Routine emergency surgery for children must be available locally

No parent ever wants their child to be ill. But if a child does need emergency surgery for an appendicitis or because they have fractured a bone for example, it is very important that they can access high quality care close to home.

Unfortunately, there is an increasing trend for local district hospitals not to offer general surgical services for children. A recent survey by The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reported a gradual reduction in the range and volume of procedures performed outside specialist paediatric centres with concerns from a number of surgeons and anaesthetists about deficiencies in their hospital’s facilities that might compromise the delivery of a safe children’s surgical service [1].

The lack of children's surgical services locally is particularly worrying for children with time-sensitive, emergency conditions, who are instead transferred to a specialist centre. There are concerns that some children are suffering worse outcomes due to delays in treatment. If, for example, a young boy with torsion of the testis is not treated quickly, the consequences can be tragic and it could result in him losing a testis.

It is also more efficient for the NHS to treat general surgical conditions in a local hospital.  This is because there is an increased cost to the NHS of providing a bed in a specialist unit for a patient who does not require that greater level of medical expertise. Beds in these units are at a premium, and if they are unnecessarily occupied by a patient who has been transferred from a local hospital, it can prevent children with complex needs from being admitted to hospital.

For families there is the additional inconvenience, as well as increased expense, of having to travel to a specialist centre which is further from home, when their child could have been treated in a hospital nearby.

At the Royal College of Surgeons we want to support and encourage local surgeons and hospitals to offer non-specialist surgical care for children in both elective and emergency situations.

This is why the Children’s Surgical Forum (CSF) - which is comprised of surgeons, anaesthetists, other medical specialists and lay representatives - is today publishing agreed National Standards for Non-Specialist Emergency Surgical Care for Children.

The document is primarily intended for Clinical Commissioning Groups (CCGs), NHS managers and clinicians. For the first time, it combines the numerous standards and guidance already published by key stakeholders over the last ten years into one document.

Topics covered include: pre-hospital care, networks, locally delivered care, collaboration between paediatric and surgical services, transfers, education and training, and patients and their families.

The overarching intention is to encourage the creation of local networks and better collaboration between specialist and general commissioning for children’s surgical services. Put simply: hospital trusts need to make sure they provide elective and emergency children’s surgery.

Networks can improve communication between trusts, in addition to offering an opportunity to review best practice and offer training opportunities for staff.

I encourage anyone involved in commissioning or the delivery of healthcare to read this publication. It supports regional co-operation, collaboration and a uniform national standard of care for children with a non-specialist surgical emergency. We owe it to the children and young people who have the misfortune of needing emergency surgery to make sure they have access to safe, high quality care close to home.

Mr Richard Stewart is a Consultant Paediatric Surgeon, Council Member at the Royal College of Surgeons, Deputy Chair of the CSF at the RCS and past Chair of the East Midlands General Paediatric Surgery Strategic Clinical Network.

Notes

1. NCEPOD (2012) Children’s surgery: a national survey of consultant clinical practice