I am grateful for the opportunity to update members about progress on provision of paediatric services at St John’s hospital in Livingston. I emphasise my commitment to St John’s, and recognise the excellence and dedication of the staff who work there in caring for and serving patients and families in the surrounding communities.
It is important to say why an interim service model for the in-patient paediatric ward at St John’s hospital has been implemented. In July 2017, the Scottish Government was advised by NHS Lothian that staffing levels were fragile and that there would be no backup available if a member of staff were to be absent at short notice. In those circumstances, there would have been an immediate withdrawal of the in-patient service, which would have caused confusion and anxiety for parents and, possibly, delays in emergency care.
As a result, the board took the decision to implement an interim service model, in the best interests of children and their families. Within the interim model, the majority of children’s services have been maintained at St John’s. That includes the children’s ward being open from 8 am to 8 pm seven days a week and providing a short-stay paediatric assessment service, and the paediatric ward remaining open for day-surgery activity, planned day-case procedures and programmed investigations.
The paediatric out-patient services, neonatal services and community child health services have all been unaffected. Since last July, the assessment unit has seen nearly 2,800 children and has seen more than 2,000 planned investigation unit attendances. The emergency department continues to see more than 11,000 attendances a year, and out-patient clinics have seen more than 4,000 new and review patients.
The board has evolved the interim model since it was first implemented, and that evolution has seen a drop in the number of children who have been transferred but not admitted to the Royal hospital for sick children in Edinburgh. When the interim model began, the average figure was 12 children a month; since March, the average has been four, which reflects more confident triaging of patients.
Additionally, although the original plan was for children to be redirected to the Royal hospital for sick children at weekends, the board has maintained a daytime weekend rota on all but three weekends in 2017, and every weekend so far this year.
A wide range of children’s services continue to be available at St John’s, and the vast majority of children who require services locally receive them at St John’s. Where there have been shortcomings, I have made it clear to the board that they must be addressed.
For children and their families who have to attend the RHSC, it is vital that support is provided. The case that was raised last week by Angela Constance at First Minister’s question time was of great concern to me, so I asked the board to confirm that an apology would be made to the family involved, and that expenses would be reimbursed. That has been done. The incident was a distressing time for the family, and the board has been left in no doubt that what happened was unacceptable and must not be repeated. The board has acknowledged the shortcomings and ensured that staff at St John’s and the Royal hospital are clear about the support that is available to parents and carers in respect of travel expenses.
Last summer, NHS Lothian asked the Royal College of Paediatrics and Child Health to review its efforts to secure a sustainable 24/7 staffing model, and the interim model that it had put in place. The college’s report reiterated that the preferred option remains a 24-hour model, reflecting the population projections for West Lothian. The college’s report envisages a three-year to five-year programme to develop a clear vision and to recruit sufficient trained medical and nursing staff to provide sustainable overnight care.
The college concluded that, in the meantime, the current daytime-only paediatric assessment and decision-making service should be maintained.
The board is working to develop and deliver a 24/7 service that is safe and sustainable. That requires a staffing rota that ensures resilience to sickness leave and other short-notice reductions in staff availability. It requires that the majority of shifts be filled by permanent staff, so that rotas can be planned for six-month periods, and it requires a model that equates to having two tiers of trained staff to look after the children of West Lothian overnight—that is, consultant paediatricians supported by a second full rota of other medical and nursing staff.
One of my first actions on taking up post as health secretary was to write to NHS Lothian to press the board on how it could make further progress towards a 24/7 service. I asked the board to escalate efforts to recruit to the advanced nurse practitioner training programmes for paediatric and neonatal nurses, and I asked for confirmation that all activity on recruitment to those programmes is being undertaken in the speediest possible timeframe.
NHS Lothian has reviewed recruitment activity since the royal college’s original report was produced in 2016, and has concluded that a model of care that is delivered mainly by consultants and other medical staff will not fully deliver the board’s absolute commitment to reinstating the in-patient service at St John’s.
Currently, the board has enough staff to cover the extended-hours daytime service seven days a week. The board recognises that a different approach is required to provide a safe and sustainable in-patient service, and is actively progressing development of the multidisciplinary team, which is made up of medical staff and advanced paediatric nurse practitioners.
There is encouraging progress to report, with training being under way and one advanced paediatric nurse practitioner already able to support the out-of-hours rota. Another advanced paediatric nurse practitioner will be able to do that from October, and one nurse, who is currently on maternity leave, will complete training by the end of 2019. In addition, the board has just recruited three more trainees, two of whom will be available to support the rota in a year, with the third being available the following year. Two advanced neonatal nurse practitioners start training this month.
Recruitment activity to staff the model is live and, in order to build in resilience, the board has committed to overrecruit to the consultant and advanced paediatric nurse practitioner posts. That should mitigate the risks that are associated with the impacts of sickness and other absences, and long-term leave. It means that, in addition to putting into effect the next round of advertisements for two consultants—the advertisements are due to go out in October—the board will advertise for additional qualified or trainee advanced paediatric nurse practitioners, and will offer posts to all applicants, medical and nursing, who are assessed as being appointable through the recruitment process.
I have received an assurance from the chief executive that the board has set milestones for reinstatement of the service when adequate and safe levels of staffing are in place, with the aim of having the service back on a sustainable basis as quickly as possible. The board will continue to review progress regularly and will bring forward a contingency plan should progress fall below trajectory.
I have asked the director general for health and social care and the chief medical officer for Scotland to review progress by the end of January and to report to me. I intend to inform Parliament of the situation at that time, in order to ensure that members are updated on progress.
The board’s improved approach to developing a sustainable model of service is welcome. I have asked the chief nursing officer for Scotland to liaise with NHS Lothian and to provide advice and support to the board on training and development of the advanced paediatric nurse practitioner appointees. Discussions in that regard are under way, and I expect to receive a report by the end of October.
I know that members and the local community are anxious to know when the 24/7 service will be reinstated. I share that anxiety and concern. The board’s chief executive has sought to assure me that reinstatement of the full 24/7 paediatric service has the full commitment of the board and will continue to receive the highest level of priority. That, too, is my commitment. We will continue to act, as we have done, to bring that about.