Demand for paediatric services at CGH?

[Murdina Bug]

I don't know how many of you have seen the front page of the Groat regarding the journey to Inverness by a sick toddler but it really struck a chord with me. I agree with everything Carl Swanson said regarding the situation he and his family found themselves in.

I have a young son who a few months ago had a vomiting bug, took him to the GP for a check and was shocked when he said that if I could not get fluids into him it would be a trip straight down the road to Raigmore. Fortunately, he took the rehydration sachets and recovered well. I couldn't get over the fact that CGH could not even seem to admit a child to rehydrate them - surely that does not need a consultant paediatrication to supervise?

I can understand the NHS argument regarding needing resources (it is after all, the very same one we had over the maternity issues). We can all accept that specialist services are at Raigmore but I believe that a basic first line treatment should be available at CGH. Surely it makes common sense to be able to monitor children at their local hospital on an overnight basis?

I seem to recall these issues being raised in parallel at the time of the maternity consultant debate. Was someone not looking into anecdotal evidence of this type of incident? Is there any record kept within NHS of transfers to Raigmore?

Anybody else have any feelings on this issue?

[sweetpea]

I can see both sides but I do think in cases like this the helicopter should be used.

[Murdina Bug]

I'm not talking about emergency cases though Sweetpea - of course then an ambulance or helicopter transport would be appropriate. This child was not an 'emergency', it's just that CGH does not have paeds and the NHS policy seems to be to ship all kids to Raigmore.

The cases I am talking about are non life-threatening that may need just monitoring - why can't that be dealt with locally? Why is there no provision for overnight stays of children?

Can you imagine trying to drive 2+hrs (on good weather days)in a car with a child that is puking or worse, only to get to Raigmore wait hours to see a Paed then be told that they don't need admitted and to go all the way home again? Bloody ridiculous!

[Thumper]

I had to take my son to raigmore to be seen by a paed,drove down myself with my son in the car,got there and was seen and then sent straight back home!Nightmare!x

[rainbow]

I agree with everything that has been said, and I think some of the doctors need to look at a map and see how far Wick is (or even drive it to have direct experience of the journey). The doctors may have lots of 'grey matter' up top when it comes to medical matters, but when it comes to common sense they seem to be lacking.
My daughter had to go to Raigmore on numerous occasions and had to get a blood test every month - in the paed clinic in Inverness they asked her to come every month - I questionned them and asked could she get it done at the local doctors, and they said if that was easier for us then they would be happy. I ask you - what would you prefer, a monthly visit to Raigmore that takes up all day, or a 10 min visit to the local doctors.

[badger]

Totally agree with this - it is quite scandalous that young children have to travel all that way often for treatment which could be administered locally with a bit more training up here and maybe some telephone advice. Medics. here seem terrified of administering treatment they once would have dealt with and I'm sure it's because Raigmore just don't allow it. They simply don't consider the problems for parents with more than one child who may not be able to make alternative arrangements for siblings' care at short notice, to say nothing of the inconvenience and danger of that long double journey.

As always we're told it comes down to money. Their official response was "too much work for one paediatrician and not enough for two", which is more or less what they used to say about maternity. If the people responsible had to put up with this, things would soon change.

[ocd]

I too, can see the argument from both sides. However, I don't think CGH should be getting the flack, at the end of the day if they allowed any of these children to be kept and "monitored" in Wick and then something went wrong, who would the parents blame.... oh yes, the doctor in the hosptial. Granted the trip down the road may not be pleasant but better safe than sorry. I have had to take my child down and was happy to do so to get him the correct treatment by properly qualified staff. CGH won't turn kids away if its an emergency either, my child had to get an emergency op or there would have been serious implications and the op was carried out in CGH.

The fact remains that we need paediatric cover in Caithness and as this is unlikely to happen we just have to grin and bear it I'm afraid.... unless anyone out there fancys getting a group together to fight the cause.

[badger]

I too, can see the argument from both sides. However, I don't think CGH should be getting the flack, at the end of the day if they allowed any of these children to be kept and "monitored" in Wick and then something went wrong, who would the parents blame.... oh yes, the doctor in the hosptial. Granted the trip down the road may not be pleasant but better safe than sorry. I have had to take my child down and was happy to do so to get him the correct treatment by properly qualified staff. CGH won't turn kids away if its an emergency either, my child had to get an emergency op or there would have been serious implications and the op was carried out in CGH.

The fact remains that we need paediatric cover in Caithness and as this is unlikely to happen we just have to grin and bear it I'm afraid.... unless anyone out there fancys getting a group together to fight the cause.

