The Child Health Clinical Outcome Review Programme delivered by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has released Right Place, Right Time, Right Team, examining the care of children and young people undergoing non-elective surgery. The findings reveal significant progress in some areas but also highlight critical gaps that need attention.
Key Findings:
- Timely Access: Over 92% of patients reached the admitting hospital without delay but 15% experienced surgical delays due to team availability
- Network Support: While 84% of hospitals are part of emergency surgery networks, around 10% remain outside these arrangements, potentially impacting thousands of patients
- Staff Confidence: Centralisation of elective paediatric surgery has reduced confidence among some clinicians in non-specialist units
- Fasting Concerns: 17% of patients were fasted longer than clinically necessary risking discomfort and harm.
Recommendations:
- Strengthen specialist networks and ensure timely transfer pathways
- Guarantee access to appropriately trained paediatric surgeons and anaesthetists
- Introduce emergency theatre coordinators to reduce delays
- Implement daily theatre capacity reviews
- Adopt protocols to minimise unnecessary fasting.
These recommendations aim to improve safety, reduce delays and enhance patient experience across the perioperative pathway. For perioperative leaders the report underscores the importance of robust networks, clear escalation processes and consistent standards of care.
Dr Samantha Black said: "This review provides a valuable and timely insight into the quality of emergency surgical care for children. It is encouraging to note that, despite rising demand and significant operational pressures, overall quality has continued to improve, with several findings acknowledging the sustained efforts of clinical teams to deliver equitable, timely and safe care. Nevertheless, the report also highlights important ongoing challenges—both clinical and organisational—that must be addressed across paediatric networks. As a paediatric anaesthetist working in a district general hospital, I recognise how complex this can be in practice, particularly where resources and expertise vary across sites. For perioperative leaders in each trust, the findings provide a strong foundation for organisations to drive further improvements to deliver equitable, timely, and safe emergency surgery for children and young people.'
Dr Samantha Black is the CPOC Perioperative Lead for Medway NHS Foundation Trust and Patient Information lead at the Royal college of Anaesthetists. She is a consultant paediatric and perioperative anaesthetist at Medway NHS Foundation Trust.