During an assessment of Services for children & young people
Date of assessment 13 January 2025 to 11 February 2025.
We carried out this assessment as a focused responsive inspection due to new and emerging risk using the Single Assessment Framework (SAF). We assessed 3 key questions; safe, effective and well led, and have combined the scores for these areas with scores from the last inspection to give the rating. We issued a Section 29A Warning Notice under the Health and Social Care Act 2008. Our rating of this location went down. We rated it Inadequate because:
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There was not a strong learning culture with a focus on learning from significant incidents. The service did not have enough medical staff. Consultant paediatricians did not lead at least 2 medical handovers every 24 hours. Not every child who was admitted to the paediatric department with an acute medical problem was seen by a consultant paediatrician within 14 hours of admission. Mandatory training compliance did not meet the trust target for safeguarding level 3. There were not sufficient staff trained in paediatric advanced life support in the hospital at all times. There was a lack of assurance of the quality of the external training, and whether those undertaking that training followed the same procedure/process in an advanced life support scenario. Children who required high dependency level care were transferred to adult intensive care if their condition deteriorated, and cared for by trained adult nurses, or supported by a paediatric nurse which depleted the nursing team on the ward. The service was not always able to control potential risks in the care environment due to an ageing estate. Child protection medical assessments were not being completed by a consultant paediatrician with child protection experience and skills.
However, staff kept clear and up to date records of children and young people's care and treatment. Records were stored securely and easily available to all staff providing care. The service had 24-hour access to mental health liaison and specialist mental health support The service had enough suitable equipment to help them to safely care for children and young people and carried out daily safety checks of specialist equipment. The risk of infection was assessed and managed. The service made sure medicines and treatments were safe and met people's needs, capacities and preferences.
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The service did not always tell children and young people about their rights around consent and did not always respect their rights when delivering care and treatment. Records showed a lack of understanding of the Mental Capacity Act, Mental Health Act, restraint and consent. Staff were not confident and lacked demonstrable legal compliance knowledge. There was a risk children and young people stayed in hospital longer than they needed to as there was not always a second consultant led handover in 24 hours to facilitate discharge planning.
However, the service routinely monitored care and treatment to improve it and participated in relevant national and local clinical audits to review its effectiveness. The service made sure children and young people's care and treatment was effective, by assessing, reviewing and planning their health, care, wellbeing and communication needs with them. The service worked well across teams and services to support children and young people.
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Governance systems were not operating effectively to ensure risk and performance issues were addressed with timely action. The issues identified in the safe key question had been recognised by the trust but agreed actions to address these issues and mitigate the risk to patients had not been timely to drive improvement in the quality and safety of the services provided. There was a level of resentment felt by some medical staff. Some staff told us the key leadership roles had been appointed and therefore felt new ways of working had been imposed upon them. There was not a culture of continuous improvement. Some staff told us they perceived a culture of individual blame. There was no clear oversight of paediatric life support training compliance overall as the trust did not have a system to record external training. This was something the trust was working on.
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However, the service aimed to work together with the local children and adolescence mental health service to create an integrated and inclusive paediatric service that delivered holistic care. There was a direction and vision for the service, with long term strategic aims. Some staff felt supported, respected and valued, and were positive and proud to work in the service.
The service was previously in breach of the legal regulations in relation to mandatory training and safeguarding service users from abuse and improper treatment. Improvements were not found at this assessment, and the service remained in breach of these regulations.
The service was also in breach of the legal regulations in relation to, staffing, need for consent, premises and equipment and good governance.
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In instances where CQC has decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been included.
We have asked the provider for an action plan in response to the concerns found at this assessment.
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