Can we #AskListenDo? …making reasonable adjustments to how we seek and use feedback to drive improvement

This week I had the privilege of attending the House of Lords (it’s such a grand building) for a really important celebration of the work that’s been happening across the NHS and beyond, in adopting the principles of #AskListenDo https://www.england.nhs.uk/learning-disabilities/about/ask-listen-do/

So often we don’t receive feedback, hear of concerns or have complaints from people with learning disabilities/Autism or their families, purely because WE don’t make the engagement and feedback process easy. Yet we do have a duty under the equality act to have processes in place to engage, seek out, hear and act on information that service users have.

This short story shares how life can feel for someone with a learning disability and how vital it is we listen and take action on their feedback.

Families who care for, along with people with learning disabilities, have led the #Asklistendo work.

You’d think that surely we would already ask people what matters to them, intuitively pick up on concerns, actively listen and then take action, BUT what’s clear from various reports into health, education and social care, is that we sadly fail at this repeatedly.

This powerful poem explains it and provides a call to action …

https://vimeo.com/297133519

The event in the House of Lords brought people with LD/Autism, families, the voluntary sector, education, social care and health together to hear from those who had already adopted the principles and are working to socialise the #AskListenDo approach.

The wonderful Tricia Handley, our LD Nurse Specialist at Barts Health spoke of the work to be truly person centred across the Trust and specifically, to make blood tests less traumatic and daunting. Kindness, patience and the commitment to make ‘reasonable adjustments’ can make all the difference to creating positive experiences of hospital care that can last a lifetime, as well as impacting on people with LD accessing healthcare confidently in the future.

Adopting the spirit of #AskListenDo can be achieved by asking ourselves:

1. Have we got our active listening right? Do we ensure people have the attention and focus needed in busy frenetic environments? How can we make environments calmer? What connections have we got with our local community and voluntary sector to hear about what matters most to people?

2. Are our basic processes for getting things done right? Are we using flagging systems effectively? Do we have easy read complaint leaflets? When we listen, do we follow up on our commitments and deliver on actions?

3. Are we supporting staff/teams delivering care with the education and skills to meet the needs of those with LD/Autism? Do our reception, call centre as well as healthcare staff have the education and insight they need to enhance their practices?

Someone commented how straightforward the #AskListenDo approach is and whilst I agree I also think we need to be committed universally to nurturing a culture that makes giving feedback easy for everyone. And of course we need to be honest about the changes we can make and get on with, or the stuff that’s really ‘wicked’ and may take a bit longer.

So an ask, will you be a champion for #AskListenDo and spread the approach?

Creating cultures that deliver great care, involve everyone, work to continuously improve, recognise and value staff, and grow connectivity…

4/7/19

I’ve been reflecting on cultures this week, thinking about the depth and feel of a team, or system of care. The cultures we create make such a great difference to patients, staff and the ability to progress agendas.

I went searching online for a great short animation by the Foundation of Nursing Studies @FoNScharity, its a few years old now yet it sums up that culture is ‘how things get done around here’ its worth a watch https://youtu.be/cZyN_UZvYnQ

With ever greater complexity in our day to day lives it’s hardly surprising that cultures are complex, get a great one and its magic, an awful one by comparison means stress levels rise, people are anxious coming to work, keep their heads down when they are there and ultimately don’t stay, walking away.

The ‘Culture of Care Barometer Report’ published in 2015 provides a strong evidence base to reflect on cultures in organisations https://www.england.nhs.uk/wp-content/uploads/2015/03/culture-care-barometer.pdf its a helpful tool that we can use to ‘check the climate’ of our teams. The tool addresses 4 key elements that influence cultures:

Having the resources to do a good job and deliver quality care is challenging when finances are stretched nationally, but there is certainly significant support from senior leaders for us all to do a good job. And of course something that the NHS wins outright with is an opportunity to do a worthwhile job that really makes a difference to people’s lives. Having this ‘shared purpose’ to make a difference in society is a key motivator. The NHS also offers the opportunity to always be learning and developing our knowledge and skills, whether via mandatory training, annual updates, continuous professional development, academic study or research.

