OVERVIEW & SCRUTINY COMMITTEE

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					OVERVIEW & SCRUTINY COMMITTEE

Minutes of the Extraordinary Meeting held on Thursday, 13th October 2011 at Worksop
Town Hall


Present:       Councillor G J Wynne (Chair)
Councillors:   B Barker, K Bullivant, H Burton, I J Campbell, A Mumby, D Potts,
               Mrs M W Quigley, J Scott, J C Shephard, Mrs A Simpson and C Wanless.

Officers:      G Blenkinsop, V Cookson, L Dore and R Theakstone.

Standards Committee Members: None

Managers and clinicians present:

Chris Beattie – Senior Nurse Neonatal/Special Care Baby Unit
Andrea Bliss – Matron of Children’s Services
Dr Robin Bolton – Medical Director, Doncaster and Bassetlaw Hospitals NHS Foundation
                                                                                  Trust
Dr Phil Foster – Medical Director NHS Bassetlaw
Ian Greenwood – Director of Strategic and Service Development, Bassetlaw Hospital
Phil Mettam – Chief Operating Officer, NHS Bassetlaw
Denise Nightingale – Clinical Advisor NHS Bassetlaw and NHS Doncaster
James Scott – General Manager Children’s Services
Dr Bhupendra Singh – Consultant Paediatrician and Co-Clinical Director, Doncaster and
                       Bassetlaw Hospitals NHS Foundation Trust
Dr Jon Train – Consultant Anaesthetist, Clinical Director of Anaesthetics


Others present: Sasha Summers – Patient Representative

Also present: Hazel Brand – Communications Manager, Doncaster and Bassetlaw Hospitals
                                                             NHS Foundation Trust

(The Chairman welcomed all to the meeting and read out the Fire Alarm/Evacuation
Procedure.)



62.    APOLOGIES FOR ABSENCE

Apologies for absence were received from Councillors J Anderton, B A Bowles,
R B Carrington-Wilde, I Jones, J W Ogle, T Rafferty.

63.    DECLARATIONS OF INTEREST BY MEMBERS AND OFFICERS

(a)    Members

There were no declarations of interest by Members.

(b)    Officers

There were no declarations of interest by officers.
SECTION A – ITEMS FOR DISCUSSION IN PUBLIC

Key Decisions

None

Other Decisions

64.    THE FUTURE OF SERVICES AT BASSETLAW HOSPITAL

Questions by Members of the Overview and Scrutiny Committee

From Councillor G J Wynne:
Question 1

“Do you plan to announce a range of service options for paediatric services?”

Before answering, Mr Mettam commented that he was happy to be here and to continue to
engage in this process with the Committee. He offered apologies for absence from Dr Kell
who would have liked to attend the meeting today (from Bassetlaw Commissioning
Organisation) but was unable to due to other commitments.

Reply by Phil Mettam:

What we want for the local population is to provide services that meet local needs and meet
quality standards. The available services commissioned are evidence based and meet local
needs; £200m is spent on a range of services.

Reply from Dr Foster

There are no plans to announce a range of service options although they have been looked at
for some time and work is on-going. Some services are looked at on a regional or national
basis, e.g. trauma treatment and these may have an impact in the future.

From Councillor J C Shephard:
Question 2

“If the service is to remain the same – how will this be communicated to clinicians and the
public?”

Before answering, Mr Greenwood commented that he was also pleased to be present at the
meeting and thought it a useful exercise with a different team attending today.

Reply by Ian Greenwood:

There are some well-established mechanisms within the organisation for effectively cascading
information to everyone and in addition, the Chief Executive undertakes face-to-face
communication. We have video conferencing and written information is available on the
intranet and website. It is also a two-way process where information is encouraged to move
from the ‘ground floor’ upwards. Children’s services have been topical for some months with
concern shown on the ground and in the media which has reinforced the methods of
communication used. We can never do enough. It is always very difficult within any large
organisation to keep staff informed all the time.
There are two lines of communication to send information out to the public: firstly our role as
provider to advise what we are doing and secondly that of the PCT with the BCO. The two
organisations each have their own external communication function.

Reply by Phil Mettam

Joint communication for both organisations would need to have the agreement of the GPs.
We need to consider more effective and dynamic ways of communicating with the public, for
example, through social media.

