Better Health For All

The Commonwealth Games took place in Birmingham 28^th July to 8^th August in (for once) balmy, sunny weather harking back to the days of the 2012 London Olympics. Here is an account of the final months of a five-year journey that UKHSA was a key part of, through three registrars who worked on the project:

Steve Barlow, ST3

Steve Barlow – Pictured on ‘Black Sabbath Bridge’ in Birmingham, along with Games mascot Perry, and Cassie Gregory, Principal Health Protection Nurse from the West Midlands Health Protection team

When I joined the Registrar training scheme in 2019, I never imagined that there would be a global pandemic. However, this provided me with a unique opportunity to observe mobilisation of a combined local authority (LA), UKHSA (then PHE) and wider healthcare response to an unprecedented public health type incident. Interestingly, this also helped in building relationships which then played out on another global platform: the Commonwealth Games (CWG).

As part of the CWG team, given my previous knowledge and experience, my main workstream was liaising with LAs and Integrated Care Boards (ICBs). As with all CWG work, it required degrees of overlap to ensure that the health protection response was as cohesive and comprehensive as possible. This involved a series of meetings to define and document the whole system preparedness should any health protection issue arise from CWG. Whilst some may consider this business as usual, we needed to streamline the system, to make the response more timely by calling on local relationships built during the pandemic.

Through leadership, advice and influencing, I worked on assessing any opportunities, good practices, and gaps in each area’s health protection response, looking at role and responsibilities, trying to clarify and agree these, and then share this information wider to develop more robust systems. I documented the current situation with a baseline survey and through our discussions, helped to produce formal plans for each local authority area. With support from the team, I then held a workshop for all the LAs in which over 80 individuals attended, to put plans into practise through a series of scenarios.

During Games time we were co-located in the Games Operational Centre (GOC) which was fascinating. Here we worked with a number of commercial partners as well as a few familiar faces. From the beginning, we became established (with our branded UKHSA branded, teal-coloured tops!) and, I believe, added value as we were able to assess and control situations in real-time. As part of the legacy work, I am evaluating the local partnerships workstream and looking longer term to make the health protection planning, commissioning, and response more cohesive in the wider health and social care system.

Clare Brehmer, ST4

Clare Brehmer – Wishing her children goodnight on the phone, with Games mascot Perry in the background, whilst working an evening shift in the Games Operations Centre

As the last member to join the core CWG team (fresh from maternity leave!) I was keen to “hit the ground running”. From the start the team were incredible to work with as there was nothing but positive vibes – all of us had chosen to work on the Games and were excited to showcase our work in the West Midlands.

My main workstream was to help develop operational plans for the laboratory testing during the Games period. One quirk of the Games was that there were pop-up polyclinics at five accommodation sites across the region, with a 24/7 motorbike service to courier samples to our UKHSA public health lab at Heartlands site. These services were set-up by the medical arm of the Organising Committee for the Games and provided routine medical services for all athletes and officials residing at these locations.

At UKHSA, we provided bespoke packs of consumables to each site, to be used in the event of an outbreak. We also developed a pathway for surveillance and reporting of any results related to the Games, and a round-the-clock rota for specialist laboratory technical and microbiological advice. This brought together staff from the public health lab, the local hospital lab, the CPHIs (Consultants in Public Health Infection) and health protection team, in a collaborative effort to streamline the testing and reporting processes for the Games period.

Our UKHSA public health lab also started providing Monkeypox testing for all Midlands samples a few weeks before the start of the Games; a useful addition to cut turnaround times should any potential cases arise.

The workload ramped up quickly, with extended hours starting a week before the actual start date of the Games, to allow for an enhanced public health response as athletes and officials entered the country. This meant we were all well-versed in the “Battle Rhythm” by the start of the Games. I was involved in the early preparations in the Games Operations Centre (GOC), meeting partners and introducing UKHSA to many people for the first time. Event planning is not something we often get involved in as registrars, and it was exciting to collaborate with others in health and safety, venues management and security to ensure all plans were in place. Several people even approached us to ask about careers in public health. During the Games I have to say, it was very quiet! We had heard similar reports from colleagues involved in London 2012 Olympics, but I didn’t want to jinx it. In reality, we had a steady workload of low-risk incidents and cases which rumbled along for the duration of the Games. This meant there was plenty of time for learning as a registrar and even acting-up as the public health adviser to the Games. As expected, there was a certain amount of politics involved and people management, at times with conflicting views. However, we continued to work effectively with our partners while providing sound public health advice and this undoubtedly contributed to ensuring a safe and successful Games.

