Back in November last year there was a helpful discussion with our North East London community about what we needed to focus on going forward, kindness and compassion featured strongly and ensuring that we were all ‘trauma informed’ featured strongly as this would help us in empowering others, whether the public or staff.
Having the time to understand the evidence base and think about the practical actions we can take has been really valuable. I had time to chat with a Paediatric registrar about how her approach to engaging with a young person, she shared that providing a route for the young person to chat (without their parent) made a huge difference to their diagnosis, care and management. The registrar highlighted the importance of investing in building trust and when we do this outcomes can be influenced positively. A speech and language therapist talked about the importance of ensuring patients have control over health and empowering them to have their voice heard.
These conversations brought to life the importance of ensuring that we’re all thinking about trauma and it’s impact. Trauma occurs when an incident/s leaves a person so overwhelmed or threatened that it leaves a long last impact.
It can occur at any stage in life, yet being exposed to Adverse childhood experiences (ACEs), potentially traumatic events that occur in childhood (0-17 years) can be particularly challenging. These can include experiencing violence, abuse, or neglect, violence in the home or community and the death of a close family member, or events that undermine a child’s feeling of safety, stability, and bonding, such as growing up in a household where there are substance use, mental health problems or instability due to parental separation or a parent being in prison along with wider adversities such as poverty, discrimination, lack of economic opportunity and social connectivity.
Adversity in childhood can disrupt cognitive, social, emotional and behavioural development with prolonged exposure resulting in toxic stress. This adversity can cause hyper arousal, adversely affecting a young person’s ability to regulate their emotions. It can also increase the risk of developing health-harming behaviours that can impact on physical and mental health in later life including cardiac disease, diabetes and depression.
Children of course adapt to their circumstances, finding ways to survive, seek control/safety, they find ways to mitigate or tolerate adversity in some way, along with making sense of their experiences. So the impact of trauma on individuals is hugely variable and the context and support available can play a huge part in building resilience and this is a dynamic process.
To be trauma informed is for us to understand that trauma can be at the root of behaviour and shifting our focus from ‘what happened to you’ rather than ‘what’s the matter with you’ can be helpful.
The 4 R’s can help
1. Realise the impact of trauma
2. Recognise the signs and symptoms
3. Respond integrating this knowledge about trauma
4. Resist re- traumatising people
Some thoughts
1. investing time in relationship building is widely appreciated and has huge value
2. Breaking down ‘them and us’ barriers either with patients/families or team members can be really helpful
3. Animal human relationships can be calming – one of our dentists managed to get dogs into the dental hospital and everyone loves it!
4. Focusing on a ‘shared understanding’ with active participation is powerful
4. Reviewing how we respond collectively to challenging behaviour an be helpful, emphasising deescalation and avoidance of re-traumatising patients
5. Encouraging greater control over health and care, through real shared decision making is needed
6. We all need to be taking mental health concerns seriously
7. Understanding and utilising a trauma lens to recognise signs, symptoms and impact on lives, allows us all to understand better the root causes of behaviour, enabling us to provide appropriate care and support. It seems we all need to become trauma champions …
And a final key thought we can’t care for other unless we care for ourselves ….
One of the #EarlyRisersClub shared this morning affirmation graphic and I love it!
Prior to an organised ‘ultra run’ there’s normally a race briefing and it was the Brecon to Cardiff event by ‘Run, Walk, Crawl’ that captured my attention, there was a gentle reminder that a ‘tidy’ pace would be required to cover the required distance (43miles) in the allocated time and that this was an adventure not a walk! After a long sunny day last Sunday I was very grateful to have completed this adventure and having wonderful people such as Ruth Norway cheering me on in person I managed to bank some fabulous memories!
It got me thinking about the importance of adventuring in life. One of my occasional treats on a Saturday afternoon is touring our local Hertfordshire charity shops where I picked up a great Jamie Oliver cookbook focusing on recipes from his travels to Spain, Italy, Sweden, Morocco, Greece and France. I’m looking forward to dipping into culinary adventures prior to sleeping! A couple of paragraphs is generally all I need before heading off into the land of nod!
