Running to 2020 and resetting the #NHS1000miles clock…

Back in 2018 we celebrated the 70th birthday of the NHS, a number of us decided that our ‘birthday present’ to the NHS would be a commitment to get a bit more active in anyway we could.

The idea behind #NHS1000miles was that if we personally took responsibility for our physical and mental wellbeing, we’d hopefully reduce our reliance on the NHS, easing pressure where possible so it would see it’s 100th birthday. More walking, running, skipping, swimming, cycling, in fact the challenge included any mileage that contributes to covering 1000 miles in the year. The fab ‘Trail Magazine’ have #Run1000miles which happens every year, so the #NHS1000miles built on this, whilst hopefully making it a bit more inclusive and accessible for individuals or teams who feel running not was for them but wanted a target and to cover the miles in other ways. Here’s the link to the original blog post shared thanks to the awesome Theresa Chinn @AgencyNurse of the ‘We Communities’ http://wecommunities.org/blogs/3338

Well thanks to a core team, including Jackie, Karen, Michalis, Celia, Phil, Flo, Tree, Trudy, Sue, Tricia, Jen, Dionne, Tony, Zoe, Amy, Nick, Marc, Leigh, Cat, Steph, Fiona, Ruth, Nicola, Becky, Sian, Lucy, Anne, Clare, Claire, Rebekah et al, who are all the backbone of the #NHS1000miles challenge, we decided to continue! So on 31/12/18, we reset the clock and continued the challenge into 2019, here was last years blog http://www.wecommunities.org/blogs/3443

So as we bring 2019 to a close let’s reflect on what we’ve achieved in being a bit more active and fulfilling a commitment to a work/life balance that includes regular exercise.

Personally I’ve found ParkRuns really valuable and pals in my local running club have kept me motivated. I find I can’t get home in time on week nights for the club training sessions, but ParkRuns, Cross Country and other local weekend events bring us all together. This is a few of us on our Christmas lights tour recently.

I’ve accepted that I’m never going to speedy but I do love ultra running, I was thrilled to do 52miles in one go this year (an ultra I’ve learnt is a running distance over 26.2 miles). Gathering the 2019 bling together showed me the range of races I’ve embraced and finished this year!

Many of these races have been with NHS 1000miles pals. The Yorkshire Marathon was a particular highlight, even in the rain!

So I’m hoping you’ll join us for the 2020 #NHS1000miles challenge, all miles count, just keep a tally & post updates either at 7.30pm on a Sunday evening or on the #NHS1000miles Facebook page. Everyone’s welcome to join in, come on, what’s stopping you? 😉

Building a workforce for and with children, young people and families/carers…

What do babies, children, young people and families/carers who come from a range of socioeconomic and ethnic backgrounds need from the NHS? As custodians of precious public resources allocated to healthcare its a fundamental question to challenge ourselves with, having a competent and compassionate workforce that can meet these needs now and in the future is essential.

Knowing that children, young people and families want to self care where possible, have access to high quality preventative care, reliable assessment and competent compassionate interventions, receive support locally and at home where possible with specialist support when needed, are key principles to work to. This population group are of course digital natives which is a critical consideration going forward for service planning and workforce development.

Having this clarity of purpose helps us design roles, recruit, educate and retain a workforce that is fit for purpose, across the public health, community/primary, secondary and tertiary care domains. Partnership working across provider NHS organisations in collaboration with users of services, education, the voluntary sector, and social care are also essential requirements as we go forward.

Taking all of these elements into consideration I returned this week to the work of the Children’s Outcomes Forum https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/410561/Theme_Group_report_Workforce.pdf and it helpfully summarises the layers of workforce provision to meet population needs whilst recognising children, young people and families/carers as the most significant assets in meeting their health care needs and achieving better health outcomes.

Since the work of the health outcomes forum new structures/roles have developed, including Primary Care Networks (PCNs), Nursing Associates, Physicians Associates, and Advanced Clinical Practice Roles have evolved. Mental Health needs along with Special Educational Needs and Disability (SEND) have continued to increase, community violence is having a significant impact and the technical care skills continue to demand increasing levels of competence from professionals.

The support by charities such as Roald Dahl and Well Child in creating Specialist Nurse posts have had significant impact in creating better, consistent support for those children, young people and families who need it most.

