Five step plan to protect children and maternity services across hosptials during Covid-19 ‘surge’

In-patient paediatric wards at Newry’s Daisy Hill Hospital are expected to close within the coming days when ‘Step one’ of a five-part plan to deal with the COVID-19 surge is implemented.

But maternity services are to be retained at all current hospitals bar deliveries which would have been due to be made at the Causeway Hospital.

The Health and Social Care (HSC) system has today (Friday) published a further element of its planning for the expected surge in increasing numbers of patients.

This part of the plan involves protecting children’s and maternity services while releasing bed space to contribute to the overall surge response. It complements the critical care surge plan to establish the Belfast City Hospital Tower Block as Northern Ireland’s first Nightingale Hospital.

Children’s and maternity services will be temporarily reconfigured to free up to 130 beds during extreme surge in acute hospitals, which will be vital in treating the sickest patients and makes best use of hospitals.

A regional plan has been agreed with all Trusts and paediatric units which contains a number of steps that can be triggered depending on the pressures on services.

Around 50 beds for adults could be made available when Step One is implemented in the days ahead.

The plan has been developed with paediatricians and children’s nurses from across Northern Ireland. It is designed to protect children’s services and make sure babies and children who need urgent or emergency care are able to get that care from suitably qualified and experienced paediatric staff in a timely way.

While the plan includes a temporary reduction in inpatient paediatric services, every acute hospital will continue to have senior consultant paediatricians located in these facilities to assess and treat acutely unwell children.

The temporary measures are also designed to protect highly specialised paediatric services which are only available in the Royal Belfast Hospital for Sick Children, and make sure they can continue even if many staff are absent because of illness.

This is to make sure children in Northern Ireland can continue to access highly specialised and life-saving services such as Paediatric Intensive Care throughout the surge.

After careful consideration, it has also been agreed that while antenatal services will continue at Causeway Hospital, it is not possible to deliver babies in the Causeway Hospital during this surge period.

This is because there is not enough skilled paediatricians available to provide emergency care to a baby born in distress throughout the 24 hour period. To protect the wellbeing of mothers and babies, women booked to deliver in Causeway will be contacted and have their delivery transferred to Antrim or Altnagelvin Hospital.

Maternity services in Daisy Hill, South West Acute, Craigavon, Altnagelvin, Antrim, the Ulster and the Royal Jubilee Maternity Hospital will continue.

There will be daily monitoring and communication across the paediatric network during the surge to ensure there is enough paediatric capacity to deliver safe urgent and emergency care for children right across Northern Ireland.

An HSC spokesperson said: “We would urge parents and carers if your child is unwell is to seek medical advice. You should contact your GP in the first instance.

“If your child is very unwell you should bring them to your nearest Emergency Department, contacting the hospital ahead of arrival if they have respiratory symptoms.”

A full summary of the potential ‘Five Steps’ has now been drawn up.

Step one will start in the coming days, but the other steps will only be implemented at the appropriate stages, depending on the level of surge on services.

1. Step one:

• South West Acute Hospital (SWAH), Daisy Hill (DHH) and Causeway Hospitals to close in-patient paediatric wards. Ambulatory services retained on all sites.
• Cover for deliveries and neonatal unit in Daisy Hill will continue. Maternity services are unaffected.
• Cover for deliveries will continue in SWAH, but some neonates requiring neonatal admission (small number) will be transferred to Altnagelvin or Craigavon.
• Intrapartum care – deliveries of babies – will stop in Causeway. Women booked there over the coming weeks will be transferred to Antrim or Altnagevlin. Antenatal and postnatal care will continue.2. Step two:
• Ulster Hospital paediatric inpatient ward will close.
• Ambulatory care, where paediatric consultants assess and care for sick children, will continue until 12 midnight every day. 24/7 cover for maternity and neonatal ward will remain.3. Step three:
• Either Antrim or Craigavon Area Hospital will close to paediatric inpatients. Ambulatory care will continue, and 24/7 cover for maternity and neonatal ward will remain.4. Step four:
• Antrim or Craigavon closes to paediatric inpatients (depending on which was remaining open).5. Step Five
• Extreme surge. Only two inpatient units remaining open – the Royal Belfast Hospital for Sick Children and Altnagelvin. Cover for ambulatory and maternity continues (unless unforeseen staffing or other issues).Staff will be redeployed to support these units.Additional Information
• The Royal Belfast Hospital for Sick Children has also freed up capacity through the cancellation of elective work meaning more beds are available there for paediatric admissions (52 beds available at 7.00am on 2nd April 2020).
• In the months from April – June, paediatric services in District General Hospitals typically have bed occupancies of under 50%.
• This surge plan with its temporary reconfiguration of paediatric services aims to ensure that all children in NI continue to have access to safe and resilient urgent and emergency paediatric services throughout surge. In particular that:
• Pathways are in place to ensure children with Covid-19 receive appropriate care.
• Children with non-Covid conditions requiring urgent and emergency care continue to receive appropriate specialist and general care.
• Key regional specialties located in the Royal are strengthened and protected.
• Required paediatric cover is in place to support obstetric and neonatal units.
• These urgent and emergency services are as resilient and safe as possible.

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