04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
1
The organisation and future of paediatric surgical services
Kathy Wilkinson
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
2
Change in location of surgery for children
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
3
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
4
Copyright ©2008 BMJ Publishing Group Ltd.
Field, D. J et al. BMJ 2008;336:1221-1223
The changing paediatric surgical population
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
5
• Fewer routine ENT procedures• Increased laparoscopic surgery• Increased endoscopies• Increased number of radiology
cases
Changes in medical and surgical practice
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
6
Paediatric surgical practice in England 2008-9
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
7
Where do children have surgery? NCEPOD 2011
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
8
Workload
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
9
Do we have the complete picture?
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
10
Assessment of care
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
11
Deaths-Age and gender
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
12
Deaths-Diagnostic group
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
13
UK has a relatively high child mortality
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
14
How long does transfer take?
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
15
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
16
Assessment of care
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
17
Obstacles to safe paediatric practice?
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
18
Networks
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
19
SWACASWACA WACAWACA SEPAPSEPAP
PAGWPAGW
OxfordOxford
PAN WMPAN WM
NW PAGNW PAG
East Anglia Network
East Anglia Network
NENESPANSPAN
THAMESPAG
THAMESPAG
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
20
The new NHS in England…
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
21
CYPHOF
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
22
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
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
23
Why can’t we have this sort of detail in rest of UK?
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
24
2013CSF standards
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
25
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
26
Some snippets
04/19/23 Norfolk and Norwich University Hospital NHS Foundation Trust
27
Specialist services…