Wonderful Jane Galloway of ‘Quiet the Hive’ a few weeks ago recommended ‘Simple Abundance’ a day book of comfort and joy by Sarah Ban Breathnach. It’s a lovely book to enjoy with my morning coffee. On 25th February she highlights that most women she knows have one priority… ‘to make it through the day’. I suspect many of us can connect with that, and yet pausing to acknowledge, recognise and reordering priorities can help strengthen our purpose and perhaps take a moment for adventuring either physically or mentally.
In order for children to adventure through life we need to provide them with the best foundations possible and I was delighted to hear Sadiq Khan announce that London would provide school meals for all primary school children, I’m excited by the impact this will have in reducing stigma and providing nutrition to aid learning. If we could only get a school nurse in every school and a school governor leading for health and well-being we’d be on the right track to build sustainable health and wellbeing into our schools.
North London this week had a call that highlighted yet again the numbers of children requiring dental extraction and a conversation with a paediatrician reinforced the amount of time spent explaining fever and fever management to families in busy EDs, the importance of health visiting and growing this workforce was reinforced yet again!
In order to adventure we all need a bit of support, a briefing, a cheerleader, let’s keep making sure we’re helping children adventure through their lives.
Right I’m off on my adventure of the morning ‘the Baldock Beast’!
The last few weeks have been frustrating! Our brilliant practice educators in our neonatal teams have lined up our next group of fabulous nurses to do their Qualification in Specialty (QIS) Course at our local University but the funding for these programmes hasn’t been confirmed from Health Education England yet. Our staff have lives to organise, families, caring responsibilities to juggle not knowing if they’ll be starting in April creates uncertainty that seems so unnecessary.
When I spend time on our neonatal units our littlest humans never cease to make me catch my breath! The tiniest bonnets, tapes, splints, drug infusions, their positioning, the preciseness of the care is all so vital as we know these neonatal graduates are often our children with Special Educational Needs and Disabilities, are sometimes our ‘Looked After Children’ and others have ongoing medical complexity requiring life long input from the NHS. The expert care they receive (or don’t receive) in the neonatal period affects the rest of their lives.
I’ve been privileged throughout my career to access a whole range of education and training that’s made a huge difference to my practice. I remember one particular incident when I’d moved from a specialist area back into a very busy general Paeds setting. I’d come on shift one evening and a little one in our high dependency cubicle stopped breathing, I remember a sense of panic yet almost instantly I recall Loretta an experienced Paeds Nurse coming alongside me, sweeping into action as she pulled the crash bell and started resuscitation, after a lot of complex interventions, all was well. However I felt out of my depth so, I knew I had a knowledge gap, so the next day I’d secured my place on EPLS and had read extensively on deteriorating children and earliest recognition. I never wanted to feel that sense of panic again.
The report highlights the essential need for us to do all we can in supporting staff to have the expert skills to care for our patients safely, and where things go wrong to care for families compassionately.
Ensuring our staff have access to education and training to provide complex, technical and ever evolving care is essential. Not all education can or should provided ‘in house’ access to education in academic settings to challenge, be with other colleagues from other units to debate, inspire, enhance our practice is ESSENTIAL for care and must be invested in if we’re to make progress …
Goodness I hope those Education Budgets from HEE are released soon!
I was with a colleague this week who reminded me how much I enjoyed blogging, sharing thoughts on key current issues that many of us face across the public sector, particularly those who advocate for improvements in Child Health.
So here I go, I’m committing to blogging regularly again!
So what’s on my radar? Well my heart has gone out to those affected by the earthquake and to amazing colleagues from emergency services grappling with helping. This video highlights the joy of being rescued ‘Six remarkable rescues amid earthquake chaos’ https://www.bbc.co.uk/news/world-europe-64588602 Organisations such as the International Red Cross have asked us for donations via the Disasters Emergency Committee (DEC) https://donate.redcross.org.uk/appeal/turkey-syria-earthquake-appeal supporting this through a donation seems like a very practical action we can take.
Closer to home, London held an online discussion about why children die in the Capital, led by the Office for Health Improvement and disparities (OHID) the National Child Death Mortality Database (do follow them on Twitter @NCMD_England) provided data and thematic learning to influence a whole system improvement programme. Poverty and health inequalities are the most significant challenges, yet consistent, understandable, practical information about issues such as safe sleeping are required too. Organisations such as @LullabyTrust do a fantastic job at conveying information to families.
