Chase Farm Paediatric Assessment Unit Frequently Asked Questions October 2016 1. What is a Paediatric Assessment Unit (PAU)? The service is led by a Paediatric Consultant and supported by nurses. It sees and treats children between 0-18 years old who have minor illnesses, injuries or a worsening long-term condition like asthma. 2. What does the PAU at Chase Farm Hospital provide? The PAU is a consultant-led service and sees children and young people aged 0-18 years (up to day before 18th birthday) who have been referred by either a GP or by Urgent Care Clinician, to be assessed, treated and observed by trained paediatric staff, without the need to be admitted to an in-patient bed. 3. What are the opening times of the PAU at Chase Farm? The PAU is open for referrals between 9am-9pm every day of the year. 4. How do you use the service? Access to the PAU is usually through a patient s GP who requests a referral to the service or via a clinician at another service, such as the Urgent Care Centre (UCC). 5. For what reason did the children and young people attend the PAU? A review of the data on PAU attendances from February 2016 to date (52 cases) showed that children and young people attended for a wide range of issues including fever, rash, vomiting, feeding problems, and so on. 6. The CCG says that attendances at the PAU have been consistently low, how do numbers compare to other similar units in neighbouring hospitals? We have not been able to find a similar stand-alone PAU but NHS England is currently carrying out an anonymised survey of all PAUs in London and out of 16 units who have currently responded: 7 units have attendances figures which are substantially higher; 6 responses did not include attendances or were incomplete; 3 have similar attendance figures to Chase Farm Hospital PAU of which 2 are being queried; Page 1 of 5
7. What is the ethnicity of the children and young people who have attended the PAU? For those who registered their ethnicity the figures are as follows:- 8. The rate of population growth in Enfield is outstripping both the rate of population growth for London (4.5%) and the UK (1.5%), Is the CCG confident that there is sufficient capacity in the system to meet demand? The Urgent Care Review which is currently being undertaken by the CCG will address the issue of population growth, and will consider that capacity of current units to meet expected demand. As over 94% of children who attend the Chase Farm Urgent Care Centre are managed within the Urgent Care Centre, we believe the low attendance rate at the PAU is evidence that an alternative model would be more appropriate. 9. The high numbers of children attending Emergency Departments suggests that the demand exists for a PAU on the Chase Farm site? Over 94% of children who attend the Chase Farm Urgent Care Centre are managed within the Urgent Care Centre, which is both well utilised and well regarded and will continue. The issue with the PAU whose staff are also well regarded, is about the model of care. We believe the low attendance rate at the PAU suggests that an alternative model would be more appropriate. The proposed introduction of urgent access outpatient appointments will extend access and will benefit more patients. Page 2 of 5
10. Is lack of publicity the reason for the low number of referrals to the Chase Farm site? The PAU at Chase Farm Hospital is not a self-referral unit. The existence of the PAU and hotline to a paediatric consultant was well publicised to GPs as part of the implementation of the Barnet, Enfield and Haringey (BEH) Clinical Strategy. If a child is seen by a GP and a referral to a PAU is required then a choice of unit is offered. The clinical case review findings were that of the 52 cases reviewed 25% (13) were referrals from GPs. Also there is evidence of children, young people and families choosing alternative units. Over 94% of children who attend the Chase Farm Urgent Care Centre are managed within the Urgent Care Centre. 11. What do we mean by self-referral? Self-referral means that patients are able to refer themselves directly into a service. The PAU is not a self- referral unit so patients cannot access the service directly and access is via a referral from the GP or other clinician. 12. If I attend the Urgent Care Centre at Chase Farm and need to be referred to the PAU at another hospital will I need to start at the beginning of the queue at the new hospital? If you are assessed by a GP in the Chase Farm Urgent Care Centre and require assessment by a paediatrician then a transfer to another unit will be arranged, and rather than start at the beginning of the Urgent Care Centre or Emergency Department process you will be dealt with as a referral to the PAU. There will be no change to other referral pathways. 13. Is the proposal to close the Chase Farm Hospital Paediatric Assessment Unit being driven by financial considerations? Ultimately given 94% of children of children who attend the Chase Farm Hospital Urgent Care Centre are managed within the Urgent Care Centre, we believe the low attendance rate at the PAU is evidence that an alternative model would be more appropriate. However it is also our responsibility to ensure that services offer good value for money. The 409,000 funding for the PAU currently comes from a fund set up by the 5 north central London clinical commissioning groups (CCG) to support the implementation of the Barnet, Enfield and Haringey Clinical Strategy. This funding is due to come an end in March 2016 and normally the service would be funded through the Payment by Results tariff whereby the provider is a paid a set amount for each attendance that is meant to cover the cost of running the service. The low attendance rate means that the normal tariff would not cover the costs of running the unit, and therefore Enfield CCG would have to find the additional funding. Given the CCG s deficit financial position, competing pressures on budgets, and low numbers being referred to the unit, value for money cannot be demonstrated. Page 3 of 5
14. If the paediatric staff currently working in the PAU are no longer on site will this affect the Urgent Care Centre s ability to see and treat children? All Urgent Care Centres are GP led units commissioned to see and treat children which is a key element of both GPs training and their role in General Practice. The low attendance rate at the PAU has meant that the paediatric staff working in the PAU have provided support to the Urgent Care Centre. The Royal Free Hospital are aware of a possible change in provision, and subject to the outcomes of the public consultation, there is time during the consultation to ensure a transition to the new model. 15. Is the proposed closure of the PAU, subject to public consultation, part of a longer term plan to remove all services from the Chase Farm Hospital site? No. The Urgent Care Centre and the Older People s Assessment Unit are well utilised, well regarded and offer excellent care and value for money. The Older People s Assessment Unit is a part of our integrated care system for patients along with ambulatory care at North Middlesex University Hospital and community health and social care teams. The Urgent Care Centre meets the urgent care needs of children, adults and older people and is a part of a wider system of urgent care services. Enfield CCG is a signatory to, and supports the Royal Free London NHS Foundation Trust s ambitious plans to redevelop the Chase Farm Hospital site which will meet the needs of our local population now and in the future. You can find out more about the plans for the redevelopment of Chase Farm Hospital on the Royal Free London NHS Foundation Trust website. 16. Does the proposed closure of the PAU, subject to public consultation, mean that there will not be a children s footprint on the Chase Farm Hospital site? In July 2014, Barnet and Chase Farm Hospitals NHS Trust was acquired by the Royal Free London NHS Foundation Trust. One of the first commitments of the Royal Free London NHS Foundation Trust following the acquisition of Barnet and Chase Farm Hospitals NHS Trust was to redevelop Chase Farm Hospital, making it fit for purpose to deliver 21st century healthcare and to provide world class care. Enfield CCG as lead commissioner for the Chase Farm Hospital site is working closely with the Royal Free London NHS Foundation Trust to support the plans for redevelopment. This is an opportunity to develop even better NHS services for local people by designing a new hospital with space and services to meet the needs of our local population now and in the future. The government has approved the full business case submitted by the Royal Free London NHS Foundation Trust which will allow the redevelopment of Chase Farm Hospital, creating a state of the art facility delivering 21st century healthcare to the local population. The Chase Farm Hospital site will include world class facilities for elective (non-emergency) care, diagnostics, out-patients, including children s outpatients, an urgent care centre, planned elective Page 4 of 5
surgery and post-operative care, an older people s assessment unit and rehabilitation facilities. You can find out more about the plans for the redevelopment of Chase Farm Hospital on the Royal Free London NHS Foundation Trust website. Page 5 of 5