The Mail Online website warns that children’s hospital services are “not providing 24/7 care”, while The Guardian argues that “child services are spread too thinly”. The Independent makes the point that “Children [are] at risk until NHS units close”.
All three statements have been prompted by a review of children’s hospital services carried out by the Royal College of Paediatrics and Child Health (RCPCH).
Two years ago the RCPCH published 10 care standards that hospitals should comply with to ensure best quality care for children admitted to hospital. The current review was carried out to see how well paediatric NHS units are complying with these standards.
Overall, the results are encouraging. For example, 77% of children and young people are seen by a consultant or senior paediatrician within four hours of being admitted to hospital, and 88% are seen within 24 hours.
However, the Royal College’s audit also highlights major concerns:
President of the RCPCH, Dr Hilary Cass, says “There are too many units in the UK to provide a safe and sustainable service”. Over the coming two years the RCPCH will look into how best to address the issues raised.
The report, which has been published by the Royal College of Paediatrics and Child Health (RCPCH), is called Back to Facing the Future: an audit of acute paediatric service standards in the UK.
The report aimed to address how paediatric units in the UK are complying with the 10 care standards for acute paediatric admissions that were drawn up in the 2011 Facing the Future report (PDF, 192kb).
The care standards cover various best practice issues, such as ensuring a child or young person is seen by, or their case discussed with, a consultant or senior doctor within a designated time of admission.
The report presents the findings of an audit carried out over the summer and autumn of 2012.
The first stage of the audit involved a general survey of all the UK’s acute paediatric units. The units were asked 32 questions to assess their compliance with the care standards. The researchers then asked them to conduct a retrospective case note analysis on 20 acute paediatric admissions, dating from March 1 2012. Details assessed included the date and time of admission, who assessed the child, when they were first seen by a consultant and the outcome.
The second stage of the audit involved a series of more in-depth visits to 14 units across England, Northern Ireland, Scotland and Wales. These visits involved a series of structured interviews with the clinical lead, nurse or ward manager, and up to two paediatricians in training positions.
The following represent the main findings of the assessment into whether paediatric units in NHS hospitals are compliant with care standards for acute paediatric care:
The RCPCH makes the following key recommendations:
The RCPCH report concludes that the initial Facing the Future care standards have had a great impact on services, and are being used on a daily basis to ensure quality care is provided, and to help paediatricians to reflect upon their practice. The college says that most of the standards are being met across the UK, and that this is to the credit of health professionals.
Nevertheless, the audit has highlighted that these standards are not being met as regularly during weekends and evenings as they are between the working weekday hours of 9am and 5pm. At times of high activity, senior experienced staff are not always present. This is of particular importance as a child may suddenly need to go into hospital at any time of the day or night.
So, the RCPCH says that it is essential that paediatrics is a 24-hours-a-day, seven-days-a-week speciality and that the service is organised to meet the needs of children and young people. In some areas, this may require careful job planning and reconfiguration of services.
It also says that some units considered the standards to be the ‘bare minimum’ for service provision. Other units picked standards that they felt were more applicable to their unit than others rather than attempting to meet all 10. Often this was said to be due to resources being spread too thinly.
Dr Hilary Cass, president of the RCPCH says: “There are too many units in the UK to provide a safe and sustainable service; health services can’t continue in their current form. Reconfiguration needs to happen to deliver the best possible care to children and young people. We also need to look at more innovative models of service provision, providing more care in the community. But it’s going to take bold and brave leadership to make it happen.”