To all our amazing staff, firstly it is great to see you using the link to submit your questions and concerns. We understand that it is a really difficult time and we fully understand how it can be hard to raise concerns so we are really grateful that you are using this facility. Below are responses to the queries raised so far.

We want to say a huge thank you to you all

Recently raised queries

What happens this year with annual leave if we don’t get chance to take it due to staffing levels? Can we carry it over or get paid for what we do not use? We only have a couple of months left to use it and staffing on IPU is poor atm. Thanks

Throughout the year we have continued to encourage everyone to use annual leave in order to give us all time to rest and be with our families and no changes were made to our annual leave policy. Whilst we continue to encourage staff to take their allocated leave for 2020-21by 31st March, we are aware that some members of staff have been specifically asked to provide extra cover and support during busy periods or when staffing levels are low. In these exceptional circumstances and with agreement from department manager, a certain amount of leave can be carried forward.

In exceptional circumstances to ensure our ability to respond adequately to the 2nd and 3rd peaks in this Covid-crisis, we may mutually agree to buy-back some leave.  This would be subject to ensuring staff welfare is maintained.

Previous queries raised

There are many work places now testing staff on a weekly basis for Covid, as some people are Asymptomatic. ie Blackpool hospital and Blackpool transport. Are staff at Trinity going to be offered weekly tests?

This is a very important question and one that we have been raising regularly on the weekly Fylde Coast System calls, but up until now there has been no capacity to test Trinity staff.

Fortunately, our local Public Health department now have the lateral flow tests available and the capacity to offer our staff regular testing. Dr Au is in discussion with our public health and FCMS partners this week to plan for regular, twice weekly testing of all of our Trinity staff in the near future.

The Inpatient Unit has seen very low numbers of patients in the last few weeks. There is alot of speculation and uncertainty about what will happen if the number of patients doesn’t pick up. Could you give any clarification as to what will happen and are you able to explain why numbers are so low? Thanks

Numbers on the inpatient unit are at a low level at present and it is understandable in the current climate that this is causing uncertainty for some colleagues.  It is difficult to fully ascertain why this is the case but there are some interesting theories which might explain things including:

  • the reticence to be admitted to hospital / hospice due to perceptions on restricted or no visiting promoted in the media and /or risk of catching Covid-19;
  • the desire for people to die at home where possible and the increasing opportunities through our expansion in community provision (we still only support a proportion of those who die at home and normally approximately 47% of EOL patients still die in hospital on the Fylde Coast – more than need to);
  • the possibility of referral breakdown as partner clinicians including consultants, nurses, GPs and DNs focus more re-actively during a Covid peak with fewer face-to-face consultations resulting in more deaths defaulting to home perhaps earlier than expected but without consistent palliative care support;
  • An increasing prevalence of late-presentation EOL conditions with short deterioration periods – not admitting after 3pm or weekends may be having a detrimental impact on these rapidly deteriorating patients?;
  • Our previous success in keeping non-complex EOL patients at home with IPU increasingly used for complex situations – have these complex patients stayed in hospital, or are already in excess death statistics for this year?  (IPU had seen slightly more patients than last year by June but length of stay was much shorter leaving more bed capacity available);
  • August has historically always been a quieter month for reasons we don’t really understand.

Other hospices are having mixed experiences with some busier and others quieter. The effectiveness of the referral process; better integration of CNS teams into the new GP Primary Care Network MDT Hubs; the establishment of a ‘single point of access’ model (one telephone number) to triage all EOL patients in better integrated pathways; the ability to admit outside of shortened hours; constant ongoing repeated messages and marketing to partner clinicians and the public reminding them that we are still taking referrals and visiting is permitted; increasing visiting hours; and opening up inpatient unit referrals to less complex EOL patients requesting IPU whilst we have spare capacity seem to be material here.

Worryingly, recent Office for National Statistics data shows a 40% increase in people dying at home during 2020 but there has not been an equivalent up take in community end of life services.  An article in the HSJ points to inconsistent referrals and the increased likelihood of poor end of life care outcomes.  This highlights that we MUST find these patients with partners.

