"Behind the scenes". Pharmacy Dept, Torbay Hospital

This  is one of series  of co-created drawings that has been developed through continuing discussions and shadowing of staff at Torbay hospital to explore experiences of burn out and response to the word ‘wellbeing’.  Staff are encouraged to talk about and visualise meaning and metaphor in their work and environment. 

This work was produced as part of a residency with Torbay and South Devon Healthcare Trust 2022 -2025, funded by NHS Charities Together and will be part of a permanent exhibition in the historic boardroom at Torbay Hospital.

Accountable Pharmacist

The drawing reflects a facility that is rather old and tired. I particularly note your inclusion of the clock with the plastic bag over it and the kitchen style cupboards. I can see that your artist’s eye has focussed in on everything accurately. Other than that, I think, the image also reflects the standards we now work within. When I started in Pharmacy this scene would have been rather different with me simply wearing my regular work clothes and a white coat or perhaps a green non-sterile fabric surgeon’s gown, standing at the back of the pharmacy dispensary. The large light box that you can see on the bench, which is a particle viewer for checking infusions are clear, would have been a laminar flow clean air cabinet and we would have been piling up infusion work in an unmodified area of the department. So, I guess it is contemporary that we are in a dedicated support room in this image and that reflects the sort of facility that we need to be in now.  The clock has got a plastic bag over it because the face housing is cracked. It fell off the wall. We’re not allowed to change anything ourselves. This is reminiscent of the cracked mirror we used to have in the Radiopharmacy. If anyone comes in and looks at your facility and asks “Why have you got a plastic bag on your clock?” We’re actually trying to stop dust gathering in the crack but what we should be doing is getting a new clock.  I think that’s emblematic. I can see also that there are a number of things that we don’t use. There are these fan controls that we don’t use, they are redundant and belong to a period in time when that area had a different life. There is a lot of residual redundant stuff that hasn’t been removed as it should have been and you find that in the NHS because of the cost of the work. I think to be fair, this image captures Aseptic services as it was but the dedicated facility needs upgrading as part of a whole new future… After Lord Carter’s review... (which wants pharmacists to be patient facing), the final Carter report did actually recognise the pharmacy workforce in in Aseptic Services as unsung heroes, working behind the scenes. We are a bit like the oboe, the musical instrument, an endangered species in fear of dying out. And we’re really highly trained and very necessary. It has been realised that the idea of a junior pharmacist wanting to follow the stereotypical moustachioed male pharmacist who used to run these ‘under the stairs’ technical services, was a turn off to most people coming into our profession. 

‘These technical services’ Pharmacists are clinically trained and most would rather be out on the ward talking about blood levels of drugs with a narrow therapeutic index or catching doctors to say, “Do you realise you have not prescribed this correctly?” or whatever or prescribing themselves. Ward based clinical pharmacy all seems very glamorous by comparison to the majority.  

Those people ‘in the cupboard under the stairs, it’s not at first glance a particularly exciting place for people to go coming out of university. None of the degree training really is linked much to that, it has however now finally been really well recognised at high level nationally that people like me are retiring and there’s nobody queueing up to replace us. The regulations governing “Section 10” unlicensed aseptic preparation have changed, tightened up significantly and demand has increased just exponentially. Everybody is on a monoclonal antibody now; cancer treatments are triple therapies instead of monotherapy that go on and on. New treatments can be highly complex to prepare and eye wateringly expensive. It’s not 6 months of chemo and that’s your lot, many people will now actually be treated until there’s no longer any treatment response. So, the face of cancer treatment has changed dramatically. They want virtual wards. We’ve halved the beds in this hospital. They used to have 600, there’s now 300. So no wonder there’s nowhere to put anyone when they come in the front door. The idea is of the virtual ward, they will want antibiotics in elastomeric pumps. It’s all got to be made. There was brief delusion in the NHS that we could buy everything in from commercial companies and close these aseptic units and not worry about ‘these people’ that we really don’t understand very well. You have to go back to basic principles and ensure there’s resilience within. There’s been a lot going on in the last few years at a very high level but then not so much at grass roots level and it’s trying to make those two things come together. I mean that’s what it’s like to be in the NHS aseptic services-there are massively ambitious things going on in our discipline that will change things for the good, but they’re all glacial in their pace.  

Second Drawing? What you have created there to me is very calm. When I look at it, it is very calming because it’s little fish and it’s not a shark coming in to bite my arm off or you know. The scene is the snorkeler who is just diving down, having a look. The pace at which the items turn into seaweed and the fish and the conger eel. To me that reflects how I feel if I’m in there. Yes, I am calm when I’m in there. I think we’ve done a good job with that because sometimes it’s really busy and because that is so isolated, although you find it subterranean, if it was more linked to the outside world it would be infected by the tension that can be in the environment when you’ve got the phone ringing a lot. … It’s necessarily a subterranean vault. I don’t think it is to us what it is to someone from elsewhere going in there. I think I did say, when it’s populated, people are in there doing what they’re expecting to do and there’s generally a fairly light atmosphere. It’s not, “Oooh we’re all in here …,”  If someone from the ‘upstairs world’ goes, “How could you possibly be in here, it’s awful” but for us, if you go in there... (I ‘ve just been in there in my Accountable Pharmacist role to do some internal auditing) and there’s the slight whistling which needs adjustment. It’s not pleasant, it’s cos the door doesn’t fit properly. It needs fixing. I think it’s like it’s being in another world… You’ve gone to somewhere else, where other people can only come and have a look. And that’s quite good because other people do come and have a look through the door, but they’re not allowed to be opening the door. That snorkeler (in the drawing) can’t talk to us or anything. They could come and look through the window but that’s all they can do. It’s got the other world, the oasis of calm and tranquillity.  

