1. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 1 The organisation and future of paediatric surgical services Kathy Wilkinson

2. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 2 Change in location of surgery for children

3. 10/4/2015 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

4. 10/4/2015 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

5. 10/4/2015 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

6. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 6 Paediatric surgical practice in England 2008-9

7. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 7 Where do children have surgery? NCEPOD 2011

8. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 8 Workload

9. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 9 Do we have the complete picture?

10. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 10 Assessment of care

11. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 11 Deaths-Age and gender

12. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 12 Deaths-Diagnostic group

13. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 13 UK has a relatively high child mortality

14. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 14 How long does transfer take?

15. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 15

16. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 16 Assessment of care

17. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 17 Obstacles to safe paediatric practice?

18. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 18 Networks

19. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 19 SWACA WACA SEPAP PAGW Oxford PAN WM NW PAG East Anglia Network NE SPAN THAMESP AG

20. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 20 The new NHS in England…

21. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 21 CYPHOF

22. 10/4/2015 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

23. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 23 Why can’t we have this sort of detail in rest of UK?

24. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 24 2013 CSF standards

25. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 25

26. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 26 Some snippets

27. 10/4/2015 Norfolk and Norwich University Hospital NHS Foundation Trust 27 Specialist services…