Crisis for Britain's sick children

Hundreds denied urgent treatment because of staff and bed shortages in paediatric intensive care units

LIZ HUNT

Health Editor

At least 300 children have been denied urgent medical treatment in the past year because of a nationwide bed and staffing crisis in paediatric intensive care units, an investigation by the Independent has found.

Some children have died while others are being cared for in less than optimum conditions on adult wards, or in district hospitals without specialist staff or facilities. Those who were lucky were admitted to intensive care elsewhere. Almost all experienced a delay in getting the treatment they needed.

The Independent survey shows most big hospitals face a daily battle treating the sickest children in the country, more than two years after health ministers promised to boost intensive care services in response to a damning report from the British Paediatric Association.

Dr Keith Dodd, consultant paediatrician at Derbyshire children's hospital and honorary secretary of the BPA, said last night: "How many children do we have to let die before we prove that intensive care is a necessary part of the service?"

Leeds is particularly hard hit, with some cancer treatments suspended at St James's University Hospital owing to pressure on children's IC beds. Only 11 of 18 IC beds are in use because of financial restraints. At Leeds General Infirmary one child a day is regularly refused admission to the IC unit.

Thirty-one children have been turned away from the Royal Manchester Children's Hospital since September. At the Bristol Children's Hospital, 21 children have been refused admission since November.

London's St Mary's hospital has referred 41 children with meningitis to other hospitals in the past year. Two died in December after the hospital could not find beds for them.

The British Medical Association and the Royal College of Nursing last night called for immediate action to resolve the crisis, as Labour demanded a freeze on bed closures.

The crisis in children's IC services has particular resonance for the Government. A review of the NHS, announced in March 1988, was triggered in part by the outcry over IC bed closures and a shortage of specialist nurses at Birmingham Children's Hospital. Urgent operations were cancelled repeatedly and two children with heart problems died.

Estimates put the number of IC children's beds at about 220. But lack of specialist nurses means up to 20 per cent may be closed at any one time. Several hospitals in the survey said they had approval for more beds but could not get the nurses.

Medical advances have added to the demand for IC, according to Babulal Sethia, director of special services at Birmingham Children's Hospital. Its 12 ICU beds are run at close to 95 per cent occupancy, compared with a recommended figure of 70 per cent. In 1993 the Government ordered a review by all health regions of paediatric intensive care provision, following the first ever national survey carried out by the BPA.

Reports were submitted in December 1994 but no national overview has been produced. The BPA wants a regional network of paediatric ICUs set up with safe ambulance transfer for children, and with care specified and funded within service agreements between purchasers (health authorities and fund-holding GPs) and providers.

The British Paediatric Association said Stephen Dorrell, Secretary of State for Health, must make more money available for what is still regarded as a Cinderella service.

Trust hospitals had less incentive to fund the expensive high-tech beds, Dr Dodd said, or recruit highly qualified nurses and pay them up to pounds 20,000 a year.

The RCN said nurses became disillusioned when hospitals refused to fund the extra training they needed to work in IC, or give them time off to study.

A spokesman for the NHS Executive said last night that it had commissioned a new study on paediatric IC needs, and the Medical Research Council was considering a study to determine the provision of beds. A national computerised bed service was also a possibility.

"[Paediatric intensive care] is a speciality that has a variable and predictable demand and we recognise a very considerable peak this year, exacerbated by meningitis," he said.

Death of a child, page 3

Tally of shame: the top hospitals that cannot cope

St Mary's Hospital, London: Has turned away 41 children with meningitis in the past year. Two of them later died.

Great Ormond Street Hospital for Sick Children, London: Has turned away 150 children in the past year, and has only 11 of 19 IC beds open.

Sheffield Children's Hospital: Had to refuse admission to 52 children in the last three months of 1995, and has turned away 10 this month alone.

Royal Alexandra Hospital for Sick Children, Brighton: Has turned away 7 children in 3 months, one with meningitis.

Bristol Children's and St Michael's Hospital: Turned away 21 children in November and December. One child taken to Birmingham.

Royal Manchester Children's Hospital: Has turned away 31 children since September 1995.

St James's University Hospital, Leeds: "We have 11 beds in use in the ICU but have 18 available to us which we can't use because we can't afford it.''

Leeds General Infirmary: "One kid was brought here DOA [dead on arrival] from Manchester..."