A manager of the South East England Paediatric Networks looks at the Long term Plan and what it means for critical care and specialised surgery for children:
The NHS Long Term Plan has outlined how over the next five years services will evolve to meet the changing needs of patients.
Our region has been selected as an ‘implementation test site’, as part of the Specialised Commissioning review of paediatric critical care and specialised surgery in children aimed at ensuring that children and young people can access high quality services as close to home as possible.
To ensure that there will be enough capacity to provide the right care for critically ill children at peak times, now and in the future, the review has advocated that hospitals in each region need to work together in networks – ODNs or operational delivery networks – that co-ordinate capacity and resources.
With clinical colleagues, I co-ordinate the network for our area.
Hospitals across south London and the south east have been working together for many years, but we are formalising how we collaborate to meet the challenges to our critical care services. Paediatric critical care covers a range of services, with intensive care offering the highest level of support.
Although paediatric care is delivered in most hospitals, intensive care facilities for children are concentrated in specialist hospitals. In south east England, there are three specialist hospitals in London: King’s College Hospital, Evelina London Children’s Hospital and St George’s Hospital.
This means that children from across the region covering South London, Kent, Surrey and Sussex have to travel to London if they need intensive care. While children are in intensive care it can disrupt the whole family with everyone missing school and work, particularly if they have to travel long distances, so it’s important we move children from intensive care into a hospital closer to home as soon as is safely possible.
There are several very good reasons why it’s so important to start looking at how we can work more collaboratively.
The number of children requiring critical care continues to rise, and increasingly a number of these children have very complex, and potentially life-limiting, health conditions. Some need intensive care following major interventions such as heart surgery or cancer treatment. For other children, their health concerns are a longer-term issue. Medical advancements mean that far more children with life-limiting conditions or disabilities are surviving, and some of these children will continue to need high levels of support, including long-term ventilation or tube feeding.
No parent would choose for their child to be growing up in hospital, and so we need these vulnerable children to live the fullest life possible at home or as close to their family as possible.
If hospitals can work together to better understand bed capacity across our whole patch, we hope that we’ll be able to manage this more effectively. If there are insufficient intensive care beds, children have to travel out of the region, which means even longer journeys for families. But this isn’t a case of just providing more intensive care beds, as we need to ensure that we have the right support available outside of paediatric intensive care units to ensure that all children requiring intensive care can access facilities locally.
Staffing is also a real concern with shortages across the country, so we need to find a different way of working but although the challenges are daunting, we are already beginning to explore some potential solutions.
We’re looking at developing new, more flexible, roles where staff can work in different organisations, depending on when and where they’re needed. To facilitate this we are looking at the training available and ways of sharing expertise to meet the demands of working in critical care services.
We’re also beginning to look at the current pathways of care for children, and how they can be improved – so that when children really need support, they get it while being able to get safely home as soon as possible.
As part of this, we are gathering together staff from across our region to talk about these issues in more detail and to plan how we’re going to solve them, alongside the families that we serve.
Our Paediatric Critical Care ODN is currently being established, with strong clinical leadership, engagement from commissioners and managers, and patient involvement, to find new ways of working that keep children and their families at the heart of everything we do.