There was also a discussion at our Trust about what we can do to prevent suicide in children and young people following in from the thematic report published by NCMD, https://www.ncmd.info/?s=Suicide online training, using the HEADSSS assessment framework and raising awareness of the issue were areas we agreed we could take action.
Sadly 62% of children who took their life by suicide experienced a significant loss in their life and this led us to explore how we can better identify and support children when we care for their families. The importance of including this element of care in our refreshed End of Life and Palliative Care Implementation plan was reinforced.
Finally for this week I want to give a shout out to London Innovation and Improvement Alliance @LondonLiia who have been working with Directors of Children’s services across London, they ran a fantastic event, it was great that health, police and the voluntary sector were part of the collaborative conversations and planning for sustainable improvement for and with London’s Children, you can read more here https://liia.london/news-article?article=39
Have a great weekend! & if you’re working, thank you!
This time of year offers an opportunity for us to look back as well as providing time to look forward to the year ahead, what will 2023 bring?
2022 has been complex and frustrating in so many ways, yet I am in total awe of public sector workers who remain committed to making a difference to others, whether in local authorities, social care, public health, education, policing, emergency services and our NHS. Our public services are delivered by people juggling super busy lives, often holding multiple personal and professional roles, including caring for family members.
The community of #NHS1000miles will this year celebrate the 75th birthday of the NHS, NHS England have blogged about the ways we can get involved in marking this fantastic year and have profiled #NHS1000miles https://www.england.nhs.uk/nhsbirthday/get-involved/ In 2018 we celebrated the 70th birthday year and commenced this annual challenge, as a result we’ve grown a community of wonderful people who’ve all been determined to be a bit more active in daily life. Each Sunday evening at 7.30 we all post a mileage update, along with a picture from our week. It’s often a quick tweet as people are juggling dinner, catching up on a TV show/good book/radio show or podcast and no doubt pondering and prepping for the week ahead. Yet a scroll through the timeline of #NHS1000miles (often at 5am on a Monday morning over my first of many coffees) offers great inspiration and fab people to follow too, I find it really uplifting as the new week commences. It reminds me regularly that activity can fitted into busy lives, whether it’s a Saturday morning ParkRun or a commitment to dumping the lift at work, taking the stairs each day or walking a bit more on a daily commute.
Whilst #NHS1000miles is about banking miles in anyway, walking, cycling, swimming etc, it’s running that’s my activity of choice. Running for me offers me a meditative plod and headspace to ponder issues, it gives me the space to ‘just be’ along with appreciating the changing seasons. Seeking out snowdrops, daffodils, followed by bluebells, will carry me through the winter and spring until lighter days return when I’ll have the chance to enjoy pre-work warmer sunrise runs again.
2022 gave me my longest run yet, 62 miles in one go, ‘race to the stones’, enjoying a sunset and sunrise in one adventure with wonderful friends was a real treat. The wettest and wildest run of the year was definitely ‘Brecon to Cardiff’ a 43 miler that was ‘character building’, getting lost added to the experience and the memories too! It’s also been good to get travelling again, visiting the Northern Irish coast and doing the ‘Giants Causeway Marathon’ was a highlight and Chicago Marathon was a fun city running experience. Yet it’s the regular weekly ParkRuns that are highlight of my week, a natter with my friend Louise on the way there and on the way back, seems to put the world into perspective and smiles from regulars including Alison (of #NHS1000miles) are always appreciated.
So some thoughts as we head into 2023, let’s all make small steps in being a bit more active, #NHS1000miles isn’t a competition, it’s a community of encouragers. Every step forward makes us stronger, why not join us? If you haven’t tried a ParkRun perhaps give one a go in 2023? I’ve lined up a number of challenges to keep me active in the year ahead which I’ll share with you in the year ahead and this year I’ll also be fundraising for brilliant Barts Charity https://www.justgiving.com/fundraising/kath-evansnhs75
Finally a thank you and a shout out to all those who’ve been part of #NHS1000miles over the past 5years, it’s exciting to see that this inclusive challenge keeps growing!