With the forthcoming Covid-19/winter pressures period approaching and demand for hospital beds likely to be under significant pressure, it is likely that we will see an increase in referrals over the coming months, especially if we implement the actions above.  We will also have to develop more flexible approaches in the coming months to be able to respond to where the needs and pressures exist in IPU, community or hospital.  In the meantime, we encourage staff to take the opportunity if it exists to recharge their batteries in preparation for a busy winter and feedback your own insights on why IPU patients aren’t arriving in the numbers we would expect.

Previous queries raised

Many staff have been off work and on furlough with 100% pay for many weeks now. Are there any plans to recognise the work that other staff have been continuing to do throughout the same period? Many organisations have given an extra week holiday or a financial reward for continuing to work. It has been difficult for staff who have remained on duty and they surely deserve something for keeping going through very stressful times.

The Board of Trustees and the Management Team remain extremely appreciative of all the contributions every member of staff is making during this unprecedented time. We are proud to have seen the organisation come together, as one team, to respond to the crisis, embrace new ways of working and support each other.

Those who have worked over the last months, either in the hospice across the community or at home, have enabled Trinity and Brian House to continue to care for our patients and their families.  Those colleagues who have been on furlough have equally helped the hospice and our patients albeit in different ways.

A small number of colleagues are on furlough due to specific health or personal circumstances.  The majority of colleagues agreed to furlough to help the charity financially, despite their overwhelming preference to physically have remained in work.  In total 81 colleagues have at some point been on furlough, which is 32% of the workforce.  As of 30th June three claims have been made to HMRC and as a result Trinity has received over £208,000 from the Government’s Job Retention Scheme with further claims to be made for the remainder of the scheme.  Given the financial impact of Covid, these are significant amounts of money to enable the hospice to continue to provide services to our patients and families.

Our colleagues on furlough are not being paid under normal conditions, having had the option of receiving 100% of pay in exchange for a reduced holiday entitlement or receiving 80% of pay in order to maintain a full holiday entitlement.  It is important to recognise that being on furlough is not easy and comes with its own pressure, stress and uncertainty.

Trinity is proud to have a generous holiday entitlement enabling employees regular and well-earned time off to rest and re-charge.  Compared to some organisations in the private sector, Trinity provides an additional 10 days more in some cases.  The option to give the two thirds of staff who have not been on furlough an extra week’s holiday would cost the organisation c£80,000 in hours that would need to be backfilled.  This is simply not prudent in a year when we are likely to have a deficit budget of £1.5 million.

In our recent staff survey we also asked the question ‘I would welcome a small gesture from the Trustees and Management Team to recognise the work everyone is doing’.  The majority of the responses answered ‘no’, with some stating it as an unnecessary financial cost.

The Management Team fully recognise and have frequently shared the challenges many have had over the last few months in working through Covid and the impact this has had personally as well as on family and friends.  Living through this crisis has been both physically and emotionally draining and many of us will be feeling tired from the ongoing uncertainties linked to the spread of the virus.   It is important that we all support one another and ensure we take reasonable breaks and time off especially now that the period of highest risk and potential anxiety has dropped off (at least for a month or two).  Do talk to your line manager about how you are feeling at present in this regard. The forthcoming CEO briefings on Friday 10th and Wednesday 15th July (via Zoom) will provide an opportunity for all staff to hear about the hospice’s current situation and what we can expect in the coming months, as well as an opportunity to ask questions to David Houston.

NHS staff can get discounts at a number of shops. Are the Nurses and staff at the Hospice entitled to the same discounts as we provide a direct service to the NHS. Thanks.

As you know Trinity Hospice is not part of the NHS. However, to reduce hospice charity costs and ensure an effective communications with our NHS partners, our email system is provided through NHS Mail and therefore all staff members have dedicated NHS email addresses.

There have been many businesses generously offering discounts to NHS staff over the last few weeks, including Dominoes, EE and Hotel Chocolate. We do hope staff are able to access some of these, however we would like to encourage everyone to first check the terms and conditions to see if the discount is specifically for those employed, or if it is available to anyone with a NHS email.

