1. Dr Ann Hoskins Regional Director of Public Health / Director Children, Young People and Maternal Services

3. Report to PCT CEs on paediatric elective surgery September 2009
Issue
Year on year increase in children being referred to children's hospitals for surgery
Limited number of procedures being carried out by surgeons in some DGHs
Different models of paediatric surgery/networks across the NW

4. Paediatric Elective Surgical Review Sir Alan Craft report July 2010
Recommendations
SHA/PCTs
Paediatric Surgical Network be established to cover the NW SHA area
Appoint Network Director with administrative support
Monitor standards and performance of network
Explore alignment with NW Quality Observatory - AQUA
Network
Set Standards, monitor/evaluate services,
Define what surgery undertaken and timing
Explore DGHs undertaking general paediatric surgery for neighbouring DGHs
Consider sustainability of service
Promote education and maintenance of competencies
Align with NW quality observatory, AQUA
13.1 For SHA/PCTs
Establish a network of surgery for children across the whole SHA area.
Appoint a Network Clinical Director with administrative support
Monitor standards and performance of the Network
The possibility of the network being aligned with the NW Quality Observatory, AquA should be explored.
13.2 For the Network
Set the standards by which the service could be monitored and evaluated.(They may wish to consider those developed for the Yorkshire and Humber SHA).
The standards should apply to all hospitals including both tertiary centres and DGHs.
The principles which are developed for general paediatric surgery should apply to all elective surgery done on children.
The network should take the responsibility for defining what surgery should be done and the timing of it. They should then monitor adherence to these network standards.
Similar principles could influence the delivery of emergency surgery for children but this would need further discussion and agreement within the Network and with Commissioners.
The possibility of some DGHs undertaking general paediatric surgery for their neighbouring DGHs should be considered.
Consider the sustainability of the service.
Promote education and maintenance of competencies within the network.
The possibility of the network being aligned with the NW Quality Observatory, AQuA should be explored.

5. Paediatric Elective Surgical Review Sir Alan Craft report July 2010
Recommendations
Trusts
Join network and adhere to standards
Facilitate and monitor paediatric competencies of clinicians providing surgical services
Ensure surgery only undertaken by those who have demonstrated competence
Childrens aspect of a doctors work appraised separately from adult practice
Ensure quality of service through education of anaesthetists and surgeons
Clinicians
Appraisal of paediatric competencies
Be aware and adhere to network standards
13.3 For Trusts
Prioritise surgical services for children and participate in network arrangements by ensuring Trust representation at Network meetings.
Facilitate and monitor appraisal of paediatric competencies of all clinicians participating in provision of surgical services.
Providers should assure the quality of their services by ensuring that;
surgery is only undertaken by those who have demonstrated that they are competent to do so. This would apply both to the surgeon and the anaesthetist
ongoing competency is assessed by the annual appraisal and revalidation process
the children’s surgery aspect of a doctor’s work is appraised separately from their adult practice
regular educational experiences should be made available for both anaesthetists and surgeons
The possibility of some DGHs undertaking general paediatric surgery for their neighbouring DGHs should be considered
13.4 For Clinicians
Participate in annual and team appraisal of paediatric competencies.
Be aware of and adhere to network standards of care

6. Response to Alan Craft report August 2010
Time limited taskforce
Develop the set of standards for paediatric surgery
Design a template for audit based on these standards with AquA
Design a self assessment tools for Trusts in the NW
Design a peer review process in the NW
Explore the opportunities to work with AquA to develop a community of practice
Make recommendations about the potential future role of a network.

7. Finished Feb

8. Next steps Report disseminated to all Trusts CE/Chairs, PCTs/CCGs
AQUA agreed to support implementation of audit and benchmarking
Clinicians keen to produce standards for other paediatric surgery e.g. ENT, ophthalmology
Future policy on clinical networks