Children's surgery and anaesthesia services


Between 3 October 2016 and 14 February 2017 we consulted on proposals to change the way children's surgery and anaesthesia services are provided in the region. A final decision on these services is expected in June.


The consultation document:

Easy read versions of the consultation document and survey:

Video/audio of the consultation document:

There are many supporting documents to the consultation, including the pre-consultation business case and engagement reports, clinical reviews and an equality impact assessment. To see the range of documents, go to the section below: Documents - children's surgery and anaesthesia services.

Paper and alternative formats and languages are available too. Please contact us at helloworkingtogether@nhs.net or by calling 0114 305 4487.

The story so far - what you told us in pre-consultation engagement

To help us with our review, between January and April 2016, we asked you, patients and the public, what would matter if your child needed an operation.

You said it was important to:

  • Receive safe, caring, quality care and treatment
  • Have access to specialist care
  • Be seen as soon as possible
  • Have care close to home - but are willing to travel for specialist care
  • Have appropriate facilities for parents and carers with excellent communication when a child is in hospital.

All feedback was used to develop the options for the future of children's surgery and anaesthesia sservices - and we now want to know what you think about the proposals.

You can read the pre-consultation engagement document here.

You can watch a short video of what people said during pre-consultation here.

Which services do we mean?

We are proposing to change a small number of services to improve the care of children needing operations in Barnsley, Bassetlaw, Chesterfield, Doncaster, Rotherham, Sheffield and Wakefield.

If a child needs an operation under general anaesthetic (where they are sent to sleep):

- At night, or

- At a weekend, or,

- They need to stay in hospital overnight

For the following services,

- Ear, nose and throat (ENT)

- General surgery (for conditions usually of the abdomen/tummy - eg, appendicitis)

- Ophthalmology (for any condition of the eyes)

- Oral surgery (for any condition of the mouth or teeth)

- Orthopaedics (for any condition of the bones, muscles, nerves etc)

- Urology (for any condition of the groin, genitals or bladder)

We are proposing they are done in a different way.

These are the only services we are proposing to change.

For most services, most of the time, nothing would change. Children would still have operations in their local hospitals for things like:

- Tonsil removal

- Glue ear

- Setting of fractures/broken bones

- Any treatment that requires only a local anaesthetic but not being sent to sleep

We're also not looking to change specialist services for children with very complex or multiple conditions needing care from specialist doctors and nurses.

For these services, you would still go to Sheffield Children's Hospital as the only specialist children's centre in our region.

Based on our review of current treatments at all our hospitals, we expect that the number of children affected by the proposed changes in each would be very small compared to the overall number of children needing an operation in South and Mid Yorkshire, Bassetlaw and North Derbyshire.

Why do we want to change children's surgery and anaesthesia services?

In our region, some children have better experiences, better and faster treatment and better access to services than others - and we don't think this is fair.

Some of our hospital doctors and nurses don't treat as many children as others do.

Children are not 'small adults' and if they need an operation, it is better and safer for them to be seen by a surgeon who is trained to and regularly operates on children.

Nationally, there aren't enough healthcare professionals qualified to treat the amount of children who need surgery every year.

As mentioned, children receive better care and treatment if they are seen by doctors and nurses who are trained to look after and operate on them.A reduced number of staff nationally, means there is also less qualified staff locally - and we need to work with the staff and resources we do have to make sure our region's children have the best possible and highest quality care.

Our proposed changes are not about cutting services or saving money, but using what we have in the best possible way to get the best services for everyone. By making changes to how children's surgery and anaesthesia services are currently provided, we believe we can better share skills and knowledge and ultimately, provide a much better, equal service to every child across South and Mid Yorkshire, Bassetlaw and North Derbyshire.

What are the options for children's surgery and anaesthesia services?