Yet we are still not in the position of having an adequate number of professionals in the community who have the skills to meet the needs of children and young people. Putting a focus on Community Children’s Nursing, Special School Nursing leadership, School Nursing, Health Visiting and roles in Primary Care including Primary Care Networks (PCNs) that take a lead for CYP is vital if we’re to shift care from secondary and tertiary care centres.

Greater integration between mental and physical health is something we’re making progress on, with programmes such as ‘we can talk’, yet there is more to do in ensuring children’s nurses with mental health skills and mental health nurses with skills in child development, family centred care models work collaboratively to enhance care for CYP experiencing MH distress.

Youth workers are a valued addition to the NHS, we are seeing increasing numbers being appointed to teams and their impact in improving attendance at clinics and in improving outcomes is already having impact. We need to gather publish the impact these roles are having in caring for young people more holistically if we’re to grow this element of the workforce.

Along side increasing skills we also need to ensure we’re widening access into the NHS and creating pathways to employment. Volunteering opportunities and the creation of Nursing Associate role offer routes into securing a professional qualification

Of course whilst I’ve focused on nursing, Allied Health Professionals and Paediatricians are a vital element and this year the RCPCH have run a campaign #ChoosePaediatrics, which you can catch up with here https://www.rcpch.ac.uk/education-careers/careers-campaign

Complementing the people development is of course the opportunity digital developments offer us, the e-red book, digital passports, apps to support better self care, navigation to services. ‘Chat Health’ has offered increasing access to advice from school nurses and ‘Parent Chat’ is having impact too.

So as we head into 2020 keeping our focus on workforce development for this population group is going to be an ongoing priority, along with continued work to actively collaborate with the children, young people and families we serve so that the workforce reflects their needs, after all that’s what we’re all about.

Having a growth mindset…

How can we cultivate and nurture a growth mindset in healthcare, one that is always curious, seeking solutions? I firmly believe that everyday provides an opportunity to learn IF we’re in the frame of mind that allows us to do this. Valuing and creating time for systematic self-reflection followed by an opportunity to take action is something I know I need to work at. Having a positive yet realistic outlook is critical in helping us develop personally, as well as professionally.

So I’ve been thinking about what actions I can take to help nurture a ‘growth mindset’?…

1. We all have strong foundations that we need to acknowledge, our upbringing, our training, placements, jobs, people that have had an influence on us, they’ve all created a base from which we grow and flourish. Taking time to acknowledge this can be helpful as we work to build on it.

2. It’s important that we look back on what’s been tough. Reflecting on how we’ve coped with complex situations, means we’re actively using learning opportunities offered to us. Keeping a journal or writing a blog can help us document this learning that can be referred to in the future, as well as providing a record to show just how far we’ve come when times are particularly challenging.

3. Can we do more of thinking big, being ambitious? So often we limit ourselves to what we think is achievable rather than being brave and exploring the potential we could grasp. We’re grappling currently with the vastness of the child health agenda, how do we progress the public health and community offer, whilst sustaining more hospital and specialised care? Realistically it can’t be an either or, we need to be ambitious and grapple with both, articulating why this agenda matters so much to society.

4. Broadening our horizons by seeking out new ideas, inspiration and perspectives can enrich and diversify our approaches, importantly energising us with new solutions, encouraging creativity. With social media offering greater connectivity than ever before, a range of scholarship opportunities available such as Florence Nightingale Fellowships, we don’t have to look too far for opportunities.

5. Asking for and seeking out feedback from others can offer insights and perspectives that can be really constructive, and whilst it can feel uncomfortable, it is so worthwhile and valuable if we can ‘lean in’ and ask for perspectives on what’s going well and ideas on ‘even better if…’

6. It’s impossible to get things right all of the time even though we all love things to always go well, in reality failure teaches us so much – we shouldn’t be afraid of it, supportive colleagues can be incredibly helpful in working through challenges when they arise.

7. Yet it’s important we use all these elements to implement change. Whilst it can seem tedious to jot down action plans, objectives and aims, when we write things down its more likely to get done. I know I need to get better at this!

8. ‘Bite sized chunks’ is a saying I repeat to myself regularly. When the demands ahead seem overwhelming its worth focusing on taking one step at a time…

I’d love to know how you cultivate a growth mindset, ideas and insights welcomed!

