ObjectiveTo identify ethical values guiding decision making in resetting non-COVID-19 paediatric surgery and maternity services in the National Health Service (NHS).DesignA 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.SettingNHS maternity and paediatric surgery services in England.ResultsSearches 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.ConclusionsOur 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 ethics-lite, 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.

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Action needs to be taken to map out the fairest way to meet the needs of all NHS stakeholders in the post-pandemic ‘new normal’. In this article, we review the NHS Constitution, looking at it from a relational perspective and suggesting that it offers a useful starting point for such a project, but that new ways of thinking are required to accommodate the significant changes the pandemic has made to the fabric of the NHS. These new ways of thinking should encompass concepts of solidarity, care, and (reciprocal) responsibility, grounded in an acceptance of the importance of relationships in society. To this end, we explore and emphasise the importance of our interconnections as NHS stakeholders and ‘re-view’ the NHS Constitution from a relational perspective, concentrating on the rights and responsibilities it describes for patients and the public as NHS stakeholders. We argue that the NHS Constitution, of which most stakeholders are probably unaware, can be used as a tool to engage us, and to catalyse conversation about how our responsibilities as NHS stakeholders should change in the post-pandemic ‘new normal’.

Study question How do donor conceived people, their parents and donors use direct-to-consumer genetic testing (DTCGT)? Summary answer DTCGT is changing how information about donor conception is accessed and managed by parents, donors and donor conceived people. What is known already Following the development and rapid expansion of DTCGT, there have been claims that ‘anonymity is dead’ in relation to donor conception (Darroch & Smith, 2021; Harper et al., 2016). Small-scale studies (Crawshaw, 2018) and media articles have reported that donor conceived adults are often finding out about the circumstances of their conception after using DCTGT.  However, there is a gap in the evidence about how donor conceived people already aware of their donor conception, as well as parents through donor conception and donors, are  using DTCGT. Study design, size, duration The ConnecteDNA project is an ongoing qualitative research study (March 2021-February 2024). It investigates how people in the UK, involved in donor conception, are impacted by DTCGT and considers the implications for policy and practice. This presentation focusses on phase two of the project: in-depth interviews with parents through donor conception, donors and donor conceived adults who have used, or considered using, DTCGT. Participants/materials, setting, methods So far, six donors, 13 parents through donor conception and 18 donor conceived adults have been interviewed via telephone or video call. Interviews are ongoing until September 2022.  Participants were recruited by advertising the project via a range of support groups and organisations for donor conception and/or DTCGT user communities. Main results and the role of chance Our findings show that people involved in UK donor conception are using DCTGT to access and manage information about donor conception. This includes donor conceived people, previously unaware of the circumstances of their conception, discovering they are donor conceived after using DTCGT. We have found that donor conceived people, already aware that they are donor conceived, may also use DTCGT in search of information about ‘donor relatives’ and/or their genetic make-up, including understandings of their ethnicity and health risks. Furthermore, some donors are using DTCGT to make themselves contactable to people conceived via their donation(s), whilst others are traced via relatives who have used DTCGT. Parents through donor conception may use, or consider using DTCGT, to trace people related to their children through donor conception. This may be done when the child is very young, with the intention of finding relatives (particularly half siblings) who they can then grow up with. Others take a more responsive approach, only using DTCGT to support a child’s request or interest in more information. DTCGT is also used to trace genetic relatives alongside, or instead of, ‘official’ routes for accessing information about donor conception, as well as social media and public records. Limitations, reasons for caution Participants in this study are self-selecting and some groups may be under-represented in our sample (e.g. fathers through donor conception). We make no claims regarding the relative prevalence of different views and experiences. However, findings demonstrate the range of ways in which people involved in donor conception are using DTCGT. Wider implications of the findings DTCGT is transforming how people involved in donor conception seek information about genetic relatives. UK law and HFEA policies will require reform to account for this. Professionals who work with people using, or considering, donor conception, should make their clients aware of the potential uses and outcomes of DTCGT. Trial registration number Not applicable

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