What’s essential clearly is our personal drive for improvement, creating the time to step back, reflect on our behaviours and actions and the part they play in the culture we function in. West et al. (2014) indicates that culture is co-created through the interactions, communications, influences and collaborations among members of an organisation or systems.

Bob Klaber this week talked about the power of ‘connectivity’ and the impact that this can have in building trust in the system in progressing a more ‘joined up’ approach to delivering healthcare, shifting us from a traditional medical model of healthcare to a more holistic approach that’s much more person centred, focusing on ‘what matters to you’ ie the person being cared for. Bob @BobKlaber and Mando @mandowatson have led Connecting Care for Children in West London, please do follow their work via @CC4CLondon. They are really shifting cultures, taking care closer to home and into GP Practices, they’re not only thinking but doing differently.

This week also saw our school nursing team employed by the local authority, the community nursing team employed by a local community and mental health trust, along with ward based staff from the paediatric ward and NICU unit supporting Ruth May on a visit to a local primary school. This collaborative and connected approach of health teams working together with schools is something we need to keep growing.

Then there was the Partnership Board led by a Local Authority, together with the Lead Councillor for Children, the Young Mayor, we all discussed the Children and Young People’s plan for the years ahead. The local head teachers discussed how we can secure system wide support for this the pupil survey, ensuring young people who aren’t in school have an opportunity to contribute too, we were able to plug the need for few more health related questions to help young people understand the services around them.

There was also the joy of attending the @Cavelltrust conversation with Teresa Chinn on Wednesday, discussing how nurses could support each other more on social media and the positive culture we can create whilst being true to ourselves. We’re all looking forward to supporting this years 10k for Nurses challenge https://www.cavellnursestrust.org/10kfornurses/

Cultures are clearly the result of our behaviours and actions, we can help others to flourish and thrive or we can make things difficult. I know the type of team, organisation, system, I’d rather work in but I have to take responsibility and know that I have a part to play ….

Growing our Future Nurses, what will it mean for us day to day?

I’ve been watching ‘Years and Years’ by Russell T Davies on catch up recently. As Russell was born in Swansea and educated at Olchfa (a school we regularly pass on our trips home to Swansea) I really enjoy his writing as the Welsh connections always sing through! Years and Years follows a Manchester family, led by ‘Gran’ through the political, economic and technological changes that take place over a 15 year period. Without giving too much of the plot away, the final episode sees Edith a feisty activist, affected by a nuclear fall out in episode one, uploading memories to water molecules with two kind and compassionate nurses listening intently and guiding her through it. So is this what nurses will be doing in the future? Perhaps Russell’s imagination is a tad too creative, but it’s an issue people have been debating for many years, what will we need from our future nurses and how can the current healthcare workforce help them grow their skills? A peer review meeting last week posed the question ‘how are you preparing for the future nurse programme’. It was a good challenge!

I went back to a blog published by Jackie Smith, who was the CEO of the NMC in May 2018 https://www.nmc.org.uk/news/news-and-updates/ambitious-new-education-standards-will-shape-the-future-of-nursing-for-next-generation/ The curriculum changes that are now being embedded follow a significant consultation that many of us inputted into.

Importantly many articulated that whilst fields of practice and in-depth knowledge of mental health, learning disabilities, adult and child were essential due to the complexity of need from each population group, all professionals need insight and experience of caring for people across all fields of practice. As a Children’s Nurse I’m delighted to see an increased focus on mental health and learning disabilities in the Children and Young People’s field of Nursing.

For us locally the new standards and associated curriculum will take affect in September 2019. It’s important our local teams are aware of the changes, so that we can proactively welcome, understand the needs and support our students as they embark on their careers and grow their ‘professional stories’ whilst working to achieve the professional proficiencies which are grouped in 7 platforms outlined here.

It’s helpful that all healthcare professionals, AHPs, Drs, Nurses and social workers can supervise nursing students going forward. Practice Supervisors (PSs) as these professionals are called, can document the student’s progress in their Practice Assessment Document (PAD). This is an important step forward in continuing to grow multi disciplinary and collaborative working cultures as the contribution of all professionals in training and educating nurses is valued and recognised.