(Mr Mettam invited Members to include suggestions regarding communicating with the public
into the final report and said their input would be valued and helpful).

From Councillor G J Wynne:
Question 3

“How do you plan to respond to the Royal College of Paediatrics and Child Health (RCPCH)
report – entitled’ Facing the Future Standards for Paediatric Services’ dated April 2011? The
Committee wish to know:-

   1) Is the Bassetlaw Hospital paediatric in-patient service classified as a very small unit?
   2) Do you expect us to be one of the 48 paediatric in-patient units that are cut?
   3) Is the Bassetlaw Hospital in-patient service, in your opinion, sustainable?
   4) Is the Bassetlaw Hospital in-patient service staffed by trainee doctors – without the
      back up of senior level consultant posts?
   5) Can you meet the 10 Royal College of Paediatric and Child Health standards for
      Paediatric Units?

Reply by Dr Bolton:

The report was first produced in December 2010 by Sir Ian Kennedy and revised in April 2011.
It was based on current information and found that nationally these services were
unsustainable. Therefore the report made some recommendations for changes to future
services. It recommended that all Paediatric units needed to be reviewed and developed as
they were unsustainable in their current form.

The RCPCH classed units into sizes with less than 1500 visits being a very small unit, 1500 to
2500 being a small unit and so on. Their figures show that last year Bassetlaw Hospital had
2700 admissions, (our own figures show that we average around 2450 admissions per year),
and is therefore classed as a borderline small/medium unit

The report states that it is not sustainable nationally to keep all paediatric in-patient units.
There is no definite information in the report, just recommendations. The hospital does not
expect to be one of the units subject to cuts. If Bassetlaw Hospital is cited as being at risk
then we would expect debate and would want to defend our position.

However, if things do not change then there is the potential for the service to become
unsustainable in the future. We are vulnerable in terms of training, – especially on-going
training, and keeping skills up to date. We see around 2,500 cases a year and that is not an
enormous amount of cases. For example, diabetes, we get around 20 cases a year admitted
so doctors are not going to see these cases often. The integration of the rotas with Doncaster
provides more exposure to a greater number of patients and conditions and therefore training
and keeping up skills.
The in-patients unit is partly staffed by trainees and also middle grade doctors who are always
available for the trainees to refer to. This is a common pattern of practice around the country.

The standards for paediatric units have been put forward as suggestions but are not written in
stone. They consider things like how soon a patient is seen, how the unit is run, access to
specialist information etc. The recommendation is that a consultant should be on site during
peak activity which is generally accepted as daytime and evenings. How consultants can be
available between 5pm and 10pm is being looked at. Currently there is a consultant of the
day who is on call for 24 hours from 9am until 9am the next day, however, it has been
suggested nationally that from November 2011, we have a consultant of the week who would
be on duty for seven days during the daytime, to concentrate on inpatients only and another
consultant would cover the out of hours duty. The consequence of this is that they would not
be able to undertake any clinic or out-patient duty that week therefore by providing one
service, another service suffers. The emphasis id teamwork and consideration has to be
given to how we get better at handovers and team working.

From Councillor A Mumby:
Question 4

“Can you confirm if children of three years and over will continue to be treated at Bassetlaw
Hospital for:
    Appendectomies
    Pneumonia
    Bronchitis
    Serious Fractures

Reply by Ian Greenwood:

For patients with medical conditions such as bronchitis and pneumonia, the aim is to keep
them in Bassetlaw Hospital. Currently, if a child needs more intervention, becomes seriously
ill, or needs more intensive care, then they are sent to Sheffield Children’s Hospital. This also
applies to children younger than three years old.

With reference to surgery such as appendectomies or fractures, very little is done on the
Bassetlaw site. Last year there were 33 children requiring emergency general surgery and
290 fractures. Numbers fluctuate but are small. There will be two reviews in the future
looking at trauma treatment and wider surgical intervention.

Reply by Dr Foster

The review of treating trauma in children is at an early stage. It is divided into a number of
categories with the high end leading; there are better outcomes if transferred to Sheffield
Children’s Hospital where staff have experience in treating trauma patients. Standards are
being driven upwards in terms of surgery guidance for paediatric surgeons and anaesthetists.

