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NHS: Children’s Emergency Beds

Volume 801: debated on Monday 27 January 2020


Asked by

To ask Her Majesty’s Government what assessment they have made of the availability of children’s emergency beds in the NHS in England; and whether they have a strategy for addressing any shortfall.

My Lords, in November 2019, 321 paediatric critical care beds were available in England, of which 268 were occupied, giving an occupancy rate of 83.5%. Management of these sensitive, difficult-to-manage services is a complicated affair. That is why NHS England undertook a review of paediatric critical care services, which advocated that hospitals in each region need to work together to co-ordinate capacity and resources.

I thank the Minister for his Answer, but he did not mention the children with mental health issues who have been bussed hundreds of miles or the extremely sick children who have been put on main wards to make way for even sicker children in the paediatric specialist units. I do not think that most professionals even trust the figure the Minister has given; the professional organisations are saying that it was nearer 100% over December. However, I am not going to trade figures backwards and forwards with the Minister. I am just going to ask him: how many more times do the professional organisations of paediatric specialists and A&E doctors have to say that the system is at breaking point before the Government take immediate action?

I thank the noble Baroness for her question and for the detailed article that she wrote for PoliticsHome giving the thinking behind it. In it, serious questions are asked by the Faculty of Intensive Care Medicine and the president of the Paediatric Intensive Care Society. The data presented by the NHS is prepared by front-line clinicians and collated by CCGs, and the adulteration or misrepresentation of those figures is an offence both to the values of the NHS and in law. We take the figures very seriously.

My Lords, this matter has been raised before in the House, but I am asking whether anything has been done about it. In Manchester, there were many children wanting operations under general anaesthesia but all the slots were already taken. Has anything been done to change that? I wrote to the Mayor of Manchester but did not even get an acknowledgment, so I would be grateful for an answer.

The specific example cited by my noble friend is not one that I am able to comment on, but she raises an important question about resources for paediatric care. This Government are putting considerable resources into both capital and spending. Paediatric care is prioritised over other areas of care and we take this matter very seriously.

My Lords, I go back to what the Minister said in response to my noble friend. It sounded to me as if he was suggesting that the faculties and Royal Colleges had somehow falsified figures. That is a very serious accusation so I would like him to clarify that and, if that is what the Government think, what they are going to do about it.

Secondly, one of the reasons for the pressure on beds is staff shortages; many units were limiting the number of patients that they could treat to fewer than their physical bed space. Does the Minister recognise that dilemma, and what action are the Government taking urgently to address the workforce crisis in paediatric medicine?

The noble Baroness asked about the statistics. The anecdotes put forward by the Faculty of Intensive Care Medicine and the president of the Paediatric Intensive Care Society are perfectly valid. They are reasonable stories. The question put was about whether NHS statistics are being falsified. These are very serious suggestions and questions. I reassure the House that the statistics put together by the NHS are blue-chip and very much ones that we are proud of.

My Lords, the Nuffield Trust report of December 2017, Admissions of inequality: emergency hospital use for children and young people, noted that children and young people from the most deprived areas are consistently more likely to go to A&E and need emergency hospital treatment. In fact, it specifically said that if unplanned admissions were at the level of the least deprived in the country, 244,000 fewer paediatric emergency hospital admissions would have been needed, saving the NHS £245 million. Given that the Health and Social Care Act 2012 makes reducing health inequalities in access and outcomes an explicit duty for the Secretary of State, can the Minister tell us exactly what the Secretary of State is planning to do to continue to lower this inequality?

The noble Baroness touches on an incredibly important point. Undoubtedly, accident and emergency services are suffering a big spike in attendance by children and young people. I travelled to 20 accident and emergency wards in December and saw for myself the long queues of children. Clearly, something needs to be done to guide children away from accident and emergency. That is why this Government are doing an enormous amount to improve primary care services by investing in the 111 service and treatment-in-a-day services, for example, which can move people from A&E to create space for those in the most need.

My Lords, I pick up on my noble friend’s question about staff shortages, to which the Minister did not reply. For many years now, there has been a serious shortage of paediatric nurses with the specialist skills needed to work in ICU. However many of these units we have around the country, they will not be very effective if we do not have the skilled staff to man them. What are the Government doing to fill these places where there are shortages?

The Government are investing in 50,000 new nurses, many of whom will be trained for exactly the kind of services that the noble Baroness described. In particular, mental health investment is a big focus for the Government, with plans to have spent £12.5 billion on mental health care in 2018-19. Our NHS funding Bill, which will receive its Second Reading in the Commons today, will explain exactly how much money will be spent.