I’m conscious that every question so far has been about care – when I think one of the biggest questions hanging over our organisation right now is cash. The challenge our Fundraising dept will face coming out of this period is huge. The uncertainty about social distancing restrictions mean they are still working on 2020/21 events which ‘may or may not’ happen – it must be massively frustrating – and have no idea what the next few months will bring. All our shops are closed, which leaves another big hole in our income. Estimates are that even with government help, and with the launch of an emergency appeal, we will face a funding shortfall of at least £1 million. Are there any untapped sources of cash we could try and get? Are there ways we can save money going forward? What can staff and volunteers do now and in the coming weeks to make a difference? I’m sure every big national charity is about to launch an appeal too – the competition for cash will be more intense than ever.

You are right to highlight that income generation will be very challenging over the next 12 months.  Hospices are fortunate that Hospice UK successfully lobbied government to ‘spot purchase’ a proportion of our capacity which is normally funded by our charitable income and this should limit our downside financial losses to around £1m to £1.5m.  This is still a very significant sum and whilst we have managed the charity’s reserves well and thus have a buffer to cover this, we need to work hard to try to reduce this shortfall as our reserves are not unlimited and we need to ensure Trinity can provide vital care long into the future.  Vital PPE which we must provide to keep our staff safe has seen its costs balloon in this challenging time so it’s important to keep focussed on all our other expenditure at this time.  We sadly are having to hold off on various capital investments this year including the staff facilities and will re-start these projects when we are more certain of our medium term cash-flows.  In the meantime staff and volunteers can help by:

  • Finding us really good patient and staff stories which we can promote in our fundraising appeals;
  • Encourage family and friends (& and yourselves) to take part in our virtual events, sign up to our appeal, and collect donations to take to our shops when they re-open possibly in June;
  • Wear your badge with pride and ensure everyone you care for or partner with knows that Trinity Hospice and Brian House Children’s Hospice are a local charity that really needs support at the moment;
  • Sign up to our lottery and encourage family and friends to do so (there’s a promotion on for staff at present);
  • Keep an eye out for how to save money whilst working for the hospice – especially if you are in charge of purchasing items and be careful not to waste things;
  • Think about innovative ways to raise funds in the community (especially if you are a volunteer). For example, one person is making cotton face-coverings with the money raised donated to the hospice;
  • Send Linzi Warburton or Helena Lavin your ideas to raise or save money!

We are fortunate to be able to ride the storm but we need to keep our boat water-tight and ship-shape so please help if you can.

I’d like to ask about re-swabbing of patients who have a diagnosis of covid19. At what point should they be re-swabbed? We have had admitted patients who diagnosis is almost 2 weeks prior. Also, even though some of our patients are poorly or approaching the end of life could they be re swabbed too? A negative result would affect the way we barrier nurse them, dispose of the clinical waste (infectious waste is more costly), funeral directors would need to know and also for mental benefits of the staff nursing them and loved ones visiting them. It is no more invasive than injecting medications/syringe driver or catheterisation.

Re- Swabbing will take place 14 days after the initial test for patients where discharge is a potential, its different for someone who is imminently  approaching end of life, in all situation we need to be pragmatic whilst trying to ensure we protect staff and visitors. We except the test isn’t very invasive, but there is a time delay between swabbing and obtaining results which would impact upon the patient and family and the patient may well die.

Once the pandemic is over, would the outcome of the re-swab be collected as data as part of the analysis of the disease? These results would help reflect the true numbers of those who have died either with or without coronavirus at the time of death.

We are collecting that information in a “Covid” template on emis, and we are going to also consolidate this in the update bulletin. We complete a tracker daily that identifies patients with Covid which feeds into the CCG and public health analysis

I have worked here a very long time and feel very unhappy at the way we are being treated in this time of difficult nursing. We all received emails stating we would not be taking any known cases of covid19,we all understand that people can have it and we may not know, but we are told one thing and then the complete opposite happens. We are now knowingly taking positive covid 19 patients with no discussion with the nurses on the floor. I would also like to ask about last offices. If the patient is positive covid ,funeral directors pick them up completely covered in PPE suits and place the body in body bags. My question is why are we still doing last offices ?.We are putting ourselves at great risk, washing and changing these patients, a risk I feel as well as most nurses we should not be taking.

It may be helpful to see our earlier response to a similar question which you can find in the Q&A section.

Further to that answer,  we recognise that supporting patients who may have Covid-19 is a potential worry for all working in health and social care settings in the UK and we have to expect Covid-19 being a significant issue for all such settings for many months to come.  We like all other hospices in the UK are playing our part in supporting patients at end of life who may have Coronavirus.

