Posted 17 April 2020 - 12:13
Posted 17 April 2020 - 12:13
Analysis
COVID-19: how redeployment is affecting children’s services
Increasing capacity in intensive care will have knock-on effects for children
Increasing capacity in intensive care to cope with the COVID-19 pandemic will have knock-on effects for children
- Paediatric intensive care units are being encouraged to admit young adults during the COVID-19 pandemic
- Redeployment of specialist children's nurses is having a knock-on effect on neonatal units and children's services
- Concerns about the secondary health effects of lockdown and its effects on safeguarding
Children are much less likely to fall seriously ill from COVID-19. But that does not mean children’s nursing services have been left unaffected by the pandemic.
Staff are being redeployed, while children's services are being overhauled and – in some cases – cut entirely.
Paediatric units are being encouraged to admit young adults
With so much demand on intensive care, paediatric intensive care units (PICU) have found themselves at the forefront of the effort to find more capacity.
The Paediatric Intensive Care Society (PICS) says the impact has been twofold. Paediatric units are being encouraged to admit young adults, while some staff have been redeployed to adult units.
So far, services in London and the West Midlands have been particularly affected.
PICS vice president Carli Whittaker says intensive care nurses are ‘understandably anxious’ about what could happen, but she says in terms of caring for adults there is little difference physiologically between a 16-year-old and a young adult.
However, she adds that the limited number of paediatric intensive care beds – there are about 250 in the UK - requires the situation to be managed carefully in line with national surge plans.
‘We have to ensure beds are available for children when they need them. They will still be admitted to intensive care, mainly for non-coronavirus-related illness. Capacity [to cope with patients with COVID-19] can be surged by bringing in specialist staff from other areas, but there may be a limit.’
Staff who have the most relevant skills for critical care are the first in line for redeployment.
0.1%
of under nines who have COVID 19 and are showing symptoms require hospital treatment
The situation has a knock-on effect for neonatal units which, the Neonatal Nurses Association says, are planning to take in children up to the age of six to help PICUs deal with younger adults.
The Association of British Paediatric Nurses (ABPN) says community children’s nurses could be moved as they are often skilled in ventilation from supporting children with complex needs in the community.
Routine care for children with complex needs may be compromised
ABPN chair Katrina McNamara says there is ‘concern’ about the effect this could have on care for children with complex needs, while the push to expand capacity for adult intensive care has already affected the availability of ventilation equipment, including tubing.
‘The redeployment of staff must not be at the expense and detriment of existing services. Services are already hard-pressed and children will still need to access routine and emergency care’
RCN Children and Young People’s Professional Issues Forum chair Jean Davies
Redeployment: what you need to know
With redeployment an ongoing issue for the NHS, the Royal College of Nursing has published detailed guidance on what nurses can expect.
It says employers can normally request staff work somewhere other than their normal environment, but nurses still have a right to feel competent in what they are being asked to do. In fact, that is a requirement of the Nursing and Midwifery Council (NMC) code of conduct.
The guidance says that if you are asked to move you should have a point of contact, and if you do not have any experience with the type of patient you are being asked to care for you should only be asked to deliver the fundamentals of care.
RCN professional lead for children and young people’s nursing Fiona Smith says: ‘You should not be asked to do something which you do not have the skills and competencies for. Look at the guidance and if you have concerns contact the RCN.’
Meanwhile, professional regulators, including the NMC and General Medical Council have issued a joint statement, stressing that they recognise staff may have to ‘depart from established procedures’ during the pandemic and regulatory standards are flexible enough to take this into account.
The key, the statement says, is using ‘professional judgement’ and working ‘cooperatively with colleagues to keep people safe’.
Families are affected in other ways too, she says. ‘Many are supported by the voluntary sector and hospices which are struggling for funding as charity shops have been closed and events cancelled which has had a huge impact on income.’
RCN Children and Young People’s Professional Issues Forum chair Jean Davies shares this concern. She says if the families of children and young people with complex health needs are not supported they risk being admitted to hospital, which places ‘even more pressure on acute services’.
She says this is a risk for all types of children’s services. ‘The redeployment of staff must not be at the expense and detriment of existing services. Services are already hard-pressed and children will still need to access routine and emergency care.’
Focus on COVID-19 is detracting from the uptake of core services for young people
RCN children and young people's nursing professional lead Fiona Smith agrees. She says: ‘The key is getting the balance right across the board.’
She is also concerned about the secondary impact on health with signs emerging that children and young people are being put off using core services by the focus on COVID-19.
0.3%
of 10–19-year-olds infected with coronavirus and showing symptoms require hospital treatment
‘Problems are beginning to emerge in terms of delayed presentation of children to GPs and emergency departments – this needs addressing through messaging to parents and the public. There is also the long-term impact of self-isolating on children and young people’s mental health, as well as domestic violence, particularly for vulnerable children and families.’
The latter point is one the Institute of Health Visiting (iHV) is particularly concerned about.
iHV director of policy Alison Morton says health visitors are now only able to offer face-to-face contact if it is deemed ‘absolutely essential’.
Safeguarding is difficult when health visitors are unable to see clients face to face
‘The majority of the support we provide has to be done remotely – even for vulnerable families. Some areas are further ahead with this than others and are able to use video-enabled technology, but others are reliant on conversations over the phone.
‘The evidence from China and Italy suggests children are going to be much more at risk from the secondary health impact of COVID-19 rather than the infection itself’
Institute of Health Visiting director of policy Alison Morton
‘It is harder for health visitors to spot the signs of problems – safeguarding issues, domestic abuse or mental health problems – if they are not going into people’s homes or seeing them face-to-face.’
1 in 20
hospital cases among under 19s need critical care
Ms Morton says some areas have seen up to four fifths of health visitors redeployed elsewhere, including on to hospital wards, to support older people in the community and even as healthcare assistants.
‘The evidence from China and Italy suggests children are going to be much more at risk from the secondary health impact of COVID-19 rather than the infection itself.’
It is a similar story for the school nursing service, although School and Public Health Nurses Association chief executive officer Sharon White says ‘thankfully’ many are advanced in the use of technology using text services, e-clinics and Facebook groups routinely.
But she says: ‘School nurses are being redeployed to all kinds of settings ranging from acting as healthcare assistants to front-line acute care. Those left behind have to try to unravel how best to support our most vulnerable.’
The impact of redeployment on nursing students
Nursing students in their final year have been invited to spend the last six months on a paid clinical placement to help with the COVID-19 crisis.
Bournemouth University senior lecturer in children and young people’s nursing Duncan Randall says children’s nursing students are not being ‘pressed’ into action yet, but there are concerns this could happen as the pandemic escalates.
‘Some students may feel able to be redeployed, but others will not. We are sending a strong message to our students that we will support them in adhering to the NMC code which indicates they should not accept tasks or work that they do not feel competent or confident to undertake, and for which they may not have received adequate training and preparation.’
He also says he is concerned about the impact the redeployment of senior staff away from children’s nursing could have on all students.
‘This leaves our students unsupported with potentially no one to assess their progress or support them during this difficult time.’
Nick Evans is a health journalist
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