NHS Specialised Services

Children's Neurosurgical Services Review

Ensuring excellent care for children and young people is one of the NHS’s highest priorities. In the field of children’s neurosurgery, the extremely complicated and specialised nature of this work makes achieving this especially challenging. In order to ensure the best outcomes for children who need neurosurgery, surgeons in the field and other clinicians have called for a review of how we deliver these neurological services to children in England.

NHS Specialised Services was asked in 2009 by the NHS Medical Director, Professor Sir Bruce Keogh, to conduct this review. The review aims to deliver a national service that:

• Has an agreed set of national standards and a model of care to ensure the very best care for all children needing neurosurgery
• Will ensure a balance between the need for convenient treatment locations for patients and their families, and the need for very specialist high quality surgery
• Delivers an expert workforce well equipped to handle the specific issues surrounding children’s neurological surgery
• Has specialist neurosurgery centres in which expert surgeons are encouraged to collaborate on research into future treatments and clinical development
• Can provide the specialised support services that children often require following surgery
• Supports the development of children’s services for cancer and trauma and rehabilitation, as well as other conditions such as epilepsy and spina bifida -all complex conditions requiring different expert multi-disciplinary professional skills

The review was requested because of concerns amongst some neurosurgeons and other clinicians that existing models of care and configuration of services do not allow some children to receive the best possible care from the various clinical teams that are expert in the care of children. Neurosurgeons were also concerned that current services are not sustainable for the future requirements and developments in this field.

14 Centres Offering Childrens Neurosurgery

One of the key elements to improving services is that there is 24/7 advice and support to all children with an urgent neurosurgical condition from a childrens neurosurgeon. Fourteen centres currently offer children’s neurosurgical services in England, only five of which are able to provide access to a consultant paediatric neurosurgeon on a 24/7 basis. Seven of the remaining centres rely on adult neurosurgeons, which makes a specialist assessment of the child’s needs more difficult in urgent or emergency situations. Around fifty neurosurgeons operate on children, of which only a very small number are in full time children’s neurosurgical posts across three centres. The remainder have a mixed adult and paediatric practice.

So far the work of the review has focused on:

• Reviewing current arrangements for children’s neurosurgical services including levels of need and activity in each of the 14 centres in England
• Developing formal criteria to ensure children’s neurosurgical services meet specific standards and national demand
• Developing a national model of care
• Seeking the views of stakeholders on the future shape of children’s neurosurgical services

In 2012 the review will progress to a process that will involve an assessment of centres against agreed standards that aim to ensure:

• Sustainable services which provide high quality care
• Neurosurgeons and clinical teams have the necessary skills and expertise to work with children and young people
• Consistent high quality of care across England
• There is a network of wide ranging expertise and support for children that build on local services as well as specialist centres

During this time we will continue to engage with interested parties including young people, parents and clinicians.