Temporary paediatric service changes: an open letter

This week, clinical leaders across north central London have written to our local newspapers, outlining the rationale for temporary changes to children and young people's services across the region. The letter reflects on some of the lessons learnt from the first wave of the COVID-19 pandemic and the need to plan ahead for a likely second surge and a busy winter with all of the challenges that will bring. You can read the letter in full here:

Dear Sir / Madam,

Thank you for the opportunity to respond to your recent articles about children and young people’s NHS services in North Central London (NCL).

The first wave of the COVID-19 pandemic put our local NHS under huge pressure with unparalleled demand, and significant staff sickness. Colleagues responded heroically and, although this is not unexpected, we will be forever grateful for their efforts and their resilience.

We changed services and care provision at an unprecedented rate to ensure the public and our staff were kept safe. Our approach was co-ordinated across the region, and this included a temporary reorganisation of children’s services which saw the closure of several paediatric emergency and inpatient departments and unfortunately the cancellation of many planned medical procedures. People worked together across NCL, and Great Ormond Street Hospital supported a number of children’s services to help out the system.

Winter is always the busiest time in the NHS, and this year we have the likelihood of a second COVID-19 surge.

With this in mind, we are working more collaboratively than ever before through our partnership of local health and care providers, North London Partners, to ensure we are one step ahead – reviewing key services and putting plans in place to make them as safe as possible.

This includes adapting services for children and young people and, as your readers will be aware, the temporary closure of the children’s emergency departments at the Royal Free Hospital and University College Hospital (which has been temporarily closed since March this year). These changes were designed by doctors and nurses, and took account of the numbers of children and young people attending and being admitted to our hospitals, including the two busiest children’s units in NCL, North Middlesex and Barnet Hospital, which has recently reopened. These changes have been implemented to ensure that emergency and planned care for children and young people can continue uninterrupted during a second surge or winter pressures.

We absolutely recognise how unsettling these changes may be for patients and their families, especially when they have been treated by a particular hospital for a long time. But we would like to reassure everybody that the changes are temporary and have been carefully thought through over the last four months. They have also been
risk assessed by experienced doctors and nurses who have worked in our hospitals for many years.

These changes are now being thoughtfully implemented to ensure that children and young people can access safe and effective care when they need it – despite the unprecedented pressure and uncertainty created by the pandemic. We have the correct number of doctors and nurses in post at all of the hospitals to provide safe care.

As always, the ambulance service provides the fastest response in a serious or life-threatening emergency. The London Ambulance Service will take children and young people to the nearest open paediatric emergency department, whilst providing any immediate necessary care. If a child does come to the Royal Free Hospital or UCLH,
they will be assessed by a member of the nursing team, and will be redirected, transferred or referred to an alternative local hospital when it is safe to do so.

As we all brace ourselves for a further COVID-19 surge, we would ask patients and the public to understand that these decisions are never taken lightly, are not implemented unless we are assured they are safe, and that any permanent changes would require full public consultation.

We hope that over the coming weeks your experience will be positive and that you will feel reassured and confident in the care we are continuing to provide to your loved ones.

If any parent is unsure where they should take a child in need of emergency treatment they should visit www.111.nhs.uk or call the NHS 111 service. In a life-threatening emergency you should still dial 999 immediately.

Yours sincerely

Medical directors and chief nurses from north central London NHS Trusts:

Dr Chris Streather, Royal Free London group chief medical director,
Julie Hamilton, Royal Free London group chief nurse

Flo Panel-Coates, Chief Nurse, UCLH
Dr Tim Hodgson, medical director, specialist hospitals board, UCLH
Dr Charles House, medical director, medicine board, UCLH

Michelle Johnson, Director of Nursing, Whittington Health
Dr Clare Dollery, Medical Director, Whittington Health

Alison Robertson Chief Nurse, Great Ormond Street Hospital
Dr Sanjiv Sharma, Medical Director, Great Ormond Street Hospital