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THE JOURNAL OF THE COMMUNITY PRACTITIONERS’ AND HEALTH VISITORS’ ASSOCIATION
JULY / AUGUST 2021
COMMUNITYPRACTITIONER.CO.UK
WHAT’S BEHIND THE RISE?
Anorexia
ARFID
Binge eating
Bulimia
Other specified
Eating disorders among children and
young people have rocketed during the
pandemic. Is there enough support and
awareness out there?
Cover_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 1 08/07/2021 15:24
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CPJULY2021.002.indd 2 07/07/2021 10:01
CONTENTS
S July / August 2021 | Vol 94 | No 04
38
COVER STORY
1.25 million
people affected by an eating 32
disorder in the UK.
Why SCID
25% are male is joining
the list of
conditions
newborns are
screened for
22
29 The most common vision problem
you’ve never heard of What you like, what you
34 love, about your journal
- the results are now in
A look at
gender
diversity
and lactation
14
Lengthy
waiting lists
are having a
deleterious
effect on
public health
NEWS 14 BIG STORY 22 HERE’S WHAT 29 CLINICAL
More than five million YOU TOLD US Cerebral visual impairment:
7 NEWS IN NUMBERS people are on NHS Key findings from the mixed messages between
Your at-a-glance guide waiting lists. Is this Community Practitioner brain and eye
storing up trouble for 2021 readership survey
8 PUBLIC HEALTH LATEST our children’s health? 32 SPOTTING THE DANGER
A look at what’s new PRACTICE An evaluation of
OPINION blood spot screening
10 PROFESSIONAL UPDATE 24 CONFERENCE SPECIAL for severe combined
Your latest round-up 20 CNO REFLECTION Health and wellbeing for immunodeficiency
AND THANK YOU all ages: experts on the
12 GLOBAL RESEARCH Chief nursing officers key issues for CPs through 34 THE RIGHT TO FEED
Recent findings from on how CPs stepped up a Covid lens, from Lactation for all across
around the world during the pandemic resilience to vaccination the gender spectrum
3
COMMUNITY PRACTITIONER | JULY / AUGUST 2021
CONTENTS_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 3 09/07/2021 15:43
Problem Solved
Passive safety pen needles protect
you from needlestick injuries, but
come with challenges of their own:
Lack of needle visibility1
Premature activation
of the safety mechanism1
Limited control during
the injection process1
If you were given more control,
71% agreed that the safety pen needle
activates before they have finished you’d take it
administering the injection1
For product information visit ateriasafecontrol.com
69% agreed that premature activation of
the safety pen needle makes them unsure
ASC-LA-PS-CPAD-UK/MCC/0720/01
© Copyright Owen Mumford 2020
that the full medication dose had been
delivered to the patient*1
* Of the 71% of healthcare professionals who had experienced safety pen
needles activating before they had finished administering the injection.
1. Project Saturn A (2017) Online study commissioned with an independent
market research agency. Data on file.
Owen Mumford Ltd, Primsdown Industrial Estate, Worcester Road, Chipping Norton, Oxfordshire OX7 5XP, United Kingdom
T : +44 (0)1608 645555 E : customerserviceuk@owenmumford.com owenmumford.com
CPJULY2021.004.indd 4 05/07/2021 15:24
WINNER!
Best Magazine for a Professional Association
or Membership Organisation 2020 Memcom Awards
WELCOME
FEATURES
38 COVER STORY
What’s behind the rise in
eating disorders? Between 2016
and 2020, rates of referrals for
eating disorders doubled across
from your editor, Aviva
England. Since March 2020,
rates have doubled again. Is it a As we edge ever closer to that elusive ‘normal’ way of life, there are plenty of
way of expressing distress? A life reminders that, even if Covid ceased to exist tomorrow, the impact would continue
lived through social media? Or to be felt. And of course Covid isn’t going to simply vanish. On page 14, our Big story
lockdown itself? looks at the waiting times facing children and young people for all kinds of services
– not just surgical procedures, but CAMHS and dental appointments too.
RESEARCH This issue’s cover feature on page 38 tackles the sharp rise in eating disorders
among children and young people during the pandemic. An upward trend had already
44 COMMUNITY NURSING started pre-Covid. What’s going on? Is there enough support and awareness out there
STUDENTS’ EXPERIENCES OF generally? And how you can help to spot the signs of an eating disorder early on?
USING E-PORTFOLIOS There’s no doubt that life has been a challenge for many, and with that in mind,
Exploring the perceptions of the Unite-CPHVA one-day conference focused on health and wellbeing for all ages
nurses when using e-portfolios to (highlights on page 24). And on page 20, three chief nursing officers offer a heartfelt
record their work. Cathy Taylor thank you to all CPs as
of Swansea University discusses they reflect on the past
the benefits and pitfalls of digital 18 months or so.
recording, and its potential for Other topics covered
expansion across health visiting this issue include
equality for people with
PROFESSIONAL PAUSE a learning disability
(page 48)and inclusive
48 TREAT ME WELL lactation (page 34).
People with a learning disability Finally, discover the
suffer health inequalities from an latest readership survey
early age, and they are more likely findings on page 22, and
to die younger and more avoidably. please keep letting us
Closing these gaps must start at the know what you think.
earliest possible moment, says Paul
Donnelly, head of campaigns at JOIN THE CO
ONVERSATION
CONVERSATION
learning disability charity Mencap
aviva@
communitypractitioner.co.uk facebook.com/CommPrac twitter.com/CommPrac
Non-member subscription rates Editorial team Obi Amadi Jane Beach and Dave Munday
Individual (UK) £135.45 Editor Aviva Attias Printed by Warners
Individual (rest of world) £156.45 aviva@communitypractitioner.co.uk
Institution (UK) £156.45 Group content sub-editor James Hundleby © 2021 Community Practitioners’ and
Health Visitors’ Association
Institution (rest of world) £208.95 Head of content (health) Emma Godfrey ISSN 1462-2815
Unite-CPHVA Executive editor Gavin Fergie
The views expressed do not necessarily
Existing Unite-CPHVA members with Subscription enquiries may be made to Clinical editor Pippa Atkinson represent those of the editor nor of
queries relating to their membership Community Practitioner subscriptions Senior designer Nicholas Daley Unite-CPHVA.
should contact 0845 850 4242 or see Redactive Publishing Ltd Picture editor Akin Falope Paid advertisements in the journal do
unitetheunion.org/contact_us.aspx for PO Box 35 Advertising not imply endorsement of the products
further details. Robertsbridge TN32 5WN or services advertised.
