A CHILDREN’S ward which was forced to close to inpatient admissions more than two years ago will not fully re-open as planned next month amid an ongoing doctor shortage.

The 14-bed unit at St John’s Hospital in Livingston was expected to resume full opening hours from October, but Health Secretary Jeane Freeman said the “current staffing situation prevents the safe reinstatement of a 24/7 inpatient service”.

In particular, Ms Freeman told MSPs that the number of clinicians in post would only be enough to cover 32 out of the 40 out-of-hours shifts needed to run a round-the-clock inpatient service.

READ MORE: St John's childrens ward to resume 24-hour opening four days a week 

She said: “Whilst NHS Lothian has been reasonably successful in recruiting additional consultants and Advanced Paediatric Nurse Practitioners, there has been an issue with staff leaving their post for various reasons, including personal circumstances and decisions to move on to other posts.”

Ms Freeman said the reinstatement of a full 24/7 paediatric service will “continue to receive the highest level of priority” by NHS Lothian.

She added: “I fully appreciate how disappointing this will be for local people, but I am sure you will agree that the safety of children must be of paramount concern.”

The children’s ward had battled a string of temporary shutdowns due to staffing shortages but was eventually closed to inpatient admissions in July 2017 while additional paediatric consultants could be recruited.

Although the ward remained open daily from 8am to 8pm so that day case procedures and assessments could continue, children from the West Lothian area who required overnight care had to travel 20 miles to Edinburgh’s Royal Hospital for Sick Children.

READ MORE: Fire risk at delayed Edinburgh Sick Kids 

The closure was initially billed as being for summer 2017 only, but has dragged on due to recruitment struggles.

In March this year, the ward resumed 24/7 opening from Monday to Thursday, with limited opening hours remaining in place from Friday to Sunday.

Since then, 456 children have been admitted as inpatients.

Dr Tracey Gillies, medical director for NHS Lothian said the safety of children treated at St John’s “will be the overriding priority in any decision relating to the resumption of 24/7 inpatient services”.

She added that they had hired two extra consultants in August, and further recruitment efforts were ongoing.

She said: “Unfortunately, however, we have experienced some unexpected and unavoidable changes within the dynamic of the team in recent weeks.

"The rota has now been assessed and it has unanimously been decided that the service cannot safely step up from four to seven nights at this point.

“We will continue our enhanced efforts to recruit the required staff, which will allow us to fully re-open 24/7 seven days a week.”

Scottish Labour’s health spokeswoman Monica Lennon said: “The situation at St John’s is another symptom of the SNP’s mismanagement of the NHS in Scotland - a chronic staff shortage.

 “With a public inquiry into hospital scandals hanging over her, the Health Secretary should be producing a deliverable plan to ensure there is enough staff to look after sick children, but after 12 years in government it is clear the SNP is not capable of running the NHS."


THE recruitment struggle facing St John's hospital is a symptoms of a wider crisis. 

According to a report by the Royal College of Paediatrics and Child Health (RCPCH), Scotland's health service needs around a 100 extra consultant paediatricians to keep up with demand. 

The report in March described a system "on the brink of crisis" following years of "incoherent and inconsistent" workforce planning.

It warned that rota gaps and vacancies in Scotland were worse than the UK overall, and that the situation would be exacerbated by a looming "retirement timebomb" among older consultants in around 15 years and a growing preference among younger medics to work less than full -time. 

Current increases in demand are reflected by figures showing a 30 per cent surge in emergency hospital admissions among children in Scotland, from just under 45,400 in 2012/13 to just over 59,000 in 2017/18.

This has been driven by a growing number of children surviving with complex conditions or suffering from multiple illnesses, such as Type 2 diabetes and asthma, as well as long delays in diagnosis for autism and Attention Deficit Hyperactivity Disorder (ADHD).

As a result, general paediatrics in particular is grappling with "the greatest difference between demand and actual consultant numbers".

The problems at St John's are long-standing. Between 2012 and 2015, staffing shortages caused a string on temporary closures. A review of the children's ward carried out by RCPCH in 2017 said had "been running on fragile staffing rotas since at least 2008".

The review said that the facility's "longstanding reputation as a unit that is under threat of closure" had been a "blight on recruitment", but rejected claims that NHS Lothian had implemented restrictions to inpatient admissions to save money. 

Patients have borne the brunt: 954 children were transferred from St John's to Edinburgh's children's hospital between the first shutdown in 2012 to September 2018.

By now they should be going to the brand new (but much-delayed) Royal Hospital for Children and Young People. It is hard to guess which crisis will be fixed first.