Proposed changes to PACU Paediatric unit opening times to keep service open in Withybush Hospital

Members of Hywel Dda University Health Board will discuss temporary changes to the opening hours of the Paediatric Ambulatory Care Unit (PACU) at Withybush Hospital, whilst there are fewer consultant paediatricians available, at a full health board meeting on Thursday November 24.
The issue has emerged due to a combination of long standing difficulties in recruiting paediatric consultants across the UK and an exacerbation locally due to the coinciding retirement of one Pembrokeshire paediatric consultant, along with maternity leave of another.
Doctors, nurses, hospital managers and the Executive Team have been in discussion about how to best serve children and families in Pembrokeshire by doing all that is possible to maintain the Paediatric Ambulatory Care Unit (PACU) at Withybush Hospital whilst there are fewer consultant paediatricians available. To do nothing is a risk. The health board’s prolonged attempts at substantive and locum recruitment have been unsuccessful and agency consultants are only sometimes available which creates the risk of an unsafe, unreliable and fragile service.
The recommendation to full health board is to get agreement in principle to progress towards continuation of a 12 hour, seven day PACU at Withybush Hospital, with remote paediatric consultant support. However, our consultant recruitment difficulties mean we must consider how we can do this temporarily in a safe way until we have developed this method of working for our locality. One option for providing paediatric consultant cover, whilst minimising the number of families affected, is to reduce opening hours for PACU by four hours a day. This means PACU would be open from 10am until 6pm.
There is also a recommendation, in line with original service change plans and advice from the Royal College of Paediatrics and Child Health, to merge the overnight on-call rota with the one operating in Carmarthenshire. This would mean that if there was a paediatric emergency out-of-hours at Withybush Hospital, the on-call paediatric consultants would offer remote advice.
Chief Executive Steve Moore said: “We share the desire of our Pembrokeshire community to retain community and hospital services for sick children as close to home as possible and within the county whenever we can. We are committed to keeping the Paediatric Ambulatory Care Unit at Withybush Hospital open seven days a week and we think there is an option to allow us to safely do this, even with the renewed and significant workforce challenges.
“However, to do this safely, the recommendation from our staff is to temporarily reduce the opening hours of Withybush PACU by four hours a day.
“It is our duty to be realistic about the availability of our consultants and to plan care around this so that it is safe, consistent and to avoid public confusion. Otherwise, we risk the event of having insufficient staff and having to close the unit in an unplanned and uncoordinated way, risking patient safety and public confidence.
“Our recruitment efforts continue and we are pleased to have successfully appointed one agency consultant until the end of the month. We will review hours when the staffing situation improves and we want to work with our staff, partners and community to look at how we can strengthen services in Pembrokeshire, and across our whole area, in the long term.”
PACU is due to move closer to the Emergency Department at the end of the year and there are plans to strengthen links between the two departments, including development of Advanced Paediatric Nurse Practitioners. The health board also wants to improve telehealth links with the acute paediatric team based at Glangwili Hospital and provide more protected clinic time and community service capacity.
Clinical lead for Child and Adolecent Health Dr Simon Fountain-Polley said: “Families generally look after their own children for the majority of acute illnesses. If they need advice they can still access NHS Direct, community pharmacists, or their local GP. Most children, thankfully, don’t need to see the hospital paediatric team for acute illnesses. For that relatively small proportion of children who do, their GP can refer them into hospital services. Up until 6pm, Withybush Hospital PACU will still be open. After 6pm, the Withybush Hospital emergency department team will seek advice from Glangwili Hospital paediatric team, and if a child needs admitting they will be referred to the children’s ward at Glangwili Hospital, as is the case currently after 10pm.”
The health board will make a decision on Thursday and whatever the outcome will keep the situation under close monitoring.
In the meantime, the health board continues to reduce the impact on families as much as possible. This includes provision of the dedicated ambulance vehicle for transfers between Withybush and Glangwili hospitals, provision of funded transport schemes such as that provided by Action for Children, help under the NHS Travel Costs scheme and, in exceptional circumstances where no alternatives are available, vulnerable families will be provided with a paid for taxi to return home.

Paediatric consultant vacancies continue to be advertised with one applicant scheduled to be interviewed in January and the health board is speaking to potential recruits to demonstrate the benefits of working in Withybush Hospital and the wider paediatric team.

To support the intention to provide longer term continuation of the 12 hour PACU service at Withybush Hospital, with consultant support provided remotely by the acute paediatric team based at Glangwili Hospital, the health board plans to hold a patient, staff, public and stakeholder engagement process to co-design the future service for children in the area.

Advice for parents

What would this mean for Pembrokeshire families?
If Hywel Dda University Heath Board accepts the recommendations, it would mean in the short term, that the Paediatric Ambulatory Care Unit (PACU) at Withybush Hospital would be open daily, but would close at 6pm instead of the current 10pm.

What is PACU?
Withybush Hospital’s Emergency and Urgent Care Centres (EUCC) and PACU provide the vast majority of hospital care required for children in Pembrokeshire. About 75% of those children who are referred into Withybush Hospital PACU, are treated there and do not need to be transferred to another hospital. It provides care for children with sudden onset of pain, high temperatures, sickness, infections, or requirements for dressings, blood tests, x-rays or scans.

What about children who need to stay in hospital overnight?
Currently any Pembrokeshire children who need an overnight, inpatient stay in hospital, are transferred to Glangwili Hospital, in Carmarthen. This will remain the case under the recommendations. There is a dedicated ambulance vehicle for women and children’s transfers between Withybush and Glangwili and a parent or carer can remain with their child on transfer and on the wards.

What about sick children who need assessment after 6pm?
At the moment, children who require paediatric assessment after 10pm are referred or transferred by ambulance to the PACU at Glangwili Hospital. If recommendations are accepted, this will happen from the earlier time of 6pm.

What about hospital appointments for children?
Scheduled care including procedures, tests and outpatient clinics will continue at Withybush Hospital during the daytime. In addition, the PACU service described above will also be available 10am-6pm.

What do you do if your child is unexpectedly sick at night?
Parents should continue to access care for their children as they do now.

If your child is unwell, you can do a number of things:
Call NHS Direct Wales – 0845 46 47 – they can advise you if you are unsure what to do, as well as provide health information on a wide range of conditions, treatment and local health services
Use your community pharmacy if open
Make an appointment with your GP as usual, including out-of- hours GP services, which are contacted through your normal GP telephone number
For a paediatric minor injury, go to Withybush Emergency and Urgent Care Centre (EUCC) 24 hours a day
In an emergency, if your child is very sick, you should dial 999 for assistance. Children who present at Withybush Hospital out-of-hours will usually be transferred to Glanwgili Hospital for paediatric input. In the exceptional circumstance where emergency resuscitation is required, emergency and anaesthetic staff will resuscitate, stabilise, and arrange transfer onto another hospital.What about families with open access?
​The advice already in place after 10pm, will come into action from the earlier time of 6pm temporarily. Families will retain open access to both WGH and GGH PACU as they do now. 

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