The Facing the Future Audit 2017, published today by the Royal College of Paediatrics and Child Health (RCPCH), calls on UK Government to expand the consultant workforce to help units increase consultant presence at peak times – usually between 08:00 to 22:00 - and improve the standard of hospital care. To do this, the report recommends that in the UK, 465 full time equivalent (FTE) paediatric trainees are recruited at ST1 (trainees in their first year of training) level every year for the next five years which will help achieve the consultant expansion required.
The College recommends an increase in total of 752 FTE paediatric consultants to meet standards - 520-540 in England, 84-110 in Scotland, 84-91 in Wales and 30-31 in Northern Ireland.
The Audit analyses data submitted by paediatric clinical directors on two sets of standards produced by the RCPCH in partnership with children, young people and families - the ‘Facing the Future: Standards for acute general paediatric services’ and ‘Facing the Future: Together for child health’ standards. The audit provides UK-wide evidence to help us understand how services are meeting standards and what impact they are having on the ground.
Audit data captured from ‘Facing the Future: Standards for acute general paediatric services’ found:
- on weekdays, a paediatric consultant is present in the hospital during times of self-identified peak activity in 38.7% of units
- at weekends, a paediatric consultant is present in the hospital during periods of self-identified peak activity in 28.6% of units
- across all training rotas, 30.1% of paediatric units have the recommended number of staff to manage care (10 or more WTE)
- averaged across the eight specialties, 75.4% of units have access to specialist paediatricians for immediate telephone advice.
Dr Carol Ewing, Vice President for Health Policy, the Royal College of Paediatrics and Child Health, said:
"It is down to the sheer dedication of our doctors that children are being treated as safely as they possibly can on paediatric wards in the UK but the risk of ‘burn out’ is all too real.
"To improve the care delivered by units, it is vitally important they meet each and every one of the standards set out in this audit. However, as we have seen from our hospital visits, units are only going to be able to do this is they have the resources in place to support them.
"In order to meet three key standards – children seen by a consultant within 14 hours of admission, two consultant led hand overs and presence at peak times - paediatric departments need increased consultant presence from around 8am to 10pm. The growth in the paediatric workforce is crucial if this is to happen."
To help units drive up the standard of care, the RCPCH recommends:
Government must:
- prioritise adequate resource to fund the workforce needed to implement standards in children’s health services
- centrally fund an increase to the number of paediatric trainee places to ensure at least 465 full time equivalent trainees enter each year of training across the UK to achieve an expansion in the consultant-level workforce by the desired 752 full time positions
- commit to developing a cross-departmental child health strategy for England by 2019.
Health Education England must:
- fund an increase in the number of paediatric trainee places to achieve an expansion in the paediatric consultant level workforce of 520-554 full time positions
- clarify whether the expansion of medical undergraduate numbers beginning in 2018 and 2019 will translate into more postgraduate training places in future years
RCPCH will:
- continue to support our members and work with NHS leaders, service commissioners, planners and regulators to embed the standards so the care provided to children improves to the level which families and paediatricians expect
- continue to improve the promotion of paediatrics as an attractive specialty, whilst removing the fee for Affiliate ʼһfor Foundation Doctors and improving the membership offer for both Foundation and Medical Students by 2019
The audit also found:
Audit data captured for ‘Facing the Future: Together for child health’ found that GP practices are linked with consultant paediatricians in just 7.4%, risking ongoing communication issues between services and a lack of professional development and teaching opportunities.
And:
- GPs have access to immediate telephone advice from a consultant paediatrician in 86.2% of units
- 26.4% of acute general children’s services provide a consultant paediatrician-led rapid-access service so that any child referred can be seen within 24 hours
- 45.1% of healthcare professionals have access to the child’s shared electronic healthcare record
- 16.9% of acute general children’s services work together with local primary care and community services to develop care pathways for common acute conditions
- 14.9% of acute general children’s services are supported by a community nursing service that operates 24 hours a day, seven days a week, creating difficulty in discharging children early from hospital.
Dr Ewing said:
“Children and their parents have told us that navigating health services is challenging. With improved communication comes a more efficient service - patients see the right professional at the right place and at the right time.
“GPs having access to immediate telephone advice was reported as being an important factor in delivering high quality care. Where practices didn’t offer it, they cited funding as a direct barrier. This is an excellent service but unfortunately commissioners are not recognising it. We’d like to see the remaining practices – some 14% have access to immediate telephone advice so that GPs and their patients can reap the benefits.
“Similarly, units should be providing a service to the 74% GP practices which do not have a linked consultant paediatrician-led rapid access service. This will further enhance the care children and their families receive. We want GPs to pick up the phone and speak to a child health expert if they are worried about a patient. We can then ensure that child is seen by an expert, often much more quickly – within 24hrs - and with a reduced length of inpatient stay if admission is required.”
Doctors say involving children in the design and delivery of their care also improves results.
“Children have a right to be involved in the design of their care and we know that where there is involvement, satisfaction of the service increases” says Dr Ewing.
To help drive up the standard of care, the RCPCH recommends:
Health Service Commissioners:
- ensure their services have a lead for children
- ensure there are mechanisms to develop and implement integrated services for children across primary, secondary and tertiary care settings so that professionals can work together to embed Facing the Future standards
The Department of Health:
- should identify the barriers to implementing guidelines and standards then create an action plan to overcome them
Service planners:
- must have a dedicated lead for children at executive or board level by 2020
- must evidence the routine involvement of children and their parents/carers into the design, delivery and evaluation of child health services by 2019
Jack Welch, 24, RCPCH &Us young representative said:
“Healthcare settings, especially acute hospitals which deliver paediatric care, have to bring in the voices of young patients and parents/carers to ensure that from admission to discharge, it reflects the depth of patient experience and that improvements are based upon the responses and guidance of those who receive the care.
That ensures information, such as what happens at discharge, is easily understood by everybody concerned and that by meaningfully having patients as part of service design more substantively than in many cases at the moment, there will be more accountability within services to enable greater patient influence.”
Across the UK
This new UK-wide report also makes recommendations specifically targeted at improving the health service in Scotland, Wales and Northern Ireland, making recommendations to the respective governments.
In Scotland, it calls for:
- an increase in the number of paediatric trainee places to achieve an expansion in the paediatric consultant level workforce of 84-110 full time positions
- the barriers to implementing these standards identified and create an action plan to overcome them
- the Scottish Government must demonstrate delivery of the Child and Adolescent Health and Wellbeing Action Plan using the accompanying framework by 2019.
In Wales:
- must fund an increase in the number of paediatric trainee places to achieve an expansion in the paediatric consultant level workforce of 84-91 full time positions
- a Child Health Plan must be published by 2019.
In Northern Ireland:
- must fund an increase in the number of paediatric trainee places to achieve an expansion in the paediatric consultant level workforce of 30-31 full time positions
- should identify the barriers to implementing guidelines and standards then create an action plan to overcome them
- a cross-departmental child health strategy by 2019 must be developed.