As we come to the end of 2021 members of the #NHS1000miles community from across the country are adding up their mileage, selecting pics and composing their final tweets, celebrating a year of being a bit more active than perhaps they normally are because they are nudged gently onwards by others, knowing that investing in our well-being pays dividends in so many ways. Yet ‘knowing and ‘doing’ are sometimes different, hence the importance of the #NHS1000miles community which inspires us all! Thank you to everyone who’s contributed in 2021 💫
But where did #NHS1000miles start? Back in 2017 Antony Tiernan who tweets as @AntonyTiernan was leading on the 70th Birthday celebration arrangements for the NHS, he was encouraging us to think up fun ways to mark the occasion, so a few of us thought that making an effort to be more active would make a great practical gift. And so in the 70th birthday year of the NHS the inclusive community of #NHS1000miles was born, all miles, anyway count, walking, swimming, cycling, running. Here’s the link to the first blog, kindly supported by the @wenurses team Teresa and Nick Chinn http://wecommunities.org/blogs/3338
So 2018 saw a phenomenal community of people regularly adding up their miles and posting updates on a Sunday evening at 7.30pm, the end of the year 2018 blog shouts out some of the fab people who helped get #NHS1000miles going http://www.wecommunities.org/blogs/3443
So as we reflect back on 2021, what have been the highlights?
@NorthwayRuth is a regular ParkRun volunteer and a member of her local running club who supports others on their running journey… @wendyjnicholson has shared amazing wild swimming pics!
@MarcHarder has made a remarkable recovery ❤️🩹 this year after a significant cardiac episode and has shared how we can get active again when health issues challenges us…
@Ushert head of staff well-being at the Royal London hospital won an ultra run this year!!! … talk about awesome 💫
@Triciahandley who leads on improving care for people with Learning Disabilities regularly shares her ParkRun adventures and has recently been posting about her chilly lido swimming adventures 🏊♀️
@LindaChibuzor is always glamorous (there’s usually a fab splash of pink in her outfit!) and inspires us all to squeeze in activity in amongst busy jobs.
@THCPrimarycare has some big adventures ahead in 2022. She blends her active life with supporting primary care and is definitely worth a follow!
@SaraTurle our ever chirpy early morning runner posts her wisdom each day with beautiful pics to encourage us all.
@JackieSmith_nmc our #ChiefCoach has continued to encourage us all even though an injury has caused significant challenges in 2021 … we’re all so delighted to see her running again!
I could go on forever! The #NHS1000miles community is full of fabulous ‘normal’ people with very busy lives, who are making a choice to keep active by counting the miles, snapping fun pics and sharing adventures…knowing others are willing us onwards always helps!
So I suppose in this community, we’re accountability pals, and we’d love others to join us in 2022
Everyone is welcome, here’s what’s needed …
1. Set a goal to reach 1000miles in the year
2. Prioritise being more active (all ways count) … a flight of stairs … a brisk walk .. starting couch to 5k …
3. Using the ‘check-in’ at 7.30pm on a Sunday to share progress and pics if you can
4. Use a spirit of encouragement and empathy to support the community, recognising life can and indeed is pretty tough on occasions YET exercise can be hugely therapeutic.
I’m certainly looking forward to hearing about about your adventures in 2022 💫🏃🏻♀️🚴🏻♂️🏊🏼
Did you know that April is stress awareness month? Public Health England have a great quiz to help you explore routes of our stress and provides some suggested interactions, I had a go and it got me thinking https://www.nhs.uk/oneyou/every-mind-matters/ Why not have a go and share with others?
A recent Barts Health Twitter chat about well-being got me thinking about about personal well-being plans, and I’ve been pondering if can they help us become more intentional in promoting our own well-being? Could they encourage us to pause and reflect on where we are now and what we need to do more of? We’re used to creating ‘Care Plans’ for patients, but perhaps we can adopt the nursing process of ‘Assessment, Diagnosis, Planning, Implementation and Evaluation’ for ourselves when it comes to reviewing where we’re at personally and what we need to ensure we keep flourishing.
There are many reasons why we may not prioritise this, why we do allow ourselves to focus on ourselves? Perhaps some of our thinking includes …I don’t have enough time; I don’t have enough energy; I have more important things to do; I have to take care of everyone else first; it’s too hard; it’s not going to make a difference; I don’t know how to do that; I’ll have more time tomorrow; it’s going to be to uncomfortable or painful; I’m not worthy, important enough to focus on …
As managers and leaders in health and care, our actions can encourage others to address some of these thoughts. Perhaps through role modelling and encouragement we could nudge others to develop their own personal plans too just as we expect people to have continuous professional development plans?
