Over three quarters of children see a senior paediatrician within four hours of admission, but there remains a shortage of consultants at peak times, according to the Royal College of Paediatrics and Child Health’s Back to Facing the Future report.
Back to Facing the Future presents the results of the RCPCH’s audit of acute paediatric units in the UK against the 10 minimum standards set out by the College in its blueprint: Facing the Future two years ago. The standards include: every child admitted to a paediatric department with an acute medical problem to be seen by a senior paediatrician within four hours of admission, at least one medical handover in every 24 hours led by a paediatric consultant, and specialist paediatricians are available for immediate telephone advice about acute problems for all specialties and for all paediatricians. While some standards are being met by the majority of units, others are falling short and the RCPCH is warning that the current configuration of services is putting children’s health services at risk and is unsustainable.
Back to Facing the Future finds:
• Over three quarters (77%) of children see a paediatrician on middle or consultant grade rotas within four hours of admission – just under a quarter do not.
• 88% of children or young people admitted to a paediatric department with an acute medical problem are seen by a consultant paediatrician (or equivalent) within the first 24 hours.
• Just 11% of units had a consultant presence during the evening. During peak times at weekends, consultant presence was reported for just 6% of units.
• Immediate telephone advice is not always available across some specialties – and arrangements are often informal.
• There is a shortfall of staff across all rotas when measured against the Facing the Future standards.
Dr Hilary Cass, president of the RCPCH, said: “These standards have gained a great deal of currency within the paediatric community and it’s encouraging that many units are meeting the standards well. There are countless examples of paediatricians going beyond the call of duty to deliver out-of-hours care – and it is thanks to the diligence and dedication of these doctors that most of the standards are being met and the level of healthcare delivered to children remains high. “But perhaps the most concerning area is the consultant presence at times of peak activity. When units are at their busiest, it’s crucial that the most experience and skilled members of the team are present – and currently this is not happening in too many services. Acute paediatricians are under significant pressure within the current structures and we have to be prepared to re-examine the way in which we deliver care because this way of working is not sustainable.”
