NHS Lothian confirms commitment to St John’s Hospital Children’s Ward

​Board members today (Wednesday 22 June) gave the green light to plans to ensure the sustainability of inpatient children’s services in NHS Lothian.

The health board agreed to adopt the recommendations from the Royal College of Paediatrics and Child Health (RCPCH) report meaning that implementation work will now get underway.

The expert review concluded that inpatient children’s services should be retained on two sites in Lothian - St John’s Hospital (SJH) and the Royal Hospital for Sick Children (RHSC).

Now board members have approved the proposals and said they were the first step towards a safer, more effective and sustainable service for children of Lothian.

Brian Houston, Chairman of NHS Lothian, said: “I am confident that the board has agreed to implement a set of plans that will help us to deliver the safest services for children across Lothian.
“We will create a programme board, headed by one of our non-executive board members, to help steer and monitor progress across these important recommendations. However the importance of securing the agreement of the current clinical teams cannot be underestimated.”

NHS Lothian invited the Royal College of Paediatrics and Child Health (RCPCH) to review paediatric inpatient pathways, workforce and key services across the Royal Hospital for Sick Children, St John’s Hospital and the Royal Infirmary of Edinburgh.

Taking account of the continuing recruitment challenges, despite significant investment, and the health board’s plans to move to a new £200m hospital for children and young people, the team of experts was asked to recommend the most reliable, sustainable and affordable models of providing care.

Jim Crombie, Chief Officer of Acute Services, NHS Lothian, said: “We have a number of recommendations, in relation to recruitment, changing working patterns and fostering closer relations between departments.
“Our staff are pivotal in moving forward. We have begun early discussions with them and over the coming weeks we will work closely with them to ensure they play a key role in putting the plans in place.”
​“We are grateful to the college for their expertise and their in-depth knowledge, which has allowed us to see how other systems across the UK operate.”

Lothian board members agreed to adopt the college’s recommended option for the workforce model for the St John’s Hospital children’s ward. Outlined as option one in the report, it proposes establishing a staffing model based on consultants being resident in the hospital overnight, which paediatric team at St John’s Hospital would be required to support.

Each consultant would do occasional overnights to provide on-site senior presence, supported by a non–resident consultant on-call from home, which is in line with other hospitals in the UK. The college estimates that it would take up to two years to implement in full.

The board also agreed to increase the number of consultants based at the Royal Hospital for Sick Children to help meet the steady rise in the number of admissions.

While change is being implemented and the staffing infrastructure is being put in place, the board has agreed to the college’s second recommendation which would see option two used as an interim solution from the end of August 2016.

This means that that the children’s ward at St John’s Hospital will provide overnight inpatient care as a 24-hour ‘low acuity’ unit. Children who have been admitted to the ward, assessed by a consultant and are stable, would remain on the ward overnight. Children who require to be admitted during the night would be cared for at the Royal Hospital for Sick Children in Edinburgh.

In total, the report has made 31 recommendations for inpatient children’s services and the response to these will be delivered by the programme board.

The review began last year and asked patients, families, carers and staff from across Lothian for their views on acute paediatric care during a series of focus groups, meetings and via an online survey.

The team of experts aimed to understand how families use the services when a child is unwell and what arrangements would be most effective in the future, given the current difficulties across the UK in recruiting medical staff with the expertise to provide some of the more complex care.

The college also looked at how the service performs in comparison to other acute inpatient, paediatric services in the UK and how it benchmarks in relation to national standards and spoke to staff and asked them to share their experiences and expectations of the service.​