Grantham Children’s Services A Problem or an Opportunity?

Lincolnshire

Grantham Hospital - Paediatrics u From 1993 to 1998 provided by QMC u QMC Report –“It is no longer possible to sustain Children’s In-patient services at Grantham” »Risk of low quality service »A day time Assessment Unit with community nurses would enhance the care of children

Establishment of Task Force u Key Stakeholders –Paediatricians –Trust Managers u Range of options from:- –Full service –Only out patients

The Grantham Model for Ambulatory Paediatrics u New Concept u Total Package u Integrated Services u Unique Model u Research Based

Paediatric Services - Grantham u Assessment Unit at Grantham u Community Children’s Nursing u Enhanced Specialist Nurse Support u In Patient Care at Pilgrim or Lincoln u Tertiary Services at QMC u Outpatient Services u Day Case Surgery (ENT, Oral & General) u Community Paediatrics in S. Lincs. u Inter Unit Transport Services –Nurse Escort, PICU Retrieval –Minibus for Relatives

Implementation u Refining the Proposed Model u Seeking Professional Advice u Public Consultation u Political Pressures u Public Presentations/Information u Geographical Concerns u Policy & Standards Development u The Implications on other Services –Maternity, A&E, Ambulance, Social Services u Recruitment & Retention

Essential to Success u Contract Held by One Trust –Responsibility for the Service »Clinical Governance »Complaints and Litigation »Employing the majority of Staff u Close working together of all 3 Lincolnshire Acute Trusts at all levels u Enthusiasm to provide a good paediatric service for Grantham u Good Communication with and involvement of G.Ps, Community Trust, Ambulance Trust, Health Authorities and QMC

Accident & Emergency u Train medical and nursing staff to APLS standard. u Include Children’s Trained Nurses in staff of A&E department. u Have clear protocols for management of paediatric conditions. u Provide Children’s Nurses for Escort where necessary. u Training input from Paediatricians. u Training for Ambulance Paramedics.

Trust Merger u United Lincolnshire Hospitals NHS Trust u Formed from –Grantham Hospital NHS Trust –Pilgrim Health NHS Trust –Lincoln & Louth Hospitals NHS Trust

Financial Position u 1996/7 - £ 1.3M budget for previous service u 1998/1999 –Direct Pay £ –Non Pay £ 35.9 –Services £ –Community £ u Total £1,304.8 –Plus Inflation

Advantages u “Children should be admitted to hospital as in-patients only if appropriate care cannot be provided daily or in the community” u Children’s Community Nursing Service based on the Unit 7 days a week, 24 hours per day. u Senior paediatric opinion immediately available. Development of special interest clinics. Outpatient waiting time short. u Availability of specialist nurses u Medical Staffing support for 2 Lincolnshire Inpatient Units.

Disadvantages u Distance from Inpatient Units u Closure of Consultant-Led Obstetric Service u Continuity of Consultant Care u High input of Senior Medical Time u Public Perception

Activity Levels - Assessment Unit u Assessment Unit Admissions –1998/ –1999/ u Transfers out to other Hospitals –1998/ (12.5%) –1999/ (11.2%)

Activity Levels - Accident & Emergency u Children Seen in A&E –1998/ –1999/ u Children Transferred Out of Grantham –1998 / (7%) –1999/ (7.2%)

Children Escorted u Transfers by Paramedic Ambulance Crews –With Nurse Escort »1998/ »1999/ –With Doctor Escort »1998/ »1999/ –With Retrieval Team »1998/ »1999/

Future u Improve Public Awareness of Service u More use of the facilities by Community Medical Staff and Paramedics. e.g. –Child Development Clinics –Psychology, ENT etc. u Close Working Relationships with the new Primary Care Trust u Training of SHOs & Medical Students