Why NHS Highland believes having 24/7 paediatric cover for Caithness General is not a viable model
Dr Deborah Shanks
Service Lead Paediatrics
Dr Stephanie Govenden
Consultant Community Paediatrician and Lead Doctor for Child Protection and Looked After Children
The key point is that when babies are being cared for, specialists are needed who have appropriate skills, knowledge and experience.
The very low volume of cases has never justified there being a paediatric department in Caithness General Hospital. The low numbers would make it impossible to maintain appropriate levels of skills and expertise and therefore it would not be possible to maintain a quality service. The clinical evidence shows that survival of babies is better in larger neonatal units (level 3 units) compared to smaller units such as Caithness General.
NHS Highland would need around seven additional WTE consultant pediatricians and junior doctors and neonatal nurses to support them, in order to have sufficient staff to provide 24/7 pediatric/neonatal cover. Alongside the staff there would also need to be appropriate facilities which would amount to creating a new purpose built unit.
But, even if we could set that up, such a unit would still not offer the safest option for caring for neonates. They are better served in large centres that offer a higher level of care, are used to dealing with sicker babies and have all the necessary back-up for both mothers and babies (as per the British Association for Perinatal Medicine guidance). There is, however, a visiting consultant paedatric service to Caithness and that will continue.
This is why taking all things into consideration a Hub and Spoke model offers the best balance between providing safe local care where appropriate which is backed up by Raigmore clinicians and with higher risk births and specialist care provided in Raigmore.