Agenda item

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provides the Committee with an update on Children and Young Persons' Services.  Dr Neill Hepburn, Medical Director ULHT will be in attendance for this item)

Consideration was given to a report from United Lincolnshire Hospitals NHS Trust, which provided the Committee with an update on Children and Young Persons' Services.

The Chairman welcomed to the meeting Dr Neill Hepburn, Medical Director ULHT, Suganthi Joachim, Clinical Director, Family Health Division and Simon Hallion, Managing Director, Family Health Division.

The Committee were reminded that the inpatient service for children and young people at Pilgrim Hospital, Boston had been suspended from August 2018 and replaced by an interim service model, which included a Paediatric Assessment Unit (PAU).

The Committee noted that the interim model had been introduced as a result of concerns raised by senior medical staff; and the inability of the Trust to recruit middle grade doctors at Pilgrim Hospital.  It was reported that the new model had seen the average paediatric stay reduced from 43 hours to 8 hours.  It was noted that the Trust actively monitored the number of children staying over 12 hours.  It was noted further that a consultant could keep any child at Pilgrim Hospital beyond 12 hours when it was clinically required, or deemed in the best interest of the child.  The Committee were advised that the on-site ambulance was available 24/7 and for the period up to 30 April 2019, of the 2,790 children who had attended Pilgrim Hospital, 272 had been transferred to other hospitals.  The Committee was advised further that the Lincolnshire Sustainability and Transformation Partnership (STP) had proposed that the PAU model at Pilgrim Hospital should be continued, subject to engagement and consultation, and that a PAU should also be created at Lincoln County Hospital; and that this would be a key element of the 'Healthy Conversation 2019' process.

The Committee was advised that positive feedback had been received on the introduction of the Paediatric Observation Priority Score Assessment model to the Trust's Emergency Department (ED).  This tool had enabled clinicians to carry out a structured assessment of children in the ED environment and provide a clinical priority rating as the assessment output.  It was noted that plans were being finalised to recruit to specific rotational children's nursing roles between ED and paediatric areas, as experience elsewhere had suggested that such roles could attract candidates.

It was reported that the service was delivering a level 2 neonatal service at Lincoln County Hospital (from 29 week gestation) and a special baby unit at Pilgrim Hospital (from 34 week gestation).

The Committee was advised that nursing vacancies across Rainforest Ward, Safari Unit (Lincoln) and Ward 4A (Boston) were running at around 50% of establishment.  It was highlighted that this was being mitigated by the use of additional hours and by using long-term agency nursing appointments.  The Committee was advised further that the Trust was continuing with a recruitment campaign to attract registered children's nurses to Lincolnshire.  The Trust was also looking at introducing more flexible working opportunities to help retain staff and attract new staff.

The Committee was advised that the service was still fragile. Details of paediatric medical numbers as at 25 June 2019 were shown on page 39 of the report.  It was highlighted that an advertisement for 8 WTE Consultant Paediatricians posts had attracted 8 applicants; and that following interviews 3 had been offered appointments. Again, the Trust was continuing with its recruitment campaign, with further advertisements being place in September (UK and international).

Attached to the report were the following Appendices for the Committee to consider:

·         Appendix A – Details of Postcode Analysis;

·         Appendix B – Details of Readmission Rates;

·         Appendix C – Details of the Paediatric Six Month Review; and

·         Appendix D – A copy Risk Register for the Children and Young Persons' Service.

The Committee was advised that the postcode analysis had shown that in March 2018, the total paediatric admissions to Pilgrim from Lincoln postcodes had been 10; and in March 2019 the total paediatric admissions to Pilgrim from Lincoln postcodes had been 9.  Further details were available for the Committee to consider in Appendix A.

It was reported that readmission rates had remained relatively consistent, with the exception of Safari Ward, which had seen an upward trend and that more work was being done to identify reasons for the increase.  Details were provided on page 41 of the report; and further information was shown in Appendix B to the report.

In conclusion, the Committee was advised that the interim service model had delivered a safe service for the children of Lincolnshire.  It was highlighted that the interim model was now at a stage where it could be incorporated into a larger children's programme of work to ensure that it developed as part of an integrated service for children.  The Committee was advised further that recruitment still remained a concern for the service and for the Trust overall, and that the Trust was continuing through recruitment and flexible working arrangements to recruit and retain staff.  Details of the planned actions were shown on page 42; and details of Paediatric Contingency Plans were shown on page 48 of the report.

During discussion, the Committee raised the following issues:-

·         The need to ensure that the Trust highlighted the good work being carried out; and that compliments received relating to the services provided should be shared more to create a more positive picture to aid in the recruitment process.  The Committee was advised that this work was being done and was shared with prospective candidates.  The Committee noted that recruitment for consultants had been a more positive experience this time with 8 candidates applying for positions;

·         Use of Agency Staff – The Committee was advised that agency staff were continually used; and confirmation was given that agency staff were paid at a higher rate.  It was noted that agency staff generally enjoyed more flexibility.  The Committee noted further that the quality of the service was driven by the substantive staff;

·         Recruitment – Confirmation was given that the Trust provided flexible options to potential and existing staff to help the sustainability of the service; and

·         Transfer of Children from Boston to Lincoln and how many of the children under 16 were place on an adult ward.  The Committee was advised that between the ages of 13-16 young people as a day case patient were given a choice.  Paediatric patients up to the age of 16 would be admitted to a paediatric ward; and that between the ages of 16 and 18, the young person would be a choice between a paediatric ward and an adult ward.  The Committee was advised that children being transferred from Pilgrim Hospital to Lincoln County Hospital would have to be clinically stable; and that some children and young people would be transferred by private ambulance accompanied by a paediatric paramedic, whilst others who had high dependency needs were transferred by an EMAS ambulance.      

The Chairman on behalf of the Committee extended his thanks to the presenters.

RESOLVED

1.    That the United Lincolnshire Hospitals NHS Trust – Children and Young Persons Services Update be received.

2.    That a further update on Children and Young Persons Services be received by the Committee at the 18 December 2019 meeting.