Practice Assessors (PAs) are registered nurses who have been prepared for the role (this can now be locally delivered removing the need for attendance at a formal Approved Educational Institute/AEI Mentorship programme) PAs will support students, meeting them at the beginning of their placement, completing a mid point review and documenting progress in their ongoing record of achievement (OAR). They’ll work closely with PSs.

Academic Assessors who are University focused will support PAs to ensure that students are progressing through the programme appropriately, recording their progress in their ongoing record of achievement (OAR) too.

Getting our heads around these roles will of course become easier as the curriculum is embedded.

Our students bring so much to our environments, many are ‘digital natives’ which is incredibly helpful as the NHS continues to mature in its use of technology, no doubt our students will teach us how to use technology to its best advantage in healthcare and also offer IT solutions to our challenges too.

One of the areas that may be challenging is related to the clinical skills that are required of future nurses on which are outlined here https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf We face some particular issues in children’s nursing as not all our nurses do venepuncture or cannulation, and catheterising boys is not something commonly done so we’re going to need consider how we address these challenges. I don’t think we’re alone in considering this and would value ideas from other units on this.

A colleague this week also flagged the importance of staff having a positive attitude to nurses embarking on this new curriculum and acquiring a range of clinical skills that some registered nurses may not have. Encouraging and creating learning opportunities is vitally important, which is why I think we need to be discussing these issues openly out in practice with nurses and healthcare professionals involved in direct care provision. I’d like to avoid student nurses having to justify in practice why they need to learn these clinical skills.

The future is full of opportunities to continue to raise the profile of nursing and grow the diversity of skills, knowledge and experience that we offer as a profession to improve lives and health outcomes across society. The Future Nurse curriculum supports us to do this.

Nursing as we know offers so many wonderful career paths. This week saw an exciting broadcast into schools by Trusts in East London supported by the local STP, East London Health and Care Partnership. It was great to see Nurses some of whom had been qualified for many years and Ahunna a student nurse reaching out and encouraging young people to consider joining us in the NHS https://elhcpcareers.co.uk/ all online, no travel required! I love this #NursingLondon film that Capital Nurse have produced https://www.hee.nhs.uk/our-work/capitalnurse And this #NHS recruitment film https://youtu.be/GVBP1ld0_n0
is special, these were shared with the young people. I still value this Children’s Nursing recruitment film from the RCN https://youtu.be/O81ZY9wHhHw too.

So as we continue to grow our future nursing workforce let’s encourage and nurture our students as the new curriculum is embedded across the country, after all we’re their role models… Gran in Years and Years would say it’s up to us https://www.dailymail.co.uk/femail/article-7157675/Viewers-Muriels-powerful-speech-nights-finale-Years-Years.html

Advocacy in Child Health

This week I’ve been reflecting on children’s advocacy challenges. Advocacy seeks to ensure everyone is able to have their say on issues that are important to them, that their rights are met and importantly, that their wishes and views are genuinely considered when decisions are being taken about their lives.

As a Children’s Nurse you’d expect me to say I’m committed to hearing the voices of children and young people in healthcare and in ensuring their rights, outlined in the United Nations Convention Rights of the Children (UNCRC), are met. The UNCRC celebrates its 30th birthday on the 20th Nov this year https://www.niccy.org/about-us/childrens-rights/uncrc-at-30/ and just as an aside I’m wondering how we can celebrate Children’s Rights across the NHS on this day?….

As health care professionals whether in homes, schools, primary care, youth justice settings, ED, on wards, anywhere, day in, day out, we’re constantly using advocacy skills, which include:

1. Really listening to the issue at hand;

2. Finding out more, identifying what matters most in the situation;

3. Identifying rights in the situation, using the UNCRC, including addressing issues such as consent, this summary from CQC on consent is helpful https://www.cqc.org.uk/sites/default/files/20180228_briefguide-capacity_consent_under_18s_v2.pdf

4. Exploring solutions;

5. Encouraging children and young people to express their views, opinions and thoughts about the issues, ultimately reaching a decision CYP have actively participated in.

