Nurse Led Ward for Children at Cheltenham General

23/05/2005

Representatives of Gloucestershire's three primary care trusts (PCTs) this evening recommended that an overnight nurse-led ward for children be piloted at Cheltenham General Hospital.

In February this year, the PCTs made the decision to centre specialist inpatient care for children and neonatal intensive care at Gloucestershire Royal Hospital.

Following this decision, further work has taken place on possible options for overnight care for children who have no medical reason* to be in hospital overnight but who, for other reasons, have received care in hospital up to now.

The options considered were:

* a nurse-led ward at Cheltenham General Hospital;

* a hospital-at-home scheme operating throughout the county; or

* care at Gloucestershire Royal Hospital.

The option recommended at this evening's meeting was to pilot a nurse-led ward at Cheltenham General Hospital, which would assist in meeting the needs of children currently admitted to hospital and would help avoid the need to transfer them to Gloucestershire Royal Hospital.

The PCT representatives agreed that the pilot should be evaluated after 18 months, and that the evaluation should include issues of safety, staffing, access and equity.

The evaluation would also assess whether the ward were being used appropriately -for children who would have required hospital admission anyway, as opposed to children who might have been treated in the community if such a facility did not exist.

The recommendations from this evening's meeting - which also included agreement on Gloucestershire Hospitals NHS Foundation Trust's implementation and communications plans - will be taken to the three PCT board meetings in June**.

PCTs in Gloucestershire have taken the decision (in February 2005) to support the transfer of 24-hour paediatric inpatient beds and neonatal intensive care costs from Cheltenham General to Gloucestershire Royal Hospital.

This is the only area of inpatient treatment where change is proposed. The PCTs accepted the proposal because the Hospitals Trust had advised that to maintain and sustain in the future two inpatient services of the quality now found in both Gloucester and Cheltenham would be very difficult.

There will continue to be emergency services for paediatrics at Cheltenham General, supported by a Consultant Paediatrician on call.

Most children will be unaffected by the changes. For example, the following take place - and will continue to take place - each year:

* 40,000 outpatient appointments
* 17,000 accident department attendances
* 4,000 assessments
* 2,750 day cases

PCTs and the Hospitals Trust have had to consider the effect of doing nothing and trying to keep things as they are. They are clear that this would lead to a steadily deteriorating service.

Parents would increasingly be faced with having to take children out of the county for treatment. The travel options now are between Cheltenham and Gloucester. If nothing is changed, travel options may mean Birmingham, Bristol or Oxford.

The health community is faced with forces for change that pull in different directions. We all want and expect absolutely safe services for children; this says that specialist care - for example, neonatal intensive care - should be concentrated. At the same time, we all want local services; this says that services should be spread out.

Both are right, but they create a dilemma. The health community in Gloucestershire believes that safety is now the more important priority for the future of services.

Anyone interested in finding out more about the issues under discussion at today's meeting, or the children's review generally, can visit the health services' website at www.gloshealthservices.org.uk/getinvolved.

Notes

* children who do not need to be under the care of a consultant (eg orthopaedic patients)

** PCT board meetings can be attended by members of the public. The following meetings in June will discuss the recommendations of today's meeting.

Cotswold and Vale PCT: 14 June
West Gloucestershire PCT: 16 June
Cheltenham and Tewkesbury PCT: 28 June