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Children deserve safe medical care

16 October, 2020

Whittington Hospital

• TO whom it may concern,

As junior doctors at the Whittington Hospital paediatric department, we wish to express our deep unease about the reorganisation of paediatric services currently taking place across North Central London.

This reorganisation involves the closure of the paediatric A&Es and inpatient wards at the Royal Free and University College London Hospitals, with the Whittington Hospital taking on most of this workload as the sole “south hub” for paediatrics services in North Central London (population 1.5 million).

Barnet Hospital will continue to run its paediatric A&E and inpatient ward, as the region’s “north hub”.

We feel these changes are being rapidly forced through without adequate planning, oversight or consultation.

We believe our voices are important and ought to be heard. And above all, we think the children of north London deserve safe, high quality, medical care, which we doubt these plans will provide.

Our key concerns are:

1. Risks to patient safety 

The large increase in patient footfall that will follow the closures at the Royal Free and UCLH threatens to breach the Whittington’s capacity to provide safe acute paediatric care.

We are a small department in a small hospital: we lack the necessary bed space on our ward, cubicle space in A&E and medical staffing to cope with this imminent surge.

Plans are under way to increase capacity, but ambulances have already begun diverting to us before any new spaces have opened. Winter – the busiest time of year – is yet to hit and we are operating under significant pressure already. This will only get worse.

In particular we have a critical shortage of paediatric nurses. We understand that many of the nurses transferred from UCLH to the Whittington have resigned or are planning to do so. These are highly trained, skilled, professionals and it will be impossible to manage without sufficient replacements.

Adult nurses are being drafted in to assist but their adaptation will take time – something we do not have on our side. An overworked, under-experienced team, working in limited physical space, is not a recipe for safe or effective care.

Furthermore, as part of the service redesign, junior doctors from the Whittington will now have to staff the Neonatal Intensive Care Unit (NICU) at the Royal Free Hospital without support from middle-grade doctors (specialty registrars).

Many of us, particularly our GP trainees, have no experience of working in NICU and do not have Neonatal Life Support certification. It is currently unclear what sort of formal induction to the job we will receive.

Yet in just days we will be expected to attend emergency crash calls to resuscitate critically unwell newborn babies. We need cast-iron assurances that we will be properly trained and supported for this.

2. Impact on wellbeing and morale 

We were only informed that these changes to paediatric services were going ahead in the middle of September. Since then, our already demanding work schedule has been drastically overhauled in an extremely short space of time: we received a first iteration on our new rota on September 24, a final version on September 29 and a start date of October 5.

This is an unacceptably short time frame, violating BMA advice that we should be given at least six-weeks’ notice before significant rota changes.

We have no choice but to accept our new rota, which involves working extra nights and long shifts. This will inevitably erode our work-life balance and compromise our wellbeing, mental and physical health.

As front-line workers, it has already been a gruelling year responding to Covid-19: many of us have faced redeployments, cancelled time off, illness and a multitude of other personal challenges. These latest changes will further erode our morale and bring a significant risk of burn-out.

3. Effects on education and training 

We are also concerned about the impact this service redesign will have on our clinical and academic training and education.

We fully appreciate that this was not a priority during the initial pandemic, however we feel the new work arrangements could negatively impact our professional development for a long time to come.

The increased workload is already leaving us far less time for teaching, learning and reflection, which is not in our or the public’s best interests. The NHS and Health Education England have a duty to meet our training needs – not treat us as mere service providers.

Summary 

The changes to paediatric services in North Central London will have a significant, detrimental impact on our personal and professional lives and, more importantly, the wellbeing of our patients.

The changes are ostensibly to free up beds for adult Covid-19 patients; however we believe it serves as a further example of child health being marginalised in the current climate.

The pandemic-driven reorganisation of hospital and primary care services has already been shown to negatively impact paediatric care, resulting in excess morbidity and mortality among children (i, ii, iii).

We are aware that senior clinicians across all three trusts share many of our concerns.

Communication between junior doctors and the decision makers at North London Partners in Health and Care has been non existent. We are the backbone of the NHS, yet our opinions are not sought and our needs not considered.

Nor have the public’s views been explored: there has been a conspicuous lack of consultation and publicity that would usually accompany the closure of major hospital services.

We have contacted the BMA to assist us in ensuring our concerns are addressed. We hope this letter will yield more open dialogue from policy-makers and help ensure funding, resources and support are in place to safeguard us, our colleagues and patients.

i: Lynn RM, Avis JL, Lenton S, et al. Delayed access to care and late presentations in children during the COVID-19 pandemic: a snapshot survey of 4075 paediatricians in the UK and Ireland. Archives of disease in childhood 2020:archdischild-2020-319848. doi: 10.1136/archdischild-2020-319848

ii: Roland D, Harwood R, Bishop N, Hargreaves D, Patel S, Sinha I. Children’s emergency presentations during the COVID-19 pandemic. Lancet Child Adolesc Health. 2020 Aug;4(8):e32- e33.

iii: www.rcpch.ac.uk/news-events/news/covid-19-statement-delayed-presentations

A LETTER OF CONCERN FROM JUNIOR DOCTORS

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