Understanding the causes of local disputes in paediatrics to develop pathways to dispute resolution in North East Scotland. [NHS Grampian R&D Poster]

Conflicts between parents and clinicians over the care of children with life-limiting conditions can reach the point where courts must intervene, causing distress, unwanted media attention and costs. This NHS Grampian case study sought to understand reasons for disputes, identify potential solutions and reduce the risk of a case coming before a Scottish court. In-depth semi-structured interviews with 20 participants (a mix of NHS Grampian clinicians and parents) were conducted from which qualitative data were obtained on their experiences of and views on disagreements about care, how decision-making is handled, what works well and what might improve existing approaches

Understanding the causes of local disputes in paediatrics to develop pathways to dispute resolution in North East Scotland. [RCPCH Poster]

Conflicts over the care of children with life-limiting conditions can reach the point where courts have to intervene,but giving evidence causes distress, unwanted media attention and costs. The decision in Charlie Gard’s case in Englandincluded a plea for parties to mediate. No case has arisen in Scotland, where law and practice differ, but there are approximately 16,000 children with complex conditions where care might potentially be disputed. This study seeks to understand reasons for disputes, identify potential solutions (including mediation) and reduce the risk of a case coming before a Scottish court. In-depth interviews (online and face-to-face) with NHS Grampian clinicians and parents were conducted from which qualitative data were obtained on their experiences and views on disagreements about care, how decision-making is handled, what works well and what might improve existing approaches. This is being funded by the NHS Grampian Endowment Fund. Ten clinicians and five parents were interviewed. Preliminary thematic analysis suggests that clinicians feel multidisciplinary team meetings improve conflict resolution for patients with complex requirements, where specialism boundaries can blur. When disputes arise, the type of intervention varied depending on its scale, urgency and impact on other care teams. A cause of disputes is variation in goals within and between care teams, but micro-discussions and step-bystep approaches from the outset work well and mitigate risk of disputes. The settings, timing and language used in conversations with parents is important. Findings suggest that clinicians may prefer a two-stage process where meetings are held without parents in the first instance. A strong Chair facilitates useful meetings, but parents still find it difficult to know who to address questions to. Families' use of social media/online searches can be problematic and lead to strained relationships, but emphasis on 'good death' and 'doing what's right' were highlighted. When a child is hospitalised, 'handing over' a child who has been looked after at home can be difficult for parents and home care teams. A desire to connect with parents facing similar challenges was expressed. It is clear that conflict exists in Scottish paediatric care. Practice suggests that there are strategies which can be employed to minimise risk of intractable disputes arising which could be used to assess the suitability of mediation and formalised into a toolkit to support families and clinicians