Sunday, 31 January 2021

Trauma informed practice: caring for our patients, and our colleagues

Until the middle of last week, I don’t think I had ever heard of the little French town of Crepy-en-Valois. This small town is situated just 40 miles outside of Paris. It has a population of around 15,000 people. Having lived in a small town before, I know such towns can be a little like the metaphorical Peyton Place (if you were born after 1969, ask you parents what this means). It was J who brought this small town to my attention. She taught English (as part of her French degree) there from 1989 and still has friends made there on social media. Last week, the Crepy Facebook site posted that they were closing their Covid vaccination centre due to having run out of supplies, and wanting to conserve the remaining stock so as to give the second vaccination as per Pfizer and World Health Organisation guidelines.  

Of course, the supply of vaccines was much in the news last week. It worries me, and I know from many of the meetings I attended last week, other people are concerned too. Many of those people are senior NHS managers and leaders. However, it wasn’t the supply of vaccines that rose to the surface of my mind when I was thinking about this week’s blog. It was something else, that came from reading up on that little French town. And it was something I had forgotten all about.

In 1982, the second deadliest road accident in France’s history occurred. The deadliest was of course, the terrorist lorry attack in 2006 on Bastille Day in Nice. That night 86 people were killed and some 458 were injured after a lorry was deliberately driven at them by Mohamed Lahouairj-Bouhel. The 1982 road accident saw 55 people lose their lives, 46 of whom were young children. All were from Crepy-en-Valois. Most died from a fire that engulfed the coach in which they were travelling, and from which they were unable to escape.

It was a tragedy that was almost incomprehensible. Reading the story once more I was reminded of the Aberfan disaster in Wales in 1966, which I have never forgotten. Then 116 children were killed by a huge landslide of colliery spoil. It is certain that such communities don’t easily recover from the trauma of such a catastrophic and sudden loss of so many children’s lives at once. The unexpected loss of anyone is sad, but I think the loss of a child’s life will always be particularly difficult.

The suffering of children was also something of a focus in a couple of the meetings I was in last week. Whilst the UK has one of the highest Covid death rates per million of population, children’s deaths from Covid are very rare and have primarily occurred where the child has a serious underlying health problem. We know from much research that children are much less likely to become infected and if they do, are more likely to have less severe symptoms. However, it is the harm that children may be experiencing as a consequence of the restrictions and political decisions taken to deal with the pandemic that concerns me, and I’m sure many others too.

I attended a safeguarding meeting last week, where the number of children found to be at risk was almost 50% higher than in the previous year. There are other reports of the risks children have been facing as a result of schools being closed. In Ofsted’s annual report, published last December, they noted that teachers were often the first to be able to spot signs of abuse or neglect. Staying at home has meant many children became invisible to teachers and other trusted adults, and as such may well have suffered unseen abuse and neglect. Prior to the pandemic, about 20% of safeguarding notifications came from schools and early year settings. Sadly, for some children, schools provide the only respite they get from the abuse they experience at home.

The pandemic has left many of these children with nowhere to go to escape the trauma of abuse. Childline, the children’ charity helpline, has seen a threefold increase in the number of counselling sessions focussed upon child sexual abuse with the family. Some children said that as a consequence of having to spend more time with their abuser, they had been sexually abused more often during the [first] lockdown. The NSPCC has reported that it has seen a rise of 23% since the pandemic started of calls from adults worried about sex abuse occurring in the home. A number of the reports from children - about a quarter of the calls to Childline - were about abuse that happened recently, and a further 20% talked about abuse that had been going on for at least a year. Unsurprisingly, but very concerning nevertheless, were the calls from children and young people who were spending more time on their own; not having contact with friends meant that they experienced distressing memories of previous abuse. About a third of callers talked about sexual abuse that had occurred over a year ago, and for some children and young people this was the first time they had told anyone about it. These are the ‘hidden harms’ of the pandemic.

Whilst the evidence shows that with the right support, at the right time, children and young people can recover after experiencing the trauma of sexual abuse, some survivors of childhood sexual abuse do not get this support and expert help. In such cases, the impact of abuse in earlier life will be there and can manifest itself in many different way during a person’s life (see here for examples). In the context of the pandemic that worries me. The Office for National Statistics notes that 1 in 4 women and 1 in 6 men have experienced some form of abuse before they were 16 years old. These are statistics, but they are also the people we may well be working alongside each day. I worry as the trauma that many health and social care workers are experiencing in dealing with the pandemic now is, in itself, a retraumatising environment and context.

My last meeting of the week was one where I joined other Non-Executive Directors to explore our duty of care to colleagues working in our health and care services. It was a very interesting and important debate – and there was much acknowledgement of the importance of embracing a trauma-informed approach to both the care of our patients and those with whom we work. If you don’t know what that is, you can find out more here – and whether it’s a Crepy-en-Valois coach crash, Aberfan disaster, child sex abuse or the Covid pandemic we might be facing in the future, we should all strive to build a trauma-informed society (and in the case of the NHS) a trauma-informed workforce.


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