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Potential changes to the way appendicitis is managed for under 8's across our area

New children's surgery and anaesthesia proposal put forward following changes since 2017 business case proposal

In June 2017 the Joint Committee for Clinical Commissioning Groups (JCCCG) for South Yorkshire and Bassetlaw took a decision to change the way some children’s surgery and anaesthesia services are provided in South and Mid Yorkshire, Bassetlaw and North Derbyshire. 

At the time, the JCCCG agreed to clinical recommendations that children needing an emergency operation for a small number of conditions, at night or at a weekend, would not be treated in hospitals in Barnsley, Chesterfield and Rotherham, and would instead have their surgery at Doncaster Royal Infirmary, Sheffield Children’s Hospital or Pinderfields General Hospital in Wakefield.

What has happened since 2017?

Since the decision:

  • Strengthened partnerships across the region and even closer ways of working have been formed.
  • Closer joint working across the NHS Hospitals has strengthened Ear, Nose and Throat (ENT) services and made them more stable and sustainable. This has reduced the need for children’s surgery in the areas previously identified.
  • The more detailed investigation that happens before any proposed change takes place has shown reality to be more complex than the business case assumed.
  • There is evidence that pathways, from referral to treatment, for torsions of the testes are appropriate and should be retained.
  • The introduction of Sustainability and Transformation Partnership/Integrated Care System geographical footprints has changed previous joint working arrangements. In South Yorkshire and Bassetlaw this has impacted on working arrangements with Mid Yorkshire Hospitals.

What are the new proposals?

These changes of circumstance have therefore led the Children’s Surgery and Anaesthesia Managed Clinical Network to develop revised recommendations, which meet the principles from the original work around safety and care closest to home, but which do not support the three hub geographical model proposed in 2017.

A new paper, to be decided upon by the Joint Committee of Clinical Commissioning Groups (JCCCG) in February 2020, instead recommends that clinical models should be different depending on the type of surgery.

The paper proposes that:

  • The ENT models that are in place, through the close joint NHS Hospitals work are appropriate and should stay as they are.
  • Torsion of the testis pathways are appropriate and should stay as they are.
  • Consideration should be taken as to whether Mid Yorkshire Hospitals (MYH) should remain as a part of this work. Changing MYH’s involvement would have some small volume implications.
  • The pathways at Bassetlaw remain the same as current arrangements.
  • Abdominal surgery (for suspected appendicitis) is the most complex pathway and the recommendation is that a change should be made to the treatment of appendicitis in young children. The number of appendicectomies (surgery to remove the appendix) undertaken in South Yorkshire and Bassetlaw each year on children under 8 is very small. Children under 8 are not 'small adults' and if they need an appendicectomy, it is better and safer for them to be seen by a surgeon who is trained to and regularly operates on younger children. Therefore the proposal is that for children aged under 8, and also for children with complex needs, appendicectomies should be conducted at Sheffield Children’s Hospital. This would affect about 40 children a year, and arrangements would be put in place to ensure safe transfers. For those children who will continue to have their surgery in their local hospital, we are strengthening the working between surgical, anaesthetic and paediatric medical teams, to ensure that we are concentrating upon the total needs of the child, and not just the surgical aspects.

What happens next?

Should the JCCCG support the changed proposal, work would take place that would see the appendectomy pathway changed in 2020.

All of the information about the original proposal and consultation can be found here: https://smybndccgs.nhs.uk/what-we-do/childrens-surgery

How to give your feedback

We are now engaging with the public in South Yorkshire and Bassetlaw, in particular parents and carers of children aged under 8, about the appendicitis proposal. If you would like to have your say please visit the Get Involved section of the South Yorkshire and Bassetlaw Integrated care system website.