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04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
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The organisation and future of paediatric surgical services
Kathy Wilkinson
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
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Change in location of surgery for children
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
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Why have these changes occurred ?
• Changes in the surgical population
• Changes in practice have resulted in a reduction in some common operations e.g. tonsillectomy, grommets, circumcision
• Training, competencies and confidence
• Our attitude to risk and our ability to treat children requiring surgery may have changed
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
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Copyright ©2008 BMJ Publishing Group Ltd.
Field, D. J et al. BMJ 2008;336:1221-1223
The changing paediatric surgical population
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• Fewer routine ENT procedures• Increased laparoscopic surgery• Increased endoscopies• Increased number of radiology
cases
Changes in medical and surgical practice
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Paediatric surgical practice in England 2008-9
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Where do children have surgery? NCEPOD 2011
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
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Workload
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Do we have the complete picture?
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
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Assessment of care
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
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Deaths-Age and gender
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Deaths-Diagnostic group
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UK has a relatively high child mortality
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How long does transfer take?
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Assessment of care
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Obstacles to safe paediatric practice?
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Networks
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SWACASWACA WACAWACA SEPAPSEPAP
PAGWPAGW
OxfordOxford
PAN WMPAN WM
NW PAGNW PAG
East Anglia Network
East Anglia Network
NENESPANSPAN
THAMESPAG
THAMESPAG
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The new NHS in England…
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CYPHOF
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Other drivers
• See Back to the Future 2 (RCPCH April 2013)
• Audit of 10 key paediatric standards
• Results of this and further workforce planning may result in further closure IP paediatric beds
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Why can’t we have this sort of detail in rest of UK?
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2013CSF standards
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Some snippets
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Specialist services…
