16 December 2010
Children who need common, general or urological operations face delays or long journeys to specialist centres for routine elective and emergency surgical care. This is the finding of a new survey conducted by the Royal College of Surgeons’ Children’s Surgical Forum, funded by the Department of Health. The data, which covered NHS hospitals in England, also suggest that a shortfall in safe, sustainable and accessible General Paediatric Surgery (GPS) in District General Hospitals (DGHs) will continue unless local hospitals adopt measures to share resources, services and expertise and surgical training opportunities are taken up.
Currently, specialist paediatric centres – units designed to provide care for children with specialised and complex needs – carry out routine surgical procedures causing significant pressure to their workload, as the management of routine surgical services for children shifts away from DGHs. The survey found:
- there are currently 305 DGHs potentially available to provide GPS (1), but less than half of hospitals surveyed (48.5 per cent) were found able to provide an emergency GPS service (2) ;
- just under sixty per cent (58.3 per cent) were able to offer elective surgical care (2) in GPS despite more hospitals having the infrastructure in place to deliver it;
- many NHS Trusts face problems in sustaining anaesthetic services for children in general and urological surgery – 33 per cent reported that they could not anesthetise children under the age of three (2). Even in hospitals that reported a lower age limit for anaesthesia, the provision of this service varied greatly depending on the skills of the available anaesthetists. This comes despite clear guidance on training requirements from the Royal College of Anaesthetists (3).
The Children’s Surgical Forum maintains that high quality GPS should be available locally, so that children and their families do not have to travel long distances for routine surgery, and has published guidance for commissioners and services planners (4), recommending that:
- Managed Clinical Networks - systems of interconnected local providers with contractual agreements that specify service requirements and outcomes – are established to effectively deliver this service.
- Training and Succession Planning – emphasis on GPS training opportunities and incentives for trainees by advertising consultant posts with a GPS component – is put into place in order for services to survive locally after the current consultant adult general surgeons and urologists providing this service retire.
The survey provides a detailed map of service provision and training opportunities that can be used to help NHS providers and commissioners consider how networks can be implemented in their area.
Su-Anna Boddy, Chair of the Children’s Surgical Forum at the RCS said: “This survey reveals that the current way general children’s surgery is provided not only puts children and their families at a disadvantage in terms of accessing routine care locally, but also prevents trainees in adult general surgery and urology from developing skills to manage routine surgical conditions in children. The survey data from each hospital will provide a comprehensive and practical tool that will facilitate the development of managed clinical networks of care in order to maintain GPS provision in the DGH, and help reassure local communities that their children will receive safe, local care for routine surgical conditions when they need it.”
Anna-Maria Rollin, Royal College of Anaesthetists representative on the Children’s Surgical Forum said: “All anaesthetists undergo training in paediatric anaesthesia and, at the end of training, should be competent to anaesthetise children aged three years or older for simple elective and emergency surgery. In addition, they should be competent to resuscitate and stabilise seriously ill children of any age prior to transfer. Many anaesthetists then acquire additional specialist skills so that they can care for very young children having complex surgery. We welcome the opportunity to work with the RCS in establishing managed clinical networks to ensure that children receive safe and appropriate care, and that trainee surgeons and anaesthetists have to opportunity to acquire the necessary skills.
Professor Terence Stephenson, President of the Royal College of Paediatrics and Child Health said: "The Royal College of Paediatrics and Child Health welcomes the production of this report on the provision of GPS in English hospitals. The report will assist NHS providers and commissioners in implementing high quality, safe and sustainable services for children. RCPCH believes this can be best achieved through ‘managed clinical network arrangements’ in which surgical teams and other professionals work together across NHS organisational boundaries.”
- Ends -
Notes to Editors
1. Hospital Episode Statistics (2008-2009)
2. Children’s Surgical Forum, Survey of Service Provision in the DGH. RCS, London 2010.
3. Royal College of Anaesthetists, Guidance on the Provision of Paediatric Anaesthesia Services, Chapter 8, revised 22 April 2010.
4. Children’s Surgical Forum, Ensuring the Provision of General Paediatric Surgery in the District General Hospital – Guidance to Commissioners and Service Planners. RCS, London 2010.
5. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk
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