This week there is has been much to watch. We are uncertain what releasing of lockdown means in terms of keeping our patients and ourselves safe; what antibody testing of NHS staff may mean, if contact tracing, and wearing of surgical masks in public, and quarantine for travellers, may contain a second wave of Covid-19. We are watching out for the new paediatric multi system inflammatory syndrome, vaccine development , and the scramble for Covid-19 trial outcomes. What does seem certain is that harnessing new ways of working, planning the recovery of services and maintaining social distancing will be important to maintain for many months as we move out of lockdown and start to resume paused activity.
Please do take the time to respond to the request the questions in the survey so that Bspghan can support members in capturing beneficial clinical changes
Update to RCPCH advice – Shielding children
BSPGHAN continues to work with colleagues in the RCPCH to produce guidance on which children remain more at risk of COVID-19 related disease. It hasn’t been straightforward to produce the update with the uncertainty of what the releasing of lockdown/ school return will mean at this stage of the pandemic. Publication of the document is expected this week. The delay will allow engagement with colleagues in primary care, and more widely across the UK through the CMOs, thereby maximising the benefits of the update into a wider policy around shielding.
Resetting, restoring and recovering services
The ability of PGHAN services to deliver care during the pandemic has also been tested. Now we are moving forward re-starting services. The need for ‘COVID- safe’ practice with social distancing, will be a reality for the medium to long term and challenge our ability to manage the backlog of clinics and endoscopy cases.
A robust system of documenting patients waiting, and triaging is important.
The RCPCH has set out principles for recovery here:-
- Planning children’s health services should be reset and underpinned by data and evidence so that innovation and new models of care that meet the needs of children and young people are maintained.
- Delivery of children’s health services should be restored so that all children and young people receive high-quality, safe and effective care in every setting, ensuring timely diagnosis with a particular focus on supporting community services. There should be no diminution in facilities and adherence to current standards must be maintained.
- The paediatric workforce should be recovered, bringing paediatricians back to children’s services and their training pathway, including sharing new ways of working with a focus on wellbeing.
Capturing beneficial clinical changes in the NHS – please check the NHS E survey questions in the link and please respond to enable Bspghan to share innovative ways of working with members.
In response to the challenges of delivering care during the pandemic, new and innovative ways of working have been rapidly developed across the NHS.
As we move into the next phase of NHS recovery, NHSEI wants to ensure beneficial changes to care are embedded in our services so that patients benefit over the next 12 months and beyond.
BSPGHAN will send in a response, to be populated by your returns.
I am keen to hear from everyone (not just from those in England), what beneficial clinical changes/ innovations have occurred within our speciality to share with members.
Please think of examples of what you’ve seen working well that should be captured and sustained, and what is needed the sustain the change.
It would be handy to describe the impact of these innovations in terms of patient’s outcomes , safety, productivity and how the benefits are measured.
Please do take the time to :-
- a) email me at President@Bspghan.org.uk with your examples and
- b) open the short survey questions in this link – members in England can of course respond and share your thoughts too.
Impact of pandemic on Training
Training have been disrupted with a loss of the usual learning opportunities, particularly where endoscopy procedures and clinics have not taken place.
As clinical services begin to be restored, the urgency to deliver on the backlog of elective care, and the need to limit face-to-face clinics will continue to compromise training opportunities.
BSPGHAN Trainees have found ways to interact and learn with weekly Zoom teaching to make up for lack of opportunities to meet the curricular requirements in the expected way.
BSPGHAN will support these sessions and endorse these as we hear that for around 50% of trainees, formal weekly teaching has not been restored.
Trainees have been advised by CSACthat changes have been made to ARCP outcomes; see https://www.copmed.org.uk/publications/covid-20 to enable as many doctors in training as possible to progress. PGHAN supervisors are asked to focus on delivering high quality supervision and teaching with clear plans to address the shortfall in experience that has resulted from the loss of training opportunities during the pandemic.
Epidemiology, Clinical Features, and Disease Severity in Patients with Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in New York City, New York
Key findings from a case series of 50 children and adolescents 21 years and younger hospitalized with COVID-19 infection.
- Respiratory symptoms, while common, were not always present.
- Children commonly had comorbidities (immunosuppression including solid organ transplant * neurological disease, asthma, genetic and cardiac disease etc)
- Infants and immunocompromised patients were not at increased risk of severe disease.
- Obesity was significantly associated with disease severity.
- Elevated inflammatory markers were seen in those with severe disease.
*including hepatitis in one patient who received a liver transplant for whom the donor was found to be SARS-CoV-2–positive posttransplant
I hope that these updates are of interest and that you and your family and friends continue in good health.
As always, I welcome your feedback via email President@Bspghan.org.uk
7th June 2020