A review of NHS Lothian’s efforts to improve overnight children’s care staffing levels at St John’s Hospital has said progress remains “extremely fragile”.

The Royal College of Paediatrics & Child Health was brought in to review services after long-standing challenges recruiting enough doctors and nurses to consistently provide overnight paediatric inpatient services.

In 2017 24/7 overnight services at the children’s ward were suspended for the third time in five years on patient safety grounds, meaning patients had to be transferred to the Royal Hospital for Sick Children (RHSC) in Edinburgh, 17 miles away.

A reduced four-day-a-week model with overnight staffing commenced in March 2019.

NHS Lothian has made “considerable progress” in implementing a new staffing rota model previously recommended by the RCPCH, the report states.

But it warns: “The current arrangements are extremely fragile, and the sustainability of overnight provision may be threatened were any of the 23 clinicians who currently support the rota to move on or take leave unexpectedly.”

As a result, the report suggests the future of children’s services at the hospital could be in doubt, with staff said to have “misgivings” and being unable to see “the situation improving much beyond the current arrangement”.

If this cannot be rectified in the next year-and-a-half or further closures take place, NHS Lothian should consider making the ward a short-stay unit, the report states, with children who need overnight care being transferred elsewhere.

The RCPCH says efforts to support the workforce at the hospital should not be “at the expense” of services across Lothian.

NHS Lothian Medical Director Dr Tracey Gillies has welcomed the report:

"We will consider their findings and work with their recommendations to create a robust action plan to work towards the necessary staffing model needed to deliver a 24/7 service.

“We have always said that we could only restore the full service when it was safe and sustainable to do so and that remains our priority."

Calum Campbell, NHS Lothian’s Interim Chief Executive, says the aim is to run the ward on a full-time basis:

"I confirm we are firmly committed to doing all we can to restore the 24 hours service seven days a week for children in West Lothian as soon as we can."

NHS Lothian says children in West Lothian who need a short inpatient stay continue to be admitted to the ward as required. If they are very sick or require specialist intervention, they continue to be admitted to the Royal Hospital for Sick Children in Edinburgh.

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