Children at risk through lack of training for doctors and nurses, report warns

Children are being put at risk by inexperienced surgeons and a lack of basic child protection training in hospitals, a damning report from the health watchdog has found.

Surgeons and anaesthetists in seven out of ten trusts reviewed by the Healthcare Commission do not have sufficient experience of treating children to maintain the proper level of skill, the report said.

Smaller units offering children’s surgery may have to close because the doctors do not operate on child patients often enough, experts said.

It comes after the Royal College of Surgeons warned that waiting times for routine operations will soar as European rules mean junior doctors hours will be cut.

The Healthcare Commission report details failings in child protection training, pain management, and life support two years after first highlighting the problems.

There has been some improvement but many trusts are still failing to train staff to the correct level, the report said.

The Commission carried out a review of 154 hospital trusts where children are treated and checked on progress made since an earlier review in 2005/6.

The key findings were:

– Three in ten trusts ‘do not meet basic minimum level of child protection training for key staff’, the report said.
– Four in ten trusts did not have the equivalent of one nurse per shift who was trained to assess and treat pain in children.
– Three quarters of trusts did not meet guidelines on life support training and more than one in ten trusts have deteriorated on this score since the first review.
– More than seven out of ten trusts have got worst or been consistently poor at ensuring surgeons and anaesthetists treat enough children to maintain their skills.

Trusts must address these concerns urgently to ensure they are providing care that is safe and effective, the report said.

A spokesman for the Commission said: “The findings do raise questions about the safety and configuration of services that trusts should investigate. However, they do not in themselves provide sufficient information to say whether a particular service is unsafe.”

Anna Walker, the Commission’s chief executive, said: “We are particularly concerned about training in child protection. It is absolutely vital that NHS staff working with children know how to recognise signs of child abuse and know what to do if they see it.

“Another area of concern is that some surgeons and anaesthetists appear to be performing procedures on children without meeting the recommended levels of work to maintain their skills. There may be good reasons for this, but the figures need exploring in greater depth.”

A spokesman for the Royal College of Surgeons said specialist children’s surgery should be provided in large regional centres but non-specialist operations can safely be carried out in local hospitals if properly supported.

He added: “One solution would be to maintain simple paediatric surgery in local hospitals by specifically employing surgeons ‘with an interest in paediatric surgery’ and to fund training for this. If a solution is not found soon then local provision of care may cease in some areas.”

Dr Mary McGraw, Vice President for Training and Assessment, at the Royal College of Paediatrics and Child Health, said: “We are very concerned by the findings that although progress has been made in some areas, basic training in child protection, life support and managing pain still do not meet the guidance in a significant proportion of trusts.”

Health Minister, Ann Keen said: “We are very disappointed that some hospitals are not reaching the high standards that the Healthcare Commission assessed and expect trusts to take urgent action to ensure that staff and services caring for children are of the highest quality.


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