Being alongside people in a time of isolation

I'm a clinical psychologist and psychotherapist who has worked in the NHS for most of my adult life, most recently for a large mental health Trust. One of the things I've valued most has been my colleagues, a richly varied bunch of people with different professional and personal backgrounds. 

When the pandemic hit last year I was struck by the public reaction to the work of the NHS. People started clapping. Supermarkets allowed NHS staff in early. I was allowed to jump the queue in Tesco by showing my NHS ID card, but found myself unsure if I should as I wasn't one of those working on 'the frontline'. It made me wonder – did the public have any idea of what was going on in the NHS beyond the extraordinary work of the people tackling Covid19 head on? I'd always wanted to make a podcast, showcasing the diversity of the Trust staff, and now my idea, the pandemic and some extra time all came together. 

I took retirement from my job and with good friend and radio producer David Ian Neville (see below) I began to interview a range of people who work in the NHS. I wanted to talk to them about what they did and why, who they worked with, what it was like and how they, their service and service users had been affected by the pandemic. 

I started by talking to people I knew – friends, colleagues and in turn, their contacts. We met over Zoom and occasionally outside, giving my producer a real headache in terms of the quality of the sound, but it was all surprisingly easy to do.  

People told me things about working in lockdown that I had simply not thought about. For example, a consultant in palliative care explained how frustrating it was to be in the midst of a global pandemic and experts in managing the end of life care, but unable to get onto the wards to help patients and staff because of infection control. A social worker working in psychiatric rehab recounted how his service users, who had chip and pin bank cards as a means of protecting their finances from the risks of misuse of their cards, couldn't buy food when shops would only accept contactless payments. And some of the patients he had worried would be very damaged by the pandemic seemed to respond much better, allowing him to consider that living in lockdown was not so different from normal life for some people living with serious mental illness. They were used to isolation and lack of social contacts. A paramedic told me that 99% of the calls the ambulance service did at the height of the pandemic were to non-urgent cases of people with symptoms of Covid-19. He admitted that although his respiratory assessment skills are now top notch, work was actually pretty boring for those months.

Several interviewees had continued working face-to-face and described the anxiety and difficulty of doing so in full PPE. Others adapted to remote working from home over video call or phone. There was appreciation of saving time travelling to see patients or attend meetings, and genuine surprise at what was possible clinically. Some NHS systems, like written appointment letters rather than phone calls or emails, were thought unlikely to return post-pandemic. But there was also frustration at the impoverished quality of contact with service users and regret and worry about what might be being missed.

And I heard a lot about IT. I learned that people working in community settings, or on the interface between acute and community setting, are being driven to distraction by IT problems. A dietician working in a community learning disabilities team was frustrated by wasting time putting information into different IT systems that 'don't talk to each other'. A nurse working in hospital discharges described how she has two laptops, one for each IT system, and her delight at finally being given a log in to the acute hospital system. Given her job, working in an acute hospital setting discharging people into the community, you'd think a log in to the acute hospital IT system would be essential? As services become more integrated going forward, the need for integrated IT was expressed loud and clear. 

With each interview I was struck by something which I knew already, and which as psychologists we are very familiar with, but which I relearned each time – the key to working with patients in the NHS is the quality of the relationships we form, whoever we are and whatever our profession. Doing it effectively requires each person to offer a genuine, caring and thoughtful experience of a relationship to our service users. 

The nurses I interviewed expressed this powerfully when describing their roles as advocates for their patients, being alongside people as they progressed through the complex systems of the NHS. A psychotherapist working with people with learning disabilities spoke movingly about the terrible losses faced by this client group in the pandemic and his work with carers in a residential home where a resident had died from Covid-19, trying to help them to help the other residents who were feeling confused and angry at this sudden loss. To offer this relationship is demanding but highly rewarding and I hope these interviews show the dedication and generosity of each person in doing so, as well as the need for clinical systems to support and encourage the formation of close relationships with service users over time. 

I have enjoyed interviewing people and making connections at a time of social isolation. And I've been hugely inspired. I hope our listeners will be too.

How to start a podcast

Producer David Ian Neville with some pointers.

There is a huge amount of information on the internet about making podcasts. For example, see 'How to start a podcast' on https://thepodcasthost.com or https://www.buzzsprout.com. You can also find lots of information about the kind of equipment that is available for recording and editing your podcast on the internet. From simply using a smart phone to recording in the highest tech studios in the world, podcasts are made in lots of different ways. There is no one way to make a podcast!