Children and young people however still tell us we’re still not involving them in decisions about their healthcare as much as they want to be. Of course most babies, children and young people will, although, not always, have parents who will advocate appropriately for and ideally with them (although of course children, young people and their families can and do have differing views). Our role then as healthcare professionals is to use our skills in ensuring CYP are active, empowered participants in decision making processes whilst supporting parents too.

We need to constantly work on our refining and maturing communication skills if we’re to advocate effectively for and with individuals.The ‘CYP Me first’ model helps us as professionals to do this better, to more effectively engage with young people, there are loads of great resources on their website https://www.mefirst.org.uk/ and you can follow them on twitter @CYPMeFirst

So I wonder how can CYP using the NHS benefit from professional advocacy services? What’s their professional advocacy offer to Children and Young People across the NHS? I’ve had many conversations with respected colleagues over the years about advocacy services in health, there still seems to be an unmet need. Please correct me if you’ve got a model that we need to be sharing!

The use of professional advocacy services for those with learning disabilities or mental health needs is perhaps more commonplace than in general paediatric care. Children and Young People just as adults can benefit from neutrality in exploring issues and in making decisions.

Last week saw the publication of a Report supported by the office of the Children’s Commissioner into Advocacy Services for Children and Young People https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/06/CCO-Advocacy-for-children-June-2019.pdf

The Children’s Commissioner report highlights advocacy services in health are commissioned via a range of routes, some from local authorities and some trusts run these services internally, the report challenges the access to these services. These are the core values they’ve highlighted as important for advocacy services to work to:

The statutory advocacy support in health is focused on supporting young people to make complaints. Processes are often adult centric, increasingly though NHS complaints processes are becoming more CYP friendly. Yet there’s more to health advocacy than making complaints.

Children and young people who have special educational needs and disabilities, who are detained under the mental health act are also named as those specifically entitled to professional advocacy services but let’s not forget those with physical health needs too. Here’s the full list of situations when statutory advocacy is identified as being needed:

So as influencers in child health do we need to ask questions about what’s available locally to the CYP we serve? how are these services advertised and what training have staff had to support CYP with health related decision making issues?

Of course we also have a system advocacy role too. As Professionals we must advocate for improvements in Children and Young People’s Care and services. Even though they are 25% of the population we often end up focusing on adult related issues. Having Children and Young People in the NHS Longterm Plan puts an imperative on local systems to ensure CYP Health issues receive the focus they deserve, but we as healthcare professionals need to take our place at the STP tables and champion children and young people.

Wonderfully Children, Young People and families advocating for improvements in Children and Young People’s Care and services is another element we’re seeing more of and it’s having huge impact. It’s even better if professionals and users collaborate in advocating for improvement. Together we can be a powerful force for change. A great example of this is that NHS England supported the establishment of the NHS Youth Forum back in 2014 and they are having great impact on collectively lobbying the NHS to think more about the needs of children and young people in healthcare. This film from the Young Reporters summarises the Youth Voice Summit held back in April where young people met with senior leaders and spoke about what mattered most to them
https://www.youtube.com/watch?v=vuNfKkfctgw The @NNPCF is another example of parents advocating for improved services, particularly for disabled children so that their needs are met proactively rather than reactively, the impact they are having on the SEND agenda is phenomenal, although I know they’d say there’s much more to do!

Advocacy is going to continue be in the spotlight, especially in the UNCRC 30th year, let’s ensure practitioners supporting CYP and families have these skills and let’s champion the need for professional advocacy for all CYP across health, social care and education.

