Winter closure of Royal Free kids A&E 'boosted Covid resilience' – NHS report

The Royal Free's paediatric services are to close with the Whittington and Great Ormond Street picki

The Royal Free's paediatric services are to close with the Whittington and Great Ormond Street picking up the slack as part of a reorganisation for winter 2020-2021 amid Covid-19 'second wave' planning. Picture: Sam Volpe - Credit: Archant

Did temporarily closing children's A&E at the Royal Free help fight the second surge of Covid?

A new report evaluating the move – which saw services moved to a "southern hub" at the Whittington Hospital - suggests it did.

But it also raises concerns that staff did not feel prepared for the changes, and that some felt it was the wrong thing to do.

According to the report, an average of three patients continued to attend the Royal Free each day from September 25, 2020 to April 12 this year – more than 550 in total. Safety plans were in place for critically sick child brought to the closed department, with procedures to assess and divert the patients.

The report says no known serious incidents resulted.

Royal Free Hospital is to tackle its poor A&E waiting times. Picture: Nigel Sutton

Royal Free Hospital is to tackle its poor A&E waiting times. Picture: Nigel Sutton - Credit: Nigel Sutton


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Evaluating the temporary changes to children's A&E, the report suggests: "It is not possible to say how this model would perform in non-pandemic times."

However, it suggests benefits of the changes included helping the "resilience" of adult services during the second surge, and enabling staff from different hospitals to learn from one another. 

The rationale for the changes was, health execs said, to ensure the area's hospitals were not overwhelmed by Covid cases over the winter. But stakeholders including councillors, MPs, patient organisations and even senior staff raised concerns that the changes might cause safety issues or be quietly made permanent.

Senior decision-makers always said the changes would be temporary, and that any permanent plans would be opened to consultation.

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Arguing the changes helped mitigate some of the pressures of the Covid surge, the report says: "The new configuration did contribute to the overall response in NCL (North Central London CCG) at a time of unprecedented pressure over the autumn and winter of 2020/21."

The report was put together by North London Partners – the "sustainability and transformation partnership" (STP) responsible for NHS decision-making across Camden, Islington, Haringey, Barnet and Enfield.

In it, health bosses recommend that a "scoping exercise" should take place, looking at where sharing of NHS services can be done more efficiently across the NCL area. It argues there is a need to improve "equity" of services across the five boroughs.

Concerns raised in the report include that while attendance at children's A&E fell in general, the fall was more marked in children from the most deprived families. The report suggests hospital execs believe this is a wider issue during the pandemic, rather than one caused by the A&E changes.

Some staff "did not feel equipped" for the changes and missed out on training opportunities, while there was a "lack of alignment between policies, referrals and pathways between organisations" and this led to staff confusion on the job".

Tulip Siddiq says the government has let children down during Lockdown

MP Tulip Siddiq condemns the antisemitic events on Finchley Road last Sunday - Credit: PA/Lauren Hurley

Reacting to the report, Hampstead MP Tulip Siddiq said: “I campaigned hard to ensure that the children’s A&E returned at the Royal Free after the temporary closure this winter. This is a vital service for so many families in Hampstead and Kilburn and I will always fight for it.

“This report highlights the huge difficulties and disruption that Royal Free staff have faced during the pandemic, particularly over the winter months. I pay tribute to the amazing doctors, nurses and other hospital workers who have risen to the challenge and worked tirelessly to keep us safe."

She said it is vital to "always be learning lessons" and to improve local NHS services, adding: "I will continue to hold government, health bodies and others to account to ensure that children can get the best possible emergency care at the Royal Free.”

Matthew Parris, the new director of Healthwatch Camden. Picture: Healthwatch Camden

Matthew Parris, the new director of Healthwatch Camden. Picture: Healthwatch Camden - Credit: Archant

Matthew Parris, director of Healthwatch Camden welcomed the report's recommendations, in particular that the local NHS was "prioritising groups who may be at the risk of health inequalities”.

“We were very concerned when we came to know about the closing of A&E services for children and young people due to pandemic," he said. "As there was very little communication around it and many people were not aware of the change.

“The recognition of the need for equitable access to paediatric services across NCL, ensuring that communities with the greatest need and those with barriers to access care are prioritised is very important.

“It is essential that all local stakeholders including local authority partners, local politicians and voluntary and community sector partners are aware of the changes, which is important for delivering the right outcome.”  

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