All nurses required to go onto an inpatient roster so they could be redeployed to the most appropriate area as needs dictated.

Nurses needed to be redeployed so the right people were available in the right service at the right time.

A new actual staffing level was developed with surge and super-surge acuity levels. This was based on ITU guidance working backwards to create different ratios if patients were in ITU, HDU, step down wards or palliative care.

Introduction of the matron of the day. A matron rota was implemented so there was senior clinical leadership 7 days a week.

Occupational health worked as usual, but they had an increase in activity. This involved frequent updates of guidelines as information changed.

Enhanced support provided by the staff psychology and well-being service, supported by departmental clinical psychologists.

Numerous initiatives were implemented to improve the staff experience as a result of changes to the way of working during the pandemic, including coordinating and managing the distribution of charitable donations and food and opening of an offsite respite centre.

Information for patients and families. These needed to be developed more rapidly.

Visiting was severely restricted. There needed to be a secure process in place, development of a support package: FLO who was the single point of contact for getting information about their relatives in hospital.

Facilitating and supporting visitors who were able to access the hospital.

Refresher training – used a similar model to the influenza pandemic, built a package of half day refresher including the electronic health records system.

PPE training – a task force was set up to deliver sessions across the Trust.

Students and international nurses – NMC opened a temporary register, which enabled 37 international nurses to join the register and start work in the Trust.

Student nurses – third years in their final 6 months came into the workforce as a band 4 (approximately 70 working under supervision rather than supernumerary); second years continued to be supernumerary so moved to sites away from the site hosting the COVID-19 wards.

Upskill nurses working on a ward that was converted to a high dependency respiratory unit.