Paediatricians stand at the forefront of advocacy for children and alongside our college - the Royal College of Paediatrics and Child Health - in advocating better consultant supervision of the sick child. The 10 standards for acute paediatric care were launched in April 2011 and revisited through the RCPCH’s press launch of the recent audit (see HospitalDr).
President Hilary Cass concluded: “There are too many units in the UK to provide a safe and sustainable service; health services can’t continue in their current form. Reconfiguration needs to happen to deliver the best possible care to children and young people.”
But doctors and royal colleges do not operate in a vacuum, free from the effects on the NHS of political developments. The danger here is that college plans overlap uncomfortably with government plans to close numerous A&Es and hospitals and the choking off of funding which makes even well-run trusts struggle to breathe.
What I ask of the RCPCH and other medical colleges is to think twice before allowing aspirational emergency standards to be used – as the TSA has done in Lewisham – as a cover for summary execution of clinically safe and sound trusts for entirely financial reasons and without full consultation. In areas facing cuts, closures and irrevocable service changes the RCPCH must be publicly vocal in insisting on the highest clinical integrity and a thorough analysis of children’s needs. There must be meaningful consultation with local GPs, other clinicians, the public and local authorities. There must be real evidence that new configurations provide better care and do not replace one form of clinical risk with other very real ones, albeit less measureable, affecting large numbers of children: by reducing local access to acute care for vulnerable families and destroying local networks for safeguarding, mental health, children with disabilities and long term conditions.
This spectre threatens SE London children.
In the first-ever use of the Unsustainable Provider Regime, Secretary of State Jeremy Hunt has approved (with a gloss of some ill-thought out amendments for the purpose of spin) the recommendations of the Trust Special Administrator for South London Healthcare Trust to close acute hospital services at Lewisham Healthcare – an entirely separate, successful and widely respected trust. The TSA completed his report without any analysis of the local children’s services, networks and interdependencies (to the private embarrassment of the Medical Director of NHS London, himself a paediatrician). Treating children as collateral damage, the TSA noted virtually in passing that Lewisham’s paediatric ED and inpatient service would have to close given his recommendations on adult services. There is disgust at this total neglect of SE London’s children - 20% of the population. Our college would not comment as the issue was seen as political and locally specific.
This sounds alarm bells: here we have a back-door configuration of children’s services without a single conversation about the needs of 250,000 children in four boroughs. This should not happen without a public intervention from the college. We are not against change and are proud of our contribution to positive change in SE London. But I do not accept the impact of the dangerous and reckless reconfiguration decisions of the TSA and Jeremy Hunt, and do not expect my college to do so either.
It is unacceptable for the closure of children’s units to take place in this way. Paediatricians must insist that sick children retain local access to paediatric expertise, that there is safe transfer of sick children, protection of vital integrated children’s networks and maintenance of high clinical standards. If necessary, better to invest the relatively small amount required to help high-achieving units achieve the college standards, rather than closing down units for financial reasons without any clinical risk assessment.