Yesterday’s Evening Standard story refers to a number of different issues. One prominent case in the story was in fact never our patient.
While we would want children treated as close to home as possible, for sick children requiring intensive care, it is better they receive it further away than be delayed. NHS hospitals work together to try to get sick children an appropriate level of care in an ITU (intensive care, or intensive treatment, unit).
Transfers of sick children in London requiring intensive care usually take place entirely within London. Last year the specialist Children’s Acute Transport Service (CATS) transferred 1100 London children, largely from North of the Thames. http://www.cats.nhs.uk/
Only 28 of the 1100 transfers went outside London (2.5%). This was higher than the year before because there was exceptional demand in November and December.
In fact London was a net recipient of paediatric intensive care cases: London accepted more children needing ITU from outside London, than there were cases referred outside London.
When a child is transferred by CATS they are in effect in their own travelling intensive care unit, with a specialist team in the ambulance. Even the sickest children transferred by CATS are therefore in the best hands. A measure of the safety of transfer is that there have been no unexpected deaths in transfer since 2001. CATS specialists are not fixed in any one intensive care unit, which means there is always the capacity to move a child to where they can be helped.
The story refers to one case transferred by CATS but this was not a Great Ormond Street case. This was a transfer requested from West Middx NHS Trust to the nearest appropriate ITU, which on that day, exceptionally, turned out to be Bristol.
It also refers to a child transferred to Glasgow for an ECMO bed. ECMO is an ultra-specialist intensive care service, only supplied by four centres, which work together as a single national service. Occasional transfers to other ECMO centres are a planned aspect of the service. When the service was established, it used research from the States to develop a model that would offer these very sick children the highest survival rate.
Cases at GOSH transferred elsewhere
The figures cited in the Standard article are misinterpreted. Only in exceptional circumstances would an ITU patient already in Great Ormond Street be transferred elsewhere, because of bed issues. The Standard refers to a small group of cases whose referrer wished them to come to GOSH but where in fact a bed was found earlier somewhere else.
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