020 7880 6244
To join Unite-CPHVA, see 01580 883844 advertising@communitypractitioner.co.uk Any Unite-CPHVA member wishing to
unitetheunion.org cp@c-cms.com change their contact details must get
Recruitment in touch with their local Unite office.
The journal is published on behalf of 020 7880 7621
Unite-CPHVA is based at Unite-CPHVA by Redactive Media Group,
128 Theobald’s Road London WC1X 8TN comprac@redactive.co.uk
78 Chamber Street, London E1 8BL
020 3371 2006 Production Recycle your magazine’s plastic
020 7880 6200
Production director Jane Easterman wrap – check your local LDPE
Editorial advisory board facilities to find out how.
Community Practitioner Obi Amadi Barbara Evans Unite health sector officers
Unite-CPHVA members receive the journal Gavin Fergie Elaine Haycock-Stuart National officers Jacalyn Williams and
free. Non-members and institutions may Michelle Moseley Christopher Sweeney Colenzo Jarrett-Thorpe. Lead professional
subscribe to receive it. Janet Taylor officers Gavin Fergie Ethel Rodrigues
5
COMMUNITY PRACTITIONER | JULY / AUGUST 2021
EDITORIAL_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 5 09/07/2021 15:43
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15:48
◗
NEWS
NEWS IN NUMBERS
9pm
More than
2 million
watershed Cough
adults in England may have had
long Covid, a study of more than
500,000 adults found.
Around 37% of those who self-reported
Adverts of foods high in fat, salt and sugar
Covid experienced at least 1 symptom
can only be shown from 9pm to 5.30am
for 12 weeks or more.
on TV (and UK on-demand programmes) Headache
from the end of next year. Almost 15% had 3 or more symptoms
for at least 12 weeks.
There will also be new rules for online
promotion (paid-for adverts), the Women were more likely to suffer, with
government announced. increasing age a factor. The government
has provided £50m for research
The new restrictions could remove up Shortness
of breath
to 7.2 billion calories from children’s diets
per year in the UK, which in time could
reduce the number of obese children
by more than 20,000
Around
600,000
young people aged 18 to 25 in Scotland
are set to benefit from free NHS
dental care from the end of August,
SHUTTERSTOCK
subject to parliamentary approval
Find links to relevant reports and surveys highlighted in the news stories at bit.ly/CP_news_in_numbers
7
COMMUNITY PRACTITIONER | JULY / AUGUST 2021
NEWS In numbers_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 7 08/07/2021 15:27
NEWS
PUBLIC HEALTH LATEST KEY
DUCHESS LAUNCHES CENTRE FOR EARLY
CHILDHOOD TO DRIVE AWARENESS AND ACTION Video
come’, the Duchess said in a video
for the launch.
The centre will focus on three
areas of activity: promoting and
commissioning research; working
Report
with people across the private,
public and voluntary sectors on new
solutions; and campaigning to raise
awareness and inspire action.
The centre’s first report, Big
change starts small, is ‘a summary Campaign
of decades of science on early
childhood and research on why
the early years matter. By bringing
this body of evidence together, we
hope to demonstrate the strategic
Poll
importance of this vital issue
to everybody.’
‘THE COST OF LOST The report also revealed The Royal
The Duchess of Cambridge has Foundation’s work with the London
OPPORTUNITY IN School of Economics, which calculated
launched The Royal Foundation
EARLY CHILDHOOD ‘the cost of lost opportunity in early Website
Centre for Early Childhood to
drive awareness of, and action on, IS AT LEAST £16.13bn childhood’ is at least £16.13bn annually
‘the transformative impact of the in England alone.
early years’.
ANNUALLY IN
The aim of the centre is to ENGLAND ALONE’ bit.ly/UK_champion_
‘transform lives for generations to early_years Health
programme
THE PANDEMIC COULD HAVE A LASTING IMPACT ON
YOUNG PEOPLE’S MENTAL HEALTH, WARNS CHARITY
A poll of more than 4000 were feeling stressed Barnardo’s chief
eight- to 24-year-olds (58%), worried (54%), sad executive Javed Khan
across the UK suggests (52%) and lonely (56%) said: ‘Barnardo’s has
the mental health and more now than before consistently warned that
wellbeing of children and the pandemic. the negative effects of
young people could still be Few young adults the pandemic could last
worsening a year after the reported feeling less so (11% a lifetime if children [and]
pandemic started. or under) now than before young people don’t have
Between 28 April and the pandemic. the right support.
10 May, respondents were Younger children ‘Our survey adds further
asked how they were seemed to fare better, but weight to the argument
feeling now compared with almost a third of eight- to that children must be
before the pandemic. 15-year-olds said they were front and centre of the
More than half of 16- to feeling more stressed and government’s plans for bit.ly/UK_Covid_
24-year-olds said they worried now. the post-Covid period.’ young_wellbeing
8
COMMUNITY PRACTITIONER | JULY / AUGUST 2021
NEWS Public Heal_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 8 08/07/2021 15:28
NEWS
ANALYSIS OF CHILD DEATHS SHOWS IMPORTANCE
OF CARE FOR PREMATURE AND YOUNG BABIES
78%Actions to reduce the number of babies born
before 37 weeks’ gestation and improve their
outcomes are among the recommendations in
of child deaths occurred
in a hospital setting
The most frequent was smoking by a parent
or carer, followed by gaps in service delivery.