David Collyer, ST3

David Collyer – With family enjoying the athletics competition at the Alexander Stadium pictured with England 100m sprinter, Imani-Lara Lansiquot

I joined the Commonwealth Games project team in February of this year, and early highlights (and opportunities to meet other team members in person rather than just on Teams!) were visits to the Lee Valley velodrome, and to the prospective athlete villages. Regular meetings of our core project team meant that we all had a chance to discuss our individual workstreams, get help and support, and maintain a good overview of all the work that was taking place.

One of my areas of work was participating in a planning group for ‘Health Protection Operations’ during the Games, which included leading workgroups for 2 areas in particular – plans for how we would work with the ‘polyclinics’ in the athlete villages and plans for how we would make use of the Medical Encounter System (a bespoke computer system being developed for the Games to capture medical data).

My prior experience of health protection work was limited, so this was a very steep learning curve, but planning a health protection response ‘from the ground up’ was an interesting way to get to grips with how the different elements all fit together. I also updated the Birmingham Airport Health Protection Plan (one of the main ports of entry for the Games) which included an appendix to cover the Commonwealth Games, particularly the COVID testing requirements for arrivals/departures.  This required working with numerous stakeholders including the Organising Committee (OC) for the Games, the airport, the local authority, and other UKHSA teams including the Port Health lead, and the International Travel Contact Tracing team. 

However, the most challenging and time-consuming area of work for me was around COVID and our recommendations for testing during the Games. The plans evolved considerably as the Games approached, and it was fascinating to see how decisions made by external stakeholders were influenced as much by politics as by epidemiology! As part of this work, I was able to attend a weekly meeting with the Chief Medical Officers for various UK elite sports, which had been convened early in the pandemic to facilitate a return to competition. This was a brilliant forum for discussing our COVID plans for the Games, as well as an amazing opportunity to hear the collective wisdom of an eminent group of sports medics.

Ultimately there were no big outbreaks during this Games, but I felt reassured that we had all the structures and processes in place to detect an outbreak and respond should it occur. Despite this lack of ‘action’ it was also fascinating just to be in the Games Operational Centre, watching as an event of this huge scale unfolded.

The Commonwealth Games Project Team was great to work with. Although the work was challenging at times, and definitely pushed me outside my comfort zone, I always felt well supported. I learnt so much during the 6 months and will never forget the buzz in Birmingham as the event we had spent so long planning for, finally came to town! I would recommend getting involved with a similar mass-gathering event, to any registrar offered the opportunity.

Caryn Cox, Lead UKHSA Health Protection Consultant for the Commonwealth Games

‘Having public health registrars embedded in the UKHSA West Midlands Commonwealth Games programme team and leading on key workstreams in the planning and preparation phase for the Games was fantastic. Each brought differing skills and knowledge to enhance the core programme team.

Clare, Steve, and David also each voluntarily stepped up in the operational phase of the Games competition time – working both the 6am early morning shifts and midnight finishing evening shifts and across multiple weekends. 

They also undertook a rota slot where they were the Public Health Advisory lead in the Games Operational Centre, sat along with multi-agency colleagues. I hope they were each able to gain the development and learning opportunities they were seeking, as well as enjoying the experience and joy of being part of the largest Commonwealth Games ever held – held by all to be a great success. 

As we capture the lessons learned from this Games to transfer to future events as well as internally in the UKHSA, we have already noted and recorded that registrars should, where possible and relevant to their training, be an integral part in planning, preparation and response, as opportunities such as these do not come along very often.

Our thanks to the triumphant trio, Clare, Steve and David, as well as Dr Alex Cockburn, an ST5 West Midlands registrar who worked on the Games prior to Feb 2022 and laid excellent foundations for other registrars to follow. We now hand over the baton to the State of Victoria, Australia for the 2026 Commonwealth Games’.