I don't think anyone is criticising CGH - the problem, as always, is in Inverness.

[the charlatans]

I would say the problem was with NHS Highland rather than Caithness General or even Raigmore.

Having had to be ambulanced down with my child more than once and been throught the stress of the journey on a cold winters day then I would welcome some local consultant paediatrications.

I would also be interested in a study into the cost of the amount of ambulances/parents travelling back and forward to Inverness, plus in this greener age, the carbon footprint of this must be enormous.

This happens all over the country and not just for children. The NHS do have a budget set for them but i believe they are being short sighted in centralising so many services. Like Carl Swanson said, is it going to take a fatality before something is done?

[Froggie]

Last year I had to travel down to Raigmore with my son who was 6 months old at the time as he had a high temperature and was completely out of sorts. Because my husband works away from home i found myself having to find someone to look after my other 2 children and because I would be driving down myself and have no one to look after him I had to get a ambulance car to take me there, then leaving me in a position to find my own way home. He was only kept in overnight with the treatment of calpol every 4 hours and was allowed home the next day. I know of other families who have had to take their children all the way down to Inverness for ailments like these which could have easily been done in Wick. The distance involved is crazy and everyone knows how erratic the weather can be, how many times in the year does the A9 be closed?
I've heard it be said that there is too much work for 1 doctor but not enough for 2.............what does that say to you?

[Murdina Bug]

I intend to write to MSPs and NHS over the service provision in this area for paedatric cover. Does anyone else have any examples of trips to Raigmore which seemed unecessary or risky - or the type of appointment that lasted 3 minutes after a long journey etc?

If you can either post them on here, or PM me for privacy, I will use them as anecdotal evidence in my letter. Please post by end of this week (4 April) as I will need to get this written before I run out of steam!

[tootler]

Have PM'd you, Murdina Bug with our sorry tale.

Get a petition going - this is a ridiculous situation. All we need is one person in Caithness General who's qualified to put a line into a child to administer IV medication or fluids. It's not too much to ask in the 21st Century.

And it's not rocket science for the docs there who can already administer this treatment to an adult to learn how to do it for a child. NHS Highland - get your act together!

[mama2]

I agree that there should be paediatric services in CGH, in Jan 2006 when my youngest was only 4 months he had RSV positive Bronchiolitis and a chest infection,we had to go to Raigmore and spend 8 long nights there. Anyone who has been in the back of an ambulance will tell you it's not very nice, would rather go on the Pentland Firth in force 10 gale! It was so hard being seperated from my other child and because he had a chest infection the staff told me he couldnt visit, this was very upsetting for him and us but understandable, my husband had to go up and down the road I don't know how many times it was just a nightmare. As my youngest was infectious I wasnt able to take him out of the room so saw nobody except the staff. If there had been a paediatric service in Wick it would have made things so much easier and less upsetting. I know of at least 4 other families who were down within the next month for the same thing. The nurses there said they see so many patients from Caithness that they just couldnt understand why we didnt have a small unit of our own.

[Alice in Blunderland]

Have PM'd you, Murdina Bug with our sorry tale.

Get a petition going - this is a ridiculous situation. All we need is one person in Caithness General who's qualified to put a line into a child to administer IV medication or fluids. It's not too much to ask in the 21st Century.

And it's not rocket science for the docs there who can already administer this treatment to an adult to learn how to do it for a child. NHS Highland - get your act together!

As far as I am aware its five years separate higher specialist training after three years of junior hospital training to become qualified in paediatrics.

Its not rocket science to put a line into a child and give fluids. Its more important to make appropriate diagnosis and then institute treatment. The body compartments of a child are quite different in functions to adults.They could be easily overhydrated causing more problems than good. The overhydration can cause swelling of the brain which could cause the child to die. :( Again not rocket science but with a little inside knowledge you can see why the doctors in Caithness General will not do this.


If you are dealing with a sick child without appropriate training one could cause more harm than good. A refresher course is not the answer.The gps are more trained in paedriatrics as junior doctors to recognise unwell children.These children then in turn are to be assessed by trained paediatricians.It is not possible to employ enough paediatricians to provide 24/7 service in Caithness General Hospital. It is not a matter of money but to get enough work for paediatricians to maintain their skills. It is not as simple as one person rehydrating or watching over a sick child.

I also have endured many long trips by car and ambulance with my children to Raigmore and would do it again if it meant they were seen by the appropriate person...... their health comes first. We have chosen to live in Caithness knowing this shortcoming. :)

[Murdina Bug]

I absolutely see what you are saying Alice. However, what I would like to know is what statistics have been used to come to the conclusion that a small paed service could not be implemented in CGH. i.e. is anyone actually monitoring the flow of children sent up and down the road? Is anyone monitoring the types of conditions that are automatically referred to Raigmore?