Challenges with access to services and poor
BASIC INCOME
SCHEME COULD
a recent report. communication also feature. Others included IMPROVE HEALTH
The University of Bristol National Child substance/alcohol misuse by a parent or carer, FOR ALL, SAYS PHW
Mortality Database’s national analysis of child and unsafe sleeping. Adopting a basic income
deaths in England aims to learn lessons from Overall, there were approximately 28 scheme in Wales could be
all child deaths. child deaths for every 100,000 children in a catalyst for better health
In their latest report, the 3347 deaths of England. 78% of child deaths occurred in a and wellbeing outcomes
under-18s between 1 April 2019 and 31 March hospital setting. for all, a report published
2020 in England were analysed. The report makes a clear call to action for all by Public Health Wales
The majority of children who died (63%) were professionals involved in planning or providing has suggested.
under one year old. Of these, where known, services to children to play an active part The report, A basic
69% were born preterm. In fact, 42% of all in reducing the number of children who die, income to improve
child deaths occurred before children were 28 encouraging them to use the data available. population health and well-
days old. being in Wales?, assesses
For the first time, factors considered bit.ly/ENG_protecting_ evidence and different
modifiable in children’s deaths were analysed. young_babies approaches to policy design
and implementation.
Potential positive
effects on health included
SPIKE IN CHILDREN WITH MILD FEVER ATTENDING reductions in child poverty,
A&E PUTS PRESSURE ON STAFF improved educational
attainment, a higher
The infections In response, the RCPCH standard of living for those
are the usually mild has issued advice on how more likely to be in lower
respiratory infections parents can treat children paid jobs, greater food
such as bronchiolitis with mild fever and when to security, better nutrition and
and rhinovirus. The seek help. fewer hospital admissions.
easing of lockdown Professor Martin Marshall, Report author Adam Jones
has meant that chair of the RCGP, said: ‘In said: ‘Evidence suggests that
children are being most cases of mild fever, members of society would
exposed to these runny nose or cough, simple benefit from an income that
infections this self-care measures such supports their health and
summer as they as taking paracetamol or wellbeing and allows them
come back into ibuprofen can help, but to contribute to society
Emergency departments contact with other children. in cases where parents and flourish.
(EDs) across the UK are The RCPCH say that many are concerned, seeking ‘How well a basic income
seeing very high numbers parents have not seen fever medical assistance from a scheme works would
ISTOCK / SHUTTERSTOCK
of young children for this in their child – particularly if pharmacist, their GP or by certainly depend on how it’s
time of the year because of born during lockdown – and calling 111 is the appropriate designed and delivered.’
a rise in infections usually are taking them straight first port of call.’
seen in winter, says the Royal to A&E. However this is
College of Paediatrics and placing pressure on already bit.ly/UK_children_ bit.ly/WAL_
busy EDs. A_and_E universal_income
Child Health (RCPCH).
9
COMMUNITY PRACTITIONER | JULY / AUGUST 2021
NEWS Public Heal_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 9 08/07/2021 15:28
NEWS
PROFESSIONAL UPDATE
85%
suggested the intervention
‘The wellbeing of
staff remains a
had made them more likely
to discuss other issues critical priority
that will influence
the way that our
health and social
services recover’
WORKFORCE BURNOUT DISCLOSING ACEs £8M TO SUPPORT
AT EMERGENCY LEVELS, FORGES BETTER WORKER WELLBEING
SAYS COMMITTEE BONDS WITH HVs AFTER COVID
A report by the Health A study commissioned by The Scottish Government
and Social Care the Welsh Government has increased its
Committee (HSCC) suggests that the reveals that positive benefits are wellbeing support budget this
future functioning of services is at gained by all parties when health year by £3m to help its health and
grave risk, and calls for an overhaul of visitors enquire about caregivers’ social care workforce recover from
workforce planning. adverse childhood experiences the pandemic.
The HSCC’s inquiry into workforce (ACEs) at routine visits. The £8m package will support staff
burnout and resilience in the NHS and Feedback provided by four in every wherever they work – from acute
social care identified staff shortages five caregivers agreed that their HV hospital wards to community settings
as the biggest cause of burnout. And got to know them better by asking – supplementing the resources that
although Covid-19 impacted on the about ACEs, and 85% suggested the are in place locally.
workforce immensely, the committee intervention had made them more The priority areas for action will
was informed of serious staff likely to discuss other issues with their include the National Wellbeing Hub,
shortages prior to the pandemic. HV in the future. National Wellbeing Helpline, and
NHS workforce planning was at Despite concerns from HVs that psychological interventions and
best opaque and at worst responsible the offer of ACE enquiry would therapies for staff.
for unacceptable pressure on staff. receive a negative response, the Some £2m will be targeted
The report concludes that available proposal was well received, with nine at social and primary care in
funding was the driver behind out of 10 caregivers agreeing to take recognition of the specific needs
planning, rather than the level of part in the pilot. of staff working in those services in
demand and staffing capacity More than 40% of caregivers with responding to Covid-19.
needed to service it. ACEs said the study was the first time Health secretary Humza Yousaf
HSCC chair Jeremy Hunt MP said: they had told a professional or service said: ‘The wellbeing of staff remains
GETTY / SHUTTERSTOCK
‘Achieving a long-term solution about these experiences, with first a critical priority that will influence
demands a complete overhaul of disclosure most common among male the way that our health and social
workforce planning.’ caregivers (55.1% of males with ACEs). services recover.’
bit.ly/SCT_wellbeing_
bit.ly/ENG_NHS_burnout bit.ly/WAL_ACEs_HVs boost
10
COMMUNITY PRACTITIONER | JULY / AUGUST 2021
NEWS Professiona_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 10 08/07/2021 15:29NEWS
HEE BOOSTS CLINICAL UPDATE ON MENTAL PROTECT STAFF FROM
PLACEMENTS IN HEALTH ACTION PLAN PREJUDICE, SAYS
2021-22 BY £15M AND CARE NETWORKS RACE OBSERVATORY
Health Education England Health minister Robin Healthcare leaders and
(HEE) has pledged extra Swann reports that employers must ensure
funding to increase the number ‘substantial progress’ has been made staff are protected from all forms
of placements offered to nursing, in the 12 months since the Northern of racism, discrimination, bias or
midwifery, allied health professional Ireland Mental Health Action Plan prejudice, says the NHS Race and
(AHP) and healthcare students from was published. Health Observatory (NHSRHO).
