Colette Cowan on steering UHL’s Covid response - Part Two

IN the second part of a two-part interview, the chief executive officer of UL Hospitals Group, Colette Cowan, discusses how the intensive care unit at University Hospital Limerick operates, as well as addressing the drop in presentations at the hospital’s emergency department, and she offers an insight into the new building projects within the UL Hospitals Group which includes University Hospital Limerick, University Maternity Hospital Limerick, Croom Orthopaedic Hospital, St John's Hospital, Nenagh Hospital and Ennis Hospital. Ms Cowan also highlights the support of the public and local business organisations during Covid-19. She looks ahead to winter at UHL and talks about the responsibility that comes with being in charge of six hospitals with a staff of 4,500 people.

INTENSIVE CARE UNIT
I am an ICU nurse myself. It is one-on-one care. The intensive care nurse could be looking after a Covid positive patient or a sick patient with another illness. With the Covid positive patients, the nurses wear all the PPE, the whole gowning process. There are very strict rules in terms of how they don and doff those clothes.
They stay in the intensive care isolation room which is like a glass box, which is ventilated. It’s a very nice facility. They stay with the patient all day and they are responsible for all of their care needs. The patient could be on a life support machine. They work 12-hour shifts. They are highly specialised, skilled nurses and they are guided by the clinical intensivists who will visit those patients and guide on the treatment and care for them.
We don’t have people visiting the intensive care unit at the moment because of the high risk of contamination to the visitor, or equally for the patient, so we have virtual visits linking with phone lines, iPads and WhatsApp. The nurse manages that as well.
So the nurse, in effect, in critical care is the closest friend to that patient at that time. They are with them when they are very, very ill and, hopefully, are with them when they recover. They help them spiritually when they pass on. They are a great team.
There are people recovering in the ICU from Covid. There are rounds of applause and great celebrations and joy for staff when they see a patient recover. And then they get to see the families because there is no visiting in the ICU.
Some of the patients, interestingly, have been so ill they are not sure why we are clapping for them. They are trying to remember the journey they have been on. They are the lucky people. It is a great day when we see a recovery, a very great day.

SUPPORT FOR STAFF
We moved on that very quickly. Not only in terms of dealing with the high risk and death. Many staff across the group feel anxiety no less than a lot of the public do. We put in, very quickly, employee support for our staff, a phone line they can contact confidentially. Then we moved to provide access to clinical psychologists who come in and do one-to-one or group discussions with teams to ensure they are coping well. That is a huge focus, that we ensure people are able to manage.
There are many many people on the frontline. We hear mostly about the great nurses and doctors, which they are, but there are so many staff. The cleaning staff, we couldn’t function without them, the porters, the catering, the laboratory staff who are unsung heroes in my view and the managers.
I have put the managers to a lot of work over the last nine weeks and they have worked consistently very long hours because there has to be command and control.
And if anyone was to ask me as CEO what is different between now and my normal life, it is having meetings three times a day to command and control. You must keep control of the decision making and log it very carefully.

NEW OXYGEN TANK AT UHL
When we were looking at a critical care surge and looking towards Italy, one of the biggest issues for patients with Covid, unfortunately, and you hear it from anyone who has had it, is the ability to breathe. Not only that but the oxygen flow you need to help you to breathe with Covid-19 is very, very high so we looked at our own capacity for oxygen. We have a good oxygen supply and again because we had a good plan built in the critical care block we had the proper pipework in. So we did a mathematical analysis about the use of oxygen for Covid-19 if we did surge. We knew we needed a larger tank so we worked with BOC gases who were really excellent and with HSE Estates, who arranged the tank for us and actually got it put in place. We worked with another hospital as well to assist us with some of the products to get it in so we are very glad to have it. It’s up and running.

