Paediatric Cranial and Spinal Neurosurgery

Ensure that all paediatric neurosurgery networks are co-operating effectively for the benefit of patients and are cross-linked and engaged with all relevant paediatric ODNs and networks. a Systems should finalise the delivery models for all networks and operationalise within the funding available. b Systems should work with the GIRFT regional implementation teams to develop networks appropriate to local configuration.

All paediatric units should encourage, maintain and develop close links with their local adult neurosurgical units, if not already in place, particularly around neurovascular and neuro-oncological services. a Paediatric and linked adult providers, with support from the SBNS and BPNG, should establish, resource and support formal relationships allowing collaborative pathways, particularly around neuro-oncology and vascular surgery.

Develop and publish outcome measures to assess the quality of paediatric neurosurgery units and inform future decisions on appropriate volumes of surgery in relation to best outcomes for patients. This particularly applies to cranial tumour surgery and requires a national collaborative research programme between the BPNG and the SBNS as a priority. a The BPNG and SBNS should establish a national collaborative research programme to develop outcome measures for paediatric neurosurgery and, most urgently, to develop a robust, evidence-based reporting system for outcomes in paediatric cranial tumour surgery. b The BPNG and SBNS should develop clinical audit to enable measurement of outcome measures.

Actively promote appointment of ANPs and CNSs, particularly in hydrocephalus care, neuro-oncology and general paediatric neurosurgery care. a Providers should invest in programmes to promote and develop advanced nursing practice in paediatric neurosurgery/neuroscience linked to opportunities to develop clinical academic positions and progression to senior specialist nursing and AHP status.

Provide access to the highest-quality paediatric neurosurgery pathways for 0–16-year-olds to those in the 16–18 age group, irrespective of historic referral and admission policies. a Providers should review their access policies for 16 – 18 year-olds to ensure that they are providing equity of access for this patient cohort.

Align pathways for mild to moderate head injury in 16–18-year-olds to those in the established paediatric pathway. a Providers should ensure that equity of access exists for 16–18 year-olds, particularly around neuro-psychological and neuro-cognitive assessment and support.

Establish network-wide protocols for initial management and referral pathways to raise awareness of signs consistent with potential spinal cord abnormalities in the newborn period and engage with all neonatal units on agreed protocols and pathways for the management of neonatal hydrocephalus. a Paediatric neurosurgical services and networks and neonatal ODNs should work in collaboration between the two networks with regard to neurosurgical pathways.

Improve electronic referral management (ERM) systems to increase compatibility with hospital patient administration systems and to improve functionality. Note: This recommendation is based on proposed next step (p19) from the adult neurosurgery GIRFT follow-up report a NHS England and systems should explore how best to make fuller use of ERM systems, especially with regard to repatriation and virtual assessment. b The SBNS should define performance standards/requirements that would allow IT teams to start developing an effective interface between ERM and hospital data systems.

Reduce litigation costs by application of the GIRFT Programme’s five-point plan. a Clinicians and trust management to assess their benchmarked position compared to the national average when reviewing the estimated litigation cost per activity. Trusts would have received this information in the GIRFT litigation data pack. b Clinicians and trust management to discuss with the legal department or claims handler the claims submitted to NHS Resolution included in the dataset to confirm correct coding to that department. Inform NHS Resolution of any claims which are not coded correctly to the appropriate specialty via CNST.Helpline@resolution.nhs.uk c Once claims have been verified clinicians and trust management to further review claims in detail including expert witness statements, panel firm reports and counsel advice as well as medical records to determine where patient care or documentation could be improved. If the legal department or claims handler needs additional assistance with this, each trusts panel firm should be able to provide support d Claims should be triangulated with learning themes from complaints, inquests and patient safety incidents (PSI) and where a claim has not already been investigateded asPSI we would recommend that this is reviewed to ensure no opportunity for learning is missed. The findings from this learning should be shared with all front-line clinical staff in a structured format at departmental/directorate meetings (including Multidisciplinary Team meetings, Morbidity and Mortality meetings and regional service meetings where appropriate). e Where trusts are outside the top quartile of trusts for litigation costs per activity GIRFT we will be asking national clinical leads and regional teams to follow up and support trusts in the steps taken to learn from claims. They will also be able to share with trusts examples of good practice where it would be of benefit.