The interim paediatric assessment centre at Pilgrim hospital opened on Monday 6 August and since then has seen, assessed and treated over 1,300 children, of which 161 have been transferred to other hospitals using one of our dedicated ambulances.
Whilst these transfers were mainly to Rainforest Ward at Lincoln County Hospital, 37 were transferred to other hospitals. Of these, 15 were transferred for further specialist care and the others were transferred to other hospitals because there were no beds available at Lincoln. Every effort is made to select a hospital as close as possible to the child’s home where possible.
In addition, six pregnant women have been transferred away from Pilgrim prior to the birth of their baby for safety reasons, as the age at which we can safely care for premature babies has been increased from 30 weeks gestation to 34 weeks.
All external transfers were undertaken using the dedicated ambulances provided for the purpose, and there have been no reported instances where an ambulance has not been available on demand. No families have been asked to transfer their children themselves.
Since the introduction of the interim model, no patient safety incidents have been experienced or reported as a result of the change, although it is acknowledged that the transfers of patients have caused disruption to those patients involved and their families.
During the first few months of the new way of working, there have been a number of occasions when children have stayed longer on the unit than the agreed 12 hour standard. Decisions are made to allow children to exceed the specified time limit on an individual basis only when it is safe to do so and in the best interests of the child. The 12 hour standard is also used flexibly when the transfer would be for a short time period required to complete observations or tests.
Practical experience and international best practice have highlighted a number of conditions and circumstances where it would be sensible for children to stay longer than 12 hours. Over the last few months, this has included cases of children who have high dependency needs and require more lengthy periods of hospitalisation for stabilisation, such as patients requiring high flow oxygen therapy for respiratory relief. The 12 hour standard is still appropriate for the majority of our children and feedback from parents has been very positive.
The system of open access for some children with ongoing health needs has continued at Pilgrim hospital under the interim service model. Whilst it may be necessary for some patients to be transferred to Lincoln hospital if they require a prolonged length of stay, access to the staff and support remains freely available through the pre-existing channels. We are now writing to all registered open access families to remove any doubt, and a meeting will soon take place with a group of parents with children with ongoing health needs. If your child has ongoing needs and you are interested in attending this meeting please email firstname.lastname@example.org and we will forward details when they are finalised.
Working with local families
A number of the families from the Boston area who have been affected by these interim arrangements met with our Project Director for Paediatrics, Clive Brookes, last month to share their experiences. He will also be meeting with families in Skegness and Spalding after Christmas. A number of the issues raised are covered in this newsletter and a full response to all the questions will be sent to SOS Pilgrim, who hosted the event, by Wednesday 19 December and a summary included with the next newsletter.
In addition, we have been sent details of a number of cases where concerns have been raised over information given out to families, referral processes or delays in care. All of these cases have now been identified and thoroughly investigated, and we have taken action where appropriate. This has included increasing paediatric specialist input to A&E, establishing a Children in A&E Task and Finish Group to oversee improvements and clarifying the current service model and appropriate advice with the 111 service.
We have previously been asked to develop plans for how we can better support families whose children are transferred away from Pilgrim, including exploring support with travel and accommodation. We are now formalising some arrangements to support these parents, and a leaflet is being produced to share with them about the options available.
Recruitment and staffing
Recruitment and retention of staff remain key to the sustainability of the service and we are looking at how we can continue to improve the packages we are able to offer doctors, nurses and other key workers to join us in Lincolnshire.
The international recruitment has been very successful and after an initial period of induction and supervision a number of new international recruits are playing an increasingly important part in the service.
We will continue to recruit through this process and are also offering other incentives around training and personal development.
The role of advanced paediatric nurse practitioner (APNP) is being introduced to support alternative ways of working on the assessment unit, with the APNP taking on duties previously undertaken by medical staff. The Trust has agreed a programme both to develop APNPs from our existing workforce and to attract already qualified nurses from other areas. An exercise to scope the potential use of the new wave of associate nurse practitioners on the unit has also been carried out and will be considered further.
Links are being developed to work with the medical and nursing schools that are being established in Lincolnshire.
Royal College of Paediatrics and Child Health independent review
The Royal College of Paediatrics and Child Health carried out an independent review of neonatal and paediatric service provision, and their full report has now been received and published by the Trust. It can be found here: https://www.ulh.nhs.uk/content/uploads/2017/11/Item-9.2.2-181009-RCPCH-Lincoln-review-final.pdf
We have welcomed the report, which is broadly supportive of our current approach. We are now going through the report and its recommendations in detail and developing an action plan which we will share with you before it is finalised to ensure we have all aspects covered.
There will be a particular focus on improving rapid access arrangements for both medical and nursing care and advice.
A task and finish group has been set up focussed on the care of children in the A&E department and links to the assessment unit.
A designated focus group is also being established for families with ongoing needs where children are eligible for open access in the new year following discussions with parents.
Our most recent paediatrics engagement event in November attracted more than 40 attendees and encouraged useful debate.
We promised that we would publish the presentation and notes from our engagement meetings, which can now be found here: https://www.ulh.nhs.uk/news/paediatrics/
The next engagement session will take place from 7pm to 8.30pm on Thursday 17 January in the conference hall in the Postgraduate Medical Education Centre at the Pilgrim Hospital, Boston and we would welcome as many contributions as possible!
If you intend to come along, please RSVP to email@example.com or ring 01522 572301.
Jan Sobieraj, Chief Executive