Half of English district hospitals can’t provide emergency surgery for children, survey finds

BMJ 2010; 341 doi: (Published 20 December 2010) Cite this as: BMJ 2010;341:c7293
  1. Susan Mayor
  1. 1London

Half of the district general hospitals in England are unable to provide emergency general paediatric surgery, warns a survey published on 16 December by the Royal College of Surgeons’ children’s surgical forum.

The survey investigated the provision of general paediatric surgery in district general hospitals in England by analysing data from NHS hospital episode statistics for children and teenagers up to the age of 18-19 years undergoing surgical treatment in 2008-9. General paediatric surgery is the surgical management of relatively common, non-specialised conditions in general surgery and urology, such as herniotomy and appendicectomy, in children who don’t need complex perioperative care.

Hospitals that were providing general paediatric surgery were then sent a questionnaire to gather further information on their surgical services.

The results showed that just over half (51%) of the 305 district general hospitals providing general paediatric surgery do not provide an emergency service. The responses indicated that, with the exception of life threatening conditions, emergencies tend to be referred to larger hospitals or specialist centres.

The report recommends that high quality general paediatric surgery should be available locally in district general hospitals, so that children and their families do not have to travel long distances for routine surgery

Su-Anna Boddy, chairwoman of the children’s surgical forum, said, “This survey reveals that the current way general children’s surgery is provided not only puts children and their families at a disadvantage in terms of accessing routine care locally but also prevents trainees in adult general surgery and urology from developing skills to manage routine surgical conditions in children.”

She said that the survey results provide a detailed map of service provision and training opportunities that NHS providers and commissioners can use to develop local networks to maintain general paediatric surgery provision.

The survey showed that many hospitals had enough workload, infrastructure, and experienced surgeons to support the training of general surgeons and urologists in paediatric surgery. “Most of these training opportunities are not being exploited,” the report said. It suggests that deaneries and specialist training advisory committees use the survey findings “to make best use of available resources and existing skills to ensure that the next generation of surgeons will have confidence in their ability to treat them [children].”

One of the major limitations revealed by the survey was the provision of anaesthetic services for children undergoing general and urological surgery. A third of hospitals reported that they could not anaesthetise children under the age of 3. Even in hospitals that reported a lower age limit for anaesthesia the provision of this service varied greatly, depending on the skills of the available anaesthetists.

Anna-Maria Rollin, the Royal College of Anaesthetists’ representative on the children’s surgical forum, said, “All anaesthetists undergo training in paediatric anaesthesia and at the end of training should be competent to anaesthetise children aged 3 years or older for simple elective and emergency surgery. In addition, they should be competent to resuscitate and stabilise seriously ill children of any age prior to transfer.”

Many anaesthetists then acquire additional specialist skills so that they can care for very young children undergoing complex surgery, Dr Rollin explained. “We welcome the opportunity to work with the RCS [Royal College of Surgeons] in establishing managed clinical networks to ensure that children receive safe and appropriate care and that trainee surgeons and anaesthetists have the opportunity to acquire the necessary skills,” she concluded.


Cite this as: BMJ 2010;341:c7293