This means that we will continue to support  patients in their homes who may be Covid positive, in care homes, in the hospital and on occasion in our inpatient unit.  This gives them the best chance of great care.   The welfare of all staff at Trinity remains paramount and we continue to ensure we are  fully comply with national health guidelines on the use of PPE and infection control as well as continuing to undertake reviews of our individual staff risk assessments as any new information comes to light such as the increased risk to individuals from BAME backgrounds.

Undertaking last offices with the appropriate PPE and infection control measures, whilst  covering the deceased patient’s face with a mask,  poses no more risk than from  the care we would be delivering to our Covid suspected or confirmed positive patients whilst they are living and dying. This is consistent with current practice in our local hospital and with national guidance.

As we know, undertakers out in our community are a valued frontline service and have to collect and care for the deceased from all sorts of challenging environments including hospitals, care homes, hostels private residences. They have an established practice, even prior to Covid-19 to wear full protective suits for infection control when handling deceased with any infectious disease and this has continued and been more visible during this current pandemic.  They will also wear standard PPE in all cases where there is no concern about Covid-19 to protect themselves and those families and carers they are coming into contact with every day.

We would encourage anyone who still has personal concerns to talk with their line manager or with David Warburton our HR Manager who can provide support during this challenging period.

I appreciate we are helping the vic out and we have a duty of care for our palliative patients however it worries me that we have started to accept covid positive patients when we were reassured time and time again that we wouldn’t be accepted them. Its bothers me that as a management team you have told us one thing and then done the opposite. I understand these patients need us and that’s fine but I feel like we and getting mixed messages.

Thank you for your query, as this is an evolving situation, initially NHS England and the CCGs locally hoped that hospice inpatient units may be able to avoid Covid 19 symptomatic patients. They recognised however that asymptomatic patients or those who developed symptoms after admission remained potential carriers of the virus.  However, as the numbers increased across the UK,  government guidance regularly changed in response and it became apparent that this principle was unsustainable, especially for care home residents and other end of life patients where hospital was not the appropriate place of care in some cases.  The Government also needed to free up as many beds in hospital as possible for the expected peak.  We and other hospices across the UK felt that we were unable to exclude patients in the last days of life despite Covid 19 given our mission to support local people at end of life.  The Government’s financial support package for hospices which is expected to cover two thirds of our fundraising losses is also dependent on providing such ongoing support. We have ensured all the protective equipment was in place before we changed our criteria and made clear that we would not accept patients without appropriate PPE in order to protect staff and other patients. It remains the case that patients need to be in the last days of life and our role as a hospice is to provide the best end of life care which you have all been doing so well. We appreciate that this is a challenging time and we are all having to react to the needs of patients, families, the wider health economy and care homes which can be confusing at times.  As things progress and guidance no doubt continues to change we will need to continue to adapt to it but will remain open and honest in our communication with you based upon the situation as it stands at the time.

Have you considered scrubs for the IPU staff who are completing personal care in very hot environments with PPE. At the vic they all now wear scrubs and then give these into laundry at the end of the shift so staff aren’t taking their uniforms home so why cant we do the same. DR’s have been given scrubs so surly we should be allowed them.

Our aim is to enable care staff to have scrub tops as part of our “summer uniform” and this had been agreed by the management team. However, all our suppliers are unable to provide us with them for at least the next few weeks. Sr Cathy has a list of staff who had indicated they wanted them for the summer, so should anyone else like to add to this list then please do so. As soon as our suppliers can obtain our order, we will purchase them. In keeping with our professional image we would want them to be branded. The doctors have never had any sort of uniform so it was vital we sourced scrubs for them at this difficult time.

Is there any way the reception staff can please explain to visitors that they cannot leave a patients room or bay wearing ppe before they enter the IPU? Unit staff will of course remind them but often relatives are walking around the unit and coming to the nurses station wearing the equipment.
I appreciate that the staff covering are from other areas and are helping us which is great but it would be helpful too if they could explain to relatives on their way in.
Thank you.

