Children's patient services 'to remain at Scots hospital' as report highlights safety concerns

The Royal College of Paediatrics and Child Health was commissioned to carry out an investigation into children’s wards at several NHS Lothian hospitals in response to a staff shortage which led to the temporary closure of the children’s ward at St John’s in Livingston in the summer of 2015.

There have long been fears that the children’s ward at St John’s could face closure because of staffing difficulties.

It's newly published report highlights concerns from midwives working at St John’s neonatal unit who felt they were sometimes "leading resuscitation" rather than supporting it.

"The Review team heard mixed reports about clinical safety concerns on the St John’s neonatal unit particularly relating to resuscitation and consultants ‘acting down’ on the out of hours rota," the report said.

But the report, which also examines the Royal Hospital for Sick Children, Edinburgh, and Edinburgh Royal Infirmary, says that St John’s medical team felt there were “no safety issues” and were “confident” nurses could “handle a 23-week infant” until further expertise arrived.

The report also says an NHS Lothian management team expressed concern about "a number of incidents relating to resuscitation" in paediatric services, which deals with the medical care of children, in the weeks prior to the review team’s visit.

"These were reportedly attributed to inadequate training and maintenance of competencies compounded by overworked staff with minimal backup," said the report.

The review report told of of a discussion in April which indicated that there was "not an open culture of reporting with staff feeling ‘guilty’ to report and lack of clarity over which incidents required logging" Nurses believed that practice in the neonatal unit was "variable" due to lack of confidence in some medical staff.

The report also stated that the governance arrangements across NHS and within each hospital were "not consistent" and "seemed to lack openness" and this appeared to affect staff morale.

Despite this, the review team says staff at St John's were dedicated "despite serious staff shortages".

NHS board members are being asked to consider a staffing model at St John's based on consultants being resident in the hospital overnight and would see them carrying out occasional overnight shifts to provide an on-site senior presence.

It is suggested in the short-term the children’s ward at St John’s Hospital would be a 24-hour unit but should not admit children overnight when consultants are not present. Out of hours cover would be provided by a mixture of advanced practice nurses and medical staff, with a non-resident consultant on-call from home.

NHS Lothian board members will meet next Wednesday to agree what actions should be taken from the many recommendations included in the 80-page report to "ensure a safe, effective and sustainable service for children of Lothian".

Lothian Labour MSP Neil Findlay, who has just been appointed convener of the Scottish Parliament’s health and sport committee said: "This is a fantastic victory for the community campaign. We said from the beginning that it would be unacceptable for any closure or downgrade of the ward at St Johns and we have been successful in defending these services.

"There are however huge issues relating the services being provided and we have to ensure that the concerns raised in the Royal college report are addressed - but today is a victory for people power and I want to thank everyone who supported the campaign.

Jim Crombie, chief officer of acute services at NHS Lothian, said: “I want to ensure that we can deliver the safest services for children across Lothian which is why we commissioned the experts at the Royal College of Paediatrics and Child Health to carry out an independent review."