RCPCH report on inpatient children's services at St John's Hospital

​A report by clinical experts has recognised NHS Lothian’s commitment to restoring paediatric inpatient services at an NHS Lothian hospital as soon as possible, but warned there was no “quick fix”.

The review, carried out by the Royal College of Paediatrics and Child Health (RCPCH), highlighted the dedication of paediatric teams at St John’s Hospital in Livingston and commended the progress being made.

It supported the health board’s decision to temporarily suspend inpatient services in order to maintain safe facilities for children and it said the service should only resume once the extra staff are recruited or trained.

Jacquie Campbell, Chief Officer of Acute Services, NHS Lothian, said: “We are working extremely hard to recruit additional senior staff so that we can reinstate 24/7 services at the site and we remain committed to the service.

“But so far we have been unable to provide sufficient staffing cover to ensure patients receive a safe service overnight.

“We know this is frustrating for patients and families, but the RCPCH has been explicit in their clinical and expert opinion that this decision was the right thing to do.

“Our overarching strategy remains a commitment to St John’s Hospital and the children’s ward and this has been demonstrated by the significant and on-going investment we have made into recruitment.”

The report was carried out after NHS Lothian invited the RCPCH to review progress following their first evaluation of children’s services overall in 2015.

At that time, the RCPCH said that inpatient children’s services should be retained on two sites – St John’s Hospital, Livingston, and the Royal Hospital for Sick Children, Edinburgh – and it was recommended that an additional eight consultants were recruited.

The 32 recommendations from the report were taken on board and wide-ranging rounds of recruitment began to help fill the gaps in the rota. However despite extensive campaigns, the required number of posts have not been filled.

The Paediatric Programme Board, which was appointed two years ago to oversee and decide how best to implement the findings of the original report, is now considering the recommendations from the follow-up report.

The RCPCH said that their initial assessment remains the same, but they understand the increasing difficulties in recruitment has caused the current situation.

The report said: “The report reaffirms that for the population of West Lothian the continued provision of inpatient paediatrics is the right model if it can be achieved with sustainable medical staffing. 

“This is not a ‘quick fix’ as demonstrated by attempts to recruit paediatricians and advanced children’s nurses. Until sufficient trained medical and nursing staff are available to provide sustainable overnight care, the current daytime only paediatric assessment and decision-making service should be maintained and strengthened. 

“Its opening times should be mapped more closely to activity and it should be supported with strengthened community and transport services."
NHS Lothian is now developing a longer-term strategy to continue to deliver safe and sustainable services, and maintain and strengthen the current provision of the short stay paediatric assessment unit and review the possibility of extending the opening hours.

Ms Campbell added: “We will be looking at these recommendations very carefully in the context of how we can provide patient services safely.

“I would emphasise that parents are not being asked do to anything differently. Most of the children who currently attend the unit will continue to be cared for as normal. They will either be referred by their GP for an urgent medical opinion or attend with a pre-arranged appointment for treatment, assessment, tests or minor day surgery.”

Children will still be assessed and treated in the Emergency Department at St John’s Hospital at night and weekends.  A paediatric consultant will be available on-call 24/7. If a child needs to be admitted to hospital a transfer to the Royal Hospital for Sick Children, Edinburgh, will be arranged. Maternity and neonatal services at the hospital are unaffected.

The full report is available to read now
Notes to editors:
1. Around 3,000 children attend the children’s ward at St John’s Hospital each year, around one third of these children require to be admitted to hospital.
2. In June 2015, the NHS Lothian Board agreed to recruit eight additional paediatric consultants to support services within St John’s and the Royal Hospital for Sick Children, following a comprehensive review by the Royal College of Paediatrics and Child Health. A total of five additional consultants have been appointed as a result of an extensive recruitment campaign.
3. In order to provide a 24 hour, seven-day-a-week service in the children’s ward and maternity unit, including the special care baby unit, the following level of out-of-hours paediatric staffing is required:
• One junior doctor who is resident at the hospital overnight
• One experienced doctor or consultant who is resident at the hospital overnight
• An on-call consultant who can attend the hospital at short notice to provide a second pair of experienced hands.