Dr Ann Hoskins Regional Director of Public Health / Director Children, Young People and Maternal Services

Report to PCT CEs on paediatric elective surgery September 2009 Issue Year on year increase in children being referred to children's hospitals for surgery Limited number of procedures being carried out by surgeons in some DGHs Different models of paediatric surgery/networks across the NW

Paediatric Elective Surgical Review Sir Alan Craft report July 2010 Recommendations SHA/PCTs Paediatric Surgical Network be established to cover the NW SHA area Appoint Network Director with administrative support Monitor standards and performance of network Explore alignment with NW Quality Observatory - AQUA Network Set Standards, monitor/evaluate services, Define what surgery undertaken and timing Explore DGHs undertaking general paediatric surgery for neighbouring DGHs Consider sustainability of service Promote education and maintenance of competencies Align with NW quality observatory, AQUA 13.1 For SHA/PCTs Establish a network of surgery for children across the whole SHA area. Appoint a Network Clinical Director with administrative support Monitor standards and performance of the Network The possibility of the network being aligned with the NW Quality Observatory, AquA should be explored. 13.2 For the Network Set the standards by which the service could be monitored and evaluated.(They may wish to consider those developed for the Yorkshire and Humber SHA). The standards should apply to all hospitals including both tertiary centres and DGHs. The principles which are developed for general paediatric surgery should apply to all elective surgery done on children. The network should take the responsibility for defining what surgery should be done and the timing of it. They should then monitor adherence to these network standards. Similar principles could influence the delivery of emergency surgery for children but this would need further discussion and agreement within the Network and with Commissioners. The possibility of some DGHs undertaking general paediatric surgery for their neighbouring DGHs should be considered. Consider the sustainability of the service. Promote education and maintenance of competencies within the network. The possibility of the network being aligned with the NW Quality Observatory, AQuA should be explored.

Paediatric Elective Surgical Review Sir Alan Craft report July 2010 Recommendations Trusts Join network and adhere to standards Facilitate and monitor paediatric competencies of clinicians providing surgical services Ensure surgery only undertaken by those who have demonstrated competence Childrens aspect of a doctors work appraised separately from adult practice Ensure quality of service through education of anaesthetists and surgeons Clinicians Appraisal of paediatric competencies Be aware and adhere to network standards 13.3 For Trusts Prioritise surgical services for children and participate in network arrangements by ensuring Trust representation at Network meetings. Facilitate and monitor appraisal of paediatric competencies of all clinicians participating in provision of surgical services. Providers should assure the quality of their services by ensuring that; surgery is only undertaken by those who have demonstrated that they are competent to do so. This would apply both to the surgeon and the anaesthetist ongoing competency is assessed by the annual appraisal and revalidation process the children’s surgery aspect of a doctor’s work is appraised separately from their adult practice regular educational experiences should be made available for both anaesthetists and surgeons The possibility of some DGHs undertaking general paediatric surgery for their neighbouring DGHs should be considered 13.4 For Clinicians Participate in annual and team appraisal of paediatric competencies. Be aware of and adhere to network standards of care

Response to Alan Craft report August 2010 Time limited taskforce Develop the set of standards for paediatric surgery Design a template for audit based on these standards with AquA Design a self assessment tools for Trusts in the NW Design a peer review process in the NW Explore the opportunities to work with AquA to develop a community of practice Make recommendations about the potential future role of a network.

Finished Feb

Next steps Report disseminated to all Trusts CE/Chairs, PCTs/CCGs AQUA agreed to support implementation of audit and benchmarking Clinicians keen to produce standards for other paediatric surgery e.g. ENT, ophthalmology Future policy on clinical networks