September 2021. In his update, the minister Along with three regulators, it says
It is hoped that the increased highlighted key achievements that healthcare employment policies
number of placements will help HEE including the creation of a mental and processes need to be fair, inclusive
deliver sufficient numbers of skilled health champion, approval of the and in line with the 2010 Equality Act.
healthcare workers for the NHS of business case and securing of £4.7m NHSRHO director Habib Naqvi said
the future. funding for the development of a the body would identify and tackle
The £15m boost is in addition to specialist perinatal mental health structural inequalities that lead to
the £180m spent each year by HEE community service model, the differential experience and outcomes
on placements for around 120,000 establishment of the CAMHS and for the workforce and patients.
nursing, midwifery and AHP students. Forensic Mental Health Managed ‘The Observatory operates by
The funding will be allocated Care Networks, and the launch of a shining a light on discriminatory
regionally to ensure it meets local Mental Health Innovation Fund. policies and practices, and by
demand, and will be used for extra He said that the progress made gathering evidence that supports
supervision and coaching models to was a ‘considerable achievement’, healthcare organisations to progress
support growth. given the pressures of Covid. in a way that eradicates, rather than
Some of the money will be used He added: ‘The progress that has exacerbates, inequality.’
to evaluate the quality, impact and been made is due in no small part NMC chief executive Andrea
value of this investment and consider to the drive and dedication of so Sutcliffe said it is determined to play a
capacity and funding options for many people working tirelessly to ‘significant part’ in becoming a better
the future. improve services.’ and fairer regulator.
bit.ly/ENG_placement_ bit.ly/NI_mental_health_ bit.ly/ENG_equality_
funding plan healthcare
11
COMMUNITY
COMMUNITY
PRACTITIONER | JULY
PRACTITIONER | FEBRUARY
/ AUGUST
2018
2021
NEWS Professiona_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 11 08/07/2021 15:29NEWS
u For more
information on
these studies, visit
GLOBAL RESEARCH the bit.ly links
UK
THE EARLY WARNING UK
SIGNS OF SELF-HARM
Researchers have identified two distinct
SENSE OF COMMUNITY INDICATES
subgroups among young people who self-
ENTHUSIASM FOR VACCINE UPTAKE
harm, with risk factors showing as early as People who feel a sense of identification, sense of duty,
age five. It may therefore be possible to community belonging are more and vaccination willingness.
predict which individuals are most at risk of willing to have a Covid-19 vaccine, The authors recommended
self-harm up to a decade ahead of time. according to a study in the Journal volunteering to increase
The study, published in the Journal of Community and Applied people’s strength of identification
of the American Academy of Child and Social Psychology. with their community.
Adolescent Psychiatry, found that while The 130 study participants were
u bit.ly/JOCASP_community_vaccine
both groups were likely to experience sleep questioned on levels of community
difficulties and low self-esteem at age 14,
other risk factors differed.
The first group showed a long history
of poor mental health, as well as
bullying. The second group were
harder to predict, but a key sign was
more risk-taking behaviour.
Co-author Duncan Astle said: ‘Boosting
younger children’s self-esteem, making
sure that schools implement anti-bullying
measures, and providing advice on sleep
training could all help reduce self-harm
levels years later.’
u bit.ly/JAACAP_predict_self-harm
USA
FATHERS’ DEPRESSION CONTINUES
AFTER BABY’S INTENSIVE CARE STAY GERMANY
Both mothers and fathers with a baby in the neonatal ALCOHOL CONSUMPTION
intensive care unit are at risk of depression, a study of IN EUROPE DECREASED
more than 400 people in Pediatrics found. DURING COVID – BUT NOT IN UK
Depression symptoms were identified in 33% of The European Alcohol and Covid-19 Survey collected
mothers and 17% of fathers. However. the probability of data from nearly 32,000 alcohol users across 21
reporting symptoms declined significantly European countries from late April to late July 2020.
for mothers but not for fathers after the Published in Addiction, the study showed significant
baby came home. decreases in average alcohol consumption in every country
Author Craig Garfield said except Ireland (decreases and increases evened each other
SHUTTERSTOCK / FREEPIK
the finding ‘underscores the out) and the UK – where there was an increase.
importance of reaching out to Less binge drinking was behind most of the reduction.
fathers, who might not even be Those who reported distress were less likely to reduce
aware that they need help’. drinking than those reporting no distress.
u bit.ly/P_fathers_depression u bit.ly/A_alcohol_Covid
12
COMMUNITY PRACTITIONER | JULY / AUGUST 2021
NEWS Research_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 12 08/07/2021 15:31CPJULY2021.013.indd 13 05/07/2021 15:49
NEWS
HS waiting times analyst in the policy team at The Concern for children with SEND,
N have been hitting
the headlines in
recent months as the
immediate pressure
of Covid-19 recedes, and the longer-
King’s Fund. But as she points out,
it was ‘already going in the wrong
direction prior to the pandemic’. So
in fact ‘what the pandemic has done
has increased the pace’.
including those with conditions such
as autism, is echoed by children’s
commissioner for England Dame
Rachel de Sousa, who says: ‘Too
many of these children weren’t
term impact on healthcare services Within that headline figure were getting the right therapies and
begins to be understood. 245,699 children waiting to start support even before the pandemic
The combined effects of routine treatment in paediatric services, with and we know Covid has disrupted
work being halted, especially during almost a third waiting longer than these services still further, and
the peaks of the pandemic, as well the target 18-week period. April was has had a lasting impact. Three-
as staff redeployment, sickness and the first time data relating specifically quarters of families surveyed by
self-isolation, and changes to the to paediatric services had been pulled the Disabled Children’s Partnership
delivery of service, have seen waiting out and presented separately. were experiencing delays to routine
lists lengthen significantly as demand April’s data also showed that appointments and treatments during
has continued – or even risen – while nearly 3000 patients, both adults and the pandemic, and six in 10 families
activity dropped. children, had been waiting for more were still experiencing these delays
The figures are now huge. The than two years to start NHS hospital in April 2021.’
latest data revealed that a record high treatment – another figure captured Disruption has hit every facet of
of 5.1 million people were waiting for the first time. children’s healthcare. The British
for NHS treatment in England in Dental Association (BDA), for
April. Of those, 385,490 patients DISRUPTED AND DELAYED example, revealed that from March to
were waiting more than a year (NHS But even this number doesn’t present May 2020 more than 50,000 children
England, 2021a). the whole picture, even for England in England had surgery postponed.
