Hospital care for sick children at weekends and in evenings needs to be better organised to ensure senior staff are available when needed, according to the Royal College of Paediatrics and Child Health.

The college warned the urgent need to reconfigure paediatric services to ensure safe care could be being “masked” by paediatricians “hard work and commitment to go above and beyond the call of duty.”

The findings follow a recent audit and series of “deep dive” hospital visits by the college.

The visits were to evaluate the take-up of its 10 standards for acute paediatric care, published in its 2011 “Facing the Future” report.

The audit, called “Back to Facing the Future”, found on average 23 per cent of UK child admissions were not seen by a middle grade or consultant grade clinician within four hours.

Weekend performance was worse, at 27 per cent, compared to 21 per cent on weekdays. It was worse still between the hours of 10pm and 9am, with 30 per cent of admissions not seen by a middle or consultant grade clinician within four hours.

Auditors also found varying compliance with the standard that all children should be seen by a consultant within 12 hours.

This was met in 26 per cent of daytime cases, and just 17 per cent of evening cases.

Fifty-seven per cent of night admissions were seen by a consultant within 12 hours because they were usually covered bythe morning ward rounds.

The report concluded: “At times of peak activity, when one would expect the standard of service to be at its most robust, the most senior, skilled and experienced staff are not always present. It is essential that paediatrics is a 24/7 specialty, and consequently service planners should organise rotas more carefully around the needs of the child.”

College president Dr Hilary Cass told HSJ: “Paediatrics is by its very nature a seven-day specialty. Children can fall sick at any time of the day, at any time of the week, and their condition can deteriorate very quickly. We need to develop a service that reflects that, and that will involve making some difficult choices about how and where we provide care.

“We urgently need to look at more innovative models, providing more care in the community, whilst centralising expertise.

“Seven day working is an issue across the NHS, but the consultant workforce is not endlessly elastic and cannot be stretched to meet increasing demand.”