Doughnuts and the courage to continue…

When did you last have a doughnut?

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.

In the height of the pandemic we were concerned about delayed presentations to A&E so information resources were created by local GPs and Paediatricians to reassure families that we were open for them https://www.eastlondonhcp.nhs.uk/ourplans/children-and-young-people.htm

Yet now we’re facing challenges with managing social distancing and the prevention of nosocomial infection. So there’s been a need to reconsider how we build resilience within families. Many years ago I worked on a programme to reduce emergency department attendance (https://www.rcem.ac.uk/RCEM/Quality_Policy/Clinical_Standards_Guidance/External_Guidance/Paediatric_EM_Guidance__NHS_Institute_/RCEM/Quality-Policy/Clinical_Standards_Guidance/Paediatric_EM_guidance__NHS_Institute_.aspx?hkey=d37183bc-4ad0-4649-b6cf-3c659f79ebe4) so we’ve recently been revisiting this, data analysts confirmed the top reasons for A&E attendance in North East London as being for

1. Accident/Injuires

2. Fever

3. Abdominal pain/diarrhoea & vomiting

4. Respiratory issues

5. and Rashes/skin presentations

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).

In another borough over 400 Royal Society of Public Health (RSPH) Youth champions https://www.rsph.org.uk/our-work/programmes-hub/young-health-champions-test.html have been developed by one the Public Health teams, they are now peer health influencers.

Most recently we’ve looked at how we support young people who are care experienced into employment in the NHS bringing to life the model of ‘anchor institutions’ (https://www.health.org.uk/news-and-comment/charts-and-infographics/the-nhs-as-an-anchor-institution) and exploring what the ‘care leavers covenant’ https://mycovenant.org.uk/about/ means for us in the NHS.

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.

Children’s views on well-being and what makes a happy life was published in October by ONS offering important evidence based insights into the things that children say matter for a happy life, vitally including that feeling that their views are being listened to by decision makers matters https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/childrensviewsonwellbeingandwhatmakesahappylifeuk2020/2020-10-02

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.

Childhood in the time of Covid19 was published by the office of the children’s commissioner, (https://www.childrenscommissioner.gov.uk/wp-content/uploads/2020/09/cco-childhood-in-the-time-of-covid.pdf.) The reports highlights that before the pandemic 2.2 million children in England were living in households affected by any of the so-called ‘toxic trio’ of family issues:

domestic abuse,

parental drug and/or alcohol dependency,

and severe parental mental health issues,

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.

Author: @kathevans2

I’m a Children’s Nurse who is passionate about improving healthcare and life with people who use services. I love getting out in the countryside or to the seaside to promote my mental health and well-being. On a journey to doing 100 marathons (slowly!) & part of team #NHS1000miles (new members always welcome!) I also love charity shopping, cooking and healthy eating too 😉 Sharing thoughts on a range of things that interest me. Comments, challenge, links to further thinking and research are most welcome. Learning and thinking together is always more fun!

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