Five million is a ‘pretty terrifying alone, focusing as it does on hospital- It pointed out that tooth decay is
number’, says Deborah Ward, senior based and consultant-led care. The the number one reason for hospital
picture for community care services admissions among children aged five
is far less tangible, but problems here to nine in England (BDA, 2020).
BIG STORY have also been flagged.
A recent Ofsted/Care Quality ACROSS THE FOUR NATIONS
As waiting lists for NHS Commission report explored the
impact of the pandemic on children
The picture of longer lists and
lengthier waits is also repeated across
services reach record highs with special educational needs and the four nations. In Scotland, waiting
following the pandemic, disabilities (SEND). It highlighted the
absence of essential services such as
times in general have risen for
diagnostics, inpatient and outpatient
journalist Juliette Astrup physiotherapy or speech and language appointments – there were 37%
support during the pandemic, and more new outpatients waiting for
takes a look at what it means long waiting times for assessment and an appointment at the end of March
for children and families. treatment (Ofsted, 2021). 21 compared with a year previously.
WAITING
IN VAIN
ISTOCK / SHUTTERSTOCK
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COMMUNITY PRACTITIONER | JULY / AUGUST 2021
NEWS Big Story_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 14 08/07/2021 15:32NEWS
Of the 354,782 waiting, 51.9% had waiting list, the problem has become developed and exciting new plans to
been waiting more than 12 weeks – so big that children have got lost in it. transform our ND services, too many
double the percentage as at the same A year on a waiting list is such a huge children are currently waiting for
time in 2020 (Scottish Parliament proportion of a child’s life in which specialist assessments.’
Information Centre, 2021). all the things they are supposed
In Wales, the total number of to be doing are interrupted – their WHAT DOES IT MEAN FOR
patients referred but waiting for development, education, family life. CHILDREN AND FAMILIES?
treatment has risen each month since ‘And when you think about Professor Steve Turner, registrar
May 2020, to 595,272 at the end of conditions such as scoliosis, for at the Royal College of Paediatrics
April 2021. This is the highest since example, there is a time-critical and Child Health (RCPCH), says
comparable data was first collected in window in which children need that while the child healthcare
2011, and 34.8% higher than in April surgery and treatment – it is a very community across primary and
2020 (Welsh Government, 2021). big worry if children are missing secondary adapted well during
And Northern Ireland’s waiting that window because of the list. We the pandemic – developing ‘very
lists are the worst of any UK region, have heard of families good systems of provision for
with more than 330,000 patients paying privately for ongoing care’ – ‘services have been
waiting for their first consultant- scoliosis treatment, ‘THE MOST PRESSING substantially redesigned.’ This may
led outpatient appointment; more going to places like CASES WILL BE have meant some patients met
than 110,000 waiting for inpatient Turkey for surgery. problems with gaining face-to-face
or day case treatment; and some We also know many
PRIORITISED, BUT access to services, and operations
130,000 waiting for a diagnostic test parents are now AN OPERATION for children had been cancelled
(Department of Health, 2021). paying privately for CONSIDERED NON- and delayed, as they have across
Again, children are being autism assessment the NHS.
impacted: between March 2020 because the wait is URGENT, SUCH AS A Steve adds: ‘Surgical waiting lists
and March 2021 the percentage of too long. HERNIA TREATMENT, are painfully long and it will take a
children on the list waiting more ‘ENT and long time to catch up. Additionally,
WILL NOW HAVE A
than a year for their first consultant dermatology have specialist tests that children may
outpatient appointment doubled long waiting lists too. LONGER WAIT’ need – a brain scan or endoscopy –
from 22% to 41% (Information When you have a child things that would have been routinely
Analysis Directorate [IAD], who is poorly, that done pre-Covid have been impacted
2020a; 2021b). impacts on the whole too, which is terribly frustrating and
And the proportion waiting more family too, siblings in particular.’ worrying for parents.
than a year for inpatient/day case Professor Sally Holland, children's ‘Clearly the most pressing cases
appointments under a paediatric commissioner for Wales, says: will be prioritised, but an operation
speciality increased from 40% to ‘Neurodevelopmental [ND] waiting considered non-urgent, such as a
69% over the same period (IAD, lists have also continued to be a real hernia treatment or a tonsillectomy,
2020b; 2021b). worry throughout the pandemic, and will now have a longer wait.’
Koulla Yiasouma, NI commissioner here in Wales a lower proportion of While there would be ‘delay in
for children and young people, says referrals are accepted for face-to- some investigations and a likely delay
waiting times are ‘devastating’ for face assessments than in the rest of for operations that aren’t urgent’
families there. the UK.’ compared with pre-pandemic waits,
She says: ‘With one in four people She continues: ‘While I’m he says parents ‘shouldn’t expect
in Northern Ireland now on an NHS encouraged by some recently there to be an additional delay in
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A CLOSER LOOK AT CHILD AND
ADOLESCENT MENTAL HEALTH
SERVICES (CAMHS) SCOTLAND
With between one in six and one in seven The number of children waiting
UK children having a recognised mental over a year to begin treatment
health problem, pre-Covid-19 waiting lists was over 2000 at the end of
had already been ‘unwieldy’, with ‘a lot of March 2021, a record high and
unmet need’, says Professor Steve Turner more than double the figure
of the RCPCH. Covid-19 made things more from a year before.
difficult, as well as exacerbating anxiety
for children during the pandemic. Of all the 11,007 who were
But Steve indicated that children on the waiting list at the end
and young people had found remote of March this year, more than
video consultation and assessment half had been waiting longer
‘very acceptable and very successful at than 18 weeks, compared to
delivering socially-distanced care’. 44% a year before.
