Challenges to pediatric services during COVID-19 pandemic: A London, UK perspective

To the Editor:

Bansal et al's paper¹ on clinician wellness is a welcome addition to the growing canon highlighting the importance of maintaining a psychologically healthy workforce. We identify with the COVID-19 challenges to wellness, including the new anxiety around staff mortality that the article highlights so well, and wish to provide a pediatric trainee perspective regarding the adjustments that have been made thus far to mitigate some significant changes to service provision and training.

In the north London pediatric network to which we belong, we have witnessed an unprecedented reconfiguration of pediatric services, with the temporary closure of 2 pediatric emergency departments and 5 inpatient pediatric wards. Although this has enabled the crucial redeployment of nursing and medical colleagues to areas of highest need, with up to 10% of the pediatric medical workforce unable to work due to sickness or self-isolation,² there has been a striking diminution of the familiar teams we once worked alongside. Still, adversity often breeds creativity and the challenges faced have proffered new avenues. Our service has rapidly adapted to telemedicine clinics, and clinicians shielding due to heightened vulnerability to COVID-19 have been reassigned to this alternative model. The trainee rota has been rationalized, with strategic adjustments made to reduce the risk of burnout. The rapid creation of new regional hubs for Paediatric Ambulatory Care and Mental Health Services has been successful in diverting those requiring dedicated but nonacute care away from the increased risk of COVID-19, whilst ensuring that the needs of its stakeholders continue to be met. Alongside this has been a more explicit focus on clinician well-being, with innovative approaches embraced. Who could have envisaged several months ago that newly grounded cabin crew from the aviation industry would customize a “First Class Lounge” area of the hospital coffee shop, bestowing their free time, kindness and to those inclined, valuable crisis resource skills, to hospital staff seeking a short break.

In common with other specialties, there has been widespread disruption to pediatric training in the United Kingdom, with examinations and courses critical for career progression on hold. With the added challenge of reaching those trainees temporarily dispersed elsewhere, a coordinated approach to meet training needs via regional networks has been adopted. Virtual teaching has been wholly embraced, with the incidental benefit of capturing a greater audience due to its ability to be recorded and then watched at a more convenient time.

We are hopeful that the focus on clinician well-being can be maintained, even as the acute stresses of working in a pandemic dissipate. Organizations that have a genuine culture of staff well-being at their core often do better with recruitment, retention, and productivity, all essential qualities for a sustainable, high-quality health service. The gains may indeed have been borne out of hardship, but we should look toward the future, embracing the changes made to improving clinician wellness.