Scottish Government

EXECUTIVE SUMMARY

• The four areas covered by the RARARI Paediatric project (Western Isles, Orkney, Shetland and rural Highland) all currently provide paediatric services.
• There is a different means of delivering the service in each area and there are gaps, particularly Community Paediatrics, for the island health boards.
• Other than in Stornoway, unscheduled (medical) care of children and neonates is provided by individuals who have not received accredited training in paediatrics. Shetland, Stornoway and Fort William have Children's nurses covering some shifts.
• In Stornoway secondary care is provided by a locum Consultant Paediatrician, but he is single handed, continuously on-call and relatively isolated from his peers.
• Each of the other services is dependent on the skills of individuals currently in post and is therefore vulnerable should any one of these individuals be lost to the service.
• There are informal contacts between the remote and rural areas and large centres and good working relationships between individual clinicians. However there is no formal network of support for the remote and rural child health services.
• For remote and rural paediatric services to survive, they need to become part of a managed clinical network with a large centre.
• Within the network there needs to be acceptance of responsibility by the large centre for the maintenance of the remote and rural service. This responsibility should extend to accredited training of non-paediatricians working in the remote and rural areas and clinical supervision of their practice as it relates to paediatrics.
• Training and support for Nurses, Midwives and Allied Health Professionals in remote and rural areas should be part of the managed clinical network.
• Each remote and rural area should be the responsibility of a Paediatrician, either based locally and spending time in the large centre to maintain skills, or based at the large centre and providing a comprehensive outreach service.
• The Paediatrician should be supported by appropriately trained GPs and/or Physicians. In future this role might be filled by the remote and rural hospital practitioner with skills covering the secondary care of children, babies and adults.