We are recommending three options for the future of children's surgery and anaesthesia services. For all options, children would be taken to the next nearest hospital. We would like your view on the following options:

Option one

If a child needs an operation under general anaesthetic (where they are sent to sleep):

- At night, or

- At a weekend, or,

- They need to stay in hospital overnight

For the following kinds of surgery:

- Ear, nose and throat (ENT)

- General surgery (for conditions usually of the abdomen/tummy - eg, appendicitis)

- Ophthalmology (for any condition of the eyes)

- Oral surgery (for any condition of the mouth or teeth)

- Orthopaedics (for any condition of the bones, muscles, nerves etc)

- Urology (for any condition of the groin, genitals or bladder)

They would go to:

- Chesterfield Royal Hospital

- Doncaster Royal Infirmary

- Pinderfields General Hospital in Wakefield

- Sheffield Children's Hospital

Based on current numbers, this would affect 1 in every 10 children needing an operation in Barnsley and 1 in 8 children needing an operation in Rotherham.

Option two

If a child needs an operation under general anaesthetic (where they are sent to sleep):

- At night, or

- At a weekend, or,

- They need to stay in hospital overnight

For the following kinds of surgery,

- Ear, nose and throat (ENT)

- General surgery (for conditions usually of the abdomen/tummy - eg, appendicitis)

- Ophthalmology (for any condition of the eyes)

- Oral surgery (for any condition of the mouth or teeth)

- Orthopaedics (for any condition of the bones, muscles, nerves etc)

- Urology (for any condition of the groin, genitals or bladder)

They would go to Doncaster Royal Infirmary, Pinderfields General Hospital in Wakefield or Sheffield Children's Hospital.

Children's operations for these services would no longer be provided in

- Barnsley

- Chesterfield

- Rotherham.

Based on current numbers, this would affect 1 in every 10 children needing an operation in Barnsley, 1 in 16 children needing an operation in Chesterfield and 1 in 8 children needing an operation in Rotherham.

Option three

If a child needs an operation under general anaesthetic (where they are sent to sleep):

- At night, or

- At a weekend, or,

- They need to stay in hospital overnight

For the following kinds of surgery,

- Ear, nose and throat (ENT)

- General surgery (for conditions usually of the abdomen/tummy - eg, appendicitis)

- Ophthalmology (for any condition of the eyes)

- Oral surgery (for any condition of the mouth or teeth)

- Orthopaedics (for any condition of the bones, muscles, nerves etc)

- Urology (for any condition of the groin, genitals or bladder)

They would go to Pinderfields General Hospital in Wakefield or Sheffield Children's Hospital. Children's operations for these services would no longer be provided in

- Barnsley

- Chesterfield

- Doncaster

- Rotherham hospitals.


Based on current numbers, this would affect 1 in every 10 children needing an operation in Barnsley, 1 in 16 children needing an operation in Chesterfield, 1 in 7 children needing an operation in Doncaster and 1 in 8 children needing an operation in Rotherham.

Which option do we prefer?

We prefer option 2. This is because with careful planning to ensure we have the right staff in each hospital, and to make sure patients could get to one of the hospitals within 45 minutes (as a national standard), we believe that option 2 would give all patients in South and Mid Yorkshire, Bassetlaw and North Derbyshire access to the same quality and standard of children's surgery services.

We don't think that option 1 would be sustainable as we would not have enough doctors or nurses to provide cover cross all sites meaning we would risk facing further safety and quality problems.

We also think that option 3 would be challenging in terms of the increased amount of patients going to only one of two places.

In our survey, we ask if you think there is another option we could consider. If you wish to describe this, and say why you would prefer this option, please either fill in the survey of send your option to us at:

helloworkingtogether@nhs.net or by post to FREEPOST COMMISSIONERS WORKING TOGETHER (you don't need a stamp any by putting just these words on the envelope it will get to us),


I live in Barnsley / Chesterfield / Rotherham - where will I go if my child needs an operation?

In the future, you may need to go to Doncaster Royal Infirmary, Pinderfields General Hospital in Wakefield or Sheffield Children's Hospital if your child needs a specific operation that is no longer provided at your local hospital at night or at a weekend - but at the moment, nothing will change.

What if my child needs an emergency operation?

At the moment children would go to their local hospital, where depending on their needs, they may be transferred to Sheffield Children's Hospital for care.

