11. Children - ward or walk-in? (matter for discussion)

London Board

That this meeting of RCN Congress discusses the implications of reducing the status of children's wards in district general hospitals to 18 hour ambulatory care units.

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Progress report

Council Committee: NPPC
Committee decision: Already covered by existing work
Council member/other member/stakeholder involvement: Gill Cort,
Anne Kennedy
Staff contact: fiona.smith@rcn.org.uk

This work already features within joint work with the Royal College of Paediatrics and Child Health about the future design of services for children and young people.

Debate report

There was a discussion on the implications of reducing the status of children’s wards in district hospitals to 18-hour ambulatory care units.

Andy McGovern, from the London Board, said parents just want the best care for their children.
He said: “Wherever possible, children should be treated closer to home. It is not right that children have to travel far – they just do not cope as well as we would.”

Kathy Doughty, from Brighton and Hove branch, asked about the impact if the local facility had closed for the evening. She said: “If you have an 18 hour service in the district hospital, what happens if the child comes in at 6pm? Are they going to be moved to somewhere else?” She added: “What if you have a long journey to a unit that is open?”

Denise Chaffer from Croydon branch said the idea had come from Lord Darzi’s High quality care for all report, which focused on centralising some specialist services so general services could move closer to patients.

Patricia Pullen from the UK Stewards’ Committee asked how it would fit with the working capacity of district nurses and health visitors; while A&E nurse Billy Drysdale from the Northern region said it is important paediatric nurses are always available in emergency departments to provide the specialist care children need.

Background

Since the Platt report in 1959 one of the key principles underpinning hospitalisation for children has been to admit children only when the care they require cannot be provided as well at home, in a day clinic or on a day basis in a hospital. This approach has been reinforced by subsequent health strategies, policies and service frameworks in all four UK countries.

While the number of children and young people admissions has increased in recent years, the majority of stays are less than 24 hours in duration. Many areas across the UK have successfully introduced children’s ambulatory care provision and short stay observation between the hours of 08.00am and11.00pm, alongside expanding community children’s nursing availability to provide enhanced support at home.

The specific needs of the local population and the geographical location, however, must be taken into account when planning future service provision. Service changes across Greater Manchester, for example, have been the culmination of 10 years’ planning which included both professionals and the public in decision making.

At present there is a deficiency in the number of community children’s nurses available to provide the level of service required across the UK, while the impact of the European Working Time Directive has resulted in insufficient junior medical staff being available to provide a safe rota across many children’s inpatient units. Indeed, there are future nursing and medical workforce issues related to the staffing of children’s inpatient units 24/7 across the UK; such staffing issues are often linked to neonatal service provision. Furthermore, for parents the cost and transport issues of travelling some distance to children’s specialist services are likely to become more onerous and there will be a need to expand onsite accommodation within tertiary services.

The RCN has been involved in joint work with the Royal College of Paediatrics and Child Health (RCPCH) in relation to future service configurations for children and young people’s services and its Modelling the future programme, which highlights a move toward less inpatient provision and the need for expansion in community children’s nursing teams to provide access to a 24/7 service.

The RCN, in conjunction with the WellChild charity, has been lobbying for an increase in the availability of community children’s nurses as part of the Better at home campaign, and is involved in a Department of Health project for commissioners of services around the role and importance of community children’s nurses. RCN Wales has successfully lobbied for the inclusion of recommendations around community children’s nursing within the recent Welsh Assembly Government community nursing strategy.

References and further reading
Healthcare for London (2009) Meeting the health needs of children and young people – guide for commissioners, London: HfL.
www.healthcareforlondon.nhs.uk/project-documentation-3/ 

Royal College of Paediatrics and Child Health (2009) Modelling the future III: safe and sustainable integrated health services for infants, children and young people, London: RCPCH.
www.rcpch.ac.uk/Publications

Evans K (2008) Improving paediatric emergency care, Emergency Nurse, 16(6), pp.14-15.