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Providing children’s surgery close to home

The President of the British Association of Paediatric Surgeons shares why he’s encouraging fellow surgeons to work together as active members of their local developing surgical networks to ensure that children and young people get the right access to specialist care locally wherever possible:

It probably goes without saying that the management of common surgical conditions in children should be delivered by competent staff as close to the patient’s home as possible.

As a paediatric surgeon, I feel that we have an opportunity to make this happen, working together through surgical networks to consider the delivery of routine and more complex surgery within the areas that we serve.

Consultants in most surgical specialties, such as ear, nose & throat (ENT) and orthopaedics, combine adult and childhood practice, but paediatric surgeons will only see patients up to the age of 16 to 18, providing a wide range of operations covering both routine and specialised surgical care. Such surgeons tend to work in specialist centres in large towns and cities, which can mean long journeys for some patients.

For example the only specialised centre in the South West is Bristol, which is a journey of 190 miles from Penzance. If a child needs specialist care, then of course they should be treated in a specialist centre, but this may not be the best option for more routine surgery, if it could safely be provided by a team in a local hospital.

However, at a national level we have seen a trend towards more care being delivered in specialist centres. Analysis of more routine surgeries, such as inguinal hernia, undescended testes and acute appendicitis, from 2013-17 demonstrates a small but steady year-on-year growth in activity performed in specialist centres of around 6%.

We all need to think beyond what happens in individual hospitals and consider the needs of the population that we serve, which is why the development of local networks will be so important.

No one hospital will be able to meet the wide range of surgical interventions that children require, and we need to find a balance where routine surgery can be undertaken safely, quickly and as locally as possible, with specialist access for more rare and complex procedures when that’s required. Surgical networks should work together with other paediatric networks within their region to ensure we align where services are provided if there are clinical interdependencies between them, under the guidance of an overarching forum that will set a strategic direction for the delivery of paediatric services.

The potential benefits of working through surgical networks include:

  • increased capacity within specialist centres for the treatment of those children that need specialist care, as there are increased options available for the treatment non-specialist cases;
  • increased capability and skills among staff, including anaesthesia, radiology, paediatric surgical nursing, O.T. and physiotherapy, which would need to be supported by appropriate education and training;
  • patients and families able to access services locally, reducing the need to spend long periods away from home, as well as travelling long distances to clinics;
  • increased treatment options for patients with time sensitive conditions, reducing delays in accessing routine treatment.

By looking at the needs of local children and young people, we can work with our hospitals to ensure that the right balance of skills, staffing and resources exists to enable the provision of high-quality services in the right place at the right time.

Richard Stewart

Richard Stewart is President British Association of Paediatric Surgeons – a role he has held since July 2018.

He was appointed Consultant Paediatric Surgeon, Queen’s Medical Centre in 1992 having trained in The Royal Children’s Hospital, Melbourne and Queen’s University, Belfast.

Previous roles have included Assistant Medical Director Queens Medical Centre 2001-2005 and Regional Professional Advisor to the Royal College of Surgeons for Paediatric Surgery 2010-2014. He was also Clinical advisor & GPS lead, East Midlands Specialist Commissioning Group 2010-1012, and the lead for General Paediatric Surgery, East Midlands Strategic Clinical Network 2013-2015

He was a steering group member and Surgical Lead for NHS England’s ‘Specialised Surgery in Children Review’ held from December 2016-19.

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