Focusing intensive care for children

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The Independent Online
Intensive-care beds for children should be concentrated in a few large regional centres, rather than being dotted around in district general hospitals, according to an expert advisory committee.

The national advisory body on paediatric intensive care, meeting in London yesterday, is believed to have said that 250 beds could be concentrated in as few as 16 centres instead of the 30 main centres which now deal with intensive care for children.

The news came as it was revealed that a three-year-old girl, flown 200 miles for hospital treatment, has died. Jodie Levy, of Doxford Park, Sunderland, was taken to the Glenfield Hospital in Leicester last Wednesday by helicopter suffering from meningococcal septicaemia. She needed specialist treatment to put oxygen into her blood, which doctors in Sunderland had been unable to offer.

The National Co-ordinating Group on the Provision of Paediatric Intensive Care is believed to have recommended that future policy should allow for about two centres per region, with at least eight intensive-care beds per centre as a minimum.

At present, many beds are dotted round district general hospitals. About 12,000 children are admitted to intensive care each year. The majority of units have six beds or less.The result is that about 40 per cent of children needing intensive care are treated on children's wards or in adult units.

Sources say that the group is also urging the training of more staff to specialise in paediatric intensive care. "It cannot be done on a part- time basis," one source said. At present, only half the nurses who work on paediatric intensive-care wards have trained in this speciality, though 90 per cent are trained to work with children. The group was expected to call for a doubling of those specifically trained.

"The best results for children are services with dedicated medical nursing staff who have gone through the proper training," the source added.

Retrieval systems should also be improved, with senior staff being sent in the ambulance to collect the child. There would need to be agreed arrangements with the control units over how children should be transferred. Parents should go with their children. Anthony Harrison, fellow in health policy analysis at the King's Fund, said the idea "was aimed at reducing risk" but that good retrieval practices were essential if deaths were to be avoided.

Ann Coffey, Labour health spokeswoman, called for more research to be done to ensure sufficient beds. She said any overhaul of specialist centres would require close inspection of primary and secondary care.

The group was set up last June following the report into paediatric intensive care by the National Health Service executive which promised 30 extra beds and called for specialist staff and greater flexibility.

That had been sparked by a crisis the previous winter, when hundreds of children in need of intensive-care were turned away from major hospitals. The peak came with the death of Nicholas Geldard, 10, in December 1995. He suffered a brain haemorrhage at home in Stockport, Cheshire and was ferried, already brain-dead to Leeds after hospitals in Liverpool, Manchester and Sheffield turned him away.

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