Policy responses and statements
- Name of organisation:
- Royal College of
Paediatrics and Child Health (Scotland)
- Name of policy document:
- A Framework for Support of Specialist Services
for Children and Young People within a District General Hospital
- Deadline for response:
- 31 August 2010
Background: As part of the implementation
of the SG National Delivery Plan for Children and Young People, it
was felt important to seek consensus on the range of services, staff,
and competencies that should be available to support the delivery of
specialist services for children and young people within a District
General Hospital. To facilitate this, a short life working group was
set up with representation from Child Health Commissioners, Regional
Planners, Medical Directors and Board CEOs, NES and clinicians.
This draft Framework of Standards is designed to guide and inform
the development of a more devolved model of delivery of specialist
services for children and young people. RCPCH Scotland feels that such
a Framework will influence important issues such as staff training
and education, workforce sustainability and future commissioning arrangements
and ensure as locally based service delivery as possible.
RCPCH Scotland asked the College to share this document with colleagues
and send comments by 31 August.
COMMENTS ON
ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH
(SCOTLAND)
A FRAMEWORK FOR SUPPORT OF SPECIALIST SERVICES
FOR CHILDREN AND YOUNG PEOPLE WITHIN A DISTRICT GENERAL HOSPITAL
The Royal College of Physicians of Edinburgh is pleased to respond
to the Royal College of Paediatrics and Child Health (Scotland) on
its draft document A Framework for Support of Specialist Services
for Children and Young People within a District General Hospital.
This is a clear and concise document, which sets out a framework for
paediatric services in a range of settings. The format of the
framework is useful, and facilitates an integrated approach to service
delivery. The development of a more devolved model for specialist
services for children certainly presents challenges, and most are addressed
in this document. Recruitment, skill mix, flexibility of working
practices, training, patient safety and Scotland's geography are all
considered.
Many specialties have had a variety of models for provision of paediatric
care, many of which have been developed on an ad hoc and individual
basis and are dependent on the goodwill of individual clinicians, some
of whom are nearing retirement, without having colleagues who are appropriately
trained to take over, or having established any form of systematic
succession planning.
The four level model of care that is used is necessary and familiar. The
overall project Objectives and Outcomes are clear and recognise that
delivery of services needs to be realistic, particularly with regard
to devolution of services versus centralisation of those that are highly
specialised or have particular demands.
We do have some concerns around the ability of interested parties
to plan and commission across regional boundaries. National Managed
Clinical Networks (MCNs) have been set up for a substantial number
of paediatric specialties in recent years. However, tensions
exist between such nationally determined priorities for service delivery
(relating to the provision of, and equity of access to, high quality
care as near to the patient’s home as possible in a particular
specialty) and funding for such services which is determined regionally
and locally using a different set of comparisons, generally between
other competing specialties. There is no overarching body that
would effectively resolve and integrate such differences in current
regional planning.
In the evolution of more robust links with the Deaneries, the mantra
that service is part of training could usefully be emphasised.
There is a typo on p 15: “their” should be “there” and
the Glossary (p 41) could be expanded to include “APA”, “SAMD” and “SAS”.
The sub-specialty areas discussed seem fairly comprehensive and relevant,
although there is not much reference to Diabetes Services – perhaps
these are subsumed within Endocrinology and Metabolic, so it would
be helpful to place these together, particularly since most of the
discussion is aimed at Level 2 & 3 services – but diabetes
care in this context does have its own challenges and needs.
With regard to specific aspects of the document:
Generic skills and competencies
These seem reasonable for the settings described in the paper. However,
there is, for example, very little relevant to a DGH A&E department
in an ECF Level 2 facility. It would be expected that the standards
of clinical competence listed on page 6 would apply equally within
an A&E department expected to assess, treat, stabilize and transfer
unwell children to a local Level 3 facility.
The comment on page 8 that the Paediatric Consultant on call should
serve only one clinical site might not be optimal in all circumstances. For
example, if an unstable patient in a Level 2 A&E required Paediatric
Consultant assessment, it could, in some geographical locations, be
quicker for the Consultant to attend the Level 2 site, and still be
available to the Level 3 site within 30 minutes if needed.
Specialty Guidance and Transition Care
Again, this is clearly set out and seems reasonable. There is
no comment on the training of the adult link rheumatologist (for example)
in provision of transition care. It would seem appropriate that
some training be considered within CPD. There may also be a wider
opportunity to provide training to groups of clinicians within one
DGH in the more generic aspects of transition care.
Regarding transition care, there has already been considerable work
in the area of engagement with adult sub-specialties. It could
well be a useful part of this framework, in any case, to spell out
the desired outcomes of such engagement more clearly. This could
include specifics of which clinics, with what staffing and at what
frequency per 100,000 population. Both generic and more specific
issues relating (for example) to remote and rural delivery of care
are addressed in the RCPE document “Think Transition – delivering
the essential link between paediatric and adult care” published
in 2008 by the Royal College of Physicians of Edinburgh, Edinburgh
(www.rcpe.ac.uk/clinical-standards/documents/transition.pdf). Aspects
of relevant A&E competencies would be expected to be found within
the generic skills section.
In summary
This is a carefully considered document that helps to set the scene
for planning and workforce initiatives over the next decade. The
College is pleased to commend it and to support the direction of travel
that it suggests. While some of the aspects considered are well
advanced in some areas of the country and in some specialties, significant
support from planners and commissioners will be needed at the very
highest level to make progress in delivering desirable outcomes logistically
and in the current financial climate.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[31 August 2010]
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