Review of Urgent and Emergency Care Services in Northern Ireland- consultation response

RCPCH welcomes the opportunity to respond to the Department of Health’s Review of Urgent and Emergency Care Services in Northern Ireland consultation in June 2022. This sets out the proposed strategic priorities in response to the Urgent and Emergency Care Review Report, which initially launched in November 2018. The stated aim is to establish a new regional care model for Northern Ireland as part of the overall HSC Transformation agenda.

The Urgent and Emergency Care Review Team report identified that the largest group attending Emergency Departement (EDs) in Northern Ireland are the under-fives, and that the 0-19 age group more broadly, are the largest group attending EDs inappropriately. The report states that children’s needs are different to adults’ and require a specialist approach.

Ultimately the Team concluded that demand from this section of the population is unlikely to decrease but, by adapting how and where care is delivered, pressures could be dealt with more effectively.

The Department of Health’s most recent Urgent & Emergency Care Waiting Time Statistics (PDF) for Northern Ireland (January – March 2022) and Urgent and Emergency Care Strategic Priorities document clearly show a marked increase between March 2021 and March 2022 at ED Departments across NI within the 0-5 and 5-15 age groups (35.4 March 2021 and 50.0 March 2022 and 19.1 in March 2021 to 34.5 per 1000 population respectively). The document also highlights that Type 1 ED Royal Belfast Hospital for Sick Children has seen increases in both new and unplanned reviews: 2,453 new reviews in March 2021 and 3,802 in March 2022; and unplanned reviews at 224 in 2021, now at 341 as of March 2022.

Yet the Departmental response to the Urgent and Emergency Care Review report and strategic priorities document does not reflect how new models of care within and without EDs will reduce pressures on paediatrics specifically.

The recently published RCPCH audit of the Intercollegiate Standards for Children in Emergency Settings' main findings were that there is scope to improve the delivery of emergency care for children and young people. While some themes, such as safeguarding, showed many standards were widely met, other themes revealed areas for improvement, for example, support for those with mental health problems, the emergency department environment, and in integrating urgent and emergency care systems.

These were identified as UK-wide issues. But some respondents working in NI at the time of reporting stated their service was not meeting key standards around timeframes for: visual review of presentations to assess priority category; staffing; availability of paediatric practitioner/s via telephone 24/7; information sharing and collection for improvement; and limited adherence to the mental health specific standards.

In light of these data, the RCPCH response to the consultation recommends:

  • Enhanced staffing and workforce planning, linkage with the Paediatric Strategy and more detail on models of care for children and young people. RCPCH has called for a bespoke child health workforce strategy generally as we believe this is the best approach to delivering better health outcomes for children.  
  • All those involved in the planning and delivery of emergency care for children and young people must work towards meeting the 70 intercollegiate standards in ‘Facing the Future: Standards for Children in Emergency Care Settings’ which allow for individual departments and services to identify room for improvement locally, as well as setting expectations for regional and national policy development.
  • Any future Getting it Right First Time review should include the needs of children and young people.
  • Ambulatory care should be developed in addition to SSPAUs to meet population needs for paediatrics as per the Review Team’s recommendation.
  • Overall, the needs of children and the child health workforce within urgent and emergency care needs to be considered more holistically as part of a broader shift to a fully integrated HSC System. This should be at the fore within Departmental priorities.

Download our full response below.