a very positive response from our health and social care partners and will continue to do all we can to ensure that patients who are medically well can leave hospital.
Temporary changes to outpatient and not urgent appointments
As we secure the clinical space and staffing resource to care for critically ill patients and protect members of the public and our colleagues from the spread of the virus, we have temporarily suspended some of our planned care procedures. We appreciate this is a difficult development for our patients, but it is vital that we take steps to:
1)       Reduce pressure upon clinical services and release staff to help with emergency pressures
2)       Reduce face to face contact with patients
3)       Ensure that we focus our efforts upon urgent cases
4)       Manage risk appropriately.
As a result, we have suspended all routine outpatient and day case elective work (including paediatrics), although we are still providing care to patients who are referred urgently to us from a GP and running many diagnostic tests like CT and MRI. In fact, we have just ordered an additional temporary CT scanner and mobile X-ray machines so we can care for our COVID-19 and non-COVID-19 patients in different areas and use different equipment.
If you have an outpatient appointment booked with the Trust, please wait for us to contact you. We are aiming to provide as many appointments and consultations over the telephone or by email as possible (sometimes known as a virtual clinic). Our Outpatient Booking Centre team are currently inundated with queries, so please bear with us.
We are still running urgent appointment clinics for patients with suspected cancers (our 'two week rule' clinics), and you can be assured that these patients will continue to be expedited.
As you would expect, we are monitoring this situation closely and are taking steps to protect our patients in line with national guidance. We may need to postpone further appointments as the situation develops and will keep you updated.
Join us!
Yesterday the NHS announced that they were embarking on a massive recruitment drive.  There are more than 65,000 former nurses and doctors who are being told "Your NHS Needs You", with England's top nurse and top doctor calling on colleagues who have left the NHS in recent years to re-register and help the health service to tackle the "greatest global health threat" in a century.  If you or your colleagues know former nurses or doctors ask them to get in touch as we would be keen to hear from them.  Please ask them to call us on xxx.
Restrictions on visiting arrangements
There is a national visiting policy in place for hospitals. The public are being asked to limit visiting and to consider other ways of keeping in touch, like phone calls. Visitors must be immediate family members or carers. 
Visitors should not attend any health and care settings, including all inpatient, diagnostic and outpatient areas, if they are unwell, especially if they have a high temperature or a new, persistent cough or are vulnerable as a result of their medication, a chronic illness or they are over 70 years of age. 
Visitors are being limited to one per patient unless: 
*            the patient is receiving end-of-life care 
*            the visitor needs to be accompanied - accompanying visitors should not stay in patient, ward or communal areas, and this applies to inpatient and outpatient settings
*            they are a partner and birthing partner accompanying a woman in labour. 
No children under 12 should be visiting without the ward sister or charge nurse's prior permission. Hospitals and other health and care settings will restrict visiting to one hour per day at designated visiting times. 
Slightly different rules apply to paediatrics and neonatal - two visitors are allowed and this may include a child under 12. The public are being asked to help in respecting these rules.
Supporting our staff
Our staff are going above and beyond to protect our patients, keep services running and reduce the risk to the public, fellow colleagues and their loved ones. That has already meant long hours, people working on their days off and giving up their weekends to help support our response to and management of COVID-19. This is truly appreciated, and every single person involved deserves a huge thank you.
We are supporting our staff in a number ways:
*            We are delivering food and hot drinks for all staff (clinical and support staff) working in our EDs, on the cohort wards, ITU and HDU
*            Additional Occupational Health and mental health support
*            Parking for staff and visitors is currently free
*            We are increasing carers leave in response to school closures and disruption to caring arrangements to a maximum of 7 days.
*            Where we can release staff to be redeployed to different critical roles to support our patients, for example the redeployment of administrative and managerial staff, as well as practitioners whose services have been stood down, we are providing additional training and support.
We are supporting some of our staff working from home and offering local accommodation for those facing travel difficulties and others who have people in their home who having to self-isolate.
*            The WHSmith shops on the hospital sites are offering our staff 20% off as a 'Thank You' and Epsom Odeon Cinema this week visited Epsom hospital with all of their stock including sandwiches, fruit muffins and flapjacks which we distributed to all of our staff.
A big thank you for all of the messages and for thinking of our hardworking teams.
A comment from our Chief Executive
You may have noticed that the hard work of our staff is front page news this week, featuring in the Surrey Comet. Here is the statement from Daniel in full:
On Wednesday, the Surrey Comet made that a little bit easier, as they approached me for a comment on how our staff are responding following a tweet from our Matron on Gloucester Ward, Naomi Stuart, and so I had to crystallise my thoughts quite quickly! Below is what I responded with, and I'm pleased to say that the story made front page news:
"Our staff are going above and beyond to protect and care for our patients, keep services running and reduce the risk to the public, fellow colleagues and their loved ones. I could not be prouder of the whole team and am immensely grateful for their unwavering commitment.
"This is an unprecedented situation, and the way in which our different teams have pulled together to respond to COVID-19 is nothing short of exceptional. It's often said that, in times of crisis, those working for the NHS and in emergency services run toward the danger rather than away from it, and that's certainly true in this case. Our staff working in wards and departments, as well as those teams working behind the scenes, are facing this incredibly difficult situation with courage, camaraderie and determination.
"We have received some very touching messages of support for our staff, as well as some very generous donations and discount offers - these gestures are greatly appreciated by our teams and a great boost to morale in this busy and difficult time.  In fact, I received an email from Louise, our Deputy Head of Nursing in A&E this morning, that said: 'Staff feel so valued. We know we have a hard few months ahead of us, but we are ready."
Every day, you do remarkable work, but I don't think I have ever been as proud of you all, and so humbled by your sheer determination and courage, as I am now. There's just so much going on and it's taking the efforts of everyone - from our chaplains to our domestic staff, nurses and doctors, porters and our simulation centre team - it's all hands on deck.
The Chief Medical Officer's advice to the public
The public are being advised to stay at home (self-isolate) without any testing for COVID-19, regardless of travel history or contact with confirmed cases, if they have:
a. A  new  continuous cough
b. High temperature (of 37.8 degrees centigrade or higher)
The geographic element of the case definition has now been removed. Travel and contact history are no longer important for diagnosis, which is now on the basis of symptoms alone. If people who have travelled do not have symptoms they do not need to stay at home, regardless of their travel history.
Individuals should stay at home (self-isolate) for 7 days from the onset of symptoms following the current advice. If someone has serious symptoms they cannot manage at home they should use NHS 111 online (people should only call NHS 111 if they cannot get online).
After 7 days of self-isolation, people who feel better and no longer have a high temperature can return to their normal routine. If they have not had any signs of improvement after 7 days and have not already sought medical advice, they should use NHS 111 online (again, people should only call NHS 111 if they cannot get online) before they leave their home or let visitors in.
Cough may persist for several weeks in some people, despite the coronavirus infection having cleared. A persistent cough alone does not mean someone must continue to stay at home for more than 7 days.