I am not suggesting that there should be a full children's ward here but it could be that there are certain things that could quite easily be tackled at CGH which would lessen the distress caused by the travel to Inverness. I am not for one minute critising the treatment provided by either of the hospitals but rather the thinking that has not allowed for any progress or change in this area of medicine. Don't forget that these are the same arguments put forward regarding the provision of maternity cover and some re-thinking on the issue proved that there was a way forward.

Just because things are the way they are does not mean that could not be improved!

[badger]

Murdina is right - for anything serious I'm sure Raigmore is the right place but far too many children are being sent down there for minor conditions which could, and should, be dealt with locally. I know someone recently who was told to take her child to Raigmore, only to find when she got there that no treatment was needed beyond what the child was already getting and was sent home again. I do wonder whether our local GPs and hospitals are simply scared of dealing with illnesses which once they would have taken in their stride.

Yes people choose to move to Caithness, but these days you shouldn't have to enquire about paediatric services when choosing an area to live in. The fact that there are two hospitals, any number of medical practices etc. should give reassurance that you're not moving to the third world. There is far too much centralisation in every aspect of the way we are governed.

[Alice in Blunderland]

The difference between maternity and paediatric services is "maternity service was already in existence which they were trying to remove".

There is no paediatric service established in Caithness General.To run a 24/7 service you need a decent number of trained professionals to work there .Bearing in mind the effect of European Working Time Directive (ETWD) on the number of people doing the required hours.This has staffing and recruitment issues.

The out of hours GP is trained to deal with minor ailments locally.The children which are transferred to Raigmore are ones needing paediatric assesment.Some of the kids are returned home after this expert opinion.It is an inconvenience for parents and distressing for children but better safe than sorry.

There are statistics about the transfer of the kids to Raigmore.The majority of the referals are probably inaproppriate but this is a safer practice.To run a servicce not up to scratch could harm the health of a child and if this were to happen then there would be a whole new thread to post on this site.:)

I am all for decent paediatric services locally but can we build a workable business case for NHS Highland. If we can then it can be presented to the meeting of NHS Highland but I am sure they have already considered this. :)

[Fran]

It is hard to face the fact that without a paedetrician in Caithness General, children must be sent to Raigmore. And without enough children needing to be seen we cannot have a paedetrician based in Caithness,
But please remember other patients who also have to travel to inverness , some 3 days a week and it is hard for them also. These are renal patients, one at present, as there is not enough machines for them all. Until the renal Unit was established at Caithness General, they all had to travel down 3 days every week, even when the snow gates were closed.
Also cancer patients go down for extensive chemotherapy and radiotherapy on a very regular basis.
Many patients have to travel down to Inverness, not just children.

[ocd]

The difference between maternity and paediatric services is "maternity service was already in existence which they were trying to remove".

There is no paediatric service established in Caithness General.To run a 24/7 service you need a decent number of trained professionals to work there .Bearing in mind the effect of European Working Time Directive (ETWD) on the number of people doing the required hours.This has staffing and recruitment issues.

The out of hours GP is trained to deal with minor ailments locally.The children which are transferred to Raigmore are ones needing paediatric assesment.Some of the kids are returned home after this expert opinion.It is an inconvenience for parents and distressing for children but better safe than sorry.

There are statistics about the transfer of the kids to Raigmore.The majority of the referals are probably inaproppriate but this is a safer practice.To run a servicce not up to scratch could harm the health of a child and if this were to happen then there would be a whole new thread to post on this site.

I am all for decent paediatric services locally but can we build a workable business case for NHS Highland. If we can then it can be presented to the meeting of NHS Highland but I am sure they have already considered this. :)

Absolutely Alice, I dare say your "inside knowledge" helps your argument :)

However, what you have said hits the nail on the head!

Fran.. well said, there are many people face that journey. Elderly people in particular don't fare well having a journey down and back for sometimes a 5 minute appointment!

[Alice in Blunderland]

It is hard to face the fact that without a paedetrician in Caithness General, children must be sent to Raigmore. And without enough children needing to be seen we cannot have a paedetrician based in Caithness,
But please remember other patients who also have to travel to inverness , some 3 days a week and it is hard for them also. These are renal patients, one at present, as there is not enough machines for them all. Until the renal Unit was established at Caithness General, they all had to travel down 3 days every week, even when the snow gates were closed.
Also cancer patients go down for extensive chemotherapy and radiotherapy on a very regular basis.
Many patients have to travel down to Inverness, not just children.