Supplementary question from Councillor A Mumby

Is oxygen therapy still going to be available at Bassetlaw Hospital?

Reply by Ian Greenwood:

Yes it will.
From Councillor A Mumby:
Question 5

“Is the Children’s Ward at Bassetlaw to be used as an observation ward only – with children’s
conditions being reviewed and then transferred to other hospitals?”

Reply by James Scott:

It is fully intended to provide a 24 hour/365 day service at Bassetlaw Hospital with an ambition
to upgrade the Children’s Ward. In bringing children’s outpatients next to the ward it will be
possible to circulate nurses between the two. A dedicated discrete area for victims of sexual
abuse is planned. The Trust Board has accepted these plans and are working on the details
and looking at costs.

From Councillor C Wanless:
Question 6

“Do the forthcoming commissioning arrangements threaten the continuation of paediatric
services in Bassetlaw?”

Reply by Phil Mettam:

They should not do. The new BCO will be clinically led by seven local GP’s into 2013
governance arrangements. This strengthens the position for the commissioning of services for
our children.

Specialist services that are provided by prisons and GPs will be contracted out on a national
basis, but it is anticipated that the Clinical Commissioning Group will be responsible for the
budget for acute paediatric services with the intention to commission services on a local basis
where possible.

Reply from Dr Foster

I echo the comments by Mr Mettam – the BCO will be oriented towards better care for patients
locally where possible and will work within an integrated network.

Reply from Dr Bolton

Anything provided by the hospital has to be paid for and costs need to be negotiated with the
BCO to ensure services are sustainable; they will have to work within budgets. We want to
offer a local service working with a network of organisations. Commissioning has always been
an issue and we need to work on the levels of care and transfer arrangements. I am confident
with the way things are going.

From Councillor Mrs M W Quigley:
Question 7

“Can you explain how the Special Care Baby Unit operates in more detail at Bassetlaw
Hospital and how the occupancy levels compares to national levels?”

“How often is the Special Baby Care Unit full?”

How often does it take in transfers from other hospitals?”
Reply by Andrea Bliss:

We are part of a large neo-natal network: Level 3 is regional which takes babies under 24
weeks gestation excluding cardiac and surgical; Level 2 (Doncaster) takes 26 weeks gestation
and above and short-term intensive and may move babies to the regional unit; Level 1
(Bassetlaw) takes babies 32 weeks gestation and above plus some younger although these
usually require high dependency and are often transferred.

Bassetlaw Hospital has 8 beds in the special care unit with one bed defined as a holding cot.
This is so that a baby can be admitted and stabilised prior to transfer by a specialist team.

Occupancy of the unit fluctuates: the unit had 41% occupancy between April 2010 and
September 2011.

Babies do get transferred – approximately 53 last year with half returned to the Special Care
Baby Unit at Bassetlaw. Some are booked into Bassetlaw and then are transferred to another
unit. Babies have been transferred in from Nottingham and Barnsley. Doncaster babies are
sometimes moved to Bassetlaw to make high dependency cots available.

From Councillor J C Shephard:
Question 8

“How many paediatric patients are there per doctor in Bassetlaw?”

Reply by Dr Singh:

There are four consultants at Bassetlaw who see an average of 47 patients per week. With
approximately 30,000 children in Bassetlaw, four consultants equates to a patient ratio of
1:7500. With 5 consultants this would reduce to 1:6000. Doncaster has 8 consultants with 7
on call. This means 1 consultant per 10,000 for on-call purposes.

From Councillor I J Campbell:
Question 9

“We understand that skills of nurses are being developed through rotation of staff to Doncaster
Children’s Ward and Neonatal Unit. What plans are there for doctors to utilise Doncaster’s
facilities so they can develop their skills, for example, the ventilation of babies?”

Reply from Andrea Bliss:

Integration has been established for a long time based on service demands and individual
staff development. Changes are planned in children’s inpatient areas with more staff around
and greater integration. We are working with the Senior Sisters on a structured plan for the
long term which will include staff development. We are not able to implement this yet but are
working on the processes as a nursing staff team.

