Doctor's call on children's A&E

Aleesha was taken back to hospital when her condition worsened

A senior paediatrician has called for designated children's emergency centres following the death of a baby the day after she was discharged from hospital.

Dr Dewi Evans said the current system for treating children in A&E was "completely unsuitable".

At an inquest into Aleesha Evans's death in August 2006, a coroner said a senior registrar failed to recognise how serious her condition was.

The assembly government said every A&E unit already had a children's section.

A spokesperson said it would be an "inefficient use of NHS resources" to provide separate facilities for children.

A narrative verdict was recorded on the death of Aleesha, from Newport.

The nine-month old died after she suffered multiple organ failure triggered by meningococcal septicaemia.

Her parents Shiree Hanbury and Craig Evans were told by staff at the Royal Gwent Hospital where she had been taken the day before that she had a viral infection and needed only Calpol and Nurofen.

The inquest at Cardiff coroner's court heard Aleesha was taken home but later rushed back to the University Hospital of Wales in Cardiff, where doctors could not save her.

The hearing was told she would have survived had she not been discharged from the Royal Gwent Hospital.

We are actually asking young people who are often recently qualified as doctors to see a whole range of people Dr Andrew Dearden, British Medical Association Wales

Coroner Mary Hassell said the doctor whom Aleesha had been referred to at the Royal Gwent - Salawat Abdul-Salam - had been involved in a death at the University Hospital of Wales, Cardiff two years earlier.

She said she was disappointed that her report on this previous case had not been given to the Gwent Healthcare Trust.

Dr Evans, who is a consultant paediatrician at Singleton Hospital in Swansea, said nursing and medical staff, whose training was in adults, did not necessarily have the same feel or experience for looking after children.

"You can have as many procedures and protocols as you want and there are some very good ones available in all hospitals," he said.

"The problem is that there has been a very significant increase in the number of children coming in to the A&E department over the last few years and it can be impossible to distinguish the one child in a dozen or 20 whose early symptoms are identical to children who have just got ordinary viral infections."

Experts

Dr Evans said emergency centres designated specifically for children and appropriately staffed would need Welsh Assembly Government backing.

"We have one in Singleton Hospital and unfortunately we don't have the resources to ensure it is kept open 24 hours a day," he said.

Dr Andrew Dearden, chairman of the British Medical Association in Wales agreed that children should be seen by experts.

"We are actually asking young people who are often recently qualified as doctors to see a whole range of people," he said.

"GPs take many years to be trained to do the same thing. Some people working in A & E have only had a year or two after they have been qualified so this kind of expertise in paediatrics will be welcomed."

Dr Dearden added that there was a responsibility upon employers to make sure the people they employed had a suitable background to work in the health service.

A spokesperson for the Welsh Assembly Government said: "In all acute admission hospitals, there are paediatricians available on site and the normal process is that their assistance can be sought as appropriate.

"Capacity-wise, it would also be extremely difficult, and an inefficient use of NHS resources, to provide separate A&E facilities for children.

"The concerns expressed at the time of Aleesha's death triggered clear instructions from the Welsh Assembly Government to all NHS trusts in Wales to remind consultants about their responsibilities to identify poorly performing trainees, to report them to the deanery and to pass such information on when trainees move posts.

"All consultants are expected to following these instructions. However, we will obtain and study a copy of the Coroner's verdict to see what else can be done to strengthen these arrangements."