Review of paediatric inpatient services in Lothian

An expert review has 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).

NHS Lothian board members will meet next week (Wednesday) to agree how the recommendations will be translated into actions within the service to ensure a safe, effective and sustainable service for children of Lothian.

Jim Crombie, Chief Officer of Acute Services, NHS Lothian, said: “I want to ensure that we can deliver the safest services for children across Lothian which is why we commissioned the experts at the Royal College of Paediatrics and Child Health to carry out an independent review.
“The college has made a number of recommendations following an extensive review of the service and following agreement from the board, we will discuss these with our staff to establish how they are best implemented.
“We are grateful to the college for their expertise and their in-depth knowledge, which allows us to see how other systems across the UK operate.”

The Royal College of Paediatrics and Child Health (RCPCH) was asked 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.

The RCPCH has suggested three main options for securing the children’s ward at St John’s Hospital and has identified option one and two as being the most suitable.

It has also recommended an increase in the number of consultants based at the Royal Hospital for Sick Children to help meet the steady rise in the number of admissions.

Now NHS Lothian board members are being asked to approve the recommendations in the report - adopting option one for St John’s Hospital, while using option two or a variation of this option agreed with the team at St John’s, as an interim solution while the staffing infrastructure is developed.

Option one, which is the college’s recommended option, is to establish a staffing model based on consultants being resident in the hospital overnight, which all consultants at St John’s Hospital would be required to support in principle and in practice. This would see each consultant do occasional overnights to provide onsite senior presence, supported by a non–resident consultant on-call from home.

The resident consultant model is in place in other hospitals around the UK to support paediatric inpatient services and the college estimates that it would take up to two years to implement in full.

However, the importance of securing the agreement of the current consultant workforce to provide routine out of hours cover to deliver option one successfully cannot be underestimated.

Option two is presented by the college as a possible interim option while progressing option one.

This option would see the children’s ward at St John’s Hospital providing overnight inpatient care as a 24 hour ‘low acuity’ unit, which does not admit children overnight when consultants are not present. Out of hours cover would be provided by a mixture of advanced practice nurses and medical staff, with a non-resident consultant on-call from home. The board is being asked to agree to an interim option being put in place from the end of August 2016.

Option three would see the children’s ward operate as a Short Stay Paediatric Assessment Unit (SSPAU) open from 8am to 10pm, with no overnight accommodation.

The full and final report has been issued to board members today (Wednesday 15th June) with an accompanying paper as part of the pack of papers for the June board meeting.

It has also been shared with staff and published on the NHS Lothian website.

In total, the report has made 31 recommendations for inpatient children’s services and it is proposed that a programme board, led by a non-executive board member, is created to begin implementation.

Mr Crombie added: “As we fully expected, the review team reflected the concerns and aspirations shared by staff and have been able to identify areas where we can make improvements to ensure we continue to deliver high quality person-centred care.
“We have a number of recommendations, in relation to recruitment, changing working patterns and fostering closer relations between departments, and we now need to discuss these with our staff, who are pivotal in moving forward.
“We are grateful to them for all of their hard work, support and views throughout this review process and we look forward to providing a planned, safe and sustainable service, not just for all of our patients, but for our dedicated teams as well.”

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 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.

The papers for the Lothian NHS Board meeting on 22 June can be found here.