If you live in Sheffield already, you would go straight here. This won't change. Ambulance services would continue to operate in the same way as they do now.

How have we developed the options?

We developed the options with clinical and managerial NHS staff who provide children's surgery and anaesthesia services in our region's hospitals and the NHS staff who 'buy' and monitor the standards of the services. A group and expert panel was set up to support and oversee the review and has been meeting regularly.

They looked at:

- Getting to a hospital - can patients easily access these services, either independently or by ambulance within 45 minutes?

- Number of patients - if services changed, would hospitals be able to treat the potential higher number of patients being seen?

- Impact on other areas - would changing services in our region affect services and patients in neighbouring areas?

- Patient experience - based on what our pre-consultation told us was important to people (access to expert, quality care etc), would the proposed options deliver this and improve current patient and carer experience?

- Number of staff - how could we use our current workforce in the best way to meet the needs of our patients?

What our clinicians say

Dr Tim Moorhead, GP, chair of NHS Sheffield Clinical Commissioning Group and advisor to Commissioners Working Together, said:

“Over the last eighteen months we have been reviewing our children’s surgery and anaesthesia services and are now proposing changes to make sure all children in our region are able to get the best possible and safest care they deserve should they need an operation in one of our local hospitals.

“For most services, most of the time, nothing will change but for a small number of operations, at night, at weekends or when children need to stay overnight in hospital, we are proposing they are done differently.

“Across the region, there is only a small number of children needing operations for the services we’re proposing to change, which means our staff aren’t being used in the best way, which, combined with a national shortage of expert staff who are qualified to operate on children, means that in the future, your child may not have access to the high quality care they need.”

Des Breen, consultant anaesthetist and medical director for the Working Together programme, said:

“If we use our services and staff in a different way, we will be able to care for children in a consistent way - whilst maintaining the high standards of care we expect to provide.

“For some people, this may mean you will need to travel further than your local hospital for the services we’re proposing to change but it will also mean your child will receive consistently high quality and safe care in the future - with your child being treated by the right people, in the right place and at the right time.”

During our pre-consultation phase, we asked Dr Tim Moorhead, Des Breen and Fiona Campbell, the Clinical Lead for Children's Services at the Strategic Clinical Network why the way we provide services should change. This is what they said.

Questions and answers

What does this mean for Sheffield Children’s Hospital?

There would be no changes to services at Sheffield Children’s Hospital, though the hospital would see more patients. Planning for this and managing extra numbers of children is currently being discussed.

What does this mean for Doncaster Royal Infirmary?

Doncaster would likely see an increase in their children’ surgery service for children needing overnight and weekend stays. Planning for this and managing extra numbers of children is currently being discussed.

What does this mean for Pinderfields Hospital (Mid Yorkshire)?

Pinderfields Hospital is in a different NHS region and therefore outside of our authority. However, we recognise that a change in Barnsley may impact on Pinderfields and we are working with our neighbouring hospitals and organisations to plan and manage a small increase in the number of patients.

I live in Barnsley/Chesterfield/Rotherham - where will I go if my child needs an operation?

In the future, you may need to go to Doncaster Royal Infirmary, Pinderfields General Hospital in Wakefield or Sheffield Children's Hospital if your child needs a specific operation that is no longer provided at your local hospital at night or at a weekend - but at the moment, nothing will change.

What if my child needs an emergency operation?

In an emergency, at the moment, children might go to their local hospital or they might be taken to the nearest specialist centre. It is likely they would be stabilised and transferred to a specialist centre on arrival at their local hospital.

The proposals would mean all children in all emergencies would be taken to a specialist centre.

Is this just to save money?

No. Our proposed changes are not about cutting services or saving money, but using what we have in the best possible way to get the best value and services for everyone.

You say option 1 is unsustainable and option 3 is challenging. Why are they options?

