| Paediatric General & Urological Surgery & Anaesthetics Project |
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| Aim of Project: |
| To undertake an option appraisal and subsequent business case that can be considered in the commissioning process for a networked approach to the provision of surgical services for children across the partnership area. |
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| Lead
Person: |
| Mrs Julia Greensall (PiP Network Development Manager) |
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University Hospital of North Staffordshire NHS Trust |
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| Team
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| About
the Project: |
| The provision of general and urological surgical services for children was identified as an issue of concern in 1998. A position paper was prepared by a Working Group of Partners in Paediatrics, which made a number of recommendations:- Reduce number of surgeons and anaesthetists operating on children on an occaisional basis especially the under 5 year olds- Increase number of children only lists- Ensure all elective activity in under 5's is performed by experienced surgeon and anaesthetist- Ensure all activity in under 2's is performed by experienced surgeon and anaesthetist- Provide a child friendly environment for all children- Ensure good pre-op preperation for all elective surgery- Increase opportunities for training in non-specialist paediatric surgery and anaesthetist for higher trainees and interested consultants- Increase involvement of Specialist Paediatric Surgeons and Anaesthetists in: Education, Case discussion and non-surgical management, Local consultation and treatmentIt was circulated widely among paediatricians, surgeons and anaesthetists in the area to prompt and inform thinking about the future provision of surgical services for children.In October 2000, a stakeholder conference was held where a number of expert views were presented from specialists and generalists involved in both managing and delivering the services. Individual Trusts responded to the recommendations of the position paper and PiP's was charged with the responsibility of seeing that the actions agreed on the day were implemented. The full report of the conference and agreed actions is available below.The activities of PiP led to a renewal of interest in the problems raised across the West Midlands region in particular and the Regional Oversight Group decided to undertake a review of all surgery in children. The Review of Surgery for Children in the West Midlands was chaired by Jon Crockett, Chief Executive of Wolverhampton PCT and published in September 2002. The report (available below) made a number of recommendations concerning the criteria for acceptable quality for children's surgery and anaesthetics, set out options to address areas of concern and made specific recommendations for respective organisations including Strategic Health Authorities, Workforce Confederations, provider Trusts and Primary Care Trusts (PCTs).PiP contributed to the work of the regional review and has continued to undertake joint work with the three SHAs within the West Midlands and with Trusts and commissioners from outside the West Midlands to determine the implications of implementing the recommended standards.Taking forward the recommendations of the review:In order to take this work forward a Surgery Project Group was re-established. The terms of reference and the group's objectives are on the website.The membership of the Surgery Project Group includes clinicians and managers from the participating Trusts, representatives from Strategic Health Authorities & PCTs and the 3 Tertiary centres within the PiP area - Birmingham, Alder Hey and Manchester Children's Hospital. Since some time had passed since the regional document had been written and with the imminent publication of the NSF, it was decided that the standards should be re-visited.
Members of the Surgery Project Group agreed 64 standards that covered issues relating to the main aspects of paediatric care. The agreed standards were taken from the main reports of the professional bodies published in recent years and the National Service Framework (standard for Hospital services). The CD based questionnaire was circulated to the participating 25 Trusts for completion. All the Trusts completed the questionnaires which were then analysed by the information department at the West Midlands South SHA.
The list of standards was not exhaustive, but focused on the main criteria pertaining to all staff involved with children undergoing general surgical procedures and covered the 'child friendly' environment in which children should be cared for. Each standard was referenced back to the body responsible for making the recommendation. It was recognised that some of the standards were contentious and subject to on going discussion with the professional bodies - for example, the recommended training requirements for general surgeons.
The next step in the project was for each of the Trusts in the partnership area to be assessed against the standards. In order to facilitate this process, a CD based ‘self-assessment’ questionnaire was developed and circulated to Trusts for completion. This innovative way of working proved to be a less labour intensive process than undertaking “peer review” visits and reduced the workload for personnel within Trusts.
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| Project News: |
| 01 November 2004 |
SETTING UP OF COMMISSIONER / PROVIDER GROUPS |
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In line with the recommendations of the West Midlands Strategic Commissioning Group (concerning the implementation of the recommendations contained in the ‘Blue Review’) provider trusts and PCT commissioners were asked to set up Commissioner / Provider groups to develop local plans. It was envisaged that these plans would also explore the potential for developing clinical networks, where appropriate.
Four groups were set up: Pan-Birmingham, the Black Country, Coventry & Warwickshire and Shropshire and Staffordshire.
In Herefordshire, the PCT and Hereford Hospitals NHS Trust are developing a plan.
Worcester Acute Hospitals are developing a Paediatric Surgical Plan.
NB: Although the original role of the Surgery Project Group was to address issues in relation to paediatric surgery and urology, the remit of the Commissioner / Provider groups covered the wider range of surgical specialties.
The local plans were presented to the last meeting of the Surgery Project Group on 22nd March 2004 (see below for Minutes).
The Surgery Project Group acknowledged that good progress had been made in many areas, in particular:
All children < 5 yrs having shared care arrangements with surgeons and paediatricians.
Reduction of number of surgeons and anaesthetists operating on children on an occasional basis – especially < 5 yrs.
Increase in number of children only lists
Children being seen in designated paediatric clinics within OPD
Development of training plans for clinicians
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| 01 September 2004 |
Service Planning |
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A Service Planning Day, jointly organised by the 3 SHA’s and PiP,
was held on 22/09/03 at the Britannia Stadium, Stoke-on-Trent. The results of the Questionnaires were presented.
The results showed that a significant percentage of Trusts had either met, or were actively working towards many of the standards.
The main challenges still to be addressed concerned:
Paediatric surgical on-call rosters
Paediatric anaesthetic on-call rosters (not enough paediatric work or personnel in DGHs to maintain separate rosters)
Longer term succession planning to ensure continuity of paediatric surgical services over the next 5 -10 years
Access to training / CME in children’s surgery / anaesthetics
Access to training in paediatric issues for nurses and theatre staff
Access to RSCN / RN -(Child) in surgical OPDs
Children to be nursed by RSCN / RN -(Child)
Audit of surgery (including day case work) & pain management
Separate children’s areas in Wards / Recovery bays / OPDs
One advanced paediatric life-support trained member of staff to be on duty (issue of insufficient numbers currently)
The involvement of children and families as “active partners” in the provision of the child’s health care
Access to information.
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| 01 March 2004 |
Surgery Project Group |
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The Surgery Project Group concluded that, although plans were developed to maintain services in the short to medium term there are a number of longer term issues that need addressing.
A Progress report has been prepared by the Surgery Project Group and the 3 SHA Children’s Leads which is to be presented to the West Midlands Specialised Services Group on 18th May 2004. A report will then be received by the West Midlands Strategic Commissioning Group in June 2004.
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| Forthcoming Meetings: |
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| Achievements: |
| 22 September 2003 |
Stakeholder 'Service Planning Day' |
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A wide representation of clinicians and managers from both provider and commissioning agencies across the partnership area attended. There were representatives from 17 (out of a total of 21) District General Hospitals and commissioners from 13 ( out of a total of 32) Primary Care Trusts. The 2 tertiary centres – Birmingham Children’s & Alder Hey – were also represented.
David Fillingham, Director of the Modernisation Agency, gave the keynote speech. He applauded the progress the West Midlands region had made in addressing this issue and commended PiP as an “effective model for partnership working and clinical engagement”.
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| Related Papers and Reports |
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| Information for Parents: |
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