Reply by Dr Singh

The intention is to create models to rotate staff enabling clinical services to integrate at every
level and work as one team across both sites. There will also be a model created for a
consultant on-call rota, although this is not as simple as for nursing staff. For a medical
consultant, not all their duties are at one site so different criteria has to be applied; it will not be
easy to integrate on-call and outpatient commitments without adding risk to inpatient services
on site or outpatients. There has been some consultation with consultants which ended at the
end of September 2011. With reference to trainee posts, we are in discussion with the
Deanery on this matter.

Supplementary question from Councillor I J Campbell:

The consultation that has just ended. What was the consultation and who did you consult
with?

Reply by Dr Singh

The consultation concerned the integration of the consultant workforce and considered
working as one team across two sites, risks to be managed while on-call and the continuity of
work on the consultant’s base site. In proposing a different working pattern it has to consider
the 8 consultants at Doncaster and the 4 at Bassetlaw to minimise risk and also
inconvenience.

From Councillor B Barker:
Question 10

“Because of the low numbers of child protection cases in Bassetlaw, it is difficult for
consultants to get practice in this area, unlike other areas such as Nottingham and Leicester
where there are more cases. What are the plans to address this issue?”

Reply by James Scott:

It is correct that there are small numbers specifically relating to child protection cases in
Bassetlaw and consultants do need to see a certain number to maintain their skills. At present
children are sent to Nottingham which we would prefer not to do as we should be able to
manage cases locally. Doncaster and Bassetlaw are looking to integrate a viable consultant
rota to manage and respond rapidly to any child protection cases and also those of vulnerable
adults.

Reply from Dr Singh

It should be noted that the medical examination for sexual abuse is just part of child protection
and this is the area where there is an issue but in general we have the skills to deal with the
child protection cases

From Councillor D Potts:
Question 11

“How is the lack of paediatric Specialism in Accident and Emergency going to be addressed
(in addition to the nurse specialists that are to be employed/developed)?”

Reply by Dr Singh:

Both Doncaster and Bassetlaw Hospitals have staff with specialist interests on site. They are
on-call in the ward or in the clinic and can ensure some input to the Accident and Emergency
Department if a senior medical opinion or anaesthetist is required. There is always one senior
skilled doctor on site at Bassetlaw Hospital.
From Councillor D Potts:
Question 12

“What is your view on the current Accident and Emergency services available to children? Do
you think that Accident and Emergency services for children should be adjacent to the
Children’s Ward and are there any advantages to this? Would this help to develop the
specialist skills of paediatric clinicians?”

Reply by Dr Singh:

With a small Accident and Emergency Department like Bassetlaw it is difficult to fragment
services. Generally, nurses deal with all patients as there are not enough children to keep a
paediatric specialist busy in Accident and Emergency all the time. In terms of specialist
equipment for emergencies, it would not be cost effective to try and arrange for use just on the
Children’s Ward, e.g. x-ray equipment. There are also the issues of ambulance parking and
access.

The Children’s Ward could not cope with direct Accident and Emergency admissions as staff
might be diverted to deal with emergencies away from caring for inpatients.

Reply by Ian Greenwood:

Doncaster and Bassetlaw Hospitals have separate Accident and Emergency and children’s
inpatient facilities which is usually the same at district general hospitals throughout the
country.

From Councillor K Bullivant:
Question 13

“How are the physical facilities and environment for children going to be improved (we are
aware that planning permission has been granted for an extension to the Accident and
Emergency Department at Bassetlaw?”

Reply by Ian Greenwood:

The builders are in and work has already started on expanding and upgrading the Accident
and Emergency Department. We have looked at our priorities and have redesigned how we
will deal with adults and children having considered what we want to achieve. It will have
integrated facilities but will include a larger dedicated children’s area.

What we would like to do with the children’s ward is integrate the inpatient and outpatient
facilities and this currently being worked on.

Reply by James Scott:

Decisions are being made on the technical aspects and it is anticipated the work will be
completed between March and June/July 2012.

Supplementary question by Councillor Mrs W Quigley:

Last year you said there would be a dedicated paediatrician in Accident and Emergency just
for children.
Reply by Dr Singh:

There is access to a paediatric consultant 24/7 for Accident and Emergency – they are just not
based there all the time. If they are needed in Accident and Emergency they will attend and
will transfer a patient to the Children’s Ward if this is needed.

From Councillor I J Campbell:
Question 14

“How do you plan to address the out of hours emergency access to anaesthetic advanced
airway management?”