Reflections post blog

this is great short film for children on consent, thanks for sharing Lisa Ramsey! https://www.youtube.com/watch?v=h3nhM9UlJjc

Joining services up, health, education and local authority social care… and lobbying the next PM

12/6/19

Last week I sat with nurses, commissioners, the local authority team and head teachers at one of the Special Schools in our area. I love getting out to these schools, they are are always bright, welcoming and I’m guaranteed to get a dazzling smile from children who will have received acute health care at some stage but are now in their ‘right place’ in school, at home, in the heart of their community. Together we explored how to best support children and young people who have nursing needs in special schools given the challenges of recruitment and retention. From a health we talked about the importance of continuity of carer, limiting the numbers of contacts a child has with professionals by supporting teaching assistants to undertake care related roles when trained and supported to do so. Yet a different perspective was given from education of the desire to see children engaging with a variety people. It was an example of how we come from different cultures, differing perspectives, ‘we want to increase the social interactions our children have’ they shared. This simple conversation demonstrates that whilst health and education have the best of intentions to meet needs with the resources at hand, we offer different insights, reinforcing the need for collaborative dialogue. The RCN https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/forums/children-and-young-people/staying-healthy-forum/school-nurses-toolkit-2017.pdf and guidance from DfE on Supporting pupils at school with medical conditions (DfE 2015) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/803956/supporting-pupils-at-school-with-medical-conditions.pdf offers helpful direction to those providing services, the reality is it takes us all to want partnerships to work if we’re to care for children with complex needs in the very best way.

As we all work towards better integration and collaboration across health, social care and education we have to be prepared to learn more about each other’s worlds, considering different languages and cultures in these services.

I came across a guide by the Local Government Association @LGAcomms for new lead council members for children and young people, it gives a clear overview of council priorities relating to children https://www.local.gov.uk/sites/default/files/documents/15%2067%20Lead%20Member%20for%20Children%27s%20Services%20-%20First%20Ten%20Days_03.pdf Clearly the demands of this role are significant. One addition I’d make is encouraging Lead Members to spend time with local health partners to see the care commissioned by Clinical Commissioning Groups and NHS England. This will help secure a ‘whole picture’ of the support delivered to children and young people. Understanding the health contribution in meeting needs of Children with Special Educational Needs and Disability (SEND), along with identifying good practice and whilst securing knowledge relating to gaps in services is important.

I also managed to get out to one of the local Children’s centres last week to attend a session with nursery, primary school teachers and SENCOs discussing the local authority ‘Early help’ offer to children, young people and families, here’s a summary of what’s offered locally https://www.towerhamlets.gov.uk/lgnl/health__social_care/children_and_family_care/Early_Help/Early_Help_Hub.aspx Understanding the types of help these hubs can signpost to is important for all staff in EDs, Outpatients and on wards including NICUs/SCBU. We spend a lot of time with families, and raising awareness of early help is something we can do more of. One of our Assessment Unit Sisters immediately grasped the opportunity to display information.

One thing we also explored was that early help wasn’t limited to early years, adolescents can be offered early help too, as can parents of adolescents. The Children’s Society have a research briefing on Adolescent neglect that is insightful https://www.childrenssociety.org.uk/what-we-do/research/understanding-adolescent-neglect

As the political landscape is so chaotic a number of Children’s Charities have grasped the opportunity to seek help from the public to ask the new Prime Minister to set out their ambition and commitment to children, will you ask them to too? here’s the link to speak up for children… https://act.childrenssociety.org.uk/page/43598/action/1?locale=en-GB

Are we failing our BAME children and young people?

4/6/19

I’ve been asking myself this week if in healthcare we’re failing our Black, Asian and Minority Ethnic (BAME) Children and Young People (CYP).

Data highlights the variation in infant mortality across ethnic groups https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/730917/local_action_on_health_inequalities.pdf

Recently the LeDer report into deaths of people with learning disabilities alerted us to the fact that CYP from BAME backgrounds died 2 years earlier than CYP from white backgrounds, check out chapter 6 https://www.thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf .

The Care Quality Commission in the data from the Children and Young People’s National Inpatient Survey, highlights that CYP from BAME report poorer experiences of care than those from white ethnicity https://www.cqc.org.uk/publications/surveys/children-young-peoples-survey-2016

The National Child Measurement Programme indicates higher levels of obesity at age 10-11 in ethnic minority groups than the white majority.

Racial inequalities are clearly an unjust global challenge that can be avoided, so we must keep challenging ourselves, to do better.

