North Tees and Hartlepool NHS Foundation Trust was a typical case. As national guidance emerged in March 2020, and as the scale of the challenge became apparent, operational management was rapidly switched to a strategic command model, with tactical cells covering clinical decisions, infection prevention and control, workforce, estates (including an oxygen subgroup), recovery (re-establishing normal operations) and communications. The usual processes of reporting were replaced by a more agile model, and operational decisions were devolved downwards.

This approach closely matched the measures taken in the European countries that were at the forefront of the pandemic response, which in turn relied on the information available from early studies of the response in China. One study from Italy reported on the radical task force–based response to the pandemic, in terms of dedicated COVID-19 ICU spaces, pre-triage and isolation of suspected cases, training staff for work in the ICU, establishment of multidisciplinary units, estates reconfiguration, staff recruitment, logistics and training.[1]