Public Health Scotland 2020; 2021
NORTHERN IRELAND ENGLAND
Numbers waiting longer than Last year, just 20% of
the nine-week target period children referred to services
fell from over 700 in March started treatment within
2020 to 174 in October, before four weeks, with 6% – 34,550
beginning to rise again, with children – waiting longer
374 patients waiting longer than 12 weeks.
than nine weeks in January NHS Digital, 2020
2021. Health and Social Care Board, 2021
Over the past year both
urgent and routine referrals
have almost doubled for
eating disorder treatment
in England. The number of
The Children and Young People’s Commissioner Scotland was unavailable for comment.
patients waiting more than
12 weeks to begin treatment
is at a five-year high, having
risen from 45 in the last
WALES quarter of 2019-20 to 278 in
the same period in 2020-21.
In January 2020, less NHS England, 2021b
than 20% of patients
were waiting for a first
appointment over
the four-week target,
rising to 52.9% in Jan
2021 – but in March 21
that figure was down to
24%, compared to 31%
a year previously.
ISTOCK / SHUTTERSTOCK
StatsWales, 2021
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getting a child seen by a senior created a ‘backlog of things that critical window for development
decision-maker for a diagnosis’, and haven’t been picked up’. and education, and a delay in being
could be assured that ‘if investigation The other aspect, she says, is that processed through health services
and treatment is needed to be done ‘many of those people on the waiting will potentially have a much greater
now it will be done’. lists for routine surgery, for example, impact on a child than an adult,
or cancer treatment, are also parents particularly if that child is missing
FLATTENING THE CURVE and grandparents, and that unmet school as a result.’
But as Barbara Evans, a community need creates a great deal of additional Deborah says: ‘We need resources
nursery nurse in the East Midlands, stress for their families too, which is to bring down the backlog, and it’s
points out, it is not only waiting important to be aware of’. also an opportunity to innovate – we
list delays that are a concern, but In addition, there is the can’t catch up just by doing more of
delays in referral and treatment due increasingly well-documented what we were doing before. But we
to changes in the way services were impact of lockdown on the mental must also be honest about how long
provided during the pandemic. health of children and young people, it will take to get things better – it’s
‘Anecdotally, we’ve heard about with issues potentially going missed going to take several years. We need
appointments being cancelled or as children have been out of school. to acknowledge that and support
delayed, and parents waiting a long people who will be on waiting lists
time to see a paediatrician, and then WHERE DO WE GO for long periods of time.’
it’s a phone call – which might be FROM HERE? ‘The pandemic has further exposed
fine initially, but isn’t the best way,’ Moving forward, Steve says it is social and economic inequalities
says Barbara. vital that paediatric waiting lists are between children’s experiences
‘There are subtleties you can only factored into recovery plans. ‘Across and access to services,’ notes
see face to face, and we are now the four nations, chief executives Sally. ‘There needs to be a focus on
seeing a lot of speech delay and some have very much encouraged a ensuring that children who may
developmental delay that wasn’t focus on adult cancer services and have missed out more during the
picked up before. waiting lists for operations, but I pandemic are supported to access
‘Hearing tests also stopped for think it is also important to make specialist services they need. This
a long time, and we know hearing special mention of waiting times includes disabled children, those
issues can impact speech, behaviour for children. living in poverty, and children from
and many things. ‘We’re not saying children are black, Asian and ethnic minority
‘For a child, any delay in diagnosis more important, but they are in a backgrounds.’
and treatment is significant. The right Rachel adds: ‘We should thank
intervention early on can flatten all the NHS staff for their work over
the curve of that trajectory, but
‘CHILDREN WANT TO KNOW HOW the last year, not just in fighting
the longer you wait, the bigger the WE CAN HELP THEM, NOT JUST TO Covid, but in trying to maintain a
development gap gets and the worse GET BACK TO NORMAL, BUT TO DO health service for children and young
it is in the long term.’ people – from the paediatricians
Janet Taylor, CHPVA Executive EVEN BETTER IN FUTURE. IMPROVING helping children manage long-term
chair, also points to a temporary SERVICES CAN BE SOMETHING WE conditions as the world around
drop-off in referrals in some areas, them was turned upside down to the
DELIVER TO THANK CHILDREN FOR
as parents have stayed away, either health visitors who continued to go
through fear or a reluctance to THEIR SACRIFICES’ into homes despite all the risks, to
burden the NHS at that time, which help protect children at risk.’
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Rachel concludes: ‘As we come out THE WAITING GAME
of the pandemic, children will want
to know how we can help them, not
1 in 3
just to get back to normal, but to
do even better in future. Improving
services can be something we deliver
for children to thank them for the children are waiting
sacrifices they have made over longer than 18 weeks
the last year.’
WHAT CAN CPs DO?
Janet says community practitioners
have a vital role in that support for
families: ‘You have the situation
where a child might have significant
behavioural issues, for example,
and needs to be referred to the
consultant paediatrician and the
multidisciplinary team – but can’t
3000
people have been waiting
be seen for six months, and there is
two years or more
nowhere they can go in the interim,
which creates an enormous amount
of stress for that child, their parents,
their siblings.
‘That is where public health nurses
– health visitors, nursery nurses,
school nurses – are providing the
glue in the system that holds these
92%
families together while they wait for
5.1 million
that appointment.
‘They are someone that parents can
go to for advice and coping strategies, The proportion
who can help them understand people waiting for NHS of patients who
what’s happening, and link them treatment in England should be seen
with sources of information and within 18 weeks
NHS England, 2021a
support, such as the NSPCC or under the NHS
constitution
local parenting groups. Even just
listening helps.
‘We can’t wave a magic wand,
but we can provide that therapeutic
385,490
people have been waiting for
more than a year
relationship and support families
where we can.’
ISTOCK / SHUTTERSTOCK
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OPINION
CNO REFLECTION
AND THANK YOU
In part one of our series, the chief nursing officers (CNOs) for
Northern Ireland, Scotland and Wales reflect and thank CPs
for their efforts during the pandemic, and beyond.
Professor Charlotte McArdle, CNO for Northern Ireland
As I pause and reflect on the
past 18 months, we could
never have imagined the
challenges we would face
as individuals, professionals,
countries – as humanity
as a whole.
There is no doubt that this period has
been one of the most challenging ever faced
by the health and social care system. The
evidence indicates the significant impact
the pandemic has had on children, young
people and their families in relation to social
isolation, separation from family supports,
school closures and limited access to services.
