Possible temporary options for ULHT’s children’s services are published

On Friday 27 April, United Lincolnshire Hospitals NHS Trust (ULHT) Board will be reviewing possible temporary options for the provision of children’s services at Pilgrim Hospital, Boston, due to concerns caused by a severe shortage of doctors and nurses.

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The Trust is currently reviewing its children’s services, as paediatricians and senior nurses at Pilgrim hospital have said that although current services are safe, they may struggle to provide them in the future if things remain as they are.

For all of Pilgrim’s children’s services to operate 24/7, there should be eight middle grade doctors and 28.65 registered children’s nurses at the hospital. This is to cover all rotas, annual leave and sickness and to make sure safe care can be provided for patients at all times.

Currently at Pilgrim the Trust has 4.5 WTE middle grades, but a number of those are short-term agency staff. From 1 July the Trust is forecast to have just one permanent middle grade doctor, with the rest of the rota covered by temporary staff.

The Trust currently has 20.48 WTE nurses but only 17.18 WTE available to work in children’s services at Pilgrim to help cover the rotas, this is due to ongoing sickness, maternity leave and carers leave. (12.95 WTE RN child and 4.23 WTE adult).

ULHT is listening to its staff on the frontline, who say that unless the Trust can find more staff then the required actions should be considered as soon as possible as there may not be enough doctors and nurses to provide safe care where needed. This includes the children’s ward, in A&E, outpatient clinics, maternity, and the neonatal ward (sick babies) 24 hours a day, 7 days a week.  At the moment ULHT has consultant medical staffing commitment to keep paediatric inpatient services running at Pilgrim Hospital until 4 June 2018 although with continued active recruitment this period may be extended.

The staffing situation is volatile and constantly changing and the Trust is very reliant on short-term agency doctors and nurses, many of whom only work occasional shifts. In February, ULHT reduced the number of inpatient beds to eight and suspended all planned (not urgent) children’s surgery at Pilgrim to free up nurses time, as these staffing shortages became worse.

The Trust has also undertaken extensive recruitment activities in recent months to try and recruit more staff to ensure the service remains safe. This has included rolling job adverts, international recruitment, cohort recruitment of nurses and working with agencies to secure long-term cover where possible.

Trust Board will consider a paper from ULHT’s Women and Children’s department at a full Board meeting in Sleaford on Friday 27 April 2018. The paper covers the current situation, five possible short-term options which may need to be considered if the situation does not improve, and recommendations on medium term and longer-term options.

Please see the below table for the potential short-term recommendations to be discussed:

Option One ·         Maintain current services at Pilgrim hospital, this is reliant on finding additional multi-professional staff from agency to cover children’s, maternity and neonatal services and getting the right balance between substantive and temporary staff.

·         Following advice we are currently unable to identify nationally that a middle grade tier run solely by locums is safe and whether it could carry a bigger risk and therefore need to seek assurance as to whether it is safe to do so

 

Option Two ·         Temporary closure of the children’s inpatient ward at Pilgrim with effect from 4th June (providing additional staffing cannot be secured)

·         Temporary redirection of paediatric emergencies transported by ambulance to Pilgrim – redirected to nearest ED or UCC

·         Temporary re-direction of urgent GP paediatric referrals to neighbouring organisations

·         Paediatric support with emergencies in Emergency Department at Pilgrim hospital

·         Increase gestational age for delivery within the high risk birthing unit from 30 weeks to 34 weeks

 

Option Three ·         Temporary closure of paediatric inpatient services at Pilgrim with effect from 4th June (providing additional staffing cannot be secured)

·         Temporary redirection of paediatric emergencies transported by ambulance to Pilgrim – redirected to nearest ED or UCC

·         Temporary re-direction of urgent GP paediatric referrals to neighbouring organisations

·         Paediatric support with emergencies in the ED department at Pilgrim hospital up until July 1st

·         Retaining consultant led obstetrics and neonatology at Pilgrim until July 1st when medical staffing reduces beyond the ability to support neonatology.  From July 1st temporary closure of  consultant led obstetrics and neonatology at Pilgrim until the staffing gaps could be addressed

·         Increase gestational age for delivery within the high risk birthing unit from 30 weeks to 34 weeks

·         Establish midwifery led birthing unit at Pilgrim hospital and a co-located midwifery led birthing unit at the Lincoln hospital to facilitate increased activity on the consultant led unit.

 

Option Four ·         Maintain current paediatric inpatient services, consultant led obstetrics and neonatology services at Pilgrim and Lincoln hospital temporary transfer of staff (medical and nursing) from Lincoln hospital to Pilgrim hospital.

·         Stop all paediatric inpatient and day case elective (planned) activity for all paediatric specialities at both Lincoln and Pilgrim hospital sites

(This will require adjustment to bed numbers at Lincoln and cancellation of some elective activity at Lincoln)

·         Stop all general paediatric outpatient appointments

 

Option Five* ·         With effect from July 1, 2018, providers across the region to provide neonatal medical cover (Consultants and/or Middle Grade doctor) for Pilgrim maternity and neonatology.

Dr Neill Hepburn, Medical Director said, “The quality and safety of care is always our top priority. We need to balance safety with having accessible services. But we won’t compromise on safety to provide services at all hospitals.

“Faced with our current staffing issues we are taking action and looking at a number of proposals to ensure our children’s services remain safe and sustainable for the future.

“We haven’t rested and have been, and continue to, work hard to recruit. This has included extensive international recruitment but this hasn’t led to the numbers needed to maintain services over the summer.

“The service has managed to safely staff the paediatric departments by asking our consultants to work extra shifts and cover the gaps in the middle grade doctor rota, together with securing as many agency doctors as possible.

“We have employed long-term agency nurses since September 2017, and we have capped the number of paediatric beds at both Lincoln County and at Pilgrim Hospital sites according to the number of nurses available to safely staff the paediatric inpatient wards.

“We have always been open about our staffing shortages and we are working with CCGs on a sustainable service for the future.

“I want to emphasise that this is nothing to do with money. In fact, stopping planned operations and bringing in extra agency staff will cost the Trust more money not save it. This is all about ensuring we can provide safe care.

“Any action we may take will be temporary. This isn’t linked to any long-term plans or the Sustainability and Transformation Partnership for Lincolnshire.  This is about maintaining safe paediatric services at Pilgrim and Lincoln hospitals for our patients now.”

The board will consider the department’s recommendations and they will work through the options looking at risk assessments and quality and equality impact assessments before making a final decision.

The board paper will be published on our website here https://www.ulh.nhs.uk/about/board-meetings/friday-27-april-2018/