Grantham Children’s Services

A Problem or an Opportunity?

Lincolnshire

Grantham Hospital - Paediatrics

From 1993 to 1998 provided by QMC QMC Report

– “It is no longer possible to sustain Children’s In-patient services at Grantham”» Risk of low quality service» A day time Assessment Unit with community

nurses would enhance the care of children

Establishment of Task Force

Key Stakeholders– Paediatricians

– Trust Managers Range of options from:-

– Full service

– Only out patients

The Grantham Model for Ambulatory Paediatrics

New Concept Total Package Integrated Services Unique Model Research Based

Paediatric Services - Grantham Assessment Unit at Grantham Community Children’s Nursing Enhanced Specialist Nurse Support In Patient Care at Pilgrim or Lincoln Tertiary Services at QMC Outpatient Services Day Case Surgery (ENT, Oral & General) Community Paediatrics in S. Lincs. Inter Unit Transport Services

– Nurse Escort, PICU Retrieval– Minibus for Relatives

Implementation

Refining the Proposed Model Seeking Professional Advice Public Consultation Political Pressures Public Presentations/Information Geographical Concerns Policy & Standards Development The Implications on other Services

– Maternity, A&E, Ambulance, Social Services Recruitment & Retention

Essential to Success

Contract Held by One Trust– Responsibility for the Service

» Clinical Governance» Complaints and Litigation» Employing the majority of Staff

Close working together of all 3 Lincolnshire Acute Trusts at all levels

Enthusiasm to provide a good paediatric service for Grantham

Good Communication with and involvement of G.Ps, Community Trust, Ambulance Trust, Health Authorities and QMC

Accident & Emergency

Train medical and nursing staff to APLS standard.

Include Children’s Trained Nurses in staff of A&E department.

Have clear protocols for management of paediatric conditions.

Provide Children’s Nurses for Escort where necessary.

Training input from Paediatricians. Training for Ambulance Paramedics.

Trust Merger

United Lincolnshire Hospitals NHS Trust

Formed from– Grantham Hospital NHS Trust

– Pilgrim Health NHS Trust

– Lincoln & Louth Hospitals NHS Trust

Financial Position

1996/7 - £ 1.3M budget for previous service 1998/1999

– Direct Pay £ 713.0

– Non Pay £ 35.9

– Services £ 408.1

– Community £ 147.8

Total £1,304.8– Plus Inflation

Advantages

“Children should be admitted to hospital as in-patients only if appropriate care cannot be provided daily or in the community”

Children’s Community Nursing Service based on the Unit 7 days a week, 24 hours per day.

Senior paediatric opinion immediately available. Development of special interest clinics. Outpatient waiting time short.

Availability of specialist nurses Medical Staffing support for 2 Lincolnshire Inpatient

Units.

Disadvantages

Distance from Inpatient Units Closure of Consultant-Led Obstetric

Service Continuity of Consultant Care High input of Senior Medical Time Public Perception

Activity Levels - Assessment Unit

Assessment Unit Admissions– 1998/1999 - 1010

– 1999/2000 - 1149

Transfers out to other Hospitals– 1998/1999 - 127 (12.5%)

– 1999/2000 - 129 (11.2%)

Activity Levels - Accident & Emergency

Children Seen in A&E– 1998/1999 - 5651

– 1999/2000 - 5370

Children Transferred Out of Grantham– 1998 /1999 - 395 (7%)

– 1999/2000 - 389 (7.2%)

Children Escorted

Transfers by Paramedic Ambulance Crews– With Nurse Escort

» 1998/1999 - 133

» 1999/2000 - 192

– With Doctor Escort» 1998/1999 - 6

» 1999/2000 - 6

– With Retrieval Team» 1998/1999 - 4

» 1999/2000 - 3

Future

Improve Public Awareness of Service More use of the facilities by

Community Medical Staff and Paramedics. e.g.– Child Development Clinics– Psychology, ENT etc.

Close Working Relationships with the new Primary Care Trust

Training of SHOs & Medical Students