Leadership 111: managing at the frontline of Covid-19

When the early signs of the COVID-19 pandemic started to present in the UK in January, we knew that special arrangements would need to be mobilised. At Care UK – which provides NHS 111, clinical advisory services and general practice out-of-hours services in England – we set about preparing the strategic intentions and incident management arrangements in readiness.

What we were looking at fell outside of textbooks and beyond the experience that I or any colleagues had, so it became a matter of pulling on training, experience and exposure to create a safe environment to innovate, learn and succeed through this challenge.

What was fundamentally different to any other incident was that it was not localised, predictable or had a clear natural end. It was a real challenge to know where and when the pandemic would hit and what each local NHS system response would be; fortunately, the national NHS leadership really played a part in stabilising this position.

I have a small and highly competent senior team working with me in the day-to-day running of the services, but none had the experience of pace of impact. Nothing of such scale has been experienced in most of our lifetimes. This means that personal leadership would be critical to enabling the team to meet and indeed exceed the challenge.

The developing response was driven by many factors; changes in the public message were often heard in prime minister’s news briefings for the first time. This led to intense pressure on the 111 system nationally, and later in the out-of-hours services. London was in the eye of the storm, and 111 and 999 ambulance services were all receiving demand that far exceeded capacity or the ability to respond to it at the pace at which it was changing. We reached four times our normal call volume, and the national capacity for both 111 and 999 calls was seriously stretched.

In these circumstances, the fine art of leadership really matters and can define success or failure.

Being able to provide a clear direction, a sense of reality and calm with the helpful use of analogies can be critical to the direction your team takes. I used two phrases throughout, which were: “there is a huge haystack on fire, the engines are all out. The fire will burn out with time, just keep everyone safe.” The second was: “the tide is coming in, you can try and slow it with many hands, but it is still coming in.” These both helped set the tone that help was not coming fast and that we had to do our best to keep people safe and create the response to something substantial.

With my head of emergency planning, resilience and response (EPRR), we penned the strategic intentions. These were reviewed daily and remained a solid set of guiding principles throughout. We made significant changes and at real pace through team focus. As things have calmed, there is no going back to how things were done before. We are finding the ‘new normal’ with new energy.

During the peak of our response, we were presented with more than 800,000 111 calls. We redeployed colleagues in our support teams to enable recruitment of more than 600 new and temporary staff. Patient safety and staff safety priorities led us to redeploy scores of our support staff into patient safety calling roles, and we moved more than 240 staff to homeworking but still providing a clinical response.

Amid all this we had an outbreak in our largest call centre in our national network requiring us to close it, get specialists to clean it, and then re-open 24 hours later – whilst maintaining a service! The level of volunteering from across the organisation was huge and really pulled everyone for our common purpose and reinforced our values: patients at the heart of everything we do; every one of us makes a difference; and together we make things better. If there was ever a time to ask if our values are right, now was the time to test them.

Through the application of experience, judgement and the trust of the team, we innovated at tremendous pace, delivering more than 50 technical system changes to respond to changes in national information and guidance. We maintained exceptional patient safety throughout.

As we enter our new normal, the service is one of the best-performing and most responsive nationally and ready to face the next challenge. The team is fully engaged, proud of their collective work and energised by the changes we have made to how we work and how we will take those learnings into the future.

Based on what I’ve experienced, these are my ten top tips to guide a leader in a crisis:

1. Define the what, not the how as early as you can
2. Use metaphors and analogies to create vision and purpose
3. Maintain calm; provide clarity, and clear the path ahead
4. Place your faith, trust and belief in the expertise you employed
5. Promote creativity and innovation – let your team own it in a no-blame environment
6. Think about the resilience of your people in any response. Recovery is usually harder
7. Be the helicopter – look beyond the immediate and focus equally on learning and recognition
8. Communicate widely, and act fast on feedback
9. Amid all the noise, search out the discreet workers; tell your people how good they are
10. Plan for recovery as you start your response. Recovery is often the phase that gets less interest, but good planning should always include actively supporting people to take time out.

Kevin Brown is national director of integrated and urgent care at Care UK, a leading private provider of NHS 111, clinical advisory services and general practice out-of-hours services in England.

For more resources to help you manage the Covid-19 crisis, visit our Leading Through Uncertainty hub.