Reminder! Self Care isn’t selfish, we need to apply our own oxygen masks before helping others
Promoting well-being supports us to address lots of different areas in our lives, this graphic highlights that our self-care plans can cover a whole range of interventions to help us feel better about things, take control …
Then yesterday a colleague tweeted about a very tough day and another colleague responded suggested watching a Ted Talk by @drlucyhone on resilience, I have to admit it blew me away, if you can please invest 16 minutes in watching it https://www.ted.com/talks/lucy_hone_3_secrets_of_resilient_people Lucy shares that rubbish stuff happens to us all, focus on the stuff we can change and find things to be grateful for. And importantly ‘Ask yourself, is what I am doing helpful or harmful?’ Do more of what is helpful to you, stop doing what’s harmful to you. Thank you @researchnursed 💫
As Nessa, played by Ruth Jones in Gavin and Stacey would say ‘I’m not gonna lie to you…’ it’s been an odd, frustrating and on occasions very very sad year. I’ve said goodbye to too many people in 2020 and am acutely worried about the long term impact of the global pandemic on our children and young people. However something that has kept me grounded has been running and the wonderful team #NHS1000miles. As I scroll through my camera roll I’m reminded of lots of happy times in 2020 …
January 2020 ‘Cold Christmas’ ultra with Elaine & Alex Park Running with Karen, Charlotte & Jerry, Feb 2020March 2020 provided the final official run before the Pandemic took hold … April 2020 brought out rainbow running shirts When the official ultras are cancelled we make our own, thanks Barbara, May 2020 June 2020 meant running through glorious fields of poppies July meant Saturday morning running with Sharon and Louise August meant a self organised marathon from Rhossili to Mumbles. I think coastal runs are my all time favourite! September meant celebrating a 50th birthday whilst playing aeroplanes October was the very hilly and windy Beachy Head, which was brilliantly organised!
November offered beautiful views of Hertfordshire, lots of muddy trails explored in 2020
And December provided Santa’s helper, the wonderful ever cheerful Jane!
Hoping you’ll join us on the adventure of #NHS1000miles in 2021 😉
Here are the links to previous #NHS1000miles blogs for inspiration
It’s been a wonderful ‘homework’ task set by ‘Partners in Paediatrics’ to reflect on resilience, and for me it’s been about everyone having the courage to continue in the most challenging of times. Let me tell you more ….
Doughnuts were a bit of a theme here in North East London throughout wave one of the pandemic as we learnt to adapt to the challenges that were presented to us. The sugar boost I’m sure helped to draw on hidden reserves of strength, both physically and mentally seeing us through, although I’m not sure Public Health England would approve!
At the centre of every good doughnut is the jammy bit in the middle, for me it’s what a good doughnut is all about, a bit like the babies, children, young people and families who were and remain our central focus, the jammy bit!
Our absolute priority as champions for child health is to shine the light on issues that matter most to them, keep them safe and wherever appropriate and possible, out, of a hospital environment. Whilst thankfully children were not the face of the pandemic, mostly being spared the direct effects medically of Covid19, they are and will be the biggest victims of this evolving crisis. The crisis is having and continues to have a profound effect on their wellbeing.
Central to addressing child health is the presence of a resourced and cared for workforce, retaining staff, yet also releasing staff to support adult areas, was challenging, the redeployment of staff at the height of the crisis meant the development of additional skills and training. It was our senior ward managers who led the way, taking them out of their sphere of clinical confidence. But what we didn’t predict was the isolation and loneliness felt by many redeployed staff at this time. It was a Clinical Nurse Specialist who led the way in identifying this, she created a peer support group, circulating names and numbers on a Sunday evening for a checkin with staff at the beginning of each week, offering a listening ear, signposting to additional support and practically demonstrating that redeployed staff hadn’t been forgotten. The CNS who led this work was nominated for a ‘Cavell Star’ award, from the Cavell Nurses Trust (@CavellTrust) by a colleague to recognise her contribution. Encouraging individuals to lead the way and celebrating initiative taking, role models to everyone that we all have a part to play in shaping cultures and can take action. Helpfully the peer support programme has now led to further conversations about how the model of clinical supervision works for staff across the organisation, wonderfully its being led by practitioners directly delivering care, rather than it being imposed.