We have produced information at reception which tells visitors why they are in PPE and the rules around this. It is of course challenging as visitors just want to be with their loved ones, and they can forget the principles on occasion. We are monitoring this situation and re-inforcing the principles at reception through additional information. Please be assured the management team will support any difficult conversations.

Can you please please clarify the amount of visitors allowed at a bedside. We appreciate how tough it is for our relatives but there is often too much foot flow on the unit unnecessarily. We are told 1 visitor from 2 till 4 each day, no swapping out. If a pt is at the very end of life then perhaps 2 visitors but not guaranteed. We need to be supported by all teams in these restrictions as relatives are clearly distressed anyway but some have been quite rude to us when we are trying to adhere to the guidelines. There was an incident this week where the 3rd visitor was already on the unit in full ppe waiting to visit and felt we couldn’t say no.

This has been highlighted over the weekend as an emerging issue in spite of our policy. We have agreed 1 visitor during 2-4pm (not a combination of visitors amounting to two), and where a patient is actively dying two family members. We encourage you to reiterate this, and off course report this where it is not being followed. As a management team, we are very happy to have sensitive  conversations with relatives about this where needed, so please ask.

I know one of our main aims to make sure our staff are safe in work and outside work. The last thing we want is for staff to have to self isolate. Would it be therefore prudent to issue each staff member with a bottle of sanitizer for home use i.e. when going out shopping. I cannot buy it anywhere and would even be willing to pay for it myself.

Due to the increased demand of hand sanitizers since the start of the coronavirus pandemic, the limited hospice supplies needs to be prioritised for hospice use only. Therefore we do not have the quantities to provide staff with their own supply. However, washing your hand regularly with soap and water, adhering to the correct methods of hand-washing, remain the most effective way of protecting yourself.

I was wondering why all of the advice is aimed to the ipu cns and pcb staff, all of the available relaxation session are only available to those which is clearly written in the new bulletin, no time slots allocated for bh staff. Bh staff are predominantly children’s nurses, health care assistants, however they are supporting the ipu daily by working our usual shifts in the adult unit. If feels as if we’re forgotten regularly and definitely not appreciated by organisation.

It is unfortunate if this has not been as clearly communicated and explained as intended.  No part of the Trinity organisation, which embraces all of our services and roles, is any less important or valued that any other. Most importantly we understand and are committed to the wellbeing of all our staff.  Everyone is important to us and all support and all self-care and wellbeing resources are equally available to all.  Thank you for pointing this out and although we endeavour to be clear, accurate and transparent from the outset in our communications, please do continue to highlight any other messages in which you feel we haven’t got it quite right and further clarity is needed. Please be assured that the relaxation sessions are available to all staff.

Are there any plans for a card reader to make payments in the staff dining room? As is it, we have catering staff handling money and serving food at the same time which from an infection control point of view isn’t ideal.

We are working with the catering and finance team to enable a card machine to be available for payments over the next few days.

Recently I was asked by a patients’ relative why Trinity are still allowing visitors when everywhere else has stopped this. Other than reassuring her that we are doing everything we can to minimise risks i.e. checking temps and using PPE, I was unsure of how to answer this question as staff are not aware of the thought process/evidence base used to make this decision. Could we have some clarification regarding this so I know how to respond if I am asked this again?

The reason we have continued to allow visiting in the hospice, albeit restricted now,  is the value this brings to the quality of care for our patients and families. The importance of contact and connection with our loved ones at the end of life can’t be underestimated for all concerned. Retaining limited visiting at this difficult time, with the robust infection control measures we have put in place allows us to continue delivering the compassionate holistic care we so value in hospice care.

As we are receiving end of life patients as of next week from BVH, I am concerned about the impact the visiting of relatives will have on the unit. Currently we are allowing anyone with OACC score D to have 2 visitors with open visiting. When we get busier how will we managed multiple end of life patients and their relatives? Especially in bays with 3/4 patients. Also with more visitors there would be increased use of PPE as visitors need it when visiting their loved ones. I can appreciate you may not have the answers to everything at this moment in time. Thank you

We will be increasing the number of Inpatient Unit beds from 18 to 28 this week and will be opening up our service to support the rapid discharge of frail elderly end of life patients from Blackpool Victoria Hospital. This is in addition to continuing to support the most complex palliative patients with ceilings of treatment being hospice or home/ care home (including those who may/will develop COVID-19). This will inevitably increase the number of visitors to the hospice. Visiting is already by ‘pre-booking’ within the two daily allocated slots or due to being called to attend by hospice staff. Given the increased number of patients, we will move to a 1 visitor policy from Tuesday 7th April and bays with 3-4 patients will only be permitted 2 visitors (1 per patient) in the room at any time.