But if I’m honest it’s not an area I feel hugely experienced in. I grew up in South Wales and the diversity in my classroom was provided by a girl whose family came from Wolverhampton, everyone else was born and raised in the town we were being schooled in. Even when I went off to do my general nurse training in Cardiff my closest friends came from Gloucester, Brecon and Abergavenny, my nursing cohort was full of girls who came from across South Wales and the English boarders.

I recall in my 1st staff nurse post caring for more Asian children with renal illness than children of white ethnicity, yet it was really when I came to London to work at Great Ormond Street and then later at the Whittington where I cared for children with Sickle Cell disease and Thalassaemia that I became aware, first hand, of some of the wider challenges faced by BAME children, young people and families.

Now working in East London the challenges are at the forefront of my consciousness, I constantly have a voice whispering in my ear that asks me ‘would this serious case review have had the same outcome if it related to a child of white ethnicity’? These are complex issues playing a huge role in health outcomes.

There are a myriad of reasons why CYP from BAME backgrounds face health challenges, an increased likelihood of experiencing living in poverty, families speaking in different languages (some which aren’t written), along with the complexity of navigating the healthcare system and most concerningly power imbalances.

As a nurse, I’d like to believe myself to egalitarian and unprejudiced BUT the reality is that our lives shape us all, our memories and experiences help our brains to sort stuff, to categorise information so that it’s swiftly analysed, leading us to make automatic conclusions and assumptions. We all have unconscious biases and whilst I can’t and don’t desire to change my family background I am aware of my limited experience regarding race related issues, therefore I need to proactively seek out advice and guidance from colleagues from diverse backgrounds to challenge and inform thinking. A great practical example of doing this is by ensuring we have BAME representation on interview panels, at meetings, along with brave opportunistic conversations with colleagues from different backgrounds to our own. This, in my opinion, will constantly challenge ideas and offer different perspectives which are critical when striving for improvement in BAME healthcare.

In recent years there has rightly been a growing focus on ensuring we’re more aware of these unconscious biases and ensuring the NHS workforce is representative of the community we serve, particularly in ensuring that senior leadership teams are diverse which will help address this. The Workforce Race Equality Standard (WRES) has done so much to prioritise this agenda and it continues to have great impact.

My ‘go to advisors’ and follows on twitter who champion this work include Yvonne Coghill @yvonnecoghill1, Dr Habib Naqvi @DrHNaqvi whose blog for NHS England is worth dipping into https://www.england.nhs.uk/blog/turning-the-dream-into-reality/ Habib shares that he reverse mentors Simon Stevens. And another colleague who has challenged and taught me lots over the years is Scott Durairaj @ScottDurairaj.

It makes sense that if we have a more diverse and representative workforce across all bands of staff, we’ll begin to think differently and become brave enough to challenge some of the unconscious bias that exists in the NHS and across society.

It is a gross injustice that CYP from BAME backgrounds aren’t getting the access they deserve to healthcare whether due to language issues, our lack of ability as healthcare professionals to connect with people from different ethnic cultures or our failure to make services accessible to all.

But in order to ‘change the system’ and ‘mainstream’ these issues we need to be brave enough to speak out, knowing sometimes we might say the wrong thing, not deliberately but naively, yet if we’re authentic in our seeking of understanding people will open up. What is more concerning is us not challenging inequalities and being apathetic in accepting the status quo. This is a slide from @YvonneCoghill1 that challenges us to think and do differently….

So what can we all do about this? There’s possibly no single solution..,

1. We need to recognise that health inequities exist

2. We need to challenge stereotypical thinking, question our assumptions, and constantly seek to be more person centred

3. We need to proactively seek out new perspectives, increase opportunities for others, build trust, champion fairness and constantly raise awareness of these issues.

The Sure start research by @TheIFS @Gabri_EllaConti funded by @NuffieldFound published this week, summarised here https://www.bbc.com/news/education-48498763

https://www.theguardian.com/society/2019/jun/04/sure-start-saved-nhs-millions demonstrates the impact building community capacity can have on improving health outcomes, we need to be doing more of this, not less.

