In June 2017 the Joint Committee for Clinical Commissioning Groups (JCCCG) for South Yorkshire and Bassetlaw took a decision to change the way some children’s surgery and anaesthesia services are provided in South and Mid Yorkshire, Bassetlaw and North Derbyshire.
At the time, the JCCCG agreed to clinical recommendations that children needing an emergency operation for a small number of conditions, at night or at a weekend, would not be treated in hospitals in Barnsley, Chesterfield and Rotherham, and would instead have their surgery at Doncaster Royal Infirmary, Sheffield Children’s Hospital or Pinderfields General Hospital in Wakefield.
Since the decision, across the region, we have:
- Strengthened partnerships across the region and even closer ways of working have been formed across the patch
- Closer joint working across the NHS Hospitals has strengthened Ear, Nose and Throat (ENT) services and made them more stable and sustainable. This has reduced the need for children’s surgery in the areas previously identified
- The more detailed investigation that happens before any proposed change takes place has shown reality to be more complex than the business case assumed
- There is evidence that pathways for torsions of the testes are appropriate and should be retained
- The introduction of Sustainability and Transformation Partnership/Integrated Care System geographical footprints has changed previous joint working arrangements. In South Yorkshire and Bassetlaw this has impacted on working arrangements with Mid Yorkshire Hospitals
These changes of circumstance have therefore led the Children’s Surgery and Anaesthesia Managed Clinical Network to develop revised recommendations, which meet the principles from the original work around safety and care closest to home, but which do not support the three hub geographical model proposed in 2017.
A new paper, to be decided upon by the Joint Committee of Clinical Commissioning Groups (JCCCG) in February, instead recommends that clinical models should be different depending on the type of surgery.
The paper proposes that:
- The ENT models that are in place, through the close joint NHS Hospitals work are appropriate and should stay as they are
- Torsion of the testis pathways are appropriate and should stay as they are
- Consideration should be taken as to whether Mid Yorkshire Hospitals (MYH) should remain as a part of this work. Changing MYH’s involvement would have some small volume implications
- The pathways at Bassetlaw remain the same as current arrangements
- Abdominal surgery (for suspected appendicitis) is the most complex pathway and the recommendation is that a change should be made to the treatment of appendicitis in young children. The number of appendicectomies (surgery to remove the appendix) undertaken in South Yorkshire and Bassetlaw each year on children under 8 is very small. Children under 8 are not ‘small adults’ and if they need an appendicectomy, it is better and safer for them to be seen by a surgeon who is trained to and regularly operates on younger children. Therefore the proposal is that for children aged under 8, and also for children with complex needs, appendicectomies should be conducted at Sheffield Children’s Hospital. This would affect about 40 children a year, and arrangements would be put in place to ensure safe transfers. For those children who will continue to have their surgery in their local hospital, we are strengthening the working between surgical, anaesthetic and paediatric medical teams, to ensure that we are concentrating upon the total needs of the child, and not just the surgical aspects.
Should the JCCCG support the changed proposal, work would take place that would see the appendectomy pathway changed in 2020.
A short summary of the consultation
Over the last few years work has been taking place in South Yorkshire and Bassetlaw, across all of the hospitals, to make sure the children’s surgery that takes place is safe and can remain safe in the future when faced with the many things that change healthcare delivery, such as new technologies and staffing numbers. If you would like to read more about this work you can on our website here.
This work has overwhelmingly found that the majority of children’s surgery can continue to be delivered as it currently is in South Yorkshire and Bassetlaw’s hospitals.
However, surgery for abdomens (tummies) is complex and the recommendation from all the doctors and nurses who have looked at this, is that a change should be made to the treatment of appendicitis in children under the age of 8, or if the care of the child is likely to have some clearly identified complexities (for example if the child has another complicated medical or surgical condition at the same time as appendicitis).
The number of appendicectomies (surgery to remove the appendix) undertaken in South Yorkshire and Bassetlaw each year on children under 8, or with significant complexities, is very small.
Children under 8 are not ‘small adults’ and clinicians believe that if children need an appendicectomy, it is better and safer for them to be seen by a surgeon who is trained to, and regularly operates on, young children.
The majority of appendicectomies are not time-critical, meaning they do not need to be carried out within hours of diagnosis. Children who need an appendicectomy can be safely moved.
Therefore the proposal is for children aged under 8, and for children with complex needs, appendicectomies should be conducted at Sheffield Children’s Hospital. This would affect around 40 children a year.
All other appendicectomies on children aged 8 and above would continue to be performed in all of the South Yorkshire and Bassetlaw hospitals where they are currently performed (this would continue to exclude Bassetlaw Hospital, which does not carry out this surgery on children).
In the very rare case of a time-critical emergency, such as a burst appendix (rather than appendicitis), the procedure would be likely to be carried out in the hospital where the child had first arrived.
The length of stay in hospital for a child undergoing an appendicectomy is between two and four days, depending on how complex it is. Sheffield Children’s Hospital has facilities for one family member to stay with the child overnight.
We are now engaging with the public in South Yorkshire and Bassetlaw, in particular parents and carers of children aged under 8, about the appendicitis proposal. If you would like to have your say and find out more, click here.