Reply by Dr Bolton:

There is always one doctor on site with skills of anaesthetist management. Middle grade
doctors and consultants are all trained in airway management. There are issues if an
anaesthetist trained in advanced airway management is in one theatre or other area but also
required in A&E. We are looking at how to solve this but the outcome is dependent on other
interlinked decisions.

Future consideration is being given to trauma treatment and children’s services in general. All
Accident and Emergency staff are trained in airway management and for small children there
is anaesthetist back up.

Reply by Dr Train:

We are keeping the level of staffing situation under close review, particularly the out of hours
service. All staff in Anaesthetics are trained on an in-house course for advanced airway
management.
.
(The meeting was suspended for a ten minute comfort break. The Chairman advised there
could be no further supplementary questions between questions or at the end of the session).

From Councillor A Mumby:
Question 15

“It is important that paediatric resources are used in the most effective way. Why are certain
cases transferred to Doncaster even though Bassetlaw has stabilised a patient and is able to
provide the follow up care, e.g. cases of meningitis?”

Reply by James Scott:

Advice has been sought from clinical colleagues to respond to this question. Regular
transfers out of Bassetlaw go to Sheffield or elsewhere dependent upon the clinical needs of
the patient. There is an occasional need to transfer a child if a single room is required to
prevent infection. A decision may be made to transfer a child dependent on the availability of
specialist staff; paediatricians are not on the general rota which may lead to a child being
transferred.

From Councillor C Wanless:
Question 16

“What are the plans for the care of children with long-term conditions to reduce the need for
extended hospital stays?”
Reply by Phil Mettam:

It is a strategic intention to provide more primary care opportunities at home and sustainable
hospital care.

Reply by Denise Nightingale

Work is being undertaken to sustain paediatric services at Bassetlaw into the future through
Doncaster and Bassetlaw Paediatrics. Through agreement, it is anticipated that the BCO and
NHS Doncaster and Bassetlaw will support community paediatric posts. This is to support
treatment of longer care conditions in the community, i.e. GPs and parents being able to ring
for specialist advice and being able to speak to clinicians who know the patient.

 In other work done, Doncaster Paediatricians and Bassetlaw Paediatricians all have sub-
specialities that currently do not cross over, e.g. a respiratory specialist – one on holiday, the
other at work. In a second phase of community paediatrics it is intended to develop nursing
support – generalist nursing with specialist paediatric training so that patients with long term
conditions can be discharged home early and receive care support at home. This will reduce
extended hospital stays for children and mean that checks and/or changes to
dressings/medication can be managed in the community.

Reply by Dr Singh

For long term conditions, the Community Paediatricians will be part of a multi-agency
approach alongside other teams, such as social care, that patients do not always receive. We
are keen to strengthen the multi-agency approach further.

(At the discretion of the Chairman, the order of questions was changed at this point).


From Councillor A Simpson:
Question 21

“Is it correct that there are plans to reduce the numbers of doctors training in paediatrics? If
so what threat does this pose for Bassetlaw Hospital?”

Reply by Dr Bolton:

This is difficult to answer – and not just in relation to Bassetlaw and the ‘Facing the Future’
document – workforce planning to build a service has never been easy and we can frequently
get the numbers wrong. In paediatrics, we need to increase the number of consultants
nationally from 3000 to 4500 to deliver a safe service but on the other hand to reduce the
number of those in training from 3000 to 1700. The Deaneries are responsible for trainees
and have been asked to look at the situation. It is proving difficult and they have not yet come
up with a solution.

Every hospital is affected by training numbers and most rotas rely on the presence of junior
doctors: if they are removed there is the issue of the European time directive to consider and
the rota would be difficult to sustain. The RCPCH plan is to deliver the service in a different
way, more GP trainees, resident consultants and specialist nurses. If there are less junior
doctors that this would mean consultants would be on-call more than. Having done all the
extra hours during their training and early years and latterly probably established a family life,
they are reluctant to change current practice. We are looking at integrated rotas across both
sites.
As a small hospital, Bassetlaw has a low number of trainees – the Deanery determines how
many. Training hospitals tend not to be affected if numbers have to be reduced.

From Councillor A Simpson:
Question 23

“How many Bassetlaw children are admitted to a paediatric medical service each year?”

