RCS publish new standards for children's surgery

Children with emergency surgical conditions should not wait longer than 12 hours from decision to operate to undergoing surgery, and operations should be scheduled with consideration for the needs of children and their parents, according to new guidance published today by the Royal College of Surgeons.

Standards on Children’s Surgery is guidance produced by the Children’s Surgical Forum, a group that brings together a range of professionals involved in delivering surgical services to children.

The definitive guidance for commissioners and service planners within the NHS aims to ensure children consistently receive surgery in a safe, accessible and appropriate environment from staff with the right skills, in order to ensure the best quality of care is being delivered.

Approximately a quarter of the UK population is children, some of whom will require complex surgery early on in their lives. The standards stress that it is vital health professionals provide them with the best possible patient experience.

The paper highlights that parents’ involvement in decisions from the start is crucial and that information about a child’s condition is communicated in a way that preserves privacy, dignity and confidentiality.

It also recommends that consultants work within the limits of their professional competence and, where there are unexpected circumstances requiring that they act beyond their area of expertise, support is available from qualified colleagues.

The publication states that it has been more than five years since the Children’s Surgical Forum published Surgery for Children: Delivering a First Class Service. During those years, the landscape of the NHS has altered dramatically due to changes in funding and reforms of the way in which services are planned.

Standards for Children’s Surgery provides fresh guidelines for children’s surgical service provision and outlines clear procedures for all those involved in commissioning, planning and delivering services. This will ensure the services they design meet expected levels of quality and attain excellent outcomes in relation to governance, organisation of care, patient experience, training and service delivery.

The document advocates that local hospital networks give on-going support to surgeons, anaesthetists and the whole multi-professional team involved in delivering surgical care in local hospitals. This will enable vital services to be delivered locally, while establishing agreed polices and processes for transferring patients and their families when their needs cannot be met at the local level.

The standards include:

• Children and families should be represented in the design of surgical clinical networked services. They should also be involved in the decision to operate and the consent process.
• Information should be provided to patients and carers at each stage of their care pathway and communication with patients and carers should be consultant-led.
• The critically ill child with an immediate life threatening condition is assessed by a senior clinician and the decision to operate or transfer is made promptly according to network arrangements.
• Emergency surgery for children should be assessed at least once a year using routinely collected data, including the time between admitting a patient  and the decision to operate.
• Day surgery should be provided for children whenever practical with a named consultant responsible for their care.
• Structured arrangements must be in place for the handover of children at each transfer of responsibility between the consultant and other members of the medical team.

Gill Humphrey, Chair of the RCS Patient Liaison Group, said:

‘Children’s surgery is quite specialised and it can be particularly daunting when faced with the prospect of your child having to have surgery of any kind. The overarching principle must be the safety of the child and for parents or carers to be completely clear about each stage of the treatment process. Communication is key. It is also crucial that Trusts ensure staff are appropriately skilled and trained to care for children, and that training opportunities for professional development are provided where needed. Children’s lives are too precious for us to countenance anything less.’

Professor Norman Williams, President of the Royal College of Surgeons, said:

‘The landscape of the NHS is changing and will continue to change over the coming years. In order to support those providing children’s surgical services to maintain excellent outcomes, both in terms of patient experience and expectation, the profession must provide a clear understanding to patients and their carers of what the totality of their treatment will look like. The RCS standards for children’s surgery document aims to support the profession in achieving this. ’

The guidance has been endorsed by the Royal College of Surgeons of England, the British Association of Paediatric Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Anaesthetists, the Association of Paediatric Anaesthetists, the Association of Surgeons for Great Britain and Ireland and the British Association of Urological Surgeons.

Access copies of Standards on Children’s Surgery.

Notes to editors

1. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk.
2. The Children’s Surgical Forum brings together a range of professionals involved in delivering surgical services to children. This includes representatives from the College, the surgical specialist associations, other medical royal colleges, the College’s Patient Liaison Group and the Department of Health.
3. For more information, please contact the RCS press office on:

• 020 7869 6047/ 6052
• communications@rcseng.ac.uk
• Out-of hours: 07966 486 832