This document forms part of the Seeking and Providing External Second Opinion in Paediatrics guidance. For the full guidance, see our landing page. |
The Royal College of Paediatrics and Child Health will review this work with the Paediatric Critical Care Society in three years and monitor its recommendations to understand whether the work should be updated.
Supporting children and their families
Children with complex care needs are often under the care of multiple specialist teams, which can mean that families have difficulty navigating the decision-making process.
It is always important to hear the voice of the child. Sometimes families report that their experience of their child’s life is not given sufficient weight in informing treatment decisions.
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Workforce
There are workforce shortages across every paediatric specialty; ESO work can require a significant time commitment, is variably remunerated and has no formally recognised commissioning arrangement. Given that high profile cases have attracted adverse attention, it is a challenge to recruit enough paediatricians to support these processes.
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Caring for children with significantly complex conditions and/or life-limiting illnesses will become more frequent in the future. Workforce planning should ensure there is an appropriately trained paediatric workforce to deliver safe and sustainable services for this cohort of patients.
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Healthcare professionals who undertake ESO work may also undertake expert witness work. There is a national shortage of expert witnesses which impedes the work of the coroners, and the family and criminal courts. While the ESO and expert witness work are separate processes, they share similar themes and common challenges, and it is argued that increasing the pool of professionals undertaking ESO work will in tandem increase those prepared to do expert witness work.
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Education and training
Paediatricians in training will need to acquire the relevant clinical and non-clinical skills to look after a growing population of patients with significantly complex conditions and/or life-limiting illnesses. Some clinicians often feel they do not have the right skills, knowledge, or experience to undertake ESO work, as well as the time needed to step out of local clinical service. There is also a shortage of experts available to undertake this work in many paediatric subspecialties. Paediatricians are keen to be signposted to helpful resources and supported with using this document.
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Service planning
ESOs are not formally recognised in national specialised service specifications, yet occur routinely and underpin good practice and shared decision making across paediatrics.
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Supporting the ESO process locally
Second opinion work needs to be recognised as usual practice. It is currently carried out in an informal manner in a variety of formats across all paediatric sub-specialties and is not recognised by service planners. Trusts and Health Boards need to recognise that this work is essential to patient care. When conducted well, it supports patient choice and may reduce complaints and litigation. Raising awareness and standardising and supporting practice will support paediatricians and families alike.
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Key terms and definitions
- List of key terms and definitions
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Child or children Babies, children and young people under the age of 18 across the UK. Critical friend A trusted professional, usually within the same organisation, who is requested to offer a critique of a colleague’s management of a challenging situation; for example, either to advise on treatment decisions or to help navigate circumstances where the child’s family and clinical team disagree on the correct course of action. Clinical Ethics Advisory Committee (CEAC) A group consisting of health and other relevant professionals who provide advice and support to clinicians and families on ethical issues that have arisen during clinical practice. Expert witness A healthcare professional, generally appointed by a solicitor, whose skills and experience qualify them to testify on a particular medical area in a court or tribunal setting. External second opinion (ESO) An external medical opinion on the patient’s proposed course of treatment from a second independent health professional/MDT within an appropriate specialty. The initial suggestion to get an ESO may come from a patient/family, or from the child’s health care team. This is for children facing significant life changing decisions, and the second opinion should come from a separate Trust or Health Board. Family Parent, carer or guardian identified as the person with parental responsibility of the child. This could include the local authority. Family advocate A named point of contact who can provide information to the family on the ESO process, and who can signpost to sources of support. See this section for more information. Health organisations NHS Trusts and NHS Health Boards across the UK. Healthcare professional A clinically qualified person who is working within the scope of practice as determined by their relevant professional body and who is registered with that body as competent to practice. Mediation An impartial service designed to support patients, families and NHS staff work together towards resolution of disagreements. Multi-disciplinary team (MDT) A group of professionals from one or more clinical disciplines from hospital and community settings who together make decisions regarding recommended treatment of individual patients. Named consultant A named consultant taking on overall clinical responsibility for the child. National Advisory Panel A multi-disciplinary team of experts organised at national level to support decision making around treatment options in complex and rare diseases. Such panels may enhance consistency and transparency around care pathways and aim to ultimately improve survival outcomes. Parallel planning Parallel planning offers an opportunity for children with life limiting conditions to live their lives to the full while plans are made for managing their ongoing care and end of life. Referral for second opinion The administration and paperwork that is required to support the process of requesting an external second opinion. Service planner Organisations responsible for planning, commissioning, or providing health services. Team around the child The professionals that contribute to the wider health and wellbeing of the child. This would include the child’s named consultant, the MDT, GP and any professional in an advocate role.