A report by the British Paediatric Association says that every paediatric intensive care unit (PICU) in the country had to turn away critically ill children during 1991-1992. Almost half of those needing intensive care were treated on ordinary children's wards or in adult intensive care units. Staff levels in 84 per cent of PICUs and 80 per cent of adult ICUs were below the minimum recommended.
The Government, which funded the report, promised immediate action and a review by all district health authorities of their paediatric intensive care needs.
The BPA report, the most comprehensive to date, is embarrassing for health ministers. A review of the National Health Service, announced in March 1988 was triggered in part by a public outcry at intensive care 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. Three years into the NHS changes resulting from that review, the situation appears to have improved little. The BPA is calling for government action to safeguard paediatric intensive care.
Dr Peter Fleming, a consultant paediatrician who chaired the BPA working party, said that although there were now more 'potential' PICU beds - 209 compared with 120 in 1987 - the increase had not been matched by an increase in staffing, so many of them could not be used. There are between 120 and 130 staffed beds. The report estimates a national shortfall of at least 73 beds (34 per cent) and between 500 and 1,000 specialist nurses.
Dr Fleming said that survival prospects for children in PICUs were 'considerably better' than for those cared for on other wards. Asked if children were dying because of deficiencies in care, he said: 'It would be very surprising if this were not the case.'
Of 12,282 children who received intensive care in 1991, 3,671 (28.6 per cent) were cared for on children's wards and 2,627 (20.5 per cent) in adult intensive care units. Fewer than half of the adult ICUs had a consultant with a particular interest in critically ill children, and more than three-quarters had no nurses with paediatric training. Of the children who were referred on to other hospitals, fewer than half were transported in ambulances with specialist staff on hand.
The BPA is calling for a government-funded initiative to improve children's intensive care. It wants regional networks of PICUs to be set up with safe ambulance transfer for children, with care separately specified and funded within service agreements between purchasers (health authorities and fund-holding GPs) and providers (hospitals).
Dr Brian Mawhinney, the Health minister, said: 'The NHS management executive will hold health authorities to account for ensuring that improvements are made where they are needed in the care of these children.'
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