Public transport has air conditioning that comes on and off when the engine is started. It cannot be turned off, I personally know a driver who has stated this. Anyone sneezing and coughing on the bus would then put everyone at risk as particles would then be dispersed around. Could or would you consider Brian House mini bus being used to pick staff up who cannot drive? You would think that with all the information available at present people would cover their mouth and nose, but I witnessed someone sneeze yesterday and they did not even attempt to cover their face just sneezed all over everything! Also, Blackpool transport have now taken tram service off and bus routes have now gone on a Sunday service which do not start till 8am on most routes.

We have contacted Blackpool Transport who have provided a re-assuring response:

In response to the Covid 19 pandemic BTS are now operating a reduced timetable across the Fylde Coast.  We continue to run buses across the whole network to ensure that key workers are able to travel – this is just at a reduced frequency.  Our app, website and twitter account are constantly updated and you are advised to check these sites before you travel in case of any disruptions. 

As a result of the reduced frequency we are now operating a much reduced fleet.  Where possible only double decks are being used to allow more opportunities for social distancing.  We have also employed a new fleet of 20 cleaners who rotate on the network using anti-bacterial sprays and wipes to clean and sanitise key touch points on board (seats, poles and buttons etc).  To assist with this we have a fleet of ‘spare vehicles’ that are parked up at the Metropole which rotate around the fleet in service after a deeper clean during service. This is in addition to the already exceptionally high standards of cleaning that our vehicles receive each and every evening.

We have introduced a new flat fare of £1.50 for key workers to travel for 2 reasons – Firstly, to recognise the key workers traveling on our vehicles, but also to limit cash handling if the customer has the correct change.  This protects both our drivers and our customers.  Every driver has been issued with their own hand sanitiser and wipes for use on vehicle and in the cab.

Blackpool Transport is taking every step to ensure that our vehicles are clean and safe for our customers, and this is constantly being reviewed in line with Government guidance. We are encouraging our customers to follow this guidance as much as possible as we all have a job to play in protecting the safety of our drivers and our customers.

Due to the fact staff members are not allowed to go to and from Blackpool Victoria Hospital for training purposes and all external training has now been cancelled, is it still acceptable for us to be using bank staff from nursing homes or staff members doing shifts at the Vic as extras due to the extra risk of Covid-19?

It is completely understandable that staff remain anxious about the potential for onward transmission of COVID-19 from different locations whether from nursing homes, Blackpool Hospital, supermarkets or other members of their household.   As the Chief Medical Officer has highlighted, the best way of avoiding such accidental transmission is through the rigorous continued application of infection control and the use of appropriate PPE.  Hospice UK’s Clinical COVID-19 briefings has also noted that there is research that highlights that the risk to clinicians is no greater than that to the general public where the above measures are robustly implemented.

We all depend on each of us applying the highest level of professionalism in sticking to these principles and this is even more important now as we expect to see increasing pressure on our staff numbers due to growing COVID-19 related sickness absence.  We will need to be able to rota sufficient numbers of staff day and night and will likely need all our available trained healthcare colleagues. We will also potentially need other non-clinical staff in auxiliary roles when the sustained peak arrives.   Consequently, we are still using appropriate bank staff to remain flexibly able to respond following the above principles and, with robust infection control practices, are comfortable with those members of our staff supporting the NHS through bank work in these challenging times.

Will Trinity staff be re-deployed to areas in great need within the NHS? For example, ITU and the District Nurses are likely to be very busy soon?

This is unlikely though we do expect to need to potentially move staff within Trinity’s own services as COVID-19 related sickness absence levels rise. We are expecting to be much more busy over the next week onwards as we support more transfers from the hospital for the care of patients at end of life. Our Trinity clinical staff are experienced and skilled in complex palliative and end of life care and we anticipate we will need each and every one of you, especially when we expect to be down due to those staff self-isolating due to illness themselves or in their household. We will need to be as flexible as we can responding to the pressures and needs of different clinical arms of our service and may redeploy medical or nursing staff to support the community or hospital teams if needed.

