Hello, and welcome to my second blog, updating you about progress so far in NHS England’s national review of paediatric critical care and specialised surgery.
Before I bring you up to speed though, I want to mention last weekend’s (2-4 Dec) national press and social media coverage, which reported significant pressures in children’s intensive care units in some parts of the country.
Friday night, in particular, was an especially busy night for paediatric intensive care units (PICUs). Every year, at around this time, we see the number of children requiring treatment in PICUs reach a peak, mainly as a result of increased levels of respiratory infection. This increased demand for unplanned admissions can become the norm for a number of weeks, and the pressure on critical care can be exacerbated when wider hospital services, and social care, begin to feel the strain posed by winter pressures.
We are very conscious of this perennial issue and are working with our regional NHS England colleagues to closely monitor PIC capacity in local and regional networks, as part of our normal surge management processes, which looks at bed occupancy levels; nurse to patient ratios; and the management of elective surgery during peak periods.
PIC capacity and resilience are key areas of scrutiny for our national review of paediatric critical care services and we are working closely with the Paediatric Intensive Care Society (PICS), and with provider trusts, and others, to look at this issue and explore possible solutions.
I would like to take this opportunity to thank all those NHS staff who worked tirelessly last weekend – and, indeed, every day of the year – to keep our vital PIC services running safely, as well as all those who supported children in transporting them between hospitals. Your work is critical to the smooth running of the NHS, and to maintaining the best possible care for children and their families. As an (adult) intensive care clinician myself, I know just how tough your jobs can get during this busy period.
Expert Stakeholder Group
In my last blog, I talked about the acceleration of the national review of paediatric critical care and specialised surgery for children, and the establishment of an Expert Stakeholder Group to oversee this work. This group held its first meeting in London last week, getting off to a very promising start.
Attendees included representatives from the Paediatric Intensive Care Society; Royal Colleges; the Children’s Alliance; as well as the Chairs of NHS England’s Specialised Surgery and Paediatric Critical Care Clinical Reference Groups (CRGs).
The need to get on with this review has been widely recognised, so it was particularly rewarding to finally see everybody in the same room, with genuine enthusiasm for getting stuck into the work that needs to be done. Recognising the breadth of the review, we will be setting up work-streams to look at specific issues in more detail. We are still working on the establishment of these, but anticipate that these will look at ECMO; workforce; models of care (including interdependencies); and transport for children requiring critical care. All of these work streams are interconnected and interdependent, so the oversight provided by the Expert Advisory Group will be critical in keeping all of this work aligned, and on track to deliver.
In particular, members raised the following as issues to be explored:
- Variation in how children are transported, including approaches to repatriation;
- Fragmentation of ECMO delivery;
- Links between paediatric critical care and social care;
- The transition process for young people moving between paediatric and adult critical care services;
- The need to ensure that the review links with the Sustainability and Transformation Plans (STPs); and
- Definitions of Levels 1, 2 and 3 in critical care – these still aren’t used consistently, with people referring variably to paediatric intensive care and high dependency care instead.
The work being done on STPs at a local level, in particular, presents us with a real opportunity as conversations are taking place now about services may be delivered outside of hospitals, and what the acute sector may like in the future. Our work on the future delivery of paediatric critical care and specialised surgery for children will need to be played into these debates.
We know that there is likely to be a lot of public and professional interest in our work, and we are keen to offer up lots of opportunities for people to get involved.
If you don’t already have the date in your diary, we are running a number of webinars on 5 January, which will give you an opportunity to find out more about the work of the reviews, and ask us questions. Details of how to register can be found here. If you can’t make any of the webinars, don’t worry…there will be plenty of other opportunities for you to get involved as we move through the review, and if you have any thoughts/comments, you can always send them to firstname.lastname@example.org
In the meantime, I would like to take this opportunity to wish all of you – especially those working over the festive period – a very Merry Christmas and a Happy New Year!