We think options 1 and 3 are feasible but we also recognise that it would be very difficult to maintain staffing cover 24 hours a day, seven days a week. It would require formal arrangements across the hospitals which don’t exist at the moment. When we assessed each option, options 1 and 3 were within the scoring range of ‘do-ability’ with acknowledged challenges. You can see how we arrived at the assessment in the pre-consultation business case (see pages 48-62).

How many children will this affect (overall)?

Based on the high level numbers we have, we estimate around one in seven children needing an emergency or overnight stay for an operation would be affected.

During the consultation, we have been asked if the numbers we have estimated include children who would stay overnight where they have had an operation.

The numbers we have used are based on national hospital data submitted for 2014/ 15. This data includes all children who come to hospital in an emergency and who need an overnight stay. There are a number of factors in each of the sub-specialities which affect the complexity of the surgery and the level of expertise / experience needed and this means that some specialities need some staff and others need more. We now need to look at data at the sub-speciality level to better understand what the numbers affected would be.

How many Barnsley children will this affect?

Less than 65 planned operations for the services under review take place in Barnsley Hospital every year. This is around 4% of the total figure for all of South and Mid Yorkshire, Bassetlaw and North Derbyshire.

Around 500 emergency operations for the services under review take place in Barnsley Hospital every year. This is 11% of the total figure for all of South and Mid Yorkshire, Bassetlaw and North Derbyshire.

Around 830 Barnsley children already have operations for the services under review in other South Yorkshire hospitals every year.

During the consultation, we have been asked if the numbers we have estimated include children who would stay overnight where they have had an operation.

The numbers we have used are based on national hospital data submitted for 2014/ 15. This data includes all children who come to hospital in an emergency and who need an overnight stay. There are a number of factors in each of the sub-specialities which affect the complexity of the surgery and the level of expertise / experience needed and this means that some specialities need some staff and others need more. We now need to look at data at the sub-speciality level to better understand what the numbers affected would be.

How many Rotherham children will this affect?

138 planned operations for the services under review take place in Rotherham Hospital every year. This is 9% of the total figure for all South and Mid Yorkshire, Bassetlaw and North Derbyshire.

Around 700 emergency operations for the services under review take place in Rotherham Hospital. This is 15% of the total figure for all South and Mid Yorkshire, Bassetlaw and North Derbyshire.

During the consultation, we have been asked if the numbers we have estimated include children who would stay overnight where they have had an operation.

The numbers we have used are based on national hospital data submitted for 2014/ 15. This data includes all children who come to hospital in an emergency and who need an overnight stay. There are a number of factors in each of the sub-specialities which affect the complexity of the surgery and the level of expertise / experience needed and this means that some specialities need some staff and others need more. We now need to look at data at the sub-speciality level to better understand what the numbers affected would be.

How many Chesterfield children will this affect?

Around 163 planned operations for the services under review take place in Chesterfield Royal Hospital every year. This is less than 11% of the total figure for all South and Mid Yorkshire, Bassetlaw and North Derbyshire.

Around 300 emergency operations for the services under review take place in Chesterfield Royal Hospital. This is less than 7% of the total figure for all South and Mid Yorkshire, Bassetlaw and North Derbyshire.

During the consultation, we have been asked if the numbers we have estimated include children who would stay overnight where they have had an operation.

The numbers we have used are based on national hospital data submitted for 2014/ 15. This data includes all children who come to hospital in an emergency and who need an overnight stay. There are a number of factors in each of the sub-specialities which affect the complexity of the surgery and the level of expertise / experience needed and this means that some specialities need some staff and others need more. We now need to look at data at the sub-speciality level to better understand what the numbers affected would be.

You’re closing children’s services, what’s next?

We are not closing children’s services, the proposals are for children who need operations under general anaesthetic at night, at a weekend or if they need to stay in hospital overnight.

For most services, most of the time, nothing would change. Children would still have operations in their local hospital for things like: tonsil removal, glue ear, setting of fractures/broken bones and any treatment that requires only a local anaesthetic but not being sent to sleep.

We are also proposing to change the way hyper acute stroke services (the first 72 hours of care after having a stroke) are provided across the same geography. You can read more about them here.

There are no plans to close other services.


