St John’s paediatric services: Health Secretary statement

Presiding Officer, I’m grateful for the opportunity to update Members on progress made on the provision of Paediatric Services at St John’s Hospital in Livingston.

I want to begin by recognising the excellence and dedication of the staff who work there to care for and serve patients and families in the surrounding communities; the support the service has from local parents and by emphasising my commitment to the Hospital and its paediatric services.

When I came to Parliament to update Members last September I gave a commitment that I would return in January to provide a further update. I informed Members that I had asked the Director General for Health and Social Care and the Chief Medical Officer for Scotland to review progress by the end of January. I also asked the Chief Nursing Officer for Scotland to liaise with NHS Lothian and provide advice and support on the training and development of Advanced Nurse Practitioners. I would like to record my gratitude to them for their support and their professional input.

I will not rehearse again in detail why the interim service model has been implemented beyond one important point, that the decision was taken by NHS Lothian in the best interests of children and their families in the circumstances of that time. Within this interim model the majority of children’s services have been maintained at St John’s. The children’s ward is open 8am to 8pm, 7 days a week providing a short stay paediatric assessment service, with the paediatric ward remaining open for day-surgery activity as well as planned day case procedures and programmed investigations.

The paediatric out-patient services, neonatal services and community child health services have all been unaffected. The assessment unit has seen around 3,560 children since July 2017, it has also seen over 2,555 planned investigation unit attendances. The emergency department continues to see over 11,000 attendances a year and outpatient clinics have seen over 4,000 new and review patients.

The board has evolved the interim model since it was first implemented, and that evolution has seen a drop in the number of children who have been transferred but not admitted to the Royal hospital for Sick Children in Edinburgh. When the interim model was introduced in July 2017 the average figure was 12 children a month; since March 2018, the average has been four, reflecting more confident triaging of patients.

Additionally, although the original plan was for children to be redirected to the Royal Hospital for Sick Children at weekends, the board has maintained a daytime weekend rota on all but three weekends from July 2017 to date. A wide range of children’s services continue to be available at St John’s, and the vast majority of children who require services locally, receive them at St John’s.

But I am acutely aware of how important the reinstatement of the full inpatient service is to the local community.

I met with a group of parents and Ms Constance on 29 November last year when I heard first-hand about their personal experiences at St John’s and of the excellent care their children received in the inpatient unit. I heard of the dedication of staff to the service and of their willingness to go above and beyond to provide care for the local population. I am grateful to all who attended for their openness and I understand the anxiety and share the concern felt by members and the local community to have the service reinstated.

The Royal College follow-up report to the board in 2017 reiterated, that its preferred option remained a 24 hour model, reflecting the population projections for West Lothian. In turn the Board has confirmed its absolute commitment to the reinstatement of this 24/7 model through discussions with Paul Gray, Dr Calderwood and Professor McQueen.

The board has continued work to develop and deliver a 24/7 service that is safe and sustainable. This requires a staffing rota that ensures resilience to sick leave and any other short notice reductions in staff availability. It requires that the majority of shifts be filled by permanent staff so that rotas can be planned for six month periods, and it requires a model that equates to having 2 tiers of trained staff to look after the children of West Lothian overnight- that is consultant paediatricians supported by a second full rota of other medical and nursing staff.

The NHS Lothian Paediatric Programme Board met on 9 January, when two interim options to enhance paediatric service provision were considered. The options were to reopen the inpatient ward for 4 nights a week Monday to Friday, or to extend the opening hours of the short stay unit to 22.00 or 24.00 hours 7 nights a week. The Programme Board undertook assessments of both options in the context of the full 24/7 service re-opening in October this year, meaning these interim options would be required for no more than 6 to 7 months. What emerged from the assessments was a clear preference for the reopening of the 24 hour inpatient service Monday to Thursday from 18 March.  On the remaining 3 days Friday to Sunday the assessment unit would be from 8am to 8pm as now.

This is achievable because of improved medical and nursing staffing numbers. From a nursing position the ward will be fully staffed overnight for 4 nights a week Monday to Thursday with a paediatric nurse in the emergency department for the remaining three nights Friday – Sunday, as in the current arrangement.

NHS Lothian currently have 3 advanced paediatric nurse practitioners (APNPs) in post, 2 are already contributing to the out of hours rota and 1 is expected to contribute to the rota from March. This is an improvement on the position in September when only 1 APNP was supporting the rota. Of the 3 additional APNPs recruited last year 2 will be ready to contribute to the rota from October and another will be available in 2020. NHS Lothian expects that the improved staffing position will support their commitment to re-opening of the inpatient unit fully in October 2019.

The Programme Board felt that the re-opening of the unit 4 nights a week would significantly enhance the service delivered at St John’s through a reduction in transfers to the Royal Hospital for Sick Children. Over the last 18 months an average of 1.6 children a day have been transferred from St John’s to the RHSC. The Board would expect most of these children to be admitted to the St John’s Unit over the 4 nights it is open.  There are in addition on average 4 children who are transferred to the RHSC but not admitted and the Board expects that most of these children would stay at St John’s. The Board will monitor the arrangements and keep activity under review.

It was also felt that the 4 night interim arrangement would improve further recruitment efforts as it demonstrates the Board’s commitment to fully reinstate the 24/7 inpatient service from October. The Board will go back out to recruitment for the two consultant posts which were not filled after the recruitment efforts in the autumn 2018.   Advanced Nurse Practitioner posts also continue to be advertised. NHS Lothian remains committed to, where possible, ‘over recruit’ to both areas in order to build resilience and to mitigate the risks associated with the impact of sickness or any other absences or long-term leave.

I know members and the local community are anxious to know when the 24 /7 service will be reinstated and I understand that.

I believe the board’s decision to reopen the paediatric ward for 24 hours, 4 nights Monday to Thursday is welcome and I hope provides assurance to members and families that full reinstatement of the inpatient service is on track to happen in October.

The board’s chief executive has sought to assure me that reinstatement of the full 24/7 paediatric service has the full commitment of the board and will continue to receive the highest level of priority. As I said in September, that too is, and remains, my commitment. We will continue to act, as we have done, to provide assistance and support to the board, monitor progress and work to deliver 24/7 paediatric inpatient services at St John’s from October this year. That remains my commitment and I hope members see the progress to date as further assurance of that.