Cant agree more with you there Fran. :)

[Murdina Bug]

I agree too - but one thing at a time girls!! Interesting that the Renal Unit has been brought up - there is a service that was not already in-situ but patient needs (and a fantastic campaign) brought about change. The heart of what I am trying to get to is whether there are things that can be done locally but are not, I am not talking about specialist treatments but where the line is drawn on paed assessment requirements.

Alice - as you said "the out of hours GP is trained to deal with minor ailments locally. The children which are transferred to Raigmore are ones needing paediatric assessment. Some of the kids are returned home after this expert opinion. It is an inconvenience for parents and distressing for children but better safe than sorry. The majority of the referals are probably inaproppriate but this is a safer practice."

I would like to agree with this but it seems from cases that people have brought up that it is the classification of what is a 'minor ailment' that may be the problem. Someone being sent to Raigmore to be told to keep up using Calpol is surely a badly assessed patient? 'Better safe than sorry' should be not sending people on a hazardous journey as there is no-one in the county able (and I mean that under their employment restrictions, not capability) to say what is best for an under 16 year old and being obliged to send them on that journey.

I would like to think that NHS have considered these things but that is not always the case. Local provision for as many treatments as possible is something that should be rethought.

[tootler]

I'm with you, Murdina.

In our case, our daughter has had a full diagnosis and the problem is ongoing and untreatable without a major heart op. So when an episode persists, the guys in CGH know which drug is needed and have it there but will not administer it because it's only available as IV and she's a child.

She has to make the trip to Inverness - at a time when she's in extreme discomfort - when an adult, elderly or otherwise, with the same condition would receive immediate treatment in Caithness. I value my child's health above my own - most parents do - but the present system of healthcare does not reflect this usual trend in society, it certainly favours adult healthcare over that of children.

If there's not enough children to provide the necessrary level of experience could we not have a rotation system in place so that one paed isn't stuck in CGH forever? It makes more sense to me to move the doctor than the sick patient - cheaper and safer.

[A_Usher]

There are several factors to this.

1. The level of child admission is probably not high enough to sustain the required amount of paediatricians required, as you would require 3, to operate on a rotational basis, due to out of hours, working time directives etc.

2. You would also require paediatric nurses also to work alongside.

3. The cost for staff and a fully serviced wards and childrens beds etc is probably too high

4. Recruitment, even if the funds are in place it would be probably highly difficult to recruit three paediatricians to the area, given that their would be lack of work for them and issues with career development etc.

5. Paediatric nursing is at a low point, in the sense that their is a shortage of them, so recruiting them could be a problem.

6. Many cities have children's wards spread out over geographical areas, such as Glasgow, granted they are closer but for some people its still just as long a journey time.

Given this i highly doubt we will see a paediatric service, which ideally would be a great service, but i really cant see it happening.

Andrew Usher
Dunbeath Surgery.

[Murdina Bug]

Yup, ok Andrew - all good points, but you have a lot of 'probablys' in there. I actually think there is a very slim (miniscule) chance of a full paed service (although that would be good!). However, what could be considered would be a review of the automatic sending of all under 16 admissions to Raigmore by provision of an enhanced service at CGH. In my simplistic viewpoint an enhanced service would include nurses able to insert IVs, and a couple of overnight beds.

Ok, now start thinking of it from the other end and apply your background knowledge of the NHS to give me some positive points as to why local provision of services is best? :)

[A_Usher]

Yup, ok Andrew - all good points, but you have a lot of 'probablys' in there. I actually think there is a very slim (miniscule) chance of a full paed service (although that would be good!). However, what could be considered would be a review of the automatic sending of all under 16 admissions to Raigmore by provision of an enhanced service at CGH. In my simplistic viewpoint an enhanced service would include nurses able to insert IVs, and a couple of overnight beds.

Ok, now start thinking of it from the other end and apply your background knowledge of the NHS to give me some positive points as to why local provision of services is best? :)

It wont happen, it wasn't that long ago we got an email from the CHP stating they had little money in the budget for enhanced services, which actually could mean less enhanced services being offered overall. Im not at the surgery today as i am working from home but ill see if i can dig it out.

The problem with Highland was that it absorbed Argyll who had notorious funding issues and over spending and i think that will effect budgets for years to come to be honest.

[A_Usher]

Talking to my other half, i have found out that its money to be cut from enhanced services to be put into longer opening hours, so in essence extra opening hours for medical surgeries that opt into it, will actually see a decline in other services.

But even in practices don't opt in their is apparently no money for expanding services. All of this is still being negotiated, but doesn't look good.