“How many of them are admitted to Bassetlaw Hospital?”

“How many children come to Bassetlaw Hospital paediatric services that are resident outside
of Bassetlaw each year?”

Reply by Phil Mettam:

(Data had been circulated and Mr Mettam said he would be happy to take any detailed
questions at the next meeting).

In 2010/11, 4010 children up to 18 years of age from NHS Bassetlaw area were admitted to
hospital. Of these, 2761 were admitted to Bassetlaw Hospital. 1251 were admitted that were
not from the Bassetlaw area. NHS Bassetlaw patients make up two thirds of Bassetlaw
Hospital activity.

The trend over five years has seen a slight movement away from local choices. This is
thought to be a consequence of more specialisation at other centres.

(From the data sheets, Mr Mettam continued with the subject of Mortality – Q24)

The numbers of infant and child mortality cases are very low but trends over a five year period
show levels are stable.

(A table on page 11 of the data provided comparisons with other local NHS Trusts that Mr
Mettam thought the Committee would find helpful. Page 12 detailed child and infant mortality
percentage rates per 100,000 per population and this showed an increase in NHS Bassetlaw
but also most other places listed too).

The numbers should be seen in the context of the challenge of maintaining a hospital service.
NHS Sheffield has a specialist hospital service provided to a greater population.

From Councillor A Simpson:
Question 25

“What is the assessment of the training facilities and programmes for junior paediatricians by
Bassetlaw Hospital and the Deanery?”

“How will any areas of improvement be addressed”

Reply by Dr Singh:

At Bassetlaw Hospital there are five doctors in training: three for General Practice and two in
paediatrics. They are recruited by the Deanery and the RCPCH. They train and are
monitored within Deanery and RCPCH guidelines. The last assessment by the Deanery in
July 2011 provided positive feedback; however there was one issue relating to a shared night
shift rota between obstetric and paediatric trainees. It is hoped the matter will be resolved
through an alternative staffing model and as part of progression towards one integrated team
which would increase the opportunities to trainees across the two sites.

(Councillor Simpson left the meeting).

From Councillor B Barker:
Question 17

“What out of hours GP services are there for children and are there any plans for this
service?”

Reply by Phil Mettam:

Out of hours services for children are available overnight from 6pm to 8am. Last month there
were 180 admissions through the service, the equivalent of 40 to 50 per week. Rotas are
needed to maintain services so the figures are important. Between 11pm and 8am the
admissions are 5 per week – less than 1 per night. The service is co-located within Accident
and Emergency at Bassetlaw Hospital.

Reply by Dr Foster

The out of hours service is run by GPs covering evenings and weekends. Children tend to
present between 5pm and 9pm when the service is at its busiest with numbers requiring help
being very small between 11pm and 7am. Children are seen in the triage area of Accident
and Emergency by the most appropriate medic.

From Councillor C Wanless:
Question 18

“Do you anticipate that there will be a 24 hour paediatric medical admission and paediatric out
patients’ service for the foreseeable future at Bassetlaw Hospital?”

Reply by Ian Greenwood:

Yes - we intend to continue 24 hour paediatric medical admissions. Paediatric outpatients will
continue during the daytime as part of the outpatient service.

From Councillor H Burton
Question 19

“NHS Bassetlaw funded five paediatric consultants in Bassetlaw but presently there are only
four in post. What plans are there for the fifth?”

Reply by James Scott:

We are working with NHS Bassetlaw and Doncaster on the review of children’s services.
While this is being progressed, the appointment to the fifth post has not been made and the
service is being filled using consultants within that area. It is important to get the post right
following the outcome of the review.

From Councillor J Scott
Question 20

“What are your plans for the development of community paediatrics?”
Reply by James Scott:

I refer you back to question 16 and the comment that we are currently working with the BCO.
The community paediatrics service will be an important part of the development for paediatrics
in the community. We have just found out that the provider of this service will be
Nottinghamshire Healthcare Trust. They must be fully involved in developing and delivering
these services.

Reply by Phil Mettam

A future meeting will discuss the transfer of community services to this group.

From Councillor Mrs W Quigley
Question 22

“Could the development of an excellent service in community paediatrics increase the
likelihood of attracting middle grade doctors?”

