A 'Barts and The London Level' Response
St Bartholomew's Hospital has seen many important conversations in its long and unusally prominent history. Throughout the centuries, discussions that took place here have had an impact on health, not only of the local area, but globally. It is only fitting then, that the benches in the Square of St Bartholomew's played host to another conversation, between Megan Annetts and Professor Anthony Warrens about coordinating a student response to COVID-19, which had a significant impact on patients during this historic time.
‘I must give the British people a very simple instruction – you must stay at home’
Forgive me for falling to this clichéd opening, but it’s incredibly hard to start an article about the events of this year, with words other than those uttered by Boris Johnson during his press conference of the 23rd of March 2020. With those words, life in Britain changed, perhaps in the most dramatic fashion since the beginning of the Second World War. This time, our enemy was not human, but a virus.
While a shock, there were warning shots. In the preceding weeks, it was impossible to ignore the events occurring around the world; their frequency increasing as the distance from us ominously decreased. By late February, stories were flying around the student body of the new hospital isolation pods (and rumours that Whipps had lost the key to theirs), and then of the first patients testing positive at our hospitals. Such was the pace of change that a few short weeks later, the tone had changed from this one of interest and mild curiosity to one of anxiety and dread. It was clear by then that events had spiralled out of our control and that our hospitals, deep in preparations for the worst, would no longer be able to support our teaching in a safe manner.
On the 12th of March we received notice from the Dean for Education, Professor Anthony Warrens, that placements were cancelled for the rest of the year, and that teaching was being prepared for online access. Final year students, merely days from their Finals (with a capital F), were informed that their electives – months in the planning, and just weeks away – were no longer going to be taking place.
The focus for the medical school at this point was to squeeze these finals in before a looming lockdown and somehow, having hurriedly designed and put in place a range of precautions, this was pulled off. The last day of finals saw a steady stream of celebrations and mixed emotions fill the Square of St Bartholomew’s Hospital as groups were let out one by one. It was clear that students were conscious of the fact it was highly likely their Graduation events and Rites of Passage would be cancelled, but relished the opportunity to have one last day of celebration together before they parted ways to work in different hospitals around the country, unsure of when or indeed whether they would see each other again.
In the background of all this, BLSA President Megan Annetts began to receive messages from students enquiring into whether they would be able volunteer their skills during this time. Before any action could be taken, Megan was left to first scope out just how many students were interested in this; whether this was a small group of unusally active students, or whether it was, in her words, 'a Barts and The London level response’. The response was overwhelmingly 'a Barts and The London level’ response with over 700 individual responses.
At this point, it was clear to Megan, in discussion with Professor Warrens, that this much demand would require structure and coordination. Another, more detailed survey was sent out by BLSA, to take into account just how many students logistically could travel to each hospital with a shut down TfL. At the same time, Megan had started to recieve calls and emails from hospitals and other health providers about their need for students to help out.
Make no mistake, this was a mammoth task; undertaken in a matter of days. The Students' Association and the School were left to work out exactly which roles were suited to clinical, preclinical & non-clinical students whilst also ensuring it was safe and that there was sufficient indemnity. There was also the tricky question of how to support students balance their time - with them still being required to attend online lectures and sit exams while they volunteered. On top of that, they were acting almost as a response triage centre, working out which hospitals had the most need for students.
Ascertaining demand from not only a hospital level, but also a ward level was a particularly tricky; the landscape was shifting so quickly that there was no previous metric they could use to work this out and no way to measure this remotely. This is where Professor Charles Knowles, an alumnus of The London and Deputy Director of the Blizard Institute, began to work with Megan to coordinate students volunteering, specifically across the largest, Barts Trust. Over two days, armed with a clipboard, he visited each hospital individually and spoke to the medical leadership teams to work out which wards would benefit from student presence the most.
Within a few days, it seemed it was all coming together; indeminity was secured by paying students in certain roles, whereas in other places they were covered under volunteering schemes. Refresher days were put on at the Robin Brook Centre to help students who wanted to gain confidence in certain procedures. Relevant policies had been drawn up and approved through the School's pathways. Queen Mary accomodation had been secured and provided for free for students who needed to live closer to a hospital or who didn't want to expose their families to the risks they were taking.
16 final year students were among the first to get involved, in what was almost a pilot scheme. Having just finished their finals on Thursday they had for some reason decided to volunteer on the Monday in Intensive Care in the RLH. Megan worked with individual final year students to understand problems and needs of this pilot scheme, with Dr Charles Fadipe leading at The Royal London & Dr Amy Easthope leading at Homerton. Gradually, but consistently, students began being placed in hospitals across East London - getting to grips with their new roles in this very different clinical environment.
Within the first few days and weeks of students being placed into roles across the NHS, it became clear that students were being exposed to situations that were unlike any other they had before; the NHS heaving under the demands of a seemingly vindictive virus, death on a scale and of a quality that very few of the staff, let alone students had ever seen. It was clear that support had to be put in place, and in addition to improved signposting of existing resources, a new Connecting Practice platform was designed with a focus on students supporting fellow students.
Throughout the process of writing this article, I have tried many times to write this final part, somehow expressing in words the impact that these students had. That ended up being harder than I expected.
Starting with just plain numbers of students, it has been hard to quantify exactly how many students ended up volunteering or working in some scope during this initial wave; while we believe around 300 students ended up working at hospitals in East London, we don't have exact numbers for students who volunteered at hospitals, students involved in public health research schemes, final year medical students who started work early as FiY1s, students who worked at GP surgeries, students who got involved in other trusts across the country, students helping remotely from their homes, or students who volunteered in their local communities.
Regardless of the numbers, words simply could not do justice to the impact that just one person had, let alone magnify this to the hundreds that did make a difference. I am convinced for this reason that the full impact of Barts and The London students during this pandemic will be nigh on impossible to measure, but that's besides the point; students did not get involved to measure their impact. They got involved because they thought they were needed - and that's what Barts and The London is about.