I’d also really recommend this PHE document on local action in health https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/730917/local_action_on_health_inequalities.pdf

This has been a difficult blog to write … I know we can and must do better ….

Mental Health issues in Children and Young People

30/5/19

You may know that I’m a Children’s Nurse who initially trained as a Registered General Nurse back in the late 1980’s. My experience of caring for people with mental needs includes caring for a skeletally year thin young lady with anorexia nervosa on a general medical ward who required intravenous fluids. I struggled to understand why she couldn’t and wouldn’t eat and if I’m honest was totally overwhelmed as an 18 year old seeing her emaciation that wasn’t attributed to a physical health issue. Later in my training I spent a summer on a placement at Whitchurch Hospital in Cardiff, my memories of that time include enjoying the beautiful grounds with the patients being cared for, as well as accompanying patients to and from their ECT treatments. Much of my time was spent ‘being with’ people, not always chatting, just ‘being’. I remember a ward sister (who I respected greatly) remarking that that she didn’t think I’d make a mental health nurse, it takes all types to make the world turn I tell myself, as a result I have huge respect for my mental health nursing colleagues for the work they do.

As I moved throughout my career I’ve focused on nursing children and young people with renal, oncology and general paediatric ‘physical’ health related needs. Emotional well-being was an underlying theme throughout my career and whilst the mental health needs of young people have much greater focus than they’ve ever had previously, it’s something I’m still trying and if I’m honest often struggling to understand.

The Mental Health Foundation flags that while most children grow up mentally healthy, data suggests that more children and young people are having challenges with their mental health today than 30 years ago, they suggest its probably because of changes in society and it’s impact on feelings and behaviours. The transition to adulthood may also include experimenting with alcohol, drugs or other substances that can affect mental health too.

1 in 10 children and young people experience mental health issues and these can be a direct response to what is happening in their lives, issues such as:

  • having a long-term physical illness
  • having a parent who has had mental health problems, problems with alcohol or has been in trouble with the law
  • experiencing the death of someone close to them
  • having parents who have separated or divorced
  • being separated from the family resulting in them becoming ‘looked after’ by their local authority
  • having been severely bullied or physically or sexually abused
  • living in poverty or being homeless
  • experiencing discrimination, perhaps because of their race, sexuality or religion
  • acting as a young carer for a relative, taking on adult responsibilities
  • having long-standing educational difficulties.

I’m sure there are no doubt things that have been missed from this list. We’re all far more aware of ACEs ‘Adverse Childhood Experiences’ http://www.healthscotland.scot/population-groups/children/adverse-childhood-experiences-aces/overview-of-aces than ever before and the impact they can and do have on mental health and well-being.

Children and Young People don’t always know or are able to articulate what these adverse experiences are, leading to the complexity of management and care. On chatting to my 15 year old daughter, she offered the wisdom only a 15 can ‘see mum it’s not just about one thing, it’s often multiple stuff, the constant layering of difficult hard life things that makes life tough sometimes’. Beautifully put I think!

This infographic from Healthy London Partnership provides an overview of the challenges children and young people face in London.

The types of mental health issues children and young people can present with include:

  • Depression, this affects more children and young people today than in the last few decades, but it is still more common in adults. Teenagers are more likely to experience depression than young children.
  • Self Harm is a very common problem among young people. Some people find it helps them manage intense emotional pain if they harm themselves, through cutting or burning, for example. They may not wish to take their own life.
  • Generalised anxiety disorder (GAD) can cause young people to become extremely worried. Very young children or children starting or moving school may have separation anxiety.
  • PTSD or Post traumatic stress disorder can follow physical or sexual abuse, witnessing something extremely frightening of traumatising, being the victim of violence or severe bullying or surviving a disaster.
  • Children who are consistently overactive (‘hyperactive’), behave impulsively and have difficulty paying attention may have ADHD Attention Deficit Hyperactivity Disorder.
  • Eating Disorders usually start in the teenage years and are more common in girls than boys. The number of young people who develop an eating disorder is small, but eating disorders such as anorexia nervosa and bulimia nervosa can have serious consequences for physical health and development.

