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Shortage of senior doctors at peak times putting kids’ safety at risk

Current configuration unsustainable and ‘cannot continue’ paediatricians warn

Caroline White

Friday, 12 April 2013

Three out of four children get to see a senior doctor within four hours of hospital admission, but a shortage of consultants at peak times is putting children’s services at risk, and is ultimately unsustainable, paediatricians have warned. 

Services will need to be reconfigured for the sake of children’s safety, they say. 

The latest audit of children’s services, published yesterday by the Royal College of Paediatrics and Child Health (RCPCH) shows that some of the 10 minimum standards of care for acute children’s units, set out by the College in Facing the Future, published two years ago, are being met, some are not.

The audit was carried out in the summer and autumn of 2012, and included a general survey of all the UK’s acute paediatric units, asking them 32 questions about the 10 standards, and asking them to conduct a retrospective case note analysis on 20 admissions, dating from 1 March 2012.  

The second stage of the audit comprised a series of ‘deep-dive’ visits to 14 units across England, Northern Ireland, Scotland and Wales. These visits involved a series of structured interviews, typically with the clinical lead; nurse or ward manager; and up to two trainee paediatricians.

The findings show that one in four (23%) kids do not see a senior doctor within four hours of admission, while consultant or equivalent cover at peak times, considered to be between 5 and 10 pm, falls short of the standards required.

Only around one in 10 (11%) of units maintained a senior doctor presence, which fell to 6% over the weekend at peak times, although when units described their own peak periods, this rose to 26% and 20%, respectively.

The audit also showed that another of the 10 standards—the immediate availability of telephone advice about acute problems for all specialties—was not always met, and that arrangements were often informal.

Staff numbers across all the rotas fell short of the Facing the Future standards, the audit showed.

The audit found that some units treated the standards as the bare minimum while others picked out standards that they felt were applicable to their unit rather than attempting to meet all 10.

In the foreword to the report, RCPCH President Hilary Cass, and Vice President, Health Policy, Dr David Shortland, explain that the specialty of paediatrics “has frequently prided itself on being a seven-day specialty, so perhaps the most important area of concern is consultant presence at times of peak activity.

"It is an anomaly that when our units are at their busiest, the most experienced and skilled members of the team are not necessarily present in the vast majority of units.”

They add: "We fully recognise the pressures on acute paediatricians within the current structure and configuration of services, but believe that this audit demonstrates that we have to be prepared to re-examine the way in which we deliver care.

"It is apparent from our audit, as it was when we drafted the standards, that there are too many units in the UK to provide a safe and sustainable service. Reconfiguration needs to happen to deliver the best possible care to children and young people.”

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