Paediatric services latest

As we’ve previously reported, an interim model for delivery of women’s and children’s services at Pilgrim was introduced on Monday 6 August 2018 due to a severe shortage of middle grade doctors meaning the full previous service could no longer be delivered.

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Considering the fact that six months ago we thought we may need to close the paediatric service at Pilgrim all together as a result of these staffing issues, we’re pleased to have been able to maintain the majority of services at the hospital under this model.

It has been recognised that we have done everything we can to ensure services are maintained at Pilgrim, whilst prioritising patient safety at all times.

So far, the model is working well and no patient safety issues have been reported through our internal systems. In the first seven weeks, we have safely transferred a total of 74 patients to other hospitals for care, including 70 children and four pregnant women transferred prior to the birth of their baby for safety reasons. This is considerably fewer transfers than we had initially anticipated.

The majority of these (78%) have been transferred to Lincoln County Hospital, with the rest being transferred to other hospitals either due to clinical reasons or patient choice.

All have been transferred using the private paramedic-equipped ambulances we have commissioned in for the purpose.

Current model

Through public engagement, it has been raised that there is a lack of clarify about what services are now available for children at Pilgrim hospital.

We wish to be clear that it remains business as usual for the majority of patients and you should access our services at Pilgrim hospital as you normally would.

Our advice to all patients is, if you or your child is ill to call 111, visit your GP or attend A&E if necessary, where you will be assessed and the appropriate care plan decided upon.

Pregnant women and carers with regular attending children should carry on accessing the hospital as usual, if anything needs to change this will be included in care plans.

At present, the following children’s and maternity services are provided at Pilgrim hospital:

  • Enhanced paediatric service in A&E.
  • Paediatric outpatient clinics.
  • Paediatric day case surgery.
  • A 24 hour paediatric assessment and observation unit (PAU) offering restricted periods of observation.
  • Consultant-led maternity birthing unit.
  • Neonatal care for babies from 34 weeks gestation.

We anticipate that this interim level of service will remain in place until at least Christmas given ongoing staffing issues, but we will continue to keep you informed as the situation develops.

Recruitment and staffing

We continue to make extensive efforts to recruit to the service, which has resulted in one new overseas doctor starting work during August, two more starting during October and a number of others going through the recruitment process. Our recruitment efforts include:

  • A rolling NHS jobs advert for medical staff.
  • Recruitment to medical agency staff.
  • International recruitment.
  • Use of specialist recruitment support.
  • Training junior doctors at Pilgrim.
  • Exploring other models of recruitment to fill vacancies.

We have worked closely with Health Education England (HEE) to reassure them about the safety of the service so that junior doctors can remain working at Pilgrim. This resulted in an agreement with HEE that the juniors who came in on the August rotation will work at Pilgrim Monday to Friday daytimes, but not in evenings and at weekends.

In addition, we are continuing to improve the service and we are looking at how our consultants work, where and when in order to provide the best service possible given the resources available.
What now?

In the short term, we continue to review the service model, identifying any issues and always looking to make improvements where we can, whilst maintaining safe care for our patients.

Discussions are currently underway about whether we may be able to alter the service slightly, so that we could have some patients staying longer than 12 hours on the PAU where appropriate, based on clinical need and prioritising patient safety. We will keep you updated as any changes are made.

In terms of the long-term future of the service, we continue to work alongside our partners and stakeholders as part of the Lincolnshire Sustainability and Transformation Partnership (STP) to develop a long-term model for women’s and children’s services across the county for the future. We understand that these plans are developing well, and that a public consultation on proposals will be run during early 2019.

We are listening and what we’ve heard

We continue extensive engagement with our patients and public around this service, including visiting groups, gathering opinions in public areas, holding our own engagement events and analysing the results of our recent survey on the subject, which attracted 759 responses.

The survey provided us with intelligence about how our patients expect to access services, including highlighting the importance of accessibility and transport to our patients. The findings of this survey have been shared with the service leads to inform development of the service model, including consideration of transport concerns and what can be done to mitigate these.

A summary of the findings can be found here: https://www.ulh.nhs.uk/news/ulht-maternity-children-and-young-peoples-services-survey-feedback/

As we continue to manage our staffing situation, we still need to understand what matters to our patients, where you have concerns and what we can do to mitigate any concerns and risks. In the interests of ensuring our service planning takes into account this feedback, we are also running a series of paediatric engagement events.

The next one will take place from 7pm to 8.30pm on Tuesday 6 November in the committee room in the postgraduate medical education centre at Pilgrim Hospital, Boston.

If you intend to come along, please RSVP to members@ulh.nhs.uk or ring 01522 572301.

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