1. Grantham Children’s Services A Problem or an Opportunity?

2. Lincolnshire

3. Grantham Hospital - Paediatrics u From 1993 to 1998 provided by QMC u QMC Report –“It is no longer possible to sustain Children’s In-patient services at Grantham” »Risk of low quality service »A day time Assessment Unit with community nurses would enhance the care of children

4. Establishment of Task Force u Key Stakeholders –Paediatricians –Trust Managers u Range of options from:- –Full service –Only out patients

5. The Grantham Model for Ambulatory Paediatrics u New Concept u Total Package u Integrated Services u Unique Model u Research Based

6. Paediatric Services - Grantham u Assessment Unit at Grantham u Community Children’s Nursing u Enhanced Specialist Nurse Support u In Patient Care at Pilgrim or Lincoln u Tertiary Services at QMC u Outpatient Services u Day Case Surgery (ENT, Oral & General) u Community Paediatrics in S. Lincs. u Inter Unit Transport Services –Nurse Escort, PICU Retrieval –Minibus for Relatives

7. Implementation u Refining the Proposed Model u Seeking Professional Advice u Public Consultation u Political Pressures u Public Presentations/Information u Geographical Concerns u Policy & Standards Development u The Implications on other Services –Maternity, A&E, Ambulance, Social Services u Recruitment & Retention

8. Essential to Success u Contract Held by One Trust –Responsibility for the Service »Clinical Governance »Complaints and Litigation »Employing the majority of Staff u Close working together of all 3 Lincolnshire Acute Trusts at all levels u Enthusiasm to provide a good paediatric service for Grantham u Good Communication with and involvement of G.Ps, Community Trust, Ambulance Trust, Health Authorities and QMC

9. Accident & Emergency u Train medical and nursing staff to APLS standard. u Include Children’s Trained Nurses in staff of A&E department. u Have clear protocols for management of paediatric conditions. u Provide Children’s Nurses for Escort where necessary. u Training input from Paediatricians. u Training for Ambulance Paramedics.

10. Trust Merger u United Lincolnshire Hospitals NHS Trust u Formed from –Grantham Hospital NHS Trust –Pilgrim Health NHS Trust –Lincoln & Louth Hospitals NHS Trust

11. Financial Position u 1996/7 - £ 1.3M budget for previous service u 1998/1999 –Direct Pay £ 713.0 –Non Pay £ 35.9 –Services £ 408.1 –Community £ 147.8 u Total £1,304.8 –Plus Inflation

12. Advantages u “Children should be admitted to hospital as in-patients only if appropriate care cannot be provided daily or in the community” u Children’s Community Nursing Service based on the Unit 7 days a week, 24 hours per day. u Senior paediatric opinion immediately available. Development of special interest clinics. Outpatient waiting time short. u Availability of specialist nurses u Medical Staffing support for 2 Lincolnshire Inpatient Units.

13. Disadvantages u Distance from Inpatient Units u Closure of Consultant-Led Obstetric Service u Continuity of Consultant Care u High input of Senior Medical Time u Public Perception

14. Activity Levels - Assessment Unit u Assessment Unit Admissions –1998/1999 - 1010 –1999/2000 - 1149 u Transfers out to other Hospitals –1998/1999 - 127 (12.5%) –1999/2000 - 129 (11.2%)

15. Activity Levels - Accident & Emergency u Children Seen in A&E –1998/1999 - 5651 –1999/2000 - 5370 u Children Transferred Out of Grantham –1998 /1999 - 395 (7%) –1999/2000 - 389 (7.2%)

16. Children Escorted u Transfers by Paramedic Ambulance Crews –With Nurse Escort »1998/1999 - 133 »1999/2000 - 192 –With Doctor Escort »1998/1999 - 6 »1999/2000 - 6 –With Retrieval Team »1998/1999 - 4 »1999/2000 - 3

17. Future u Improve Public Awareness of Service u More use of the facilities by Community Medical Staff and Paramedics. e.g. –Child Development Clinics –Psychology, ENT etc. u Close Working Relationships with the new Primary Care Trust u Training of SHOs & Medical Students