‘Children are not the face of this pandemic. But they risk being among its biggest victims. While they have thankfully been largely spared from the direct health effects of COVID-19 – at least to date – the crisis is having a profound effect on their wellbeing.’ (Policy Brief, The impact of covid-19 on Children, UN 2020).
On Friday 31 July, the letter arrived from NHS England and NHS Improvement announcing the move into the third phase of the NHS response to covid-19.
It’s worth considering what this means for babies, children, young people and their families and carers. Does the health and wellbeing of our children have a high enough profile at the online meetings of national, regional teams, at Integrated Care Systems and local authority health and wellbeing boards? With so many competing priorities, it’s vital we as a society, not only keep children in mind, but take action to challenge, improve and evolve their care whilst working to continuously improve the services that support them.
Nigel Crisp’s recent book Health is made at home, hospitals are for repairs reminds of us of what’s important in creating healthy societies: play, being outdoors, closeness to our families, friends, being part of a safe community. All of these elements also take the pressure off the NHS, which is why the maturing Integrated Care Systems need to have vibrant programmes of work around the provision of child health and wellbeing.
Of course, whilst many children flourish, there are those who experience short episodic health episodes, have complex health needs; those who live in chaotic, difficult circumstances – there are a plethora of reasons for statutory services to ensure the spotlight is bright on this population group to ensure that health inequalities are tackled head on from cradle to grave.
During the pandemic there was an immediate risk that the crisis would widen health inequalities, leaving vulnerable, disadvantaged children further exposed and at risk, that access to key services would be disrupted including post natal care, health visiting and GPs, as well as screening and immunisation.
In addition, there was a concern that there would be significant challenges with receiving timely acute services, fewer Emergency Department visits, virtual outpatient services and delayed access to elective surgery and diagnostics – and indeed all of these played out.
Yet throughout this pandemic many examples of good practice have emerged, from virtual GP clinics in local youth hubs, conversations and support for young carers, commissioning of bereavement care for children, establishment of parent peer support networks, effective routine virtual consultations, to strengthened discharge arrangements so that babies, children and young people are not in a hospital setting a second longer than is needed.
We have much to build on as we move forward, the energy and commitment of professionals working within child health and beyond is determined and unrelenting to achieve better outcomes with and for the communities they serve.
So what are the ambitions we need to consider as we move into phase 3? Well, there are some must-dos!
- We must work harder to reach out and hear the voices and perspectives of children, young people and families. We cannot and must not do this work alone. Professionals must continue to seek out and listen to what matters most to the populations we serve, especially those voices who are quiet and seldom heard.
- We must connect our maternity, mental health and children’s programmes and integrate our approaches, assessment and signposting to services early on in the maternity pathway. This is crucial in putting in place earliest support, and whole school approaches need to focus on physical and mental health and wellbeing. The role of health visitors and school nurses are vital in providing community support in partnership with our valued voluntary sector colleagues.
- Strengthening our public health collaborations and the use of data to inform our work and to see the impact we’re having is needed. Let’s finally put a national focus on children’s dental health, rather than hospitals trying to fit in surgical extractions for decayed teeth. We must take seriously the concerns of headteachers as they wave the red flag on the obesity levels they are seeing as children return to school. Prioritising childhood immunisation catch up to prevent a resurgence of childhood illnesses must move at pace.
- Strengthening collaborations across care settings is key. Let us make sure that paediatricians are active in 111 services; grow our local children’s community nursing teams and community paediatric services for our children with Special Educational Needs and disabilities, autism and Attention Deficit Disorder (ADHD). We must put a focus of proactive management of on-going health needs for example asthma care, as well as nurturing partnership arrangements and relationships across primary and secondary care services, between GPs to paediatricians.
- Can we recruit ‘parent champions’ to support the growth of peer family networks? We can progress growing youth voice embedded in patient participation groups. Social prescribing offers us a real opportunity in child health if we engage link workers in a whole population approach, and consider appointing youth workers to these roles.
- Whilst recognising that digital poverty does exist and must be tackled, we can strengthen digital connections through the use of resources such as NHS Go, ERedbook and Co-ordinate My Care (CMC)
Addressing these elements at pace will support us in creating positive health experiences and have an impact on attendances to health care settings as we head into autumn.
The population we serve requires us to continue to be fierce, proactive champions for child health, taking action to challenge, improve and evolve services and care, preventing ill health and promoting emotional and physical wellbeing at every possible opportunity. We all have an important part to play wherever we are in the system.
Child health has to part of be an on-going conversation as we continue to advocate for and with the communities we serve. We must be collectively ambitious for our whole population and a healthy flourishing society depends on the infrastructure we put in place to support childhood.
I believe it’s the most pressing challenge of our time, but we can make things happen if we choose to…