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Paediatric and child health services must be protected from redeployment of staff and space in the future to safeguard the welfare of vulnerable and unwell children. Across the NHS, there was rapid reconfiguration in response to the COVID-19 pandemic. As children are rarely clinically affected by the disease, paediatric staff and services were often considered lower priority and therefore were reassigned to support the pandemic response. This was the right thing to do at the time. However, it is clear that children have disproportionately suffered during this period and they must now be prioritised.
Between April and July 2020, we collected weekly data from paediatric services about the impact of COVID-19 (see online supplemental material). Our study found that in this period, up to 10% of all paediatric staff were not available to work (eg, shielding). Up to 22% of junior paediatric medical staff (on the tier 1 rota) were redeployed to adult services, and up to 46% of community child health trainees and 14% of community career grade staff were also redeployed within paediatrics. By July, 10% of trainees were still not working in community settings (see figure 1).
Children have been subject to ‘hidden harm’ during lockdown, including domestic abuse and increased mental health problems due to lack of school and socialising.1 COVID-19 has also had an unequal impact on children, depending on their ethnicity, affluence and socioeconomic status. Therefore, the loss of staff in community services is particularly concerning because they provide care to the most vulnerable children at greatest risk during lockdown. This includes child protection and non-accidental injury medicals, adoption and fostering process, attention deficit hyperactivity disorder and autism spectrum disorder assessments.
During lockdown, there were worries about children with critical illnesses not accessing services in a timely way and suffering avoidable harm. A total of 309 cases of late presentation during the 12-week data collection period were reported. The most common conditions were linked to diabetes, followed by deliberate self-harm, sepsis, mental health problems and malignancy. Figure 2 shows the 10 most reported delayed presentation cases. These findings are in line with other studies into delayed presentation in children during lockdown.2
Prior to the pandemic, paediatric services and workforce already could not meet the demand for care,3 and child health outcomes in the UK were poorer compared with similar countries, with rising inequality.4 Redeployment and staff shortages due to the pandemic have therefore posed further challenges on an already stretched system. Heightened anxiety about safety, especially in higher-risk groups such as Black, Asian and minority ethnic (BAME) staff, has also been reported (see online supplemental material).
The paediatric workforce has been working intensely and beyond their usual scope this year. Child health services must be supported to restore their care, so that they are resilient ahead of winter when activity will increase. This includes protection from adult surge policies to ensure all children can see the right person in the right place at the right time.
Twitter @NawsheenNB, @sheffkids65, @Marie_R_Rogers
Contributors Each named author has substantially contributed to the planning, conduct and reporting of the work described in the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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