The first thing to think about is what the focus or subject of your podcast will be. Is it going to be a one-off or a series? If you are not already familiar with the range and style of podcasts available, take some time to hear a few. Which ones do you enjoy and why? What makes you keeping listening and what makes you turn off?

Having spent some time listening and researching you can think about how you want your podcast to sound. Many podcasts have a conversational style and sound spontaneous – just two or more people chatting. Sounds easy! But as you may know often it is the thought, preparation and careful planning that leads to a well-made talk, interview or podcast.

So, consider the range of people you want to interview; draft out the questions you want to ask and think about the scope and shape of the podcast. While recording your podcast you can use your prepared questions or comments to lead the conversation and of course ask other questions as they occur naturally.

If you are interviewing or talking to other people on your podcast you need to get their permission to use the recording and again, there are examples of release agreements on the internet. If you are using existing music you will need permission or a license to use it. You could get music specially composed. You may know some local musicians, or music societies that might be interested in recording something for you. Like so many other professions, professional musicians have had a tough time during lockdown so if you can afford get music specially composed or recorded it will be appreciated and may not break your budget!

As most of Hope's interviews took place remotely with one person, we used Zoom and recorded the sound from both sides – so both Hope and the interviewee recorded on Zoom. However we found that the sound quality wasn't consistent because of the variations in broadband signal. As a back-up we began recording on phones, again from both sides. This yielded surprisingly good results: you can boost this by changing settings to 'lossless' in Voice Memos, for example. More recently we have tried recording directly onto cleanfeed (cleanfeed.net) instead of Zoom; another option is Zencastr. There are several sites that have a facility for recording remotely so it is worth trying a few and seeing what works best for your purposes. In the future when we are able to meet people in person we'll be using portable digital recorders and a couple of microphones. We may also record on phones as back-up!

After recording you will no doubt need to edit your material. We used Audacity software (https://www.audacityteam.org). Again there is a wide range of audio editing software available. Working out what to keep in the interview and what to delete is difficult, but our feeling was to keep the interviews to 30 minutes. It can be painful listening to oneself stumbling over questions and umming and erring and it can be tricky to edit. Hope was comforted by the fact that these are real conversations and leaving things sounding natural is acceptable. But preparing your main questions and 'rehearsing' saying them to yourself will make the conversation and the editing flow smoother. You will also be more confident while recording the podcast. 

Not everyone likes hearing their own voice on a recording. It may surprise you how it sounds and you may feel quite self-critical. I often think the microphone is like a magnifying glass – it reveals everything in more detail. Experiment recording your voice. In normal conversation we mostly 'breathe' or speak from our throats. But when you are giving a speech you often need to control your breath and voice more to give a stronger delivery. You need to breathe more deeply. So when speaking into a microphone you may also need to control your voice more by, for example, making sure you have enough breath to get through a long line without your voice sounding thin and weak. Doing some breathing exercises will help you make your voice more flexible and resilient.

You will need a title and some artwork for when you publish your podcast. There are various companies that provide hosting platforms for podcasts. They all offer a range of packages at different prices and some have a free service. We are using Acast. Whatever platform you choose will guide you through the steps you need to prepare your podcast for publishing. The platform will also explain how to make your podcast accessible in different places, like Apple, Spotify and on Google etc.

The most difficult part is getting publicity for the podcast to get it to a wide audience. There are many, many podcasts out there and so far trying to get publicity in the national media has proved elusive. However, social media is good for this and getting featured in local and specialty press is another way. Please feel free to forward Healthworker Talk to as many people as possible!

So summing up – how do you make the best podcast? Change the question – how do you make your best podcast? You can get away with a lot with smartphones; along with other digital equipment they have made recording both sound and video more accessible and flexible for everyone. However, being in a purpose-built sound studio with professional grade equipment makes the technical side of the job easier and will yield superior quality. But great art and great programmes or podcasts aren't defined by the cost of the equipment or a wonderful location! Your podcast will only be as good as the content, no matter how much you spend on the equipment. So whatever you can afford, focus on what you want your podcast to be about, and enjoy creating it!

-       David Ian Neville is a freelance producer and can provide consultancy services for podcasting and other productions. Email: [email protected]

You can find Healthworker Talk on https://shows.acast.com/Healthworker-Talk

If you would like to take part in Healthworker Talk please contact me at [email protected]