So much happening …

29/11/19

Goodness it’s been a busy week! The 20/11 brought an amazing celebration at Barts Health (#CYPBartsHealth) focusing on Children’s Rights thanks to the Youth Empowerment Squad ‘YES’ ‪@YES_BartsHealth‬ and the wonderful Play Specialist team ‪@PlayTeamRLH‬, it got us all talking about how we continue to put a focus on Children’s Rights going forward beyond the 30th Anniversary celebrations of the UNCRC.

I also got to catch up with Starlight ‪@starlight_uk ‬ this week, they were with us at Barts Health earlier this year when Janie our ED Play Specialist won Play Specialist of the year.

Starlight are a wonderful charity that ‘punch well above their weight’ and are known for providing wishes to sick children, providing entertainment in hospitals and wonderful distraction boxes for healthcare environments (amongst other things!). It was this tweet that caught my eye reinforcing that how we engage and support children in healthcare is so much more than what we do in hospitals.

Then on Wednesday our wonderful Roald Dahl Epilepsy Nurse Specialist Lynn @LynnKeen7‬ organised a Children’s party with the marvellous Roald Dahl Charity ‪@RoaldDahlFund‬. A highlight was having a visit from Marvin the crocodile, here we are doing our power poses and having a giggle with him! The charity make such a difference to the lives of sick children and families through their pump priming of specialist nurses, do watch their Christmas campaign video it’s fabulous https://www.roalddahl.com/charity

So whilst this time of year is incredibly busy with our inpatient areas caring for sick children it’s so appreciated when Charities work with the NHS to create fun experiences not only for patients and families but for staff too. This is the stuff that keeps everyone going.

It was Sophia ‪@SophiaTouzani‬ who shared this position paper from the RCPCH and RCN on winter pressures and the importance of not losing the focus on Children and Young People, particularly regarding community care https://www.rcpch.ac.uk/resources/winter-pressures-childrens-emergency-care-settings It follows tweets from the QNI and Children’s Community Nurse Champion Trudy Ward reinforcing the importance of growing our Children’s Community Nursing workforce to keep care closer to home when it’s safe and appropriate to do so.

And I’m sure all of us have been caught up in politically charged conversations as we head towards the election ‪@mollycasespeaks‬ shares her views on retention of nurses, it’s really worth a read https://www.theguardian.com/commentisfree/2019/nov/26/more-nurses-nhs-50000-frontline-funding

Friday provided an opportunity to say a proper hello to our newly qualified nurses here at Barts Health, our Practice Development Nurses are doing a great job of supporting them as they transition into their new roles across Whipps Cross, Newham and the Royal London Hospitals.

So as all staff providing direct care to children, young people and families continue to work incredibly hard in the weeks ahead I hope you get a moment to have some fun too as the festive season gets underway.

Children’s Rights #UNCRC30

Thirty years ago children were formally recognised as having non-negotiable rights and that active support was required for them to claim their rights. Nearly all Governments have pledged to respect, protect and promote these rights by signing the United Nations Convention on the Rights of the Child ‘UNCRC’ https://www.savethechildren.org.uk/content/dam/gb/reports/humanitarian/uncrc19-child-friendly.pdf.

Notable progress has been achieved globally in the past three decades, through ongoing work to end child poverty along with a focus on increasing school attendance. Yet significant challenges remain in particular for girls, for children with disabilities and for children in disadvantaged and vulnerable situations, and frustratingly children still die from preventable diseases.

Lot of the articles in the UNCRC resonate with us in Healthcare, the right to life and good health care (Articles 6,23 & 24); the right to education, play, to relax and have fun (Articles 28,29 & 31); the right to what is best for children (Article 3); the right to information (Articles 13 & 17); the right to respect (articles 2 & 14); the right for children to have their say (Article 12); the right to consent (articles 5 & 12); the right to privacy and confidentiality (Article 16); the right to be safe (Articles 19, 33, 34 & 36) and the right to a family life (Article 1, 2 & 42). They complement the NHS Constitution https://www.gov.uk/government/publications/the-nhs-constitution-for-england providing the ‘blue print’ for services to achieve.

