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Children's surgery overhaul call Children's surgery overhaul call
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Children's surgery in England and Wales is being undermined by lack of funding and training, warn medics.Children's surgery in England and Wales is being undermined by lack of funding and training, warn medics.
The Royal College of Surgeons says "strong action" is needed to make sure routine operations can be done locally.The Royal College of Surgeons says "strong action" is needed to make sure routine operations can be done locally.
At the same time, complex procedures, such as heart and brain surgery, should be carried out in specialist centres to ensure the best results, they add.At the same time, complex procedures, such as heart and brain surgery, should be carried out in specialist centres to ensure the best results, they add.
It is expected the number of consultant surgeons will need to more than double over the next few years to meet demand.It is expected the number of consultant surgeons will need to more than double over the next few years to meet demand.
The Children's Surgical Forum last reported on the state of services seven years ago but say much has changed since then.The Children's Surgical Forum last reported on the state of services seven years ago but say much has changed since then.
Techniques have improved and more can be done for sick children, but fewer hospitals are able to provide these services Mr David JonesTechniques have improved and more can be done for sick children, but fewer hospitals are able to provide these services Mr David Jones
Low take up of training in general paediatric surgery means fewer routine operations are being done in local district general hospitals.Low take up of training in general paediatric surgery means fewer routine operations are being done in local district general hospitals.
And although it is important that various difficult operations, such as removal of tumours, are done in specialist centres, children need to have access to services near to home when it is safe to do so, the report states.And although it is important that various difficult operations, such as removal of tumours, are done in specialist centres, children need to have access to services near to home when it is safe to do so, the report states.
There are currently only 104 consultant paediatric surgeons - significantly lower than the 256 predicted to be needed by 2010 - and many general surgeons who also have expertise in children will soon retire leaving nothing to fill the gap.There are currently only 104 consultant paediatric surgeons - significantly lower than the 256 predicted to be needed by 2010 - and many general surgeons who also have expertise in children will soon retire leaving nothing to fill the gap.
Recent health reforms may have a further detrimental effect as hospitals are encouraged to compete against each other rather than work together to develop the best services.Recent health reforms may have a further detrimental effect as hospitals are encouraged to compete against each other rather than work together to develop the best services.
Funding may have to be increased in order to keep local services running, the report concludes.Funding may have to be increased in order to keep local services running, the report concludes.
Best practiceBest practice
Across the country there is variation in best practice in children's surgery.Across the country there is variation in best practice in children's surgery.
The report rules that children should normally be treated on dedicated paediatric theatre lists and surgeons must have life support training specific to children.The report rules that children should normally be treated on dedicated paediatric theatre lists and surgeons must have life support training specific to children.
Procedures for giving anaesthesia and sedation to children need to be standardised.Procedures for giving anaesthesia and sedation to children need to be standardised.
And where possible children undergoing elective surgery should be admitted to a children's surgical ward as their inclusion on general paediatric wards can lead to cancellation of operations and increased risk of cross-infection.And where possible children undergoing elective surgery should be admitted to a children's surgical ward as their inclusion on general paediatric wards can lead to cancellation of operations and increased risk of cross-infection.
Mr David Jones, consultant in paediatric orthopaedics at Great Ormond Street Hospital and chair of the Forum said: "Surgery for children has changed beyond recognition.Mr David Jones, consultant in paediatric orthopaedics at Great Ormond Street Hospital and chair of the Forum said: "Surgery for children has changed beyond recognition.
"Techniques have improved and more can be done for sick children, but fewer hospitals are able to provide these services."Techniques have improved and more can be done for sick children, but fewer hospitals are able to provide these services.
"We have reached a point where there are now major challenges facing surgical care for children."We have reached a point where there are now major challenges facing surgical care for children.
"While routine surgery should be available locally, there is a need to centralise specialist services to achieve the best outcomes."While routine surgery should be available locally, there is a need to centralise specialist services to achieve the best outcomes.
He added: "Current health policy reforms that introduce competition can provide a disincentive for trusts to collaborate in the interests of the patient."He added: "Current health policy reforms that introduce competition can provide a disincentive for trusts to collaborate in the interests of the patient."
"The report recommends that children's surgical services be protected from competition and commissioned separately.""The report recommends that children's surgical services be protected from competition and commissioned separately."
A spokesperson for the Royal College of Paediatrics and Child Health said they welcomed the standards set out in the report. "In particular RCPCH supports the need for a network of children's surgical services, so that care is delivered safely as close to home as possible."A spokesperson for the Royal College of Paediatrics and Child Health said they welcomed the standards set out in the report. "In particular RCPCH supports the need for a network of children's surgical services, so that care is delivered safely as close to home as possible."
Government children's tsar, Dr Sheila Shribman said: "We have already said that children's surgical services being delivered as part of a clinical network is the way forward and we are already looking at the issues around the surgical workforce and specialist training as part of our ongoing work programmes."