Shockingly the leading cause of death in the 5-19 age group is death by suicide according to the Office for National Statistics http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredinenglandandwalesseriesdr/2015#number-of-land-transport-accidents-among-5-to-19-year-olds-decreases-in-2015

Some of the children with mental health needs as we know present in Emergency Departments. The RCPCH in their ‘Facing the future’ Emergency Care Standards https://www.rcpch.ac.uk/sites/default/files/2018-06/FTFEC%20Digital%20updated%20final.pdf sets out what we need to be able to offer.

The emerging crisis intervention and home treatment models of caring are hugely helpful in supporting children and young people in areas other than ED, it’s a far from therapeutic environment for those in mental health distress.

Of course we also need to support and provide support for the mental health of children and young people with complex ongoing health needs too, the RCPCH Facing the Future sets out the standards required https://www.rcpch.ac.uk/sites/default/files/2018-04/facing_the_future_standards_for_children_with_ongoing_health_needs_2018-03.pdf

We also need a workforce that has the skills to engage with children and young people, the @WeCanTalk programme developed by @RobinfromCAMHS in collaboration with young people and staff is a great example of addressing support and education of staff. Our skills as professionals to connect with children and young people to build trust, foster understanding, show value, respect and creation of safe spaces are key.

Our local mental health services NELFT and ELFT have been so welcoming to visits and collaborations, partnership working across STP patches has to be a key element of future working. Thank you @Nicola21762634 for hosting me this week, I learnt so much! Hoping to meet @bewseyr soon too.

Just as we’ve reflected on the opportunity to consider a RN Child/LD pathway to qualification in recent weeks, I wonder if going forward we could offer a RN Child/MH pathway? Perhaps it already exists? It surprises me that we have adult MH trained nurses caring for CYP and I think we encourage more Children’s trained nurses to work in MH settings?

And of course there are clear opportunities to ‘prevent’ and reduce deterioration of mental health illness too. As people who are passionate about children and young people’s well-being we can all promote and role model the importance of

  • being in good physical health, eating a balanced diet and getting regular exercise
  • having time to play, indoors and outdoors
  • support being part of a family that gets along well (most!) of the time
  • encourage taking part in local activities such as attending voluntary organisations as well as opening up volunteering opportunities.
  • support going to a school that looks after the physical and emotional wellbeing of all its pupils, do we have governors who lead on well-being in all our schools?

I wonder what more we can do to work in partnership with schools too? The Schools Mental Health toolkit developed by the Healthy London Partnership team can be used to promote wellbeing in schools https://www.healthylondon.org/resource/schools-mental-health-toolkit/

These are the ‘asks’ from young people to schools which are powerful calls to action:

I also think we can do more investing and valuing of school nursing https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/forums/children-and-young-people/staying-healthy-forum/school-nurses-toolkit-2017.pdf, ensuring they have the skills and insight to support the mental health needs of pupil and the staff that support them. Why not recruit mental health nurses to be school nurses?

And what opportunities does Social prescribing offer Paul Jarvis-Beesley, Head of Health at StreetGames @PaulWJarvis blogs about what this can offer here https://www.ukyouth.org/2019/03/05/social-prescribing/

This is clearly a conversation that will continue, please do follow…

@CYPMentalHealth http://cypmhc.org.uk/

@YoungMindsUK https://youngminds.org.uk/

There are loads of really helpful resources from the @rcpsych that are worth dipping into too, they’ve got a great short film on anxiety https://www.rcpsych.ac.uk/mental-health/parents-and-young-people

@EmmySelby is a mental health nurse who is really keen to support digital development and be creative, do follow her on twitter.

@lizziebessell is an ED Matron who’s been awarded a Florence Nightingale Fellowship to explore how we can best support young people with mental health needs in acute hospital settings.

I’d really value hearing more about the challenges faced and the solutions that you’ve put in place to address some of the challenges…..

Have you employed Mental Health Nurses in general paediatric areas, what difference has this made?

Have collaborations with Mental Health Teams brought benefits? Are you working with primary care on this agenda?

Love these prompts from young people to parents