Death of a child returns to haunt the NHS

Intensive care crisis: Desperately sick children pay the price as health managers struggle to balance books

LIZ HUNT and

JASON KERRIGAN

This week the ghost of Baby Barber returned to haunt the National Health Service. Few people will remember his short, troubled, life, but for the 57 days David Barber survived in the winter of 1987, he was at the centre of a political furore.

His case was a major factor in the Government review of the NHS which prompted sweeping reforms and resulted in the introduction of the internal market.

Baby Barber was the desperately sick child whose urgent heart operation was postponed five times because of a shortage of intensive-care nurses at the Birmingham Children's Hospital. When eventually he had his operation, he lived just 11 days.

Nine years on, as the Independent's survey reveals, there are many potential Baby Barbers being denied a bed in paediatric intensive care units (ICU) around the country. Some children have died. Ironically, the changes within the NHS now work against the Government taking action to resolve the problems. It is, health ministers argue, a matter for individual trusts to resolve by balancing their budgets.

But as the survey shows, demand far outstrips supply. It is worse in the winter and has been aggravated during the past two months by the meningitis scare, but virtually every hospital we spoke to reported problems throughout the year. The situation nationally is becoming increasingly desperate.

At St James's University Hospital in Leeds, a spokesman said that some cancer treatments had been postponed because "we have been unable to cope" with the demand from very sick children. "We haven't turned anyone away although we have received two patients from hospitals in Manchester. We have 11 beds in use in ICU but have 18 available to us which we can't use because we can't afford it."

At the Leeds General Infirmary children have been turned away "frequently in the past few months, often one a day," a spokesman said. "One kid was brought here DOA [dead on arrival] from Manchester. There are five paediatric ICU beds. It would be a big problem for us to find staff for any new beds."

In London, St Mary's Hospital has had to refuse admission to 41 children with meningitis in the past year. Two died in December after the hospital could not find beds for them. Great Ormond Street Hospital for Sick Children is under added pressure because of its specialist status. However, of 19 ICU beds only 11 are open, largely because of staffing problems. About 150 children have been turned away this year.

At the Brighton Health Care NHS Trust, seven children have been turned away in the last three months, one with meningitis. A spokesman said: "We could not find the extra staff to cope even if we had more beds."

At the Bristol Children's and St Michael's Hospital, three children were refused treatment in November and 18 in December. One little boy was taken to Birmingham last month because there were no beds; a spokeswoman said: "We have 12 beds in [paediatric] intensive care of which there are 10 currently in use. We are having difficulty recruiting staff."

The Royal Liverpool Children's Hospital at Alderhey, said it has had to turn children away on "several occasions".

There are 11 staff vacancies in the paediatric ICU at Manchester Children's Hospital and the trust is recommending that children are taken elsewhere. "We've been forced to refuse 31 kids since September 1995," a spokesman said. "Our human resources have been pulling out all the stops to find staff but it is very difficult."

Despite investing pounds 500,000 in paediatric intensive care and opening two more beds, Sheffield Children's Hospital turned away 52 children between October and December last year, and 10 so far this year. At Newcastle General Hospital a spokeswoman said there had been no refusals as such but "we are often having to send kids on after initial assessment and emergency treatment". In Birmingham cases are "juggled" between the Children's Hospital, Heartlands, and the City Hospital, by an emergency beds bureau. "We are coping," a spokeswoman said. But Babula Sethia, clinical director of special services said that there are still those who cannot get access to care.

Nottingham City Hospital and Queen's Medical Centre, which together provide intensive care for children in the city, said they have turned 11 away since the start of November.

In Belfast, the Royal Hospital for Sick Children said it is dealing with emergencies only. "We have eight ICU beds and operate at almost 100 per cent capacity," a spokeswoman said. In Scotland, Glasgow Children's Hospital at Yorkhill, described the situation as "extremely busy" but said no children had yet been turned away. At Edinburgh Sick Children's NHS Trust, a spokeswoman said that no children were refused care but "that is not to say we have enough beds".