Are paramedics trained to look after children in the ambulance?

Yes, paramedics are fully trained to look after children while they are travelling in an ambulance. They administer treatment and stabilise patients en route to the nearest centre, where tests immediately take place to help provide a diagnosis.

Who will pay for me to travel?

Some people qualify for help with travel costs under the healthcare travel scheme. This would be assessed by staff at the hospital and if eligible, costs would be paid.

How will relatives get to the hospital? Where can relatives stay? Will there be enough facilities for parents and carers to stay overnight with their child?

For parents and carers of children needing operations at night, at a weekend or they need an overnight stay in hospital, they would travel with the child in the ambulance if it was an emergency. Relatives would need to make their own way to the hospital at other times.

All of the hospitals within the preferred option have facilities for parents to stay overnight. These are Sheffield Children’s Hospital, Doncaster Royal Infirmary and Pinderfields Hospital in Wakefield.

Is this the first step to closing our local hospital?

There are no plans to close any hospitals.

The changes proposed are entirely about ensuring everyone in our region has the best experience and outcomes, faster treatment and better access to services.

The equality impact assessment has very little information contained within considering it was started in 2014 and was completed in 2016.

The assessment takes account of the data we have available to us. We explored the potential impact of service changes with different groups during our pre-consultation engagement phase, which was fed into the proposals, and are continuing to gather qualitative data from people with protected characteristics during the consultation. The analysis of feedback during the consultation will be done independently and be part of the information that the Joint Committee of CCGs will use to inform its decision.

The equality and impact assessment states that there will be no adverse impacts on pregnancy and maternity, is this why this protected characteristic is not included in the consultation document?

We have added this protected characteristic to our data collection on the website.

Where is the evidence to suggest that some children have better experiences and faster treatment than others?

There is a lot of supporting documentation to the proposals, including the pre-consultation business case, engagement reports and clinical reviews. The evidence around better experiences and faster treatment was gathered as part of the baseline assessment done with each hospital against the national Royal College standards. This information is on pages 16-22 in the pre-consultation business case.

There will be an increased pressure on Doncaster, Pinderfields and Sheffield Hospitals. Will this change ensure that children are seen as soon as possible?

We recognise the impact of the proposed changes on the hospitals and the planning for this and managing extra numbers of children is currently being discussed. We have asked the hospitals impacted to each put a business case together that will be considered as part of decision making.

The proposals are based on current provision across all sites being unsustainable and focus entirely on the quality of care and treatment, which includes being seen quickly and by the most appropriate person.

During the public consultation period, we are responding to your questions. Please email us helloworkingtogether@nhs.net with your questions.


What happens next and decision making?

After the consultation all the feedback will be collated and given very careful consideration by the Joint Committee of Clinical Commissioning Groups (JCCCGS), which is made up of representatives from the CCGs in Commissioners Working Together.

This will involve discussions about what changes could or should be made in response to the comments received. All the Councils in South and Mid Yorkshire, Bassetlaw and North Derbyshire have set up a Joint Scrutiny Committee to consider the proposed changes. The Joint Committee will take a view on the consultation process.

Legislation also allows the Joint Committee to make recommendations on the proposed changes to the CCGs, which it may choose to do after it has examined these in detail. The CCGs will also need to satisfy a very detailed assurance process carried out by NHS England. This process is used for all service reconfiguration and organisations proposing changes need to show that such proposed changes are based on strong patient and public engagement, patient choice and clinical evidence and have support from local doctors and other clinicians, sound workforce plans, are financially viable, that consideration has been given to accessibility and have been subject to an equality impact assessment. Proposed changes also need to be underpinned by a communications and engagement plan.

The final decision will be made, in public, by the CCGs as the bodies responsible for planning and buying health services for local people. Reports including feedback and the consideration given by the CCGs will be made public. There would also need to be discussions with the ambulance service to take into account the impact of increased journeys. If we gained all of the necessary approvals, phased implementation would begin in 2017.

We will widely communicate the findings from the consultation - which are being analysed independently - with all our stakeholders, the public and staff.