Vaccination centres are opening across the country as part of a massive programme to protect our population against Covid-19. In a race to beat the rapid spread of the virus, the centres are being set up at great speed in hospitals, GP surgeries, leisure centres and even churches and mosques. In this moving report, one NHS manager describes the extraordinary challenge of getting a mass vaccination clinic started in just a few weeks, a process that would normally have taken months.
I work at a medium sized hospital in the south west. In mid-December I was asked to join the team setting up a vaccine centre in the hospital. At breakneck speed we did this and have already vaccinated over 8,000 people.
We are using the Pfizer BioNTech vaccine. It is extremely unstable, just knocking over the vial can ruin it. It has to be mixed up slowly and carefully and, famously, stored at -70 degrees until the day before it is used. Once thawed out, it can only be moved once. So it is delivered to us at -70. We transfer it to a normal fridge in the pharmacy and then it can be moved once – down to the vaccine clinic.
The clinic set up was tricky. At the start we had no staff, no place to operate from and no clear idea of who would be coming. Initially, we thought we would just be vaccinating staff – both our own and those who work in care homes and in people’s houses. This requirement grew, almost immediately to include people over 80 years old. The clinic went overnight from a weekend only event to a 7 days a week, 8am to 8pm service.
We had to find a place in the hospital which was safe to queue and hold people, whilst not disrupting too much of the normal work of the hospital. After people have been given the vaccine, there is the possibility of a reaction, as with any injected drug. It’s a small chance, but enough to need to observe people for 15 minutes after they’ve been injected. So we needed a space big enough to hold about 30 people, socially distanced, to accommodate the observation period.
We decided on an area right on the edge of the hospital. And then brought in a large marquee (not so many weddings happening just now) to house the observation area. We designated a free car park for the patients, and got signs and floor markings sorted. We cancelled or moved all the appointments for patients that had been using this area.
Working out the booking system was the hardest part. The bookings team have tried about four different ways to organize the process. Should people phone us, we phone them, get their manager to phone them? And with older people the complexities of eligibility were legion. It is still not settled and has caused the biggest headaches.
The clinic opened at 2pm on 8 January. The team gathered – administrators to book in, log out and manage queues, nurses and doctors to do the vaccinating and a small team of managers and supervisors, all learning how to do it as we went along. Our mantra was ‘we are building this train as it runs down the track!’
Immediately we ran into problems. A mistake with the booking process meant that instead of the planned slow start, we had 8 people arriving every 10 minutes right from 2pm. Whilst the nurses were still learning how to draw up and give the new vaccine, we had people queueing down the corridor, all eager to get their jab, ignoring our pleas to keep socially distanced!
By 3.30pm we were into the groove. Nurses had got the idea of the very careful handling of the vaccine, administrators were working out how to find people on the system, book them in and then record their vaccine – very important to make sure we contacted them for their second jab. The queue was manageable.
The tent was too cold – despite the 20 fan heaters working away. By day 2 the health care assistants working there had got the message, turning up in mufflers and Ugg boots. The car park attendants got rained on – a gazebo was sourced. We ran out of the cards we give to patients telling them the type of jab they have had and, Blue Peter style, we got out the scissors and sticky labels to make them.
The IT let us down repeatedly. A system used to handling a clinic of 10 patients was being asked to manage a clinic of 450. It ran so slowly, it was virtually useless. Frantic calls were made to the Irish manufacturers and new systems were built overnight. We all remembered numerous times when this would have taken months to get sorted, and it was happening in hours!
Each day there was a huge buzz in the clinic – grateful patients and staff patiently queuing to get done. All was quiet in the tent as they waited out their 15 minutes. Lots of thank yous all the time. The section of the tent for staff was constantly stocked with chocolates, biscuits and cakes from grateful patients.
Inevitably, there were mistakes – staff turned up who thought they were on the list to get the vaccine. Whose mistake had it been? The manager, the administrator, the booker, the person on the door clutching her list? A few got grumpy, tried to pull rank. I was often called down to adjudicate. As ever, most were unfailingly accommodating, and appreciative of the complexity of building the train at this speed.
A real difficulty was the pressure of not wasting vaccine. Each vial moved from pharmacy to the clinic had to be used that day. As we could never be sure whether we would get 5 or 6 vaccines from each vial, we had a potential variance of 50 vaccines. Staff could not be easily brought down from the wards to get jabbed, as if they had a reaction, there would be no one to staff the ward. In addition, we were getting a lot of people not turning up. Most of these were people who had been offered a jab nearer to home, maybe at a neighbouring hospital, or at a GP practice at short notice.
We juggled. We brought people down at the end of their shift, or who were off duty, but in the area. We adapted the booking daily, based on the numbers we were getting from the vials. So far, we have not wasted a single vaccine, a massive achievement.
Almost inevitably, after brushing past hundreds of people, I caught Covid two weeks in. I should have had more days off, and maybe I would have not gone down with it. I had had the vaccine a week before which lessened the load. It takes three weeks to build immunity once you have had the jab. Luckily, I have recovered within a couple of weeks.
The new variant is whipping through the hospital, though. We have over 100 people in beds with the virus, many in ITU. Following the latest lockdown, the numbers are not rising, but they are not falling yet either. We still have a long way to go. The clinic needs to continue for many months yet, we are beginning to vaccinate those over 70 years old, and everyone who has had one jab, eventually needs to have the second.
It is a tribute to the flexibility, ingenuity and passion of the NHS that the vaccine programme nationally has made the progress it has. With people working on their days off, summoning up solutions in hours which would normally have taken months and coping with the confusion and complication which has gone with such a huge programme, it has, once again, reminded me how lucky I am to live in a country with a health service which is both funded and provided for everyone.
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