Celebrating contributions, Cavell Star
Bringing the over 50 members of staff from Children’s services who’d been redeployed together in July for a day of reflection (and you’ve guessed it doughnuts) helped to connect people to each other’s experiences and know that they were not alone in how they were feeling. There were other interventions that supported the resilience of the teams, which offered the courage to continue, regular daily briefings, a 10k fun run (on one of the hottest evenings of the year) organised by another one of our clinical nurse specialists, and recently as we’re heading into winter, a Trust wide ‘Winter Wellness’ week where we banked our steps to achieve #BHWalktheWorld. Oh and there was an online virtual biscuit baking session with a follow up soda bread making session too. All of these interventions and many more, reach out and connect people, bringing the NHS People Plan to life, in meaningful ways, building stronger resilient communities, growing a sense of belonging and strengthening our resilience for what’s ahead.
Throughout the pandemic we have worked collaboratively as a system across North East London, our Sustainability and Transformation Partnership (STP), the emerging Integrated Care System (ICS) which includes Community, Mental Health, Primary, Secondary, Tertiary Care, Local Authority and Voluntary Sector colleagues, has brought us all together to collaborate on Child Health issues.
It made us ask, have we got accessible parent information on accident prevention and management of these childhood illnesses? NHS Choices have them, but we took action to make sure we were promoting them locally in a range of ways. We’re also promoting culturally focused short animations developed by one of our CCGs (https://www.towerhamletstogether.com/care-confident) to supplement written information.
Another opportunity presented to us has been to explore growing resilience with young people through youth social prescribing, building on our youth volunteering and NHS Cadets programme, specifically focusing on our connections with young people who are in need of additional support.
In one of our boroughs a GP is running clinic sessions based in a youth centre alongside youth workers, mental and sexual health professionals and violence reduction programmes, its having great impact and is currently being evaluated by the Association of Young People’s Health (@AYPHCharity).
A key ingredient in all of these STP meetings has been the children, young people and families. Young people with mental health needs, reminded us of the importance of professionals building trusting relationships with them and the impact continuity of care has on them. A mum whose son has asthma challenged us on our lack of accessible information and how complex navigation of the system is for the population who may not be as familiar with health services. A sister of a 16 year old who had died in Haven House, one of our local Children’s Hospices, shared her sisters bucket list and how they’d laughed as they’d spent time in the hospice garden together plotting their next adventure. These were the highlights of the system wide meetings, giving us all a little bit of headspace and energy to build resilience and to keep working collaboratively on what matters most by hearing directly from users of services.
Helpful national reports have emerged during this time that strengthen our voices, offering affirmation on key issues as we advocate for and with children and families.
Best Beginnings and Partners published ‘Babies born in lockdown’ in August (https://babiesinlockdown.files.wordpress.com/2020/08/babies-in-lockdown-main-report-final-version-1.pdf) Alison Baum, Best beginnings CEO asks us to shift from a patchy, fragmented family support landscape, to a nurturing society that supports the caregiving capacity of parents during their transition to parenthood. They ask for support to wrap around the needs of families and communities, rightly saying this will happen if parents are enabled to take a lead in designing better systems, working alongside charities, community groups, and statutory services.
During the pandemic these numbers will have swelled, fuelled by families locked down in close quarters for weeks and months, and an emerging economic crisis adding pressures on family finances.
The report asks for the full range of services which protect children to be prioritised, including children’s centres and visits from social workers, Viv Bennet and Ruth May’s letter (https://www.local.gov.uk/joint-letter-winter-planning-support-children-and-families-7-october-2020) to the system last week, specifically asked that Health Visitors and School Nurses were not redeployed in the second wave.
Experiences of Parent Carers in Lockdown from the Disabled Children’s Partnership (https://disabledchildrenspartnership.org.uk/wp-content/uploads/2020/06/LeftInLockdown-Parent-carers%E2%80%99-experiences-of-lockdown-June-2020.pdf) highlights the experiences of 400 families in lockdown, parents talk about extreme exhaustion, stress and sleepless nights, which have pushed some families to the limits. They share their overwhelming feeling of ‘being abandoned by society’, to deal with often complex care and medical procedures on their own. Parent carers also talk about siblings, non-disabled children having to take up the slack. A lot of concern about increased behaviour challenges and meltdown, children going backwards or falling behind is also highlighted.
