An innovative approach to children’s surgery at the Royal Manchester Children’s Hospital (RMCH) has demonstrated benefits for patients and their families and is being highlighted by regional health leads as an example of how NHS services have adapted as a result of the Covid-19 pandemic.

Set up in August 2020, more than 2,500 children have now been treated using a “walk in, walk out” approach to surgery, instead of being admitted for an overnight stay as an inpatient.  This has helped to minimise their length of stay in hospital and has also meant that procedures are less likely to be affected by winter surges or high A&E attendances.

Dr Michael Gregory, Regional Medical Director for NHS England North West, said: “At a time when there’s been tremendous pressure on NHS inpatient beds, the team at RMCH have safely adapted how they work to ensure that children who need treatment can get it.  Children are scheduled to have their surgery and get back home the same day, which is proving to be much better for them and their families.”

The walk in, walk out (WIWO) approach is currently offered to ear, nose and throat, ophthalmology, dental, plastics, maxillofacial, trauma and orthopaedics, and paediatric surgery urology patients.  The service is having a significant impact across Greater Manchester with daily numbers increasing. The model has also been expanded in RMCH for children who present in the emergency department. Clinically suitable children are identified who can avoid a long wait or overnight admission and return the next day for walk in walk out treatment.

Neil Bateman is Consultant Paediatric Otolaryngologist at RMCH and is a member of the team that set up the service.  He said: “It won’t be appropriate for all children who need surgery, however the feedback we’ve got back from families and carers so far has been very positive.

“The service significantly improves productivity enabling our teams to work through patient waiting lists faster and is greatly preferred by children and families for its low impact to their lives.”

One of the first patients to use the walk in walk out service in 2020 is 15-year-old Henry who is a familiar face at the hospital. Henry was born prematurely and had a tracheostomy fitted in 2007 in their local hospital by Consultant, Neil Bateman. Neil moved hospital Trusts in 2015 to RMCH, and Henry followed to continue his care and treatment under him.

Henry’s mum, Louise Worek, said: “The walk in walk out service has transformed the way we access Henry’s surgery at the hospital. We have found it so much more efficient and easier to do as there is no waiting around on the wards. We can plan our day much better, which definitely helps having three children, and if we have a morning appointment, we are usually out by lunch.

“The service is excellently run and the team have made it so easy for us. Henry has been much more settled and reassured under the care of the WIWO team. We have so much confidence in the service and the team behind it.”

The service has also had a very positive effect on staff morale and RMCH’s WIWO Lead, Joanne Leigh has grown this service with her “can do” approach.

Dr Gregory added: “We have asked so much of our staff throughout the pandemic, and we are continuing to ask more of them as everyone strives to deal with the backlog of patients that has built up.  Improvements are being made thanks to the ingenuity and dedication of our NHS teams, who are introducing new ways to deliver services in order to see patients as quickly as possible”.

The team at RMCH has produced a short video that gives more detail about the work they’ve been doing: