Communications has been central to Alder Hey’s Covid-19 response

In March 2020, the NHS was asked to increase critical care capacity for people across the country as the first wave of the Covid-19 pandemic swept the country. While Liverpool-based Alder Hey Children’s NHS Foundation Trust was ready to play its part, as a standalone children’s hospital which cares for more than 330,000 children every year, the challenge of admitting adult patients was complex.

Colin Beaver, deputy director of marketing and communications at Alder Hey, explains: ‘It was a huge undertaking and there was a great deal of uncertainty that went with that. We had nurses and doctors, who were used to dealing with children and young people, suddenly having to retrain to care for adults. It was a steep learning curve.

‘Our role as communications people was to talk about why we were doing that, which meant looking beyond Alder Hey itself, because it was to support the wider system. We had to help staff get their heads around that, and then there was the familiarisation aspect, helping people settle into their new roles and the new way the hospital was set up.

‘Virtually overnight, the hospital was reconfigured. Wards changed their purpose, so what had been a high dependency unit, for example, was suddenly elsewhere. There was a physical reconfiguration as well as the reconfiguring of the roles of people. It was a huge undertaking and comms really was at the centre of that; we were often looked to as the people to make the final call on what information should be presented, to prevent unnecessarily burdening people, when it should go out and how it should be presented.’

But the communications team had been working on Covid-19 since 31 January 2020, when the first email to all staff on the virus was sent. (By September, more than 60 dedicated Covid-19 updates had been sent.) And by mid-February, it had launched a Covid-19 information hub on the trust’s intranet.

Like many other organisations, Alder Hey has found that the need to respond quickly to Covid-19 swept away layers of bureaucracy. ‘The NHS is not big at making snap decisions. The pandemic has helped us to shift to the mode of ‘Just do it’. To just think about what needs to be done and, without consulting 100 people, to go ahead and do it,’ explains Beaver. ‘We are trying to remain in that space mentally, where we’re happy to make decisions without feeling the need to consult dozens of people, which is nearly always what happens within the NHS.’

Senior communications manager Rebecca Murphy adds: ‘Looking at the team itself, you also see how people have grown through this time. They have been empowered to start using their own initiative. Obviously, they still come to us when necessary but there is much more of a sense of I can do this, I know I’m capable of doing this and I’m happy to do so.’

The Trust’s response to the pandemic involved both a strategic and tactical approach. Beaver and director of marketing and communications Mark Flanagan represented the communications department on the strategic side, where ‘the big decisions were being made’, while Beaver or Murphy would attend the daily tactical meetings and ‘were in the thick of those conversations’.

Virtually overnight, the hospital was reconfigured. It was a huge undertaking and comms really was at the centre of that; we were often looked to as the people to make the final call on what information should be presented, to prevent unnecessarily burdening people

Being members of this ‘inner circle’ meant that the communications team could offer their point of view and identify potential issues at an early stage, but while this emphasised the importance of their role, it also allowed them to advise on when less was more.

‘In situations like this, the knee jerk response is to communicate. Let’s get a message out. Let’s doing something. Becky and I would see this on a daily basis… something would need changing or adapting, and one of the first key actions people wanted was a communication to go out about it,’ explains Beaver. ‘Because we were involved in this conversation, we were able to say Is this actually going to help? People’s heads are full.’

The team’s approach changed from ‘rapid response’ to one of ‘as required’ saturation communications before eventually settling into a ‘battle rhythm’. He adds: ‘It’s about knowing when to communicate. When Covid-19 first hit, there was a lot of broadcast communications – a lot of us sending out important information that people needed to know. But it was also important for us to know if that information was landing with people. Did they understand what we were saying? Did they absorb what we were saying?

‘Quickly, we moved to a daily Microsoft Teams live broadcast. It was a step change in our approach. It meant people could engage with us, they could ask questions and we could interrogate whether they were actually receiving the messages we were delivering to them. It enabled our chief executive or chief operating officer to sit in front of the Trust every day – for months on end – and tell them what was important and what they needed to know. But the back end of that broadcast was an open session, which allowed people to raise questions about things they didn’t understand or were unsure.’

The first live daily broadcast, initially only open to team leads, took place on 16 March, but by 24 March it had been opened up to ‘all staff’. At their peak, more than 1,000 members of staff tuned in to the daily broadcasts, although they regularly averaged between 700 and 900 attendees. More than 1,000 questions were also asked, of which more than half have been directly answered.

