NHS staff crisis puts child safety at risk, says report

A secret report into children's wards at several Scottish hospitals has uncovered an NHS staffing crisis which has raised serious patient safety issues including concerns about the treatment of premature babies.

Midwives at St John's have expressed concern about the neonatal unit. Picture: Lisa Ferguson

Overworked staff, cancelled appointments, insufficient medical cover and plummeting morale are identified in the draft document compiled by the Royal College of Paediatrics and Child Health.

The Royal College was commissioned to carry out the investigation in response to a staff shortage which led to the temporary closure of the children’s ward at St John’s Hospital, Livingston.

The independent expert review, which also examines the Royal Hospital for Sick Children, Edinburgh, and Edinburgh Royal Infirmary is due to be presented to NHS Lothian later this month.

Scotland on Sunday, however, has been sent anonymously a “confidential draft” of the report, which lays bare the challenges hospitals face.

The 79-page document outlines the anxieties of midwives working at St John’s neonatal unit about the resuscitation of babies treated there.

“The review team heard mixed reports about clinical safety concerns on the St John’s neonatal unit particularly relating to resuscitation and consultants ‘acting down’ on the out of hours rota,” the report says.

“Midwives reported that they felt they were sometimes leading the resuscitation rather than supporting it and nurses believed that practice in the neonatal unit is variable due to a lack of confidence in some medical staff.”

Concerns about resuscitation had also been raised at monthly paediatric meetings at St John’s, where a number of “incidents” relating to the life-saving practice had been mentioned before the Royal College specialists began their investigation into the hospitals last year.

“These were reportedly attributed to inadequate training and maintenance of competencies compounded by overworked staff with minimal back-up,” the report says.

Despite the midwives’ concerns, the document reveals that St John’s medical team felt there were “no safety issues” and were “confident” nurses could “handle a 23-week infant” until further expertise arrived.

On staff shortages in the St John’s children’s services, the report says the hospital relied on a small core of people who were working extra hours to keep the unit functioning.

There were “continued concerns about the OOH (out-of-hours) rota, low activity levels and the ability of consultants, in particular, to maintain their core skills”.

The Royal College specialists were told that “staffing became unsafe if one person went off sick” and could not be replaced on the nurses rota.

According to the report, the reputation of the St John’s children’s ward had spread beyond Lothian, which may have contributed to the recruitment challenges.

The document reports that some children’s nurses expressed anxiety about high dependency units late at night when consultants were less available.

Further concerns were expressed about nurses’ access to neonatal courses and the loss of newly trained nurses to England, where it was easier to get more training.

The report says: “There are concerns that the service at St John’s may not be safe at times as it is not always possible to ensure safe staffing levels.”

It also identifies management problems, saying there is a “lack of clear vision” and a sense of insufficient leadership from the top. It says management do not involve clinical staff in strategic development.

“There was reported to be a ‘gulf’ between and among clinicians and management which was damaging to morale and resulting in potentially poor patient care,” the document says.

The future of the children’s ward at St John’s has become a major political issue with campaigners fighting to keep it open.

There have also been claims from opposition parties that the Scottish Government attempted to push back the report’s publication until after May’s Scottish election because SNP ministers were worried about what it would say. Those claims were repeated by Scottish Conservative leader Ruth Davidson when she tackled Nicola Sturgeon at First Minister’s Questions last week.

On the future of St John’s children’s ward, the report, which was commissioned by NHS Lothian, says activity and demand mean the hospital “merits retention” of inpatient paediatrics in the short and medium term.

At the Royal Hospital for Sick Children (known as the Sick Kids), the report finds, its bed capacity means it is struggling to cope.

At peak times patients are held in the Emergency Department for “longer than clinically necessary” until a spare bed is available – a state of affairs that leads to a “poor experience” for patients and families.

Increasing pressure on consultants to cover the acute receiving and assessment unit at the hospital results in the cancellation of outpatient clinics and increases in waiting times.

Nurses are “anxious” about the pressure on critical care beds caused by a high number of long-term patients. That results in patients with “high dependency needs” being cared for on general wards.

Although there is a high level of medical staffing during the day, the report says, there is “insufficient cover” at night. The report recommends recruitment of more consultants to “urgently” address the staffing issues.

At Edinburgh Royal Infirmary, the report focuses on problems with the computer system.

“The IT system is increasingly posing a clinical risk as there were reports of loss of records halfway through writing them and the system does not interface with the St John’s IT package so information on infants transferring cannot be reconciled even within the health board,” the report says.

Last night Scottish Conservative shadow health secretary Donald Cameron said: “When Nicola Sturgeon was health secretary, she gave a personal guarantee that she was committed to St John’s.

“Since then, there has been problem after problem, and it’s no surprise patients in West Lothian simply don’t believe the SNP any more.

“This report seems like it will reveal very significant concerns, and these have to be addressed as a matter of urgency.”

Neil Findlay, the Labour MSP for the Lothians, who has campaigned to keep the St John’s children’s ward open, said: “People have been waiting for this report for a long time. It was deliberately delayed until after the election and now that it has been revealed by Scotland on Sunday you can see why.

“There are a series of serious criticisms of NHS Lothian and the way concerns have been handled when it comes to paediatric provision across the Lothians, but especially at St John’s.

“There are questions around the safety of services, the recruitment practices and the ability to recruit. Question marks over the future of the ward have contributed to the recruitment crisis.

“The SNP government and Nicola Sturgeon as the previous health minister have overseen these problems and have done little or nothing about it. These problems have existed for a long time. The report provides evidence that suggests management and government have failed to secure the future stability of the service.”

Jim Crombie, chief officer of acute care, NHS Lothian, said: “NHS Lothian is committed to delivering the safest and most sustainable services for children across our board area – which is why we commissioned this independent expert review.

“We have acknowledged that, despite significant investment, we continue to face challenges with recruitment and sustaining a 24/7 workforce. We are also very much aware that our move to a new £200m hospital for children and young people, with modern healthcare facilities and more beds, will give us opportunities to deliver services differently.

“The fact that we asked the experienced team from the Royal College of Paediatrics and Child Health to carry out this significant review, and make recommendations, demonstrates our commitment to addressing these challenges.”

A spokesman for Health Secretary Shona Robison said: “The Tories’ claims on the timing of this report are as spurious and unfounded as Labour’s, which have already been shown to be false.

“The SNP government has committed more funding to the NHS than any other party, we have taken health spending to record levels, and this week saw new figures showing NHS staffing also at an all-time high.”