Starlight the Children’s Play Charity, published their review on ‘the impact of play in hospital’ https://www.starlight.org.uk/wp-content/uploads/2020/10/Starlight_ImpactOfPlay_Report_Oct20.pdf and as well as offering a contemporary perspective on the evidence relating to the importance of play highlighted the impact the pandemic is having on increased isolation, lack of access to play facilities and resources, and further pressure on families.
Clearly there’s lots more to do on our journey, so we do indeed need the courage to continue, all segments of our doughnut play a part, so together let’s ….
1. As Children’s Champions, keep speaking up for and with Children, Young People and their families.
2. Keep a focus on staff wellbeing and our workforce in the most complex of circumstances.
3. Use this opportunity to continue to progress integration across all our services, particularly supporting parents with access to health information to support them make informed, empowered choices.
4. Grow Youth Social Prescribing opportunities and youth volunteering, keeping a focus on our most vulnerable young people, such as those who are care experienced.
5. Use evidence collated in national reports to make sure in our local systems #ChildHealth has a place in the spotlight.
It feels like now more than ever, across the community of child health we all need the courage to continue in our collective ambition to ensure every child’s right to healthcare to support them in achieving the very best life outcomes, it requires us to be collectively resilient, it’s a challenge that’s never been more important.
This blog is based on a presentation at a ‘Don’t forget the bubbles’ @DFTBubbles online conference on 26/8/20.
I want to focus on you, just for a moment I’d like to get you to reflect. Who (outside your immediate family) believed in you as you grew, who encouraged you to speak up and be heard? What did they do? How did they do it? How did they make you feel?
There’s a wonderful Ted Talk (https://www.ted.com/talks/rita_pierson_every_kid_needs_a_champion) by an educator of over 40 years, Rita Pierson, it’s well worth a listen! Her message? ‘Every child deserves a champion’. She reminds us that every child needs an adult who will never give up on them, who understands the power of connections and insists that they become the best that they can possibly be’.
Significant learning comes from significant relationships, but let’s be in no doubt this is mutually beneficial to the child and the adult.
May I take you back in history? Let’s go back to 1919, Eglantyne Jebb, was a teacher and social reformer. She had a vision to achieve and protect the rights of the children, they were extended in 1954, and in 1989 the UN Convention on the Rights of the Child, a landmark human treaty was ratified. Article 12 highlights their right to express views, feelings and wishes in all matters affecting them and for them to be taken seriously, article 13 highlights the importance of accessible information.
Eglantyne formed the ‘Save the Children fund’, from the outset they listened and responded to Children’s stories of famine in Europe, and over the years extended their work to Asia and Africa. Over 100 years later stories about children’s rights are at the heart of Save the Children’s @savechildrenuk work, and why they continue to have such impact globally https://www.youtube.com/watch?v=U0RnucW3Wn0
We all have a story within us waiting to be told. The Health Foundation’s overview (https://www.health.org.uk/newsletter-feature/power-of-storytelling) on the importance of narrative in healthcare reminds us that an authentic story connects, it unleashes curiosity, taps into emotions and imagination, it uncovers the art of the possible. Stories help us understand and make sense of the world. The telling of a story can become etched in our memory, motivating us to keep improving, it can change mindsets, bringing into focus to what matters most. When someone tells us their own personal story we catch a glimpse of a world that may be radically different to our own. The experience can inspire empathy, neuroscience suggest through connecting via stories we begin to mirror one another, connecting physically as well as emotionally. We relate to an individual’s story, 1st person narratives focus on the individual, rather than on groups such as ‘Young People’, ‘patients’, ‘refugees’ or ‘the homeless’. When we connect on such a personal level the result can be transformative not only for the person telling but for the receiver of the gift of the story too.
So next let’s head to the boardroom, where either around the physical or virtual table will sit professionals with many years of experience and qualifications, yet none of them likely to be under 25. If we’re lucky in that very corporate environment, when the focus is on the 0-25 population, someone may speak up and ask, ‘so what do children, young people and families want?’. A colleague once said ‘well the engagement work has been done, we can use that and push on’. Yet it made me reflect that if we only use the engagement work of others (as important as that is) we haven’t got the magic of participation.