Firstly – thank you for putting all the measures in place. I can only imagine how difficult it is to try and manage something on such a scale. On IPU it is currently, dare I say the Q word. I know this will change and fluctuate in the weeks to come, however, over the last couple of days we have had more staff to patient ratio. I feel staff would be better off being sent home in order to protect themselves and other staff and to ensure staff are well in case others go off sick. Is there a possibility of staff being able to go home/not come in but maybe on call or is there a basic number of staff that has to be onsite?

Thank you for raising this. We are already beginning to see an increase in patient numbers, although small at present. Our discussions with the Fylde coast and BTH partners has seen a dramatic rise in the use of ITU beds, HDU and cohort wards so, unfortunately, we feel that the storm is about to break and there will be a significant increase in the use of our services in the next week(s).

Additionally, we are now asking staff to undertake tasks with support that volunteers previously undertook.  Therefore, we do not feel this is possible at this time but will be taking a very proactive approach to supporting staff welfare during the coming week with the help of the Linden Centre, Dr Thomas-Sanderson, and Paul Berry as well as providing resources that we will make available through apps and social media.

Please be assured we will do everything we can as you are our most vital resource.

Some staff are struggling with child care as breakfast clubs and afterschool clubs are closed. Can anything be done to support these colleagues?
We have really considered a number of options to try to support this, however, unfortunately we are unable to provide any further support above that provided to key workers by the Government. We recommend discussing this with your line manager to see if shifts, hours or working patterns could be altered to accommodate and use of annual leave if appropriate.  We encourage any individual who is struggling with child care to raise this with their line manager in the first instance to ensure all options are being explored.

Visiting continues to be an issue and I truly understand relatives wanting to be with their loved ones, however, the foot fall is still being questioned and there is some vagueness with regards to this compared to nursing homes and BTH.
We have updated our visiting policy.  Patients will no longer be able to go home for part of the day.  Families will need to restrict their normal visiting to 1 person per hour for each of the three visiting slots in the day.  Updated wording will be produced for reception and IPU staff. We have also put safety measures in place around temperature checking to try to reduce the risks posed as much as we can

Can you clarify what staff discretion means when a patient is dying?
Anyone with a D on the handover sheet will be allowed 2 people visiting at the same time during an hour period.  Most families who have a loved one who has been identified as approaching death are informed that we are looking to hours to a few days and this should allow visits during the 3 visiting periods in the day.  Where a patient is imminently dying, we will endeavour to provide additional virtual visiting for those who cannot visit the patient.   Families can use Facetime, WhatsApp and Skype on their own devices for this purpose.  We will also have 2 IPads in IPU.

For Brian House, we will also allow 2 people for a child where a parent is one of the visitors.

If we call a relative in at night do we need to check their temperature when they arrive?  Where is the thermometer kept for this?
Yes, you must check their temperature.  A box will be held behind main reception with a thermometer.

Why are patients being allowed out of the hospice on home visits?
We have discontinued this practice due to the risks involved.

Would it be possibility to stay at the hospice if needed?
We have two overnight rooms and 2 bedrooms in Brian House so it may be possible to use in certain circumstances.  Additionally, we are trying to link with Blackpool Teaching Hospitals to access the hotel accommodation available to NHS colleagues.  We will update you as soon as possible on these two points.

Can I take a shower at work, at least at the end of the shift?
We can provide some limited additional shower facilities and will send out further information on accessing these over the next few days.

Would you be able to provide scrubs or even t-shirts to allow us to change through the shift if we are looking after suspected or positive covid patients? I would wash them myself as per the guidance, but 14hrs in the same uniform is high risk for spreading the virus if we don’t have adequate PPE.
We are providing adequate PPE for all staff. We have a conference call daily with our Fylde coast partners so PPE is the top of the agenda. We continue to receive our normal NHS stores supplies and have also received supplies regionally and are awaiting the national drop. There are some challenges about respirator masks, however, the guidance is clear that these are only used when there is an Aerosol generating procedure. For us this is Non-invasive ventilation (NIV),  (currently we have 1 patient) but this would need to be considered as part of our approach to palliation of such patients.