This is a great poster from young people in Wales that you my want to download, develop and adapt with your local youth forum members http://www.wales.nhs.uk/sitesplus/863/page/91176

This 30th birthday gives us an opportunity to look back on what’s been achieved relating to children’s rights and to look to the future, asking ourselves what more we can do to ensure children and young people who come into contact with our services have a positive experience. Will all children and young people who access our services report feeling that rights are respected, upheld and promoted? Children’s rights are everyone’s business so we all need to take on this challenge across the NHS. 

I wonder if we’re consistently involving children in commissioning decisions? Are CYP involved in the assessment of services by using tools such as the ’15 steps’ https://www.england.nhs.uk/wp-content/uploads/2017/11/15-steps-children-young-people.pdf Are we adopting resources such as ‘We Can Talk’ https://wecantalk.online/ and ‘CYP Me First’ https://www.mefirst.org.uk/ to help us communicate as effectively as possible with CYP so that they are actively involved in decisions about their care? Do we have child friendly complaint processes? https://www.childrenscommissioner.gov.uk/publication/common-principles-for-a-child-friendly-complaints-process/

Are we focusing on mental and physical health and wellbeing, along with good effective preparation for the move into adult services ie transition?

So some asks, will you…

·   Work to involve Children more in your services? https://www.england.nhs.uk/participation/get-involved/how/forums/nhs-youth-forum/

·   Seek out and hear Children’s voices in decisions about their care? https://www.health.org.uk/blogs/ask-three-questions

·   Ensure information about services, treatment and care is accessible and understandable? https://pifonline.org.uk/resources/publications/health-info-for-children-and-young-people/

·   Identify Young Carers and signpost/refer them to ongoing support? https://carers.org/young-carers-awareness-day-2020

Committing to taking on these challenges would be the best birthday present ever! Happy 30th Birthday UNCRC #UNCRC30

#HealthInfo4Children

Some time ago I blogged on the importance of health information for children NHS The Health Literacy Place | Addressing the health literacy needs of children & young people This week the Patient Information Forum ‪@PiFonline‬ held a conference on this subject and it seems like an appropriate time to revisit the issue.

Why is health information so important? In this 30th anniversary year of the UNCRC it’s worth reminding ourselves that children have the right to high quality information and to be active participants in their care. We know that children are thirsty for knowledge, the challenge is meeting this need with engaging information that meets their developmental stage.

When I was a child I used to get lost in a book, Alice in Wonderland was one of my favourites. The quote …

seemed to confirm that even impossible things could be worked out! Creative, engaging narratives teach us so many life lessons, and creativity is a vital component in developing health information resources to convey important messages in fun engaging ways.

It’s also worth highlighting though that we know there are some children who are more vulnerable, those from BAME groups, those with learning disabilities/autism, those from looked after backgrounds, who are likely to need additional support to access health literacy information.

Some time ago PiF produced this really helpful guide https://pifonline.org.uk/download/file/38/

It explores:

1. Why the right information matters

2. How do we involve CYP?

3. What are the best ways to communicate with CYP?

4. How to produce resources

5. And ideas on what can we learn from others.

It’s worth dipping into!

The PiF conference heard from Professor Lucy Bray @LucyBray9 of Edge Hill University who has developed films with children on ‘Coming into Hospital’ https://www.edgehill.ac.uk/news/2019/02/launch-of-new-comic-book-and-animation-to-help-children-feel-less-worried-about-going-to-hospital/

CICRA ‪@CICRAcharity‬ the charity for children and young people with Crohns and Colitis https://www.cicra.org/ shared films young people had made on endoscopies and other tests that are associated with having this disease.

The Evelina Children’s team shared how they have developed great short films on having an EEG for children and families https://www.evelinalondon.nhs.uk/Home.aspx

The Motor Neurone Association ‪@mndassoc‬ shared the work they’ve developed for 4-10 year olds to help them understand what’s happening when an adult is diagnosed with this disease https://www.mndassociation.org/support-and-information/children-and-young-people/children-aged-four-to-ten/

And the Royal London team shared their work on developing a child centred information approach, information and ‘eye club’ with wrap around services for siblings and families when Retinoblastoma happens https://www.nhs.uk/conditions/retinoblastoma/

We also had an interactive session on using social media to engage children, highlighting some of the challenges and the opportunities it offers. What was clear was that when resources have been developed and invested in, sustained promotion is key if the resources are to have maximum impact.

