Lack of hospital surgery networks risking more child deaths

The National Confidential Enquiry into Patient Outcome and Death said less than half of NHS hospitals are currently part of a paediatric surgery network.

Such networks are needed to “ensure the comprehensive and integrated delivery of high quality care for children who undergo surgery”, according to the enquiry’s latest report.

In a letter to NCEPOD, health secretary Andrew Lansley said “we strongly support” the development of general paediatric networks as an “approach to organising and providing care”.

The enquiry surveyed 290 hospitals to investigate cases where children had died after surgery, following similar investigations in 1989 and 1999.

The report noted that 71 per cent of patients received “good care” and significant progress had been made since earlier reports. It said a range of areas required improvement.

For example, it highlighted delays in transferring sick children with complex health needs to a specialist centre for surgery – possibly as a result of not being part of a clinical network.

Report co-author and clinical coordinator for NCEPOD Kathy Wilkinson said: “In many cases the transfer of these critically ill children from district general hospitals to specialist paediatric centres took more than six hours… Trusts must be better prepared to admit, assess and, when necessary, transfer these children as quickly as possible.”

In addition, nearly one in five of the hospitals did not have a “comprehensive” policy for identifying and managing sick children. National acute pain management recommendations after surgery were not followed by more than a quarter.

NCEPOD also found cases where hospitals had too few nurses trained to provide immediate care for sick children when admitted. It asked whether there was at least one registered children’s nurse per nursing shift on the non-critical care ward which admitted children for surgery. In 8.3 per cent of hospitals this was not the case.

These hospitals “fell well below existing national standards” which state a minimum of two registered children’s nurses per shift should be on duty 24 hours a day in all children’s wards and departments, it said.

NCEPOD’s call for more networks was supported by Mr Lansley and the Royal College of Surgeons in their responses to the report.

Royal College of Surgeons council member and chair of its children’s surgical forum Su-Anna Boddy said: “The clear road for improvement in surgery for children lies in establishing networks.”