Shredded nerves and disrupted services - crucial lessons from the Docklands bomb

I heard it from my office that early evening, knew what it was and phoned the medical and nursing directors. We contacted our counterparts at the Royal London, the acute trust down the road, and offered help – people, beds, kit, now and later, as needed.

We then turned to what we needed to do. East London acute hospitals would take care of the 200 people who were injured, but many times that number of people living in the area were already our clients and patients, and more might become so.

A lot has changed in 20 years: the way the NHS works, its links with social care and the police, its preparedness for incidents, access to information and ease of communication. But some of the things we learned back then almost certainly hold now.

Get on the front foot with clients and patients

Community mental health teams and community nursing teams looked through client lists for people who were particularly vulnerable or likely to be affected, and called or visited them to check all was well and to offer some reassurance.

Talking with local GPs meant they knew that we would help with any increased pressure on services by facilitating additional locum GP and practice nurse support, and administrative support for, for example, extended surgery hours or opening over weekends.

School nurses let head teachers know they were available to help talk with the children and support anyone who was particularly anxious.

Health visitors considered if there were any new families that might need an extra visit during those weeks.

Team managers from all parts of the trust met to work out how they would re-distribute staff if needed and how to be absolutely sure that important home visits (medication, dressings) were not missed.

Staff were often asked by Isle of Dogs clients for advice on practical matters, including damage repair and making an insurance claim. We were not prepared for that and information was not as easily available as it is now (internet access was still quite limited for us, and local communities). It took us a few days to make the right connections with the local authority’s One Stop Shop, and the local Citizens Advice.

Prepare for general disruption to usual working

Repeated bomb alerts (and hoaxes) in the two or three weeks after the explosion led to road closures and, more than once, to the Island being sealed off completely, with no access – on or off – for other than emergency vehicles. This also meant huge traffic jams in surrounding areas with staff unable to get to clients and clients unable to get to appointments.

Community midwives checked expected dates of delivery and important ante-natal clinic appointments for Isle of Dogs mothers. They might need an ambulance transfer as they could not rely on being able to use private or public transport.

Extra staff were allocated to appointments and booking so that they could talk to people about missed appointments, including planned diagnostic and other procedures, and re-book them as soon as possible. Extended and additional clinic sessions kept overall disruption to a minimum.

Armed police around our hospitals and clinics upset some patients to the point they could not walk in: we asked the police to move away from the entrance to our mental health service buildings, and they did.

And just because it’s a cliché, it doesn’t mean it’s not true - the constant scream of sirens really did shred our nerves.

Our staff

The trust’s clinical psychology team helped us put together a swift team de-brief process, delivered though the trust’s clinical team structure and additional meetings widely distributed through the trust. Four things stand in my memory about those meetings.

First, they reminded us that some members of staff were also Isle of Dogs residents and were as shocked and frightened as any other.

Second, some of the staff members were Irish (the bomb had been set by the IRA): they feared the attention of the police and some of their neighbours.

Third, social services colleagues, who had been directly affected by the explosion, were involved in some of the clinical teams and, therefore, the de-brief. Their first-hand testimony moved everyone there.

And fourth, the level of personal and professional support among those groups of staff was just the best thing and meant everyone could do their best for local people.

Remembering Inam Bashir and John Jeffries who were killed by the Docklands Bomb, 9 February 1996.

Hilary Scott was the chief executive of Tower Hamlets Healthcare NHS trust 1995-1999.  She spent the next three years as the deputy health service ombudsman and then went to the Department of Health to work on reforming the NHS complaints and clinical negligence systems. She has worked as an independent investigator of complaints and serious incidents for the past 14 years.