But I can say with certainty that, as a
profession, health visitors, school nurses
and support staff have courageously risen
to the challenge in a positive, proactive and
solution-focused way to ensure the delivery
of safe, effective and compassionate care to
children, families and communities.
INTERNATIONAL COUNCIL OF NURSES / SHUTTERSTOCK
HEALTH EQUITY REPORT addressing the social determinants of health to create the conditions needed to
The response has driven forward innovations and building an equitable and sustainable better incorporate addressing the social
across health visiting and school nursing society for our children, young people, determinants of health into their work.
in adapting to new ways of working and families and communities. As we start to rebuild our health and
moving towards digital transformation It has been a great privilege that my team social care system from the pandemic,
to meet the needs of our children, young and I worked with the World Innovation this resource will play an important role in
people and families. ChatHealth, virtual Summit Health, Professor Sir Marmot, supporting nurses, HVs and school nurses to
contacts and virtual group work have been Dr Hannaway and Dr Rosa to publish the enhance their focus on promoting wellbeing,
introduced where face-to-face contacts have report – Nurses for health equity: guidelines preventing illness and protecting health.
not been possible. for tackling the social determinants of health As CNO, I am extremely proud and
Community practitioners have been (bit.ly/WISH_report). It aims to raise grateful to you all for your dedication,
the true leaders in delivering the Covid-19 awareness across health and social care commitment and professionalism
vaccination programme. As nurses, HVs and systems worldwide, with guidelines and throughout this unprecedented time.
school nurses, we have a significant role in actions to support and enable nurses Thank you for everything you do.
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Amanda Croft, CNO for Scotland
Much focus during the pandemic
has rightly been on our older
adults, acute services and those
in care homes. But it is important
that we also acknowledge the
responsive innovation of HVs,
school nurses, community
midwives and all our community health staff.
The commitment of our community
practitioners has shone through – they
transformed modes of service delivery almost
overnight, swiftly incorporating IT solutions to
engage to support families, ensuring continued
support and advice was readily available and
accessible. The uniqueness of the health visiting
role, engaging with almost all babies through
to pre-school children in Scotland, proved
critical by enabling continuity of support from
a health professional and the continuation of
key child health promotion and developmental
surveillance. School nurses moved into roles, in
some areas, they were not familiar with and their Sue Tranka, incoming CNO for Wales
concentration on supporting our most vulnerable
children will have been vital for their development
and protection. I have been very CPs HAVE SHOWN
Most children and young people may not have impressed with what FLEXIBILITY, WILLINGNESS
been directly impacted by COVID-19, but the I have heard and
AND ACCEPTANCE OF
indirect effects have been considerable. We have seen of the dedicated
seen increases in child protection concerns, hard work of HVs, THE NEED FOR RAPID
domestic abuse, and child and maternal mental school nurses and AND SIGNIFICANT
health problems. The continued contribution of other community
our community children’s health staff throughout nursing practitioners during the
CHANGE IN THE
the pandemic has been fundamental, in the pandemic. They have shown EMERGING HEALTH CRISIS
provision of early support and wherever possible flexibility, willingness and
preventing escalating need, mitigation of trauma professional acceptance of the need
and risk from adversity. for rapid and significant change in who were shielding and ensuring
The contribution of HVs, school nurses, the emerging health crisis, and they every child remained seen, heard and
midwives and community health staff has been are now vigorously addressing the supported. This dedication, when
invaluable as part of the whole NHS response. longer-term impacts of the pandemic some staff were redeployed to areas
I know the pandemic has impacted all of us in resolving the build-up of health need where their extensive expertise was
some way, which is why I want to wholeheartedly in our communities. required to support other clinical
thank this workforce for their continued efforts, Their expert knowledge, skill and areas, has been inspiring.
leadership, resilience and professionalism experience in population-based I will be joining the team in
throughout. I applaud each and every one of you. public health has been drawn on to September, helping to take forward
support a practical on-the-ground the challenges of recovery and
response, delivering –among other support the dedicated staff in meeting
things – the first-class response to the needs of the people of Wales. I
SCOTTISH GOV / SHUTTERSTOCK
mass vaccination that has seen Wales would like to thank the contribution
lead among the UK nations. HVs, school nurses and other
Innovative change has transformed community nursing practitioners
health provision within the have made not only in the response to
community, including utilisation of the pandemic but on the foundations
virtual technology, working together they are laying to make Wales a
across professional boundaries, healthier, happier and more equitable
supporting children and families place to live.
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OPINION CNOs_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 21 08/07/2021 15:34OPINION
HERE’S WHAT
YOU TOLD US…
Sharing some key findings from the Community Practitioner
2021 readership survey.
REACH AND BENEFIT More than
Nearly
88% 1/3
of you felt the journal
90%
of you usually
pass on your copy
of you consider
Community Practitioner
to be a key benefit
of your Unite-CPHVA
membership
ner
has been a source of
support during the
Covid-19 pandemic
of Community And for 70%, the journal rnal
Practitioner to one influenced your decisionsion
or two other people to join in the first place
ce
PRACTICAL CONTENT
85%
of you think the
articles in Community
Nearly
¾
think the research
paper summaries
Practice-related
content and
Practitioner are research are
clearly written and in the journal and important to
easy to understand full online versions readers, with
inform practice an appetite for
reflections (45%
want to read more)
Almost
80% 73%
say the journal has
improved practice
have used tips and
advice given in the
knowledge or journal at work
understanding
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OPINION Reader S_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 22 08/07/2021 15:34OPINION
DESIGN
More than
87%
think the number of
9 in 10
think the journal’s design is either
attractive or helps to improve the
images used in the overall reader experience
85%
journal is about right
think the same for the
colour scheme used
WHO TOOK PART THANK YOU
AND WELL DONE!
¾ 72%
of respondents
work for the NHS,
of you listed practice as the
main function of your role
A big thanks to
everyone who took
the time to fill out
the survey, and
congratulations to
the two respondents
the majority as
health visitors (59%) (including Elspeth
Amos) who each won
The varied list of a £75 M&S gift card
other professions in the prize draw.
included school nurses,
community nursery
nurses, team leaders
and practice teachers
97%
and Gift card
just
270 members completed the survey between 2 March and 28 April 2021.
of respondents
were female over
half
aged 55-64 ANY MORE
THOUGHTS?