We have agreed to stop using nebulisers and use inhaled medications through a spacer and stopped the practice of using saline nebulisers as this breaks up sputum and increases a risk of coughing- there is little evidence to its benefit.

In addition we have also ordered additional white polo shirts so staff can get changed mid-shift.  We have ordered scrubs for the medical team and nurse managers but there is a delay in being able to receive these due to the high volumes of orders being received from the companies. We will monitor this situation closely

Will we be supported in enforcing the amount of visitors to the patients if they are not actively dying? (Having 1 visitor every 15mins for the hour of visiting totally defeats the point trying to be made and poses a huge risk to nursing staff).
As discussed above – We have updated our visiting policy.  Patients will no longer be able to go home for part of the day.  Families will need to restrict their normal visiting to 1 person per hour for each of the three visiting slots in the day.  Updated wording will be produced for reception and IPU staff.

My concern relates to staff working within other areas as bank staff for extra hours, e.g. working within Blackpool Victoria Hospital where the virus can be carried back to the unit, even though Trinity is their main place of work. Also, bank staff whose main job is within a nursing home and working additional hours on the unit. As we are not allowed to visit family members due to cross infection should this not apply within the unit.
We fully understand your concerns. Staff undertaking work in other areas or organisations will have to maintain the below principles in order to protect themselves and others:

  • Use of PPE where applicable
  • Social distancing
  • “bare below the elbows” principles
  • Not attending any work if they are symptomatic with a persistent continuous cough or temperature
  • Change their uniforms

Unfortunately, in Healthcare, and as this crisis escalates health care workers will be required to work where the demand is, we will endeavour to reduce the risks as much as possible, but we can’t eliminate it.

Can a child be moved from house to house for childcare due to work commitments?
In the social distancing guidance “Stay at Home” The Government has also identified a number of critical workers whose children can still go to school or their childcare provider. This critical worker definition does not affect whether or not you can travel to work – if you are not a critical worker, you may still travel to work provided you cannot work from home.

Critical workers and parents of vulnerable children may leave the house to take children to and from school or their childcare provider

Parents whose work is critical to the COVID-19 response include those who work in health and social care and in other key sectors outlined below. Many parents working in these sectors may be able to ensure their child is kept at home. And every child who can be safely cared for at home must be.

Please, therefore, follow these key principles:

  1. If it is at all possible for children to be at home, then they must be.
  2. If a child needs specialist support, is vulnerable or has a parent who is a critical worker, then educational provision will be available for them.
  3. Parents should not rely for childcare upon those who are advised to be in the stringent social distancing category such as grandparents, friends, or family members with underlying conditions.
  4. Parents must also do everything they can to ensure children are not mixing socially in a way which can continue to spread the virus. They must observe the same social distancing principles as adults.

I worry that I am putting my family (two of whom are in the vulnerable group) at risk. How can I help protect them, if I’m expected to come to work?
We fully understand your concerns. As staff members you will have to maintain the principles set out below in order to protect yourself and others.

  • Use of PPE where applicable
  • Social distancing in and outside of your working environment where practically possible
  • “bare below the elbows” principles and greater emphasis on regular handwashing
  • Not attending work if you or someone in your house are symptomatic with a persistent continuous cough or temperature
  • Changing uniforms daily, bagging your uniform and washing as per guidance
  • Ensuring you disinfect surfaces within your home

In addition, we are trying to link with Blackpool Teaching Hospitals to access the hotel accommodation available to NHS colleagues.  We will update you as soon as possible on these two points.

Please do discuss your concerns with your line manager to see how we may be able to support you further.

Is car sharing allowed when visiting a patient?
We want to ensure we reduce as much risk as possible, maintaining social distancing to the best of our ability to reduce contact with each other and patients. Where ever possible please travel in separate cars, going in convoy, with car doors locked and ensuring you have your reliance devices with you. Please only leave your car when everyone is on site, ensuring you have PPE with you.

We do recognise that car sharing isn’t always possible. On these occasions we suggest as much distance between the driver and passenger as possible, with the passenger sitting in the back left side.

Please continue to discuss your concerns with your line manager or submit your questions and queries anonymously here

Please click here for other frequently asked questions regarding Covi-19

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