There are too few paediatric consultants across the UK and too many general units to deliver the best possible healthcare for children, according to the latest workforce census conducted by the Royal College of Paediatrics and Child Health (RCPCH). The RCPCH is warning that unless a radically different model of care is developed, there will be serious safety risks to children and the system will be unable to meet demand.
Dr Hilary Cass, President of the Royal College of Paediatrics and Child Health, said:
“The problem is three-fold. Firstly there are not enough senior doctors available to maintain the safety of current paediatric care; we need a 50% increase in the consultant workforce if we’re to have a round-the clock consultant presence. Secondly, expertise is spread too thinly – we have too many small units and not enough specialist centres. If we had staff and resources concentrated in fewer specialist centres, treatment would be better coordinated and of a higher standard. And finally, there are too many trainees for long term sustainability of the paediatric workforce if the current rate of recruitment into training is maintained – when they qualify to be consultants there won’t be enough posts for them to fill.”
The Census found that between 2009-2011:
- The overall paediatric workforce has decreased by 1.4%
- The number of consultants is growing too slowly to meet demand (annual growth of 2.3%) and there are 86 vacancies
- The number of SAS (Specialty and Associate Specialist) doctors decreased by 17%
- The community paediatric workforce declined from 1375 to 1245 2011 (9.5%)
- Average numbers on paediatric rotas have risen slowly to just over 8 whole time equivalent doctors, but still fall short of the Facing the Future standard of 10
- The number of academic paediatricians fell by 11%. This will jeopardise NHS research and innovation work benefitting patient care and outcomes
- The number of paediatric in-patient units decreased by 7 – falling short of the reduction of 48 recommended in the College’s Facing the Future report
Despite the low figures on inpatient unit closures, the census does reveal that a further 73 units are reviewing the way that their services are provided.
The figures are particularly concerning when coupled with the fact demand on services is greater than ever, and recent figures in the Back to the Facing Future Audit reveal a lack of consultant cover at times of peak activity.
The College is calling for more care to be delivered outside the hospital setting, with a defined career path for paediatricians which would involve a greater degree of work in the community, older consultants being able to ‘step down’ into less acute roles and GPs and other primary care healthcare professionals being better trained in child health.
Dr Cass said:
“We need to look at some short terms fixes to deal with the impending crisis – such as re-deploying consultants where they are most needed. In the medium term, we should be looking at a radically different ways of delivering care involving colleagues across the child health spectrum – from GPs, surgeons, nurses and child mental health services. General care should be moved out of hospitals ideally into a community setting – where experts can come together to provide expert care, share knowledge and take the strain off both GPs surgeries and A&E.
“And in the longer term, we need to address the infrastructure and planning problems which are causing difficulties in paediatrics, by pushing for more consultant posts and ensuring there are fewer, specialist units delivering high quality care for children.”