76%
If you didn’t manage to
complete the survey, but
would still like your voice to
SHUTTERSTOCK
be heard, or you have an
article suggestion, please
email the editor aviva@
a parent or carer communitypractitioner.co.uk
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COMMUNITY PRACTITIONER | JULY / AUGUST 2021
OPINION Reader S_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 23 08/07/2021 15:35PRACTICE
HEALTH AND
A round-up of the
inaugural one-
WELLBEING
day Unite-CPHVA
virtual conference
2021 – from
FOR ALL AGES
sustaining your
own workplace
Janet Taylor
resilience to 2:58
the impact of
lockdown on
babies, expert
speakers explored
the issues for CPs
through the lens of
Covid and beyond.
WELCOME
anet Taylor, chair of the CPHVA
J Executive, welcomed both speakers
and delegates, setting the scene
with a few words about challenges
Charlotte
of the past 18 months, adding: ‘Personally, on
McArdle 7:25
behalf of Unite-CPHVA, I would like to thank
you all. Throughout this journey we have
learned a lot, and had many challenges, but you
have maintained services and continued to visit,
regardless of circumstances.’
She also welcomed special guest speaker Really fascinating talk
Charlotte McArdle, chief nursing officer for
Northern Ireland, who spoke to delegates ahead
from @MarkWilliamsFMH
of the start of the conference, praising their on paternal MH. As a
work during the pandemic, including their male entering health
‘leadership ability’, ‘extreme dedication’ and
contribution to the vaccination programme.
visiting it’s a topic that
Charlotte stressed how important it is ‘to say really resonates with me
it’s okay to say you’re not okay’, and spoke of
the need to rebuild with optimism and the role
#CPHVAWellbeing21
of nurses and midwives as ‘holders of hope and PAUL WRIGHT
champions of change’. @lefty22_
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COMMUNITY PRACTITIONER | JULY / AUGUST 2021
PRACTICE Confere_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 24 08/07/2021 15:39PRACTICE
MENTAL HEALTH
AND RESILIENCE
‘AN EXPERIENCE THAT WILL HAUNT
Tips and ideas to support
ME FOREVER’
resilience, especially when Sam Williams
That’s how Sam Williams, health visitor with 12:47
working remotely, peppered
the Flying Start service in one of the most
chartered psychologist
deprived areas of South Wales, described the
Dr Derek Mowbray’s
experience of her redeployment to an intensive
presentation as he led delegates
therapy unit (ITU) for eight weeks at the
through aspects of mental health
epicentre of the first wave of the pandemic. But
and wellbeing at work.
her time at Aneurin Bevan University Health
He began by setting out the
Board was also a time of learning.
four pillars of resilience: self-
She said: ‘I don’t think anything prepares you
esteem, self-efficacy, motivation
for seeing death every shift, caring for patients
and mental control.
in full PPE, communicating with families over
He spoke about ‘resilience as
the phone, while relearning critical care nursing
a choice’, urging people to give
skills and worrying about infecting my family.’ and virtual consultations had not captured
time to list out what ‘makes you
There were positives too, including reigniting the true picture of families’ vulnerabilities,
feel great about yourself’, and
her passion for health visiting, being inspired especially for those where no previous triggers
‘what things entice you out of
to complete her master’s, and sharing her or risks had been identified.
your normal comfort zone’.
expertise with her team around PPE. She also found families ‘really grateful’ for
Other tips included dividing
She describes a ‘mixed bag of emotions’, the return of home visiting, which made them
the remote working day into
including guilt at leaving families in ITU and realise ‘they weren’t on their own’, and an
bite-sized activities, taking
at leaving her own team. She also felt unable influx of families asking for support.
time to both plan and review,
to share what she’d experienced because she Sam spoke too about the continued effects
anticipating adversity,
didn’t want to frighten colleagues and was still of the pandemic on public health, which she
expressing gratitude and
processing it herself. called the ‘overlooked frontline’.
assessing your own wellbeing.
On her return to health visiting and home The pandemic had shown how ‘unique and
He urged the conference
visits, she said it became obvious that telephone important’ the role of the health visitor is.
attendees to ‘tell yourself how
fantastic you are in the mirror’
first thing in the morning, and
reflected on the importance HOW ARE Mark
Williams 5:56
From sleep deprivation to
of social time with colleagues YOU, DAD? post-traumatic stress disorder,
and the need for work to be fun
Paternal mental health to feelings of guilt and
and rewarding.
campaigner Mark Williams inadequacy and worries about
He also advocated for ‘more
spoke about the importance bonding, fathers have many
leadership, less management’, a
of including fathers in the of the same issues as mothers
shift that includes giving control,
conversations around perinatal in the postnatal period,
instead of taking it, and nurturing
mental health, sharing his own explained Mark.
and prioritising the team.
struggles with mental health He said one in 10 dads
after the birth of his son. suffers postnatal depression,
He began by describing and up to half of fathers
his first panic attack in experience depression if they
Dr Derek
Mowbray 9:10
hospital when he was told his are looking after partners with
wife needed an emergency postnatal depression.
C-section: ‘Thinking that my ‘We’ve got to start asking
wife and baby were going why aren’t we screening
to die in front of me, for me ‘couldn’t tell anyone’ what he fathers for mental health when
personally, was absolutely was feeling. Years later, Mark we know the biggest killer of
horrendous.’ realised he’d never been able men under 45 is suicide.’ He
Mark describes how his to talk about that experience, also pointed out that fathers
personality ‘totally changed’ and he began a support group experiencing paternal mental
after the traumatic birth of his for ‘fathers reaching out health issues often go missed
son, but with his wife suffering to support other fathers’: and ‘end up in mental health
with postnatal depression he howareyoudad.org services years later’.
25
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PRACTICE Confere_COMMUNITY PRACTITIONER JULY_AUG_Community Practitioner Magazine.indd 25 08/07/2021 15:39You can also read