It’s also worth flagging that the NHS Long term plan asks us to work to improve care for children and young people from 0-25years, it moves us as CYP Professionals from focusing on children (those up to 18), to those who are young adults. Research tells us their brain continues to develop until they are 25, therefore child and young person/young adult health information is essential.

Yet the only way we’ll continue to grow health information resources for and with this population group is by involving children and young people and focusing on what matters to them, working with professionals, educators, writers, ‘creatives’, and the voluntary sector.

I had the pleasure of hearing Dr Kelly Harding ‪@HardingKelli‬ a physician and author of ‘The Rabbit Effect’ at an event this week. Whilst talking about the wonderful physiological impact of kindness in healthcare, shared that for every life bio medical science saves, education saves 8, it was just the affirmation I needed that whilst medicine, treatment pathways etc are vital in managing illness, high quality health information is essential to enhance education, its an area we need to do more on in co-production with those that need it most.

Young Adult Experience #YAExp

This week we’ve been reflecting on transition and young people who are cared for in adult services up to the age of 25, it’s really helpful that the NHS Long term plan raised the bar and asks the NHS to work on improving care for those from 0-25 years of age. Previously Children’s services have focused mostly on the care of young people up to 16, sometimes up to 18, the statutory definition of becoming an adult. It’s helpful that research over the past 20 years or so has confirmed that brain development continues until we’re 25, hence the need to support young adults as they continue their journey to independence, particularly those who have long term health needs.

We know how vulnerable young people can be and the impact great, positive, encouraging, support can have, which is why it’s important we continue to work to improve transition and young adult care. It’s vital children’s and adult services work collaboratively and take a ‘system wide approach’ along with primary care, local authorities, the voluntary sector and schools, colleges, universities and employers.

We know than when young people move into adult services, particularly in inpatient care they are often surrounded by much older people. Only last week we had a 19 year old with Sickle Cell Disease being cared for on a ward between two elderly patients which was far from ideal. Young People can feel intimidated by professionals who they haven’t had a life time of getting to know. Sadly we have now have evidence that health outcomes for young people with long term conditions can deteriorate and result in the worst case scenarios of significant long term complications and untimely death as they disengage with services, if they feel we don’t connect with them.

So what would good transition and young adult experience look like? This model gives us an ambition to aim for…

Young people want honesty and they want us to start preparing them early, they want their GPs to be involved, they want a named point of contact, they want shared care plans with emergency care instructions too. Importantly peers matter, young people want us as health care professionals to connect them with other young people in similar situations.

So at the Trust I’m working at there is wonderful senior leadership on this agenda, the executive team are all supportive of this work. We have 2 fabulous nurse specialists Neil Fletcher and Angela Thompson, funded by the wonderful Roald Dahl Charity who are leading the way, supported by fabulous consultants in Paediatrics and in Adult Medicine. We’re embedding the transition framework ‘Ready, Steady, Go, Hello’ https://www.uhs.nhs.uk/OurServices/Childhealth/TransitiontoadultcareReadySteadyGo/Transitiontoadultcare.aspx (thanks Arvind Nagra ‪@arvnagra‬ & Southampton UHT 😉) where teams don’t have a transition framework in place. The Trust strategy team are helping make this happen. We’re also strengthening our links with primary care, GPS like Helen Jones are testing different models for young people’s clinics. And the numbers of youth workers are growing across the Trust. We’re also been part of the National improvement programme with NHS Improvement/England.

So what do young people from us?

They tell us they want to be welcomed, reached out to, to feel safe and ideally cared for with people of similar ages. They want to be respected and for us to remember it’s scary being a young person using the NHS.

Importantly, we are just as concerned about those young people who ‘crash land’ into adult services as those who transition to adult care from Paediatrics. We need to get it right for all young adults.

Lucy‬ kindly shared her experiences of being a young adult receiving care, please follow her ‪@LucyAlexandria‬ she’s totally inspiring! Huge thanks to all of the amazing young people informing and helping to move this work forward.

Young People’s health is a responsibility of all of us shares the Health Foundation in a recent report https://www.health.org.uk/sites/default/files/upload/publications/2019/HEAJ7109-Young-Peoples-Health-Report-WEB.PDF So we asked our Trust if they’d be allies for and with young people and adults, 220 senior leaders said yes! Will you ask your Trust to do the same? 😉