It feels like a particularly bleak mid-winter, doesn’t it? I usually find my cycle commute is a brilliant way of getting mentally ready for the day, and also winding down at the end. However this week, I’ve just been focussing on staying alive! The bitterly cold wind and frozen roads are definitely reasons to not let one’s mind wander off onto an interesting new idea or attempt to solve some complex problem!
I think the weather is mirroring the mood on the clinical shop floor, too. It’s just so busy that there really isn’t time to think about anything else – other than seeing the patient in front of you and dealing with the gnawing concern about all the children in the waiting room who are yet to be assessed. It was already a very busy winter with the usual panoply of viruses… And then Group A Strep arrived.
Group A strep
Update - 17 February 2023: The NHS England interim guidance to which Camilla refers is stepped down, and clinicians are advised to use NIC guidance on sort throat - see news page.
While we are all used to Group A Strep infections and recognise that some years are worse than others, what we were perhaps unprepared for was the Group A Strep season shifting from early spring to winter, and this has placed enormous pressures on an already fragile and highly pressured system. The messaging to parents has been challenging given scarlet fever presents similarly to other winter viruses, and the media interest in this infection has meant that the public has understandably become very anxious.
We have been in close contact with the UK Health Security Agency (UKHSA) and collaborated with the Royal Colleges of Emergency Medicine and General Practitioners to publish a statement that provided a single unified voice on this issue – recognising that parents and clinicians were getting lots of differing advice which was adding to alarm levels. We are now watching the situation closely and would encourage members to look at the interim clinical guidance to support with management of these children.
The Christmas school holidays will provide a welcome break in both bacterial and viral transmission. This also provides UKHSA and NHS England an opportunity to undertake further investigations into some of the more severe cases of invasive Group A Strep infection so that we can understand this current wave of infections better. If we find that Strep A infections persist into early 2023, the results of these investigations will hopefully give us more information about how to respond to parents and public concern. There is also early evidence that RSV levels in the community have peaked and so we can only now hope that the current intense levels of activity calm down somewhat.
Advocacy on air quality
Despite the winter gloom, I am conscious that there is a fantastic amount of positive news out there! Last week we welcomed the Chief Medical Officer’s annual report 2022 which focusses on air pollution, aligning completely with our vision for how our health inequalities work will evolve next year to consider the impact of climate change.
It is important to be reminded of the progress that has been made in outdoor air quality. Clearly there is still much more to be done, and the CMO makes the very important point that most of our days are spent indoors and so the quality of indoor air must get some focus too, which chimes with work that RCPCH has already done.
Understanding disagreements in healthcare
We have all been involved in the care of babies and children with complex health needs where disagreements arise between the family and the healthcare team. This situation places huge pressure on our teams and is also very distressing for families.
It is therefore very welcome news to learn that the Nuffield Council on Bioethics has been commissioned by the Department of Health and Social Care to undertake a review of these disagreements in order to establish advice and recommendations. I think this is really good news and a very positive step forward.
Investment in genomics
Another positive development is this week’s announcement of a £105 million investment to kickstart a world-leading research study, led by Genomics England in partnership with the NHS, to explore the effectiveness of using whole genome sequencing to find and treat rare genetic diseases in newborn babies.
The plan for the project is to sequence the genomes of 100,000 babies around the country to see if this project is feasible and could be rolled out to the entire population. RCPCH is a stakeholder in this work, and we have members on all the workstreams to fully understand the ethical implications, the impact on the workforce and the many other ramifications. Join us at a free to attend webinar early next year to hear more about these exciting developments.
My thanks to you
I’m struck that this is my last message to you in 2022. It is coming at a time when being a paediatrician feels really tough and sometimes quite thankless. I know how deep people are having to dig to keep their spirits up. I cannot thank you all enough for the incredible work you do for babies, children and young people 365 days of the year.
I know that our patients and their families are incredibly grateful too and if you have any doubts about that – or just want to lift your spirits - take a listen to the first ever podcast made by our young volunteers of RCPCH &Us. It is both clever and moving, and the “moo” that punctuates the podcast is very funny!
Finally, it is the season to be merry and the whole College team knows that it isn’t always easy to feel that way in the depths of a bad paediatric winter. We've pulled together a ‘seasonal selection’ for this festive period: highlights from our work with you in 2022, members' wellbeing tips and a few cracker jokes, which I think you’ll enjoy. My favourite cracker joke is the one about who looks after Santa when he is poorly...!
Wishing you all good health and happiness over this holiday time and looking forward to the brilliant work that we will all achieve in 2023.
My very best wishes to you – and take care,
Camilla
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