As the challenges of Covid-19 dissipated during last summer, the daily broadcasts dwindled to three times a week and then once a week. But when necessary, they can revert to a daily broadcast with relative ease. The broadcasts were also important as a means for people working from home to see their colleagues, who were still onsite, on their computer screens. ‘We quickly incorporated staff health and wellbeing into those sessions as well,’ adds Beaver. ‘It was, and is, a great tool for us.’

The pandemic also necessitated changes to the way that the communications team operates. They moved to a 24/7 shift pattern. ‘There was no issue. Every member of our team just did it. Everybody has really played their part and come together, despite the fact that we’re working remotely,’ adds Murphy. ‘The way the team is normally set out, for example, we have people who work just on events. Their normal job has totally changed. But they got stuck in. It’s been very much an all-hands-on-deck approach from everyone. But we’ve also supported each other, because we all have moments when this has got to us. You’ve got people on the team who will say Right, you’re having a bad week, I’ll take this on.’

Much of the team’s traditional day-to-day work, such as filming and photographing patients or producing case studies, has also been put on hold, as access to clinical areas is restricted. But it has also been a time when it is more important than ever to connect with front line staff working in the hospital who are difficult to reach with broadcast, leading to a rise in environmental communications, such as posters and pull ups, around the premises.

A ‘Gel your hands’ campaign, for example, featured full length photographs at every entrance to the hospital, while posters were also installed in every lift advising social distancing and a two-person limit. Similarly, a ‘Coronavirus for Kids’ campaign was designed to reduce anxiety for children and young people, by explaining what Covid-19 is, how it is caught and reassuring them that it was not their fault if somebody they knew caught the virus. Many of the assets created for that campaign by Alder Hey, such as fun animations and colouring sheets, have been shared by NHS England as a central resource.

‘There’s a lot of information, about social distancing, PPE and wearing masks, that we can deliver electronically, but because the people that we’re principally targeting are in the Trust, we have to deliver it physically,’ explains Beaver. This was made even more tricky because, as Murphy adds: ‘At one point, PPE guidance was changing every couple of days, and we had to get those communications out to staff, who are mostly on the wards.’

PPE needed really simple messaging. We ended up going down a visual route – a visual guide that you can look at very quickly.

One of the ways that the communications team has achieved this is by tapping into a unique on-site resource that exists in a teaching hospital: practice education facilitators. These are nurses involved in the teaching of students, who can access all areas of the hospital.

These facilitators fed back to the communications team the questions they were asked regularly and the issues about which they felt colleagues remained unclear. ‘They were really good at feeding back to us, and helping us formulate the messaging,’ says Murphy. ‘We would obviously look at the communications around these areas and create a poster or replace a leaflet or do something that could tackle this.’

There was also a regular flow of information from NHS England which had to be ‘fine-tuned’ for Alder Hey. ‘Some things we just needed to do a little differently because we knew our staff were confused and needed extra support. But our biggest priority was communicating about PPE,’ she adds. ‘Within the team, PPE was the role I looked at more than the others. I really had to understand what I was talking about. Some of the messaging coming from NHS England was just jargon, which a lot of people wouldn’t understand. We had to use that and turn it into something that made sense.

‘We worked really closely with the infection control team, who are delivering a lot of this information themselves, to look at what messaging our staff needed. It was a question of making it as simple as we possible could.’

As Murphy points out, the PPE issue is not just one that affects clinical staff. It impacts people like domestic staff, catering staff and ward chefs. ‘They needed really simple messaging. We ended up going down a visual route – a visual guide that you can look at very quickly. You can check what area you are in and then check what PPE you need. Here’s a picture. This is what I wear: gloves, apron, goggles… done,’ she explains.

Beaver adds: ‘PPE, as you can imagine, was a huge cause of stress for our people. They wanted to make sure they were wearing the right equipment for the right circumstances, but the guidance was changing regularly. Some of the information we received was technical. You had to know what an FFP3 mask was, or a certain type of hood or glove. These people sending the information are scientists. They think and speak in technical ways. It’s the way that they speak to their peers. Becky was able to turn it into everyday Scouse, as it were, for the people. People understood it.’

He concludes: ‘In the early stages, Becky and I were often at the sharp end as we were tapped into a lot of the conversations that were going on. But as Covid-19 got into its stride, as it were, the whole team really did rise to the challenge, which was brilliant to see. It wasn’t just a case of stepping up to their roles, but it’s been about moving out of their comfort spaces and doing other things. They have jumped in, held their noses and seen what happens when they come back to the surface again.’