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Inspection Summary


Overall summary & rating

Good

Updated 21 June 2018

Our rating of services stayed the same. We rated them as good.

We did not aggregate the diagnostic services at this inspection as it was an additional service which was inspected with outpatients before.

A summary of services at this hospital appears in the overall summary above.

Inspection areas

Safe

Requires improvement

Updated 21 June 2018

Effective

Good

Updated 21 June 2018

Caring

Outstanding

Updated 21 June 2018

Responsive

Good

Updated 21 June 2018

Well-led

Good

Updated 21 June 2018

Checks on specific services

Critical care

Good

Updated 21 June 2018

Our rating of this service stayed the same. We rated it as good.

For a summary of this service see overall trust summary section.

Medical care (including older people’s care)

Good

Updated 5 October 2017

  • There was a positive culture of incident reporting at ward level and there was evidence of learning and changes in practice following incidents. Staff felt supported by their immediate team colleagues and by senior managers.

  • Staffing levels and skill mix was planned, implemented, and reviewed to keep children and young people safe.

  • Consultants took part in a ‘Consultant of the week’ rota and were present in the hospital during times of peak activity.

  • Age dependent pain assessment tools were in use and analgesia was available to children who required it.

  • The environment was suitable and welcoming to meet the needs of children and young people and their parents and carers. Services were planned and delivered to meet the needs of local area, the North West of England, North Wales and the Isle of Man.

  • We found consent to treatment was clearly recorded in the records we reviewed. We observed staff interacting with patients and their relatives with kindness, dignity and respect. Parents and patients told us they were included in decisions about their care and were kept well informed. The patients and parents we spoke with were extremely positive about the care they received and one parent told us “the staff are like a family, we will miss them when the treatment finishes”.

  • The trust had achieved 100% compliance with all cancer waiting times for the period April 2016 to March 2017 except for one month where they achieved 88%.

  • There was a clear vision which was aligned with the trust vision to provide ‘a healthier future for children and young people’ which was underpinned by a set of values. We observed staff demonstrate the set of values when they were delivering care.

  • There was a process in place to enable the performance, safety, and quality of the service to be reported and reviewed. Risk registers were held at ward and clinical business unit level with a process to escalate risks to keep children and young people free from harm.

Outpatients and diagnostic imaging

Requires improvement

Updated 23 December 2015

At our previous visit in May 2014 we found some areas of outpatients that required improvement. In June 2015, we returned to inspect outpatients and diagnostic imaging services and saw that considerable progress had been made with regard to the management and availability of medical records but that the service "requires improvement" overall. Within outpatients and diagnostic imaging services there were areas of governance that required improvement, particularly in relation to the identification and management of risks. There were no regular departmental team meetings taking place at the time of the inspection; however, some departments, such as audiology and the ears, nose and throat department (ENT) held their own multidisciplinary meetings. Lessons learned were not consistently shared with staff. Departmental risk registers were not kept up to date and there was no evidence that they were reviewed on a regular basis. Robust procedures for identifying if young female patients were pregnant prior to undergoing scans within the diagnostic imaging department were described in the trust’s radiation protection policy but they were not always followed. Emergency resuscitation equipment was available in all areas that we inspected. In outpatients, records indicated that the equipment was checked twice daily; however, within radiology, despite staff telling us that checks were completed regularly, we saw that the checklists had not been updated for several months and in some cases a number of years. Mandatory training and safeguarding (level 3) training completion rates for staff within outpatients and diagnostics were low and well below the trust’s target for the majority of the training modules. Completion rates have not improved markedly from the last inspection. Care and treatment was delivered in line with evidence based practice. Policies and procedures followed recognisable and nationally approved guidelines. Patients and those close to them were treated with dignity and respect by caring and compassionate staff. Outpatient clinics were very busy and we observed some carers complaining to members of staff about waiting times. Patient information leaflets, appointment letters and supporting information were not available in any other language except English. There was no process in place for sharing lessons learned from complaints made about the department.

Urgent and emergency services

Good

Updated 20 August 2014

The service was safe and responsive to children and young people’s needs, however, there were issues regarding nurse staffing levels, especially at night. The trust took immediate action to resolve this concern by providing an additional trained nurse for the full night shift. Some children and young people were concerned that they had to wait for long periods of time on the department and did not always realise that they had been admitted to the observation unit. Staff were caring and approachable, and engaged well with children and young people.

The department’s management team were exploring ways to reduce demand on A&E services and encouraged children and young people to seek alternative avenues of care and treatment to avoid unnecessary admissions to hospital.

Some staff told us that they did not feel appropriately supported by their managers.

Outpatients

Requires improvement

Updated 21 June 2018

Our rating of this service stayed the same. We rated it as requires improvement.

For an overall summary of this service see the trust overall summary section.

Diagnostic imaging

Good

Updated 21 June 2018

We have not inspected this service before. We rated it as good.

For al summary of this service see the overall trust summary section.

Neonatal services

Good

Updated 20 August 2014

Parents we spoke with gave us examples of the good level of care that their babies had received on the NSU. We were told about how supportive staff were, and that parents were informed about the care and treatment their babies received, and were involved in the process.

The NSU had recently introduced a breastfeeding care pathway, Promoting transition to breastfeeding, which was becoming embedded in practice. Mothers spoke positively about the support they received. There was strong local leadership on the unit, with a clear ethos about staff working together.

Transitional services

Good

Updated 23 December 2015

At our previous visit in May 2014 we found that transitional services required improvement. In June 2015, we returned to inspect the whole service. We saw that there had been significant improvements since our last inspection. We found that the trust had a co-ordinated trust wide strategy for planning and delivering transition services which supported young people. There were excellent examples of transition pathways for young people with specific long-term needs. There was a commitment from the trust to further develop existing partnerships with health and social care providers of adult services. Since our last inspection, the trust had appointed a designated transition nurse and named medical consultant. As a result, progress had been made in developing over-arching policies and procedures relating to transition arrangements for young people with complex needs. These were due to be formally rolled out across the trust shortly after our inspection. There was clear leadership, vision and a desire to use research and audit programmes to share good practice and identify gaps in transition and use this to improve outcomes for young people. There was evidence of patient, public and staff involvement in shaping policies and procedures related to transition.

Surgery

Requires improvement

Updated 5 October 2017

  • The hospital did not always ensure that a member of staff who was trained in advanced paediatric life support (APLS) was available on each department at all times. This did not meet the Royal College of Nursing (RCN) minimum staffing requirements

  • We found that compliance with mandatory training across surgical services was mixed. We had particular concerns that compliance with safeguarding level three training for surgical staff overall was only 67% at the time of the inspection.

  • We found that the governance framework for surgical services was relatively new and was still being embedded at the time of inspection.

  • On surgical wards, there was no evidence of formal risk assessments being completed, such as formally assessing the level of risk posed by resuscitation equipment being in different ward areas. We were therefore unsure if all risks had been identified and mitigated appropriately. This was not line with the hospital’s risk management strategy.

End of life care

Good

Updated 21 June 2018

Our rating of this service went down. We rated it as good.

For a summary of this service see the overall trust summary section.

Other CQC inspections of services

Community & mental health inspection reports for Alder Hey Children's Hospital can be found at Alder Hey Children's NHS Foundation Trust.