RCPCH President: Guardian Society Interview
Dr Hilary Cass, president of the Royal College of Paediatrics and Child Health, explains her vision for the future and why she thinks 'defocusing on hospitals' would improve care…
Commenting on the fact that UK mortality rate for under-16s is one of the highest in western Europe, Dr Cass talks about the College’s Child Health Reviews – UK – and says in terms of solutions, ‘it’s going to be a combination of systems, people and education, both of the public as well as the profession.’ She goes onto talk about the need to reconfigure paediatric units, arguing: ‘we cannot sustain services safely on the 218 units. That’s too many and spread too thin.’
She also refers to pressures on the paediatric workforce, highlighting the fact that a shortage of middle-grade doctors or registrars means some of the 3,000 paediatric consultants are having to fill gaps in rotas.
'That can be done in a planned way or, more worryingly, they end up having to be on call at short notice because there isn't anyone on that night and then they have to work the next day. That's where it becomes risky. You wouldn't want to be on a plane being flown by somebody who's been up the night before and is still working the next day, so why would you want your kid looked after by somebody who is sleep-deprived, who thinks they are OK but are not at their lowest possible risk level?'
The solution to too many units, staffing problems and inconsistent care is either to reduce units by 25% or increase the number of consultants by 50%, she says. Although she adds: 'I recognise that the first one is politically difficult and the second one is financially difficult.
Dr Hilary Cass on her desire to see more paediatricians working outside hospitals:
'We need 50% more paediatric consultants if we’re to comply with European Working Time Directive. But we’re not going to get these numbers unless we can show that consultants are adding significant value to how paediatrics is delivered. The Guardian mentioned more community paediatricians, but to be more specific, my proposal is that we should consider having more general paediatricians working in community settings alongside those doing traditional community paediatric roles.
'By having more paediatricians working with GPs and other community-based clinical staff, we will be able to enhance the skills of the whole community and primary care team. The long term gain would be to improve the quality of paediatric care and reduce the numbers of children using hospital services, so that the posts will ultimately pay for themselves'
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