Abstract
In this section of the journal, in the midst of a pandemic crisis it seemed incongruous to publish on any topic except Coronavirus.
At the time of writing, many health professionals who are members of CoramBAAF are at the frontline of the fight with the virus and some medical advisers and health professionals working with looked after children have been redeployed from their substantive roles to work in other areas of health care provision.
Health service interventions and assessments are critical components of adoption and fostering work. These assessments are usually reliant on face-to-face, clinical contacts with children, carers and families. How can these tasks be completed in a world where direct contact is not advised? What happens now that health staff who are normally involved in these services are not available?
Reflecting on the past few months, I realise that at the onset of the pandemic I felt as if I were facing a huge jigsaw puzzle. The pieces of the world in which I work and which once slotted neatly together were now in a jumbled heap and I had no idea how they would fit back together to make the familiar picture.
Initially it felt as if surely someone would take charge and direct the sector, making sure that normal processes could proceed. But it quickly became obvious that in an area of work where accountability for systems and provision of services is so complex and multifaceted, this was not going to be the immediate scenario.
In the beginning
During February and early March, information about this new virus affecting more and more communities abroad was becoming everyday news. We were warned of a possible approaching pandemic and the Government started delivering messages about preventing the transmission of infections. I became very conscious that many people around me, at home and at work, had limited knowledge about viral infections and how they transmit from one person to another. Suddenly there was urgency about simple preventive public health hygiene messages; teaching the whole population how to wash their hands effectively was a priority. Then the first cases and deaths were being reported in England and we were all catapulted into a rapidly changing and deteriorating situation.
As the Government discussed how the nation was going to respond to the pandemic, looked after children health care teams debated about how they would be able to carry on doing their jobs. There was a clear message that local teams should take note of national directives but put in place their own plans. The end of March was characterised by wave upon wave of information, shifting sands as decisions were constantly replaced by new directives with the resulting confusion and disorientation.
It was during this period that our advice line service at CoramBAAF was becoming very busy. There were lots of queries about the health aspects of fostering and adoption. How would the medical reports required for adopter and foster care applicants be sourced? How could a child adoption report be written if the child couldn’t be seen by a medical practitioner?
Responding to the need for guidance
It soon became evident that although many areas were developing local solutions, practitioners needed more help with interpreting national instructions and greater detailed practice guidance to enable consistent approaches. It was at this point that CoramBAAF took the decision to develop resources and guidance in response to the pandemic.
There were considerable challenges in formulating the guidance. It was clear that contradictory or conflicting advice would be extremely unhelpful to practitioners. Existing communication networks became very important. The CoramBAAF Health Group Advisory Committee, which includes membership from across the four nations and the English regions and continues to be an excellent source of expertise, was immediately available for consultation and discussion. Partnership arrangements with other organisations such as the Royal College of Paediatrics and Child Health and the National Network of Designated Healthcare Professionals became key routes of information exchange and collaboration. Other communication channels with organisations such as NHS England and Improvement, AFA Cymru and AFA Scotland could also be used at this difficult time.
By the end of March and through April, health practitioners were working in the context of an NHS geared to caring for thousands of sick patients. The public of course were ‘staying at home’ as per government instructions. Non-essential health appointments could only be conducted by virtual means in both primary care and community health services. There was a realisation that many elements of services could not be delivered according to specified statutory guidance and regulations. The clarifying government guidance about this situation, and the amended adoption and fostering regulations were not released in a full format until the end of April (Department for Education, 2020).
At CoramBAAF we had responded to our members’ needs for information and suggestions by collating practice points and publishing as rapidly as possible in March. A key requirement became the need to update and redraft the text as government guidance was issued and altered over time.
Looking to the future
As we moved from April into May there was a sense that we needed to think a little further ahead and start to plan in more detail for future phases. The phrase ‘restore and recover’ is now heard in more conversations and seen in more documents. There is a recognition that over the last couple of months, many assessments have been postponed and reports remain unwritten. There is a concern that when schools go back and life returns more to normal there will be a ‘surge’ in safeguarding referrals and that this could potentially further increase the workload for looked after children health teams. There are also concerns that children will not have had the opportunity to access other routine health care such as dental treatment, and that for vulnerable looked after children this could be particularly significant.
As the UK awaits announcements about when the population can return to certain lines of work and when schools may reopen, health professionals are waiting to see when they can safely resume face-to-face appointments to complete adoption and fostering work with children, carers and families.
Just like the general public, health practitioners working in adoption and fostering have been deluged by information. With expertise in science and medicine, doctors and nurses have not only been trying to keep up to date with rapidly changing workplace and prioritisation instructions, not to mention new clinical standards; a great number are trying very hard to also keep abreast of the emerging research, epidemiological and clinical information about this new disease. For many this is exhausting.
In the future we will look back and derive substantial learning from this harrowing time. Feedback we have received already from our practice forums has captured some positive experiences. Practitioners, the public and policy-makers have embraced and valued technology in an incredibly short space of time. There have been numerous examples of ingenuity, problem-solving abilities and pragmatism. Partnerships, working both locally and nationally, have been effective and strengthened in many ways.
There have been opportunities to try out initiatives that practitioners may not have carried out before. In particular, the use of video/telephone calls to engage with children, young people and carers has never been employed to this extent. So far, feedback about this different way of working has highlighted both benefits and difficulties. Some children have enjoyed and engaged with video call health assessments, others have not been willing to come to the phone and some do not have a working device. There is now a much greater recognition of ‘digital poverty’ and its impact.
Practitioners have found that there are different means of accessing information to appropriately inform health assessments and reports, and information has been captured in alternative ways.
Processes and systems have had to be altered over the pandemic period, and there will be opportunities to examine whether any ideas that have emerged could be usefully employed in future practice. On the other hand, this period could well reaffirm that long-established ways of working have been sorely missed and practitioners may welcome as swift as possible a return to normal practice.
I am writing this reflective piece in the week that marks the 200th anniversary of the birth of Florence Nightingale and International Nurses Day. In recognition of Nightingale’s legacy, the World Health Organization designated 2020 the International Year of the Nurse and Midwife. She was a vocal proponent of so many important concepts including hand washing, infection control and the necessity for statistics in medicine. As a nurse, I can’t help wondering what she would have made of global efforts to manage the current pandemic.