EMERGENCY DEPARTMENT
(In January of this year University Hospital Limerick broke the daily record for an individual hospital, with 92 patients on trolleys. The ED has seen consistently high figures in recent years sparking protests and calls for immediate action. However, during the initial Covid outbreak in Ireland, the number of people on trolleys at UHL dropped dramatically resulting in there being nobody on trolleys on a number of occasions. The number of presentations is slowly beginning to rise again)

I think the reason is a mix to be honest. When this hit us first, I think everyone was in shock and the public knew everything was cancelled in hospitals so they did stay away. We have done an active campaign encouraging people not to stay away and our numbers have gone up. The people who did come in then were quite sick, people with cardiac problems etc. It has plateaued now. People are coming back to the hospital.
Equally, there were probably some people in the past who were using the ED who could have gone elsewhere including our Injury Units.
There is learning in it, huge learning from this crisis.

WINTER AT UHL
We always start working on our winter plan in the month of June but I asked the team to start looking at it now because we will have a Covid challenge and a flu challenge in the winter. What I’m really hoping is that the public will realise that it’s really important to get your flu jab. Equally, the staff will be expected to get it. We will have to mandate that the flu jab is gotten, just to further protect patients and staff if Covid is circulating. I think that will help somewhat if we up that campaign and start work on that now.
I really believe the numbers getting the flu jab will go up. I’d be quite surprised if they didn’t. That aside, of course we are going to have a lot of people who don’t have Covid who will be sick with winter illness and respiratory illness so we have a number of plans around building work.
Our 60-bed block is still continuing. Construction workers are on site. The plan for handover is November. We have a 24-bed single room facility underway. The planned handover is the end of July. We have a 14-bed single room facility, planned for handover in July.
So all of those beds on the UHL site will assist in the capacity challenges that we have but there is no doubt that we will be, as always, challenged to deal with the footfall of patients that come into the only Model 4 hospital that we have in the Limerick region..

96-BED BLOCK
The 96-bed block, pre-Covid, is on the National Capital Plan. We got funding this year for the design team so the design team is appointed. What we will need next year is the funding to proceed with that. Hopefully that will happen. We have to look at the economy and economic stability. We hope it will continue to be funded. It is a three-year build. Maybe we can speed that up now that we have learned a lot more about buildings. That’s still very much on my radar.

CROOM HOSPITAL
Croom has been fantastic. It is an elective orthopaedic hospital. I needed their help about three weeks ago because I had issues with bed stock. One of my hospitals had a lot of staff out and it opened as a medical hospital for the first time since it was a TB hospital, we think.
Without any issue at all they are running it as a medical hospital as we speak. The 24-bed block is being built out there, a single room facility. It will change the face of the orthopaedic hospital for the Croom area - the elective surgery and ambulatory orthopaedic care in the future which we really need as well. So that was a positive out of everything.

GOVERNMENT RESPONSE
In all honesty I think they have done a fantastic job. They have control with the NPHET (National Public Health Emergency Team) meetings twice a week and daily media briefings. I think Tony Holohan has done a fantastic job reassuring people every evening. I think when everyone goes home, the first thing you do is log in to see what has been said. There is more to be done. It is a very difficult time to be in government and to decide on the economy for the future. With this lockdown there are very difficult decisions to be made. For example, when do you phase up. We are in a microcosm of that in hospitals because, of course, we have to decide when do we phase up and when is the right time to go back to normality.

PUBLIC SUPPORT
The public are so proud of what the staff do which is really lovely. A lot of people have come forward around the region to give us PPE and support us and develop PPE and that’s ongoing.
The support is off the scale. It’s just amazing. When I looked last week - and this number keeps rising - there are over 160 businesses that are helping us in one way or another and donating to the frontline. A huge thanks to people for that. What we are trying to do, because there is so much goodwill there now, we are giving out stock at different times to staff such as bank holiday weekends, not to flood them with different gifts and presents. I will thank all of the companies -I’ve logged all of their names - once this is over, for sure.

SWITCHING OFF
I have never in my career seen anything like this (Covid-19). Over the last nine weeks there has been no switch off really. If you’re not in the boardroom managing and controlling what is happening, you are thinking about every move and every detail. I have an hour of a drive home and that is my time to think. I don’t listen to the news during that time so I can reflect. Family is great. Family keeps you grounded. It’s good to be at home in the garden. I think that is all we can do at this time. I am six years now as a CEO so I am used to managing. This is my Olympics as well. If you have a great team around you - great experts, the job is a little bit easier.