Chiumento, Anna 
ORCID: 0000-0002-0526-0173, Baines, Paul, Redhead, Caroline ORCID: 0000-0002-7464-2853, Fovargue, Sara, Draper, Heather and Frith, Lucy ORCID: 0000-0002-8506-0699
(2021)
Which ethical values underpin England's National Health Service reset of paediatric and maternity services following COVID-19: a rapid review.
BMJ OPEN, 11 (6).
e049214-.
|
Text
Which ethical values underpin Englands National Health Service reset of paediatric and maternity services following COVID-19.pdf - Published version Download (619kB) | Preview |
Abstract
<h4>Objective</h4>To identify ethical values guiding decision making in resetting non-COVID-19 paediatric surgery and maternity services in the National Health Service (NHS).<h4>Design</h4>A rapid review of academic and grey literature sources from 29 April to 31 December 2020, covering non-urgent, non-COVID-19 healthcare. Sources were thematically synthesised against an adapted version of the UK Government's Pandemic Flu Ethical Framework to identify underpinning ethical principles. The strength of normative engagement and the quality of the sources were also assessed.<h4>Setting</h4>NHS maternity and paediatric surgery services in England.<h4>Results</h4>Searches conducted 8 September-12 October 2020, and updated in March 2021, identified 48 sources meeting the inclusion criteria. Themes that arose include: staff safety; collaborative working - including mutual dependencies across the healthcare system; reciprocity; and inclusivity in service recovery, for example, by addressing inequalities in service access. Embedded in the theme of staff and patient safety is embracing new ways of working, such as the rapid roll out of telemedicine. On assessment, many sources did not explicitly consider how ethical principles might be applied or balanced against one another. Weaknesses in the policy sources included a lack of public and user involvement and the absence of monitoring and evaluation criteria.<h4>Conclusions</h4>Our findings suggest that relationality is a prominent ethical principle informing resetting NHS non-COVID-19 paediatric surgery and maternity services. Sources explicitly highlight the ethical importance of seeking to minimise disruption to caring and dependent relationships, while simultaneously attending to public safety. Engagement with ethical principles was <i>ethics-lite,</i> with sources mentioning principles in passing rather than explicitly applying them. This leaves decision makers and healthcare professionals without an operationalisable ethical framework to apply to difficult reset decisions and risks inconsistencies in decision making. We recommend further research to confirm or refine the usefulness of the reset phase ethical framework developed through our analysis.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | medical ethics, COVID-19, health policy, protocols & guidelines, qualitative research |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health Faculty of Humanities and Social Sciences > School of the Arts |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 01 Jul 2021 14:06 |
| Last Modified: | 18 Jan 2023 21:37 |
| DOI: | 10.1136/bmjopen-2021-049214 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3128414 |
Dimensions
Dimensions
