Review finds that too many children are being treated on adult wards

Abstract

IT IS WIDELY accepted that children can have daunting or unpleasant experiences if treated on adult wards – and yet the practice is common. Northern Ireland’s health inspectorate, the Regulation and Quality Improvement Authority (RQIA) examined statistics across its health and social care regions and found that almost 4,000 children aged 13 to 17 were treated in adult wards in 2008-2009. Belfast Health and Social Care Trust recorded the most, with 1,263 cases aged 13 to 17. The analysis was published in a report (Regulation and Quality Improvement Authority 2012). Admissions to adult surgery and medical wards were most common. A major problem was that children with mental health problems were being admitted to a busy adult medical admission unit as a ‘place of safety’ while waiting for a transfer, the RQIA said. Some good practice was evident. Ulster Health and Social Care Trust had an adolescent unit staffed by children’s nurses, but some nurses elsewhere treating children felt ignorant about paediatrics. RQIA chief executive Glenn Houston says: ‘Our review team found that there was no standardisation in age limits for admittance of children to adult wards. We also observed variations in practice both within and across trusts.’ A lack of beds at Northern Ireland’s only children’s hospital, The Royal Belfast Hospital for Sick Children, is a key reason why children are put in adult wards. It has only 107 beds. The RQIA made 14 recommendations, including placing age limits on children moving to adult wards and assurances that the British National Formulary for Children is available on adult wards so that staff can ensure medication decisions are correct. increasing demand for follow-up care by paediatricians and other specialists which is not yet being fully met.’ Asked what can be done to manage the increasing number of babies and children with complex conditions, Professor Marlow says: ‘We need to do a lot of work with commissioners to ensure that we have networks for intensive care and step-down care.’ These networks do exist, but uncertainty surrounds their continued funding in the new NHS world of clinical commissioning groups, he adds. One possibility is to create larger, more specialist intensive care centres. ‘There is evidence that babies do better in bigger centres,’ he adds.