Reply by Dr Singh

Paediatricians contribute a significant community element to our work and in developing the
community paediatric service it is essential to attract candidates. We cannot rely heavily on
attracting trainees.

From Councillor Mrs W Quigley
Question 24

“From the Bassetlaw resident population what has the incidence of neonatal, infant and child
mortality been in the last five years and how does it compare to surrounding districts?”

Reply

The question had already been answered earlier as part of Question 23.

From Councillor D Potts
Question 26

“What are the main improvements in the paediatric service that GP’s would like?”

Reply from Dr Foster

An improved service, wherever possible, across the board including improved services in the
Children’s Ward and in Accident and Emergency. Also improvements to the care of long-term
conditions, children’s Unit, special needs and more community based services. This is what
the BCO is signed up to. If we get the pathways right there should be little problem, so
families are not having to go to two hospitals for the same problem. Through connectivity and
integration. We should use GP practices as much as possible and only use consultants when
really necessary. There should be more development of paediatric service with more
specialisms across the trust, better safeguarding, early detection and good integration across
the hospital and with Social services.

From Councillor D Potts
Question 27

“What are the main improvements in the paediatric services that families would like?”
Reply by Sasha Summers

As a parent I have accessed all services from the Special Care Baby Unit to general surgery.
It is important that there is communication between the consultant and the hospital. At the
Children’s Hospital, Bassetlaw Hospital and Doncaster Hospital it is left to the patient to
update doctors at the appointment.

From Councillor H Burton
Question 28

“What are the main improvements in the paediatric service that patients would like?”

Reply from Sasha Summers

The same improvements as the families would like. Having continuity of care be it from a
doctor, consultant or registrar. Sometimes you can see a different doctor every day and have
to tell them what is wrong with your child or go to a different hospital for the same reason and
get the same diagnosis after having explained the outcome of an earlier appointment.

Comment From Councillor A Mumby:

I have six children and have used paediatric services for a daughter who has medical issues.
Bassetlaw Hospital locally is the best hospital to deal with. At Sheffield Children’s Hospital I
felt my daughter was treated like she was on a conveyor belt – bigger is not always better. If a
medical issue can be managed at Bassetlaw Hospital then it should be.

Comment From Sasha Summers

I have a son 8 months old who has spent time in the Special Care Baby Unit at Bassetlaw
Hospital. The treatment is more personal because staff there, know you and your child. At
the Children’s Hospital the patient is just a number, a person passing through.

Comment from Councillor Mrs W Quigley

If your child is seriously ill and this cannot be dealt with at Bassetlaw Hospital then they need
to be treated at a specialist unit like Sheffield Children’s Hospital.

From Councillor H Burton
Question 29

“What are the main improvements in the paediatric service that NHS Bassetlaw would like?”

Reply from Denise Nightingale

I would like to point out the strong link between BCO and NHS Bassetlaw which Dr Kell would
have emphasised had he been here. We would like to see more community support
developed over time and operationally, fewer single-handed specialities which is significant
when someone is on leave. Also fewer children would be admitted due to more community
support.

Dr Foster and Sasha Summers alluded to better communication across the whole network
including health visitors, GP practices and Social Services to ensure an integrated and better
communicated system. This will lead to improved and faster access to services for children.
We need to ensure that the BCO service meets the requirements of all networks and works
well with specialist work going to other providers. It is appropriate that Bassetlaw Hospital
operates to national standards and networks well.     We are working with the Trust and
clinicians to achieve this.

From Councillor I J Campbell
Question 30

“How do you plan to maintain the current good practice of visiting specialist consultants to
Bassetlaw Hospital?”

Reply from Ian Greenwood

Consultants in cardiology, genetics, paediatric surgery, neurology and endocrinology visit
often to rarely for specialist clinics. We might wish to provide these local clinics but
sometimes there is a lack of space or limited numbers of children requiring this service. We
remain happy to continue to provide what clinics we can while ever the Children’s Hospital
wish to provide it on the Bassetlaw Hospital site.

SECTION B - ITEMS FOR DISCUSSION IN PRIVATE

Key Decisions

None

Other Decisions

None

Other Decisions

None

The Chairman thanked everyone for their participation and the co-operation shown. The
Chairman advised the next meeting will be held on 3rd November 1011 and closed the
meeting.

				
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