Fewer, but higher quality, paediatric units are best option for our children

WHEN you say the word “reconfiguration” alarm bells start ringing and people automatically think of closures (“Staffing crisis threatens care on children’s wards”, The Herald, February 18). While this may be true in some situations, it’s certainly not always the case.

The primary aim of reconfiguration is to be able to continue giving patients the best possible health care, and if they fall ill, make sure they are treated in an appropriate unit by specialist staff in a timely, efficient manner.

In Scotland there hasn’t been any growth in the paediatric workforce since 2009. There aren’t enough doctors to fill rotas that comply with European law and there’s been a fall of around 20% in the number of consultants working in Scotland’s community paediatric services.

This, along with a number of smaller paediatric units with a limited number of staff trying to provide a 24/7 service, mean resources are spread too thinly.

This also means that paediatricians who are still training aren’t gaining the experience that comes from seeing a variety of patients, which in future may result in some children failing to receive the most appropriate treatment. This simply isn’t good enough – and in the long term, it is neither safe nor sustainable.

That is why the Royal College of Paediatrics and Child Health set 10 minimum standards that all paediatric units should meet in order to provide the best health care for children.

In some cases, some services have to merge to form larger, specialist units or move to a different model providing local support for sick children. And, very rarely, a unit may have to close.

A model of care based on fewer, high quality paediatric units is likely to provide the best medical equipment and fulfil staffing requirements with appropriately trained doctors who specialise in managing specific children’s medical conditions.

The public needs reassurance that reconfiguration in whatever shape it may take will always have children’s safety at the forefront and is not being driven solely by financial or personal imperatives.

Any decision should be made with the involvement of patients and communities and must be supported by clearly identifying any improvements it will make to clinical services and by properly addressing any concerns raised about patient access.

I am confident that if we communicate the need for reconfiguration better, the understandable fear of change will fall.

For reconfiguration to work, we also need to look at those services which have already been reconfigured, such as children’s cardiac and intensive care services, to learn what has worked well.

There will continue to be debates and discussions about the size and scale of reconfiguration.

Patients are concerned about their health services and parents want both high quality and convenient healthcare for their children – and rightly so. But with workforce pressures and increased demand on services, leaving things as they are simply isn’t an option.

We need to change the way healthcare for children is delivered; not to save money, but to make sure we have a health system that is sustainable and has patient safety as its heart. Dr Peter Fowlie, Royal College of Paediatrics and Child Health’s Officer for Scotland, 12 Queen Street, Edinburgh.