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Understaffed children’s units struggling to cope across UK

Give us more resource or we’ll burn out and services will become unsafe, warn doctors

Caroline White

Friday, 27 April 2018

Children’s units are struggling to cope, because they are understaffed, reveals an audit of children’s health services* published by the Royal College of Paediatrics and Child Health (RCPCH).

Without more resource to meet the standards of high quality care amid rising demand, staff will burn out and services will become unsafe, doctors are warning.

The audit, which set out to find out how well children’s units across the UK were able to meet the recommended standards of care for quality and safety in 2017, was sent to 161 paediatric clinical directors in June 2017 (70% response rate).

An expansion in consultant numbers is now needed to help units at peak times – usually between 8am to 10pm - and to improve the standard of hospital care, says the College.

To do this, it recommends that in the UK, 465 full-time equivalent (FTE) paediatric trainees are recruited at ST1 (trainees in their first year of training) level every year for the next five years.

And an increase in total of 752 FTE paediatric consultants will be needed to meet standards: 520-540 in England, 84-110 in Scotland, 84-91 in Wales and 30-31 in Northern Ireland.

The audit captured data on two sets of RCPCH standards for acute general paediatric services (10) and child health standards (11).

On weekdays, a paediatric consultant is present in the hospital during times of peak activity in 38.7% of units, falling to under 29% at weekends.

Across all training rotas, less than a third (just over 30%) of paediatric units have the recommended number of staff to manage care (10 or more whole-time equivalent).

Averaged across the eight specialties, three out of four units have access to specialist paediatricians for immediate telephone advice.

Dr Carol Ewing, RCPCH vice president for Health Policy, commented: “It is down to the sheer dedication of our doctors that children are being treated as safely as they possibly can on paediatric wards in the UK, but the risk of ‘burn out’ is all too real.

“To improve the care delivered by units, it is vitally important they meet each and every one of the standards set out in this audit. However, as we have seen from our hospital visits, units are only going to be able to do this is they have the resources in place to support them.”

She continued: “In order to meet three key standards – children seen by a consultant within 14 hours of admission, two consultant-led handovers and presence at peak times - paediatric departments need increased consultant presence from around 8am to 10pm. The growth in the paediatric workforce is crucial if this is to happen.”

The data captured for child health found that GP practices are linked with consultant paediatricians in just 7.4% of units, risking ongoing communication issues between services and a lack of professional development and teaching opportunities.

The audit also found that GPs have access to immediate telephone advice from a consultant paediatrician in more than 86% of units, but only around one in four (26.4%) acute general children’s services provide a consultant paediatrician-led rapid-access service so that any child referred can be seen within 24 hours.

Only around 17% of acute general children’s services work together with local primary care and community services to develop care pathways for common acute conditions.

Only around 15% of acute general children’s services are supported by a community nursing service that operates 24 hours a day, seven days a week, meaning that it is difficult to discharge children early from hospital.

Dr Ewing said that feedback from children and parents indicates that navigating health services is challenging.

“GPs having access to immediate telephone advice was reported as being an important factor in delivering high quality care. Where practices didn’t offer it, they cited funding as a direct barrier.

“This is an excellent service but unfortunately commissioners are not recognising it. We’d like to see the remaining practices have access to immediate telephone advice so that GPs and their patients can reap the benefits.”

He continued: “Similarly, units should be providing a service to the 74% of GP practices which do not have a linked consultant paediatrician-led rapid access service. This will further enhance the care children and their families receive.

“We want GPs to pick up the phone and speak to a child health expert if they are worried about a patient. We can then ensure that child is seen by an expert, often much more quickly – within 24 hours - and with a reduced length of inpatient stay if admission is required.”


*Facing the Future Audit 2017: Facing the Future: Standards for acute general paediatric services Facing the Future: Together for child health. A report prepared by the RCPCH, April 2018.

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