The planning population for childhood illnesses potentially requiring admission. Report 3 Service Innovations Background Research Rapid Reviews (SIBR3)

The provision of services for infants, children and adolescents takes place in a dynamic environment in which a range of factors stimulate change. There is now a groundswell of informed opinion which sees the NHS acute sector of the future as one in which changes to hospital configuration are expected. The debate has been taken up with a number of stakeholders and has produced a range of reviews and reports on potential pathways for change. The government has set down a ten year strategy for modernisation, and substantial contribution from various clinical working parties has been made particularly in the area of paediatric, surgical, anaesthetic, trauma and intensive care services. (NHS July 2000, Royal College of Surgeons in England (RCSE) Nov 2000, RCSE Dec 2000, RCSE BOA July 2000, JWP BMA, RCP Lon. RCSE, July 1998, Royal Surgical Colleges of Great Britain and Ireland, July 1998, RCSE June1997, Royal College of Anaesthetists and RCSE 1996, Royal College of Nursing 2000, Department of Health 1996). This has been against a background, nationally, of increasing concerns regarding the quality of services for children.

There are common issues which effect service configuration nationally, however, any specific catchment is going to have issues which are unique to itself. Much of the recent literature on re-configuration of services has emphasised the importance of locally derived solutions. (Smith 1999).

One of the more considered propositions for future hospital configurations has been the networking model put forward in the Royal College of Surgeons of England’s report on the provision of elective surgical services, (RCSE 2000). While acknowledging that the optimal population catchments, recommended for paediatric surgery and trauma centres are c.1.5 million, it is considered that the feasibility of configuring the nation’s acute hospitals solely around single centres with such catchments is considered totally impractical. The need for both demographic and service responsiveness, led the report’s contributors to favour a more practical alternative, which would be to develop hospital networks serving populations of 500,000. (Even this is a challenging proposition in a system where 60% of hospitals are currently serving populations of 300,000 or less and only 10% serve a population of 500,000 or more.) This would see services with different emphases distributed across networks of hospitals, where separation was more related to intensity of care and severity of risk than in the traditional clinical divisions based on speciality alone. Elective and lower risk care does need not necessarily require a full complement of acute support services and may be better served by appropriate levels of back up (eg. high dependency support services and rapid retrieval systems with appropriate referral policies and guidance).