What would you change about drawing? I am not really a passive person. It looks like I’m quite passive. I would be doing something. It’s fair because that’s what I was doing, I was posing for you. But that’s out of kilter …I think I would be just wiping the surface. It depends on my role, when I was ‘that person’ in the image I was doing the Band 3 job cos we had no staff. So, I’d retrained as a Band 3, so I could come in on my days off to wipe things in and if I was signing chemotherapy off, I’d be at the bench checking. 

If you could change one thing about the NHS what would that be?  Waste. I would try to eliminate waste. It’s massive, it’s an impossible task. That is the one thing, that if you didn’t have it, there wouldn’t be all this misery. A good example of the prince and the pauper: Gene therapy has been on the bubble for a long time, and then I learn that in another English hospital, not in our region, they have just used their gene therapy suite for the very first time. They’ve had it for years. So, these high cost facilities are being installed, maintained, serviced, it’s got negative pressure corridors!! You go and look what we’re managing with down there in our aged department, and theirs is like being on the Star Trek Starship Enterprise by comparison. And they have just made ONE thing in it! Gene therapy is not going where we initially had thought it was going, some of it is too high risk, so the only things we’ll be seeing in units like ours are the Class one, Class two treatments that you don’t need all this super-duper bio safety for, some of them you could probably make them up at the patient’s bedside. It’s not an area I’m really very familiar with. But I think about that negative pressure corridored facility on one hand, and think about us and our dated one. I wonder if it isn’t just the wrong people making decisions, and maybe they are transient in their job role, not so accountable. So waste is my big thing. 

Did you always want to work in healthcare?I wanted to be a vet, that was what I wanted to do and I fainted (during work experience) when a Collie had it’s teeth out and I found myself on the floor. So, I watched removal of ovaries which wasn’t great. I was feeling a bit sick. When I was a kid I used to collect all the PDSA badges off the crisp packets. I always really liked animals and I thought wanted to be a vet. I also wanted to be a nurse when I was young. I used to imagine myself with a stethoscope and I actually had a nurse’s watch. I wanted to be a nurse and then that changed to be a vet. But then at my vet work experience I just couldn’t stomach the blood. And the smell. And a dead hamster. So, it was gradually starting to feel like, no… And then I think because my chemistry teacher was a pharmacist and I was really into chemistry, she channelled me. And I am pretty sure if I’d had different teachers I probably would have done engineering. I am really glad I did Pharmacy. It’s been an absolute delight of a career. I think I was drawn initially to the Periodic Table; the P T is my thing… I was then really drawn to … how drugs and things have a cause and effect. You put something in and seeing the effect is fascinating. But then I did Pharmaceutical engineering as an off the wall option as part of my final year degree course. Everyone mainly did Pharmacology but I chose that, and we had to design a build for a production plant for Vitamin C. We went to the Patent office. Then you had to learn Isometric drawing. There were only 4 of us that year instead of the usual 16…. We were all relatively relaxed individuals taking that particular option not stereotypical engineering razor sharp student types, ……… We used to sit there drawing our drawings, listening to the Pretenders on a Saturday in the college…. We had to draw the fermenter, I designed agigantic fermenter … in cross sections, using pen and ink, like an architect’s drawing. I just really enjoyed learning how much tolerance something I designed would have to the wind or other environmental challenges...  

How does the word ‘wellbeing’ sit with you? Not well… because it’s overused. It’s like all the ‘thank you’ and ‘look after yourself’ messages. I think it‘s become a patronising term now. We didn’t have “wellbeing” in the past. It’s annoying that the peoplesuggesting it think can it be administered and then all will be well in the camp. And actually, ….it’s more fundamental than that, isn’t it. People just need basic things in their life. People need a raison d’etre. Job losses, shipping our manufacturing overseas, combined with the tragic mass move of humans away from the natural way of things, ultra processed food, plastic everything… we’ve lost the plot entirely as a society. So, I think we are often firefighting, coming to work here and then being expected to ‘maintain your wellbeing’ with all the pressures. I don’t see them as pressures now as you can choose to be involved in those, but that’s where many other people fall down isn’t it?... If your basic needs are met, if you had a nice place to go and eat, or even just tea and coffee is available…We lost our tea breaks a few years ago and what has gone along with that is that people in the wider department don’t know each other anymore. That’s a real difference and as a manager I didn’t really see any meaningful increase in productivity after they went. When I first came here, you understood so many people’s lives because you’d all regularly be sat in the tea room together. People would be saying “I’m doing this, I’m doing that”. You would get an understanding of who people were. Their interests. Not anymore. We have so many new people here and now I couldn’t tell you who any of them are.