Torbay Council

ObjectivesThis paper reports findings exploring junior doctors’ experiences of working during the COVID-19 pandemic in the UK.DesignQualitative study using in-depth interviews with 15 junior doctors. Interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.12 to facilitate data management. Data were analysed using reflexive thematic analysis.SettingNational Health Service (NHS) England.ParticipantsA purposive sample of 12 female and 3 male junior doctors who indicated severe depression and/or anxiety on the DASS-21 questionnaire or high suicidality on Paykel’s measure were recruited. These doctors self-identified as having lived experience of distress due to their working conditions.ResultsWe report three major themes. First, the challenges of working during the COVID-19 pandemic, which were both personal and organisational. Personal challenges were characterised by helplessness and included the trauma of seeing many patients dying, fears about safety and being powerless to switch off. Work-related challenges revolved around change and uncertainty and included increasing workloads, decreasing staff numbers and negative impacts on relationships with colleagues and patients. The second theme was strategies for coping with the impact of COVID-19 on work, which were also both personal and organisational. Personal coping strategies, which appeared limited in their usefulness, were problem and emotion focused. Several participants appeared to have moved from coping towards learnt helplessness. Some organisations reacted to COVID-19 collaboratively and flexibly. Third, participants reported a positive impact of the COVID-19 pandemic on working practices, which included simplified new ways of working—such as consistent teams and longer rotations—as well as increased camaraderie and support.ConclusionsThe trauma that junior doctors experienced while working during COVID-19 led to powerlessness and a reduction in the benefit of individual coping strategies. This may have resulted in feelings of resignation. We recommend that, postpandemic, junior doctors are assigned to consistent teams and offered ongoing support.

Aims:There are a growing number of organisations working to address theconnections between climate change and health. This article introduces theconcept of ‘theories of change’ – the methodology by which organisations ormovements hope to bring about social change – and applies it to the currentclimate change and health movement in England. Through movement mapping, thearticle describes and offers reflections on the climate change and healthecosystems in England.Methods:Organisations working on climate change and health in England were identifiedand publicly available information was collated to map movementcharacteristics, target stakeholders and methodologies deployed, using aninductive, iterative approach.Results:A total of 98 organisations working on health and climate change (and/orsustainability) were initially identified, of which 70 met the inclusioncriteria. Most organisations target two or more stakeholders, withhealthcare workers, management structures, and government being mostcommonly cited. Methodological approaches identified include Formaleducation programmes; Awareness-raising; Purchasing-procurement power;Advocacy; Financial; Media-messaging; Networking; Knowledge generation; andPolicy making, of which education, awareness-raising, and advocacy are mostcommonly used.Conclusion:There is a tendency for climate change and health organisations in England tofocus on individual level and sectoral change over system change. More couldbe made of the potential for the healthcare professions’ voice and messagingfor the wider climate movement. Given the rapid boom of climate change andhealth organisations in recent years, a mind-set shift that recognisesdifferent players as part of a cohesive ecosystem with better coordinationand collaboration may reduce unnecessary work, and facilitate more cohesiveoutcomes.

The design, construction and maintenance of Critical Infrastructures (CI) is commonly based on standards that are rigorous, so as to withstand any climate or weather-linked pressures. However, due to climate change, climate characteristics may shift, resulting in increased frequency/magnitude of potential failures, or exposure to new unknown risks. As vital components for the normal functioning of modern societies, the resilience of CIs under climate stressors encompasses their structural integrity, their operational elements, and their capacity to maximize business output. In this work, we propose an integrated and participatory methodological approach to enhance the resilience of interconnected CIs to urban flooding under climate change, by assessing the risk and introducing adaptation measures.The main objectives of the proposed methodology and approach are: (i) to provide scientific evidence for better understanding of how future climate regimes might affect normal operation of interconnected CI in urban areas during their lifespan; (ii) to assess the cost-effectiveness of different adaptation measures; (iii) to involve local stakeholders and operators in the co-design of the approach, as well as the assessment and the evaluation of adaptation measures; (iv) to combine computational modelling with advanced 3D visualisation techniques for effectively engaging stakeholders in decision making; (v) to include risk assessment and damage functions co-designed by end-users and local stakeholders; (vi) to integrate all of the aforementioned components in a specifically designed cloud platform as a Decision Support System for end-users, (vii) to validate the DSS by the end users and local stakeholders.The paper presents the computational background and tools. Additionally, it describes a Case Study in Torbay, UK, where the full methodology and the proposed participatory approach have been applied, with all the specifics, i.e., the scenarios of extreme flooding, the numerical and visualisation results, the response of the stakeholders and the evaluation of selected adaptation measures.