Tides of change - How do we make the new normal better than the old one?

In this blog, Dr Nicola Jay, Officer for Workforce Planning and Health Services, reflects on the long road to recovery ahead, recognising that equality has to be at the core of our work going forward.

We all thought a tsunami was coming, and depending upon where you were when it hit, the height and depth of the wave has been different. In South Yorkshire & Bassetlaw, our greatest strength has been communication via our paediatric network, ODN critical care and organisations that have listened to us clinicians. We have had weekly virtual network meetings that I hope has kept us all informed, sane and thus empowered to do our best for children. We have laughed, despaired and supported each other as I'm sure many of you have, too.

The nervous energy has gone and I’m feeling a sense of weariness but maybe not in the way you think. I’ve realised I can cope with disasters and pandemics, but not with deliberate acts of unkindness such as we have seen in the US. Hate has no place in society, be it related to ethnicity or other characteristics. There is a lot to do.

It is essential that paediatric services are supported to Reset, Restore and Recover. However, the “three Rs” do not quite capture the uncertainty we are living in: How will easing of lockdown affect cases? Will there be a second peak? How large is the backlog of patients? How has children’s health been affected by the lockdown, and what support will they need?

I know that restoring services is an enormous undertaking, when many of us are feeling depleted. We are trying to do the best for our patients but we all know how rapid continuous change can have a negative effect on us as well as some of the changes not being welcome by all with a view of “just getting back to the way it was”. These are valid feelings / thoughts and need to be voiced.

Paediatric services across the UK have been submitting data every Friday for 10 weeks now, for our Impact of COVID-19 on Child Health Services study. Sometimes referred to as a “temperature check” of services, this information will be crucial to supporting restoration. Everyone can see summary findings, and RCPCH members can register for an account to view the findings in more detail on the dashboard.

We have already fed findings into the Child Safeguarding Information Group, Office of the Children's Commissioner, the Cabinet Office as well as various streams at the Department of Health and Social Care and Public Health England. We have also supported some hospital teams directly due to the worries they had.

The findings will continue to be essential for campaigning for prioritisation and consideration of paediatrics, and we will be writing up a report after 12 weeks of data collection. 

Forefront of my mind is the specific struggle that black, Asian and minority ethnic (BAME) colleagues have had during this time. I have heard the expressions of anxiety in the main, and at times anger. 

We’ve known for a long time that things are not equitable for all colleagues. Across the NHS, BAME staff are less likely to be in senior management positions. In paediatrics, people who did their medical degree in a non-UK country have to make more job applications before getting a consultant post

These findings are not in isolation, they are within a society of pervasive inequality and structural racism. Black women in Britain are five times more likely to die in childbirth than white women. Children from ethnic minorities with diabetes have poorer outcomes (PDF). But, how well did Marcus Rashford do!? He is a young black man who has improved the life of millions of children and yet this has not been celebrated in the way it should.

The RCPCH has recognised that they have not always been leaders in this area and has made a commitment to do better. To listen, act and change. I am committed to being part of this in my role at the College.

We will ensure better data collection on ethnicity of individuals, for example consultant interview candidates, and we will act on the findings. There is no point in data collection unless you formulate a plan of action and implement it. We already have been working with and providing data to the Workforce Race Equality Stream, led by Professor Mala Rao. 

I recognise that things are never going to return to how they were in the past, but there are some parts of the past we should never return to.