The personal growth and development participation brings to children and young people must not be underestimated, especially to those with complex medical conditions, young people facing economic hardship, those from Black, Asian and Minority Ethnic backgrounds or our children who are looked after for whom we are corporate parents. These young people are those most in need of enriching opportunities to support their growth in confidence, to find their voice and experience the impact of being heard. We must not miss golden opportunities to encourage children and young people, to open doors for and with them, connecting them with peers and youth workers, as well as mentoring, it’s vital social medicine.
Even as health professionals working with children and young people we still view participation through a corporate lens of providing insight, knowing if we seek information on accessing services and then listen and take action it will lead to improved experience and outcomes for current and future service users, yet we know and must continue to share that the benefits of participation are so much broader.
Children and young people who are actively supported to participate in health care acquire knowledge, develop new skills, increase their self esteem and achieve a growing sense of citizenship. It connects them to potential role models and to a glittering array of future employment opportunities. As a result they go on to convey vital health information to the peer groups, their families and communities.
The boardroom must not be a just a passive recipient of engagement work, they must open up to diverse person centred narratives, to expand thinking beyond command and control structures. Boardrooms must open up to stories from children and young people themselves, offering personal development opportunities. When young people speak directly their narratives sit on our shoulders, focusing us on what matters most, issues at the heart of the matter are articulated.
I want to take you to a conference hall in Birmingham, 2,000 professionals watched the narrative of a young lady’s experience of health care, ‘Behind the curtain’ https://youtu.be/vnUmpFP9XsU
The young lady whose experience is shared in the film was sat in amongst the professionals (they didn’t know she was there) and experienced the silence, you could hear a pin drop in the huge auditorium. We debriefed together afterwards, she reflected ‘that’s what I wanted, I wanted others to see and connect with how I’d been made to feel.’ That sense of connection and impact was more powerful that any formal complaint process. The young lady went on to do her nurse training as her confidence in the system was secured, she’s now qualified and works for our armed forces, the power of transformational listening…
Then there’s Gulwali Passarly (@GulwaliP) at 12, his dad, a Doctor in Afghanistan was killed by US forces, the Taliban wanted him and his brother to avenge their father’s death, yet his mother, scared for their futures paid people traffickers to take them to the UK, saying ‘be safe and never return’. Gulwali was separated from his brother the day after they left, and then for over a year endured hardship and incredibly tough circumstances as he travelled to the UK, spending a month in the Calais jungle, being interrogated by UK boarder forces who thought he was too smart to be someone so young, eventually making into foster care, excelling at GCSEs, Alevels & completed his degree at Manchester University. Gulwali a member of our NHS Youth forum taught so many of about the plight of refugees, his Ted Talk (https://gulwalipassarlay.wordpress.com/2014/06/22/tedxmanchester-talk-about-my-journey/) and book ‘The Lightless Sky’ are worth seeking out. Now his charity ‘my bright kite’ helps other young refugees, through his work he has grown to be the most amazing advocate for refugees, fuelled by being heard. He reflects that the toughest of times he faced was when he wasn’t believed.
So as we work to chip away at corporate structures, the powerhouses that rely on data and indicators, let’s not forget the powerful contribution of participation in social medicine. As leaders in child health we can open doors and support young people to ensure diverse, rich narratives are heard, leading to better outcomes on so many levels.
So let’s bring this all together, as we go forward let’s…
1. Think about what’s made a different to you, use that to shape your actions with others.
2. Use our history to inspire us so we keep standing on the shoulders of giants as we continue to make progress.
3. Unleash the power of narrative directly from young people, it benefits services and young people themselves, helping us address inequalities head on.
4. Never underestimate the power of a story to make transformational change and create powerful ripples in the system, stories keep whispering in our ears and hold us all to account.
5. And my final thought, let’s remember that things do not just happen, they are made to happen, it’s up to us to work in partnership with children and young people, using the teams around us the voluntary sector, youth workers, to ensure together we transform child health outcomes.
August meant a self organised marathon from Rhossili to Mumbles. I think coastal runs are my all time favourite! 
Kath Evans Connecting 