RCPCH Officer for Wales - 'my view on reconfiguration'

'Yes, reconfigure, but let's make sure we get it right by looking at what works' says Dr Iolo Doull, in a feature written for the Western Mail:

As a parent, I would expect and want my child to have the highest quality of health care when they fall ill. I’d want them to be seen quickly and assessed properly by a healthcare professional. But most of all, I’d want them to see a doctor who specialised in their condition and who could provide the best possible treatment.

It is this idea of specialist, high quality care that really sits at the heart of what has become a hotly debated topic amongst doctors, Government and patients in Wales and across the UK – reconfiguration.

The basic premise is that senior children’s doctors would be located in more specialist inpatient centres rather than general units. This means that smaller general hospital wards could potentially close or be converted to daytime-only units staffed by specialist nurses and visiting consultants.

Raising the standard

In 2010 the Royal College of Paediatrics and Child Health published a document which set 10 standards that all paediatrics units should meet. To meet these standards we calculated that 1,541 more senior doctors (consultant paediatricians) are needed and the concentration of expertise and experience in fewer hospital sites.

Currently there are too many paediatric in-patient units which all run the same service as well as run a staff rota system which is unsustainable. This means there are many units operating with dangerously low levels of staff resulting in trainee doctors being left to manage wards because there are just not enough senior consultants – not only is this unfair on doctors, it can have a directly negative impact on patient care.

Better healthcare for children

Closure and changes to children's services instil fear amongst parents and it is completely understandable that parents are worried about their local services moving away. But whilst there may be a sense that financial imperatives are pushing these potential closures, in fact the specialisation of services will increase the quality of care for children and is proven to result in better health outcomes.

As an example, an estimated 400 stroke deaths prevented in London each year as a result of concentration of resources around eight hyper-acute centres. Patients are getting better, quicker and receiving life-saving care.

Children need specialist care and equipment so reconfiguration of some services will mean that children may need to travel a little further but they will receive a higher standard of care from the right doctors, using the best equipment, at the right place and at the right time.

More specialist doctors

And for doctors on the ground, reconfiguration carries with it huge benefits. Trainee paediatricians will get to see a greater variety of patients with different conditions which will improve their medical skills and knowledge – creating well-rounded, confident and highly experienced young paediatricians.

These changes will allow doctors and nurses to be readily available to the sickest children whilst continuing to offer the local service for early diagnosis and observation. They will also mean that children are seen by senior trainees and consultants with better expertise and experience in a set period of time.

Specialist services are vital clinically to support general paediatrics services but perhaps more importantly to maintain the long-time viability and sustainability of paediatrics training in Wales. Without the ability to offer specialist training, the attractiveness of paediatric training in Wales will be severely compromised with a likely decrease in the quality of trainees. In the long term this is very likely to affect the calibre of consultant appointments for later generations.

Getting the timing right

If reconfiguration is going to work – and in order for specialist services to be effective - the infrastructure needs to be in place to support it. That means increasing local based clinical assessment at either your GP, clinic or health centre. It also means getting the transport systems in place along with children’s community nursing services to ensure that if a child does need to see a specialist, they are able to get there.

It also means being flexible. Solutions for specialist care must not be confined by current Local Health Board (LHB) boundaries, and potential solutions must have the flexibility to cross LHB borders. Restricting solutions to borders could disadvantage patients. LHB must work collaboratively across regions to implement the best configuration and location of services.

We need to look at the health system as a whole even though the ‘need’ in these areas is very different. One region will have an impact on the other. But any changes should be solely on the basis of ensuring that the right standards of care can be met and children's health is paramount, taking into consideration the implications of longer journeys and transport arrangements.

So yes, reconfigure, but let’s make sure we get it right by looking at what works, what the impact on other services would be and the direct impact on patients and their doctors. It’s not something that can be done quickly, but it’s one that if done properly will deliver the best standard of healthcare for children.