Safety risks with proposed centralisation of paediatric inpatient services

With only five days until the end of the public consultation on proposed hospital cuts, a member of the public has asked Calderdale & Kirklees 999 Call for the NHS (ck999) for info, having failed to get it from the Clinical Commissioning Groups at the drop ins.

The question was about centralisation of children’s emergency and inpatient services; they said:

“I didn’t get a satisfactory understanding from Dr Brook who I imagine didn’t actually know.”

Maybe he did, maybe he just didn’t communicate it clearly.

Here is the info CK999 has managed to glean from the Pre Consultation Business Case and from an A&E frontline staff member – because there really isn’t much detail in the Consultation Document.

We are also adding this info to the suggestions on filling in the consultation survey  – deadline 21st June.

All medical and surgical inpatient paediatric services are to be in Halifax. That means that all children who are ill and need to be in hospital – whether they need surgery or not – will have to go to Halifax.

So rather than split A&E consultants over two sites, we are having surgeons and staff split by age of patients. This has serious safety implications that the Clinical Commissioning Groups (CCGs) haven’t addressed, as far as we can see.

At the moment if a child comes into Huddersfield A&E with an appendix issue or a suspected torsion of the testicle, for example, the A&E staff can just bleep a general surgeon. The surgeon will make the call on whether they accept the referral / suspected clinical diagnosis.

As an example, there was a recent case that was not the exact normal torsion presentation but the effects of missing are such that the A&E nurse spoke to a surgeon on a Sunday at home. He told her to phone his registrar to prep theatre and he would see and decide in theatre. In 5-10 mins the surgeon was stood next to the nurse in A&E.

With the proposed centralisation of all paediatric medical and surgical inpatient care at CRH, the Pre Consultation Business Case (p54) says

“In instances where children who are ill, have serious injury or are under 5 years old present at an urgent care centre, they will be quickly triaged, stabilised and transported to the Paediatric Emergency Centre”.

Does this mean an advanced practitioner nurse or GP could be in Huddersfield urgent care centre bleeping a surgeon in Huddersfield with the need to then transfer both the child and the surgeon to Halifax?

For Huddersfield children, for safety reasons such as stated above, there is going to be a problem if they go to Huddersfield urgent care but then need admission or surgery and it’s urgent and they get sent to Halifax children’s Emergency Department.

As a result, probably most Huddersfield parents will choose Halifax urgent care centre by default if able to get there and not in the back of an ambulance, because this means that if their child needs to transfer to the Children’s Emergency Centre, they are in the “right place at the right time”.

But this would mean parents ignoring the “encouragement” to use NHS 111 for advice. It seems like a recipe for chaos.

A parent told us:

“I for example would just cut NHS 111 out now – I would see that we now have 2 walk in centres in effect so 111 would not even get a call if I’m honest – especially for a child.”

We think the powers that be have not thought this stuff through

They have not had parent hats on, and they have not had urgent care staff hats on. Since they have failed to consult with frontline staff and GPs, this is hardly surprising. And the paediatric engagement was done late, last autumn and winter, almost as an afterthought – too late to inform the proposals for children’s urgent, emergency and inpatient care.

Under 5s

Children under 5 will NOT be seen in urgent care centres, according to the Pre-consultation business case (p54). This says,

“The Urgent Care Centres will manage children 5 years and older with minor injuries and those children considered to have minor illnesses after triage by 111. All other children will be redirected to the Paediatric Emergency Centre.”

But assessment via 111 is problematic. 111 assessment often could not be further from what presents face to face.

Sending all children under 5 with urgent or emergency conditions to the Paediatric Emergency Centre, without seeing them at the urgent care centre, will impact on learning opportunities for staff in the two urgent care centres. Staff would be deskilled if all under 5s go to Halifax; so as with anything, staff would choose Halifax if they wanted the learning opportunities and the busier environment .

Sending all under 5s to the Paediatric Emergency Centre would also have an impact on its capacity. A lot more children attend under 5 than over, so if all go to Halifax, the Paediatric Emergency Centre would be busier – alongside anyone unsure if urgent or not just turning up at Halifax urgent care centre because it has the children’s Emergency Centre next door.

We wonder where they got the figures for demand / need for a dedicated children’s A&E provision and whether it will survive if staff are met with a constant stream of under 5’s with nappy rashes, upper respiratory tract infections and routine things

The consultation doc doesn’t specify anything about under 5s. We have pulled out this info from the Pre Consultation Business Case. So the question needs clarifying, because people are unlikely to plough through the Pre consultation business case for details. Parents will want the answers to the plan details.

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