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Alder Hey Children’s NHS Foundation Trust rated as Requires Improvement by Chief Inspector of Hospitals
England’s Chief Inspector of Hospitals has rated the services provided by Alder Hey Children’s NHS Foundation Trust as Requires Improvement overall following an inspection by the Care Quality Commission, although some services have been rated as Outstanding.
Alder Hey Children’s Hospital is run by one of four dedicated children’s hospital trusts in the UK. It provides integrated healthcare for children and young people from the local population in Liverpool and the surrounding North West area, as well as specialised services to children and young people nationally.
Under the new inspection model, CQC has given individual ratings to each of the core services at the hospital. Alder Hey’s palliative and end of life services were rated as Outstanding. Accident and emergency, surgery, medical care, and neonatal services, were rated as Good. Critical care, transitional services and outpatients were rated as Requires Improvement. The full report and ratings are available here.
An inspection team of 41 people which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts carried out an announced inspection in May.
Overall, CQC found that the services at Alder Hey Children’s Hospital were effective and caring, although safety, responsiveness and leadership were rated as Requires Improvement.
Inspectors found that services were delivered by hard-working, caring and compassionate staff, who were committed to providing children and young people with a service that met all their needs. Parents and carers were also treated sensitively and compassionately and supported emotionally and psychologically to cope with difficult and highly stressful situations.
But the wards were not always adequately staffed to meet the needs of children and young people, although beds were closed when possible to maintain safe staffing ratios. Initially, inspectors found that there not enough senior doctors available on the High Dependency Unit to ensure that all clinical risks were safely managed, although the trust took action to rectify this. Outpatients needed to improve its provision of records and reduce long waiting times for patients.
Among other areas of good practice found by inspectors:
- The medical division participated in research at local, national and international levels. The trust is the first Investing in Children accredited hospital in the UK.
- Alder Hey Children’s Hospital has a gait laboratory to assess walking for children with neuromuscular disorders, such as cerebral palsy, which is not available elsewhere in North West England.
- Trust physiotherapists have linked with the community physiotherapists to provide appropriate post-operative care and a trust audit demonstrated that this has translated into improved outcomes for children and young people.
- The surgical department received a significant research grant to coordinate a national trial aimed at reducing the rate of infection following operations for children with hydrocephalus (build-up of fluid on the brain). The results of this project will be used to produce good practice guidance to improve the care and treatment for children nationally and internationally.
CQC has told the trust that it must make improvements in a number of areas including:
- The trust must continue to address staffing shortfalls. Nurse staffing levels must also be appropriate in all areas, without substantive staff feeling obligated to work excessive hours or additional shifts.
- A longer-term solution must be found for the medical leadership on the High Dependency Unit
- Children and young people must receive one-to-one support in the isolation pods on the High Dependency Unit when required..
- Clinical records must be available in the outpatients department.
- Nurses must follow the trust’s policy on the safe administration of medicines.
- The trust must address the shortfalls in governance and risk management systems and Improve the timely completion of investigation of incidents and Never Events to learn from them systematically and avoid recurrence.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“I know that the Alder Hey Children’s NHS Foundation Trust is going through significant change. I am sure that the new children’s hospital which is currently being built will allow the trust to make a significant improvement to the overall experience of patients and their families.
“We came across numerous examples of staff going the extra mile to care for and treat children and young people in a highly personalised and sensitive way. Patients and relatives praised the staff for the commitment they showed to their work.
“However I am concerned that shortages of nurses in some departments may affect patient care. While there have been moves to improve the recruitment process, the trust must continue to make this a priority.
“Our judgement is that this is a good hospital in many ways – but the issues which we have identified are preventing it from achieving excellence. The trust has told us it is taking action – I hope and expect to return in due course to find that the problems have been addressed.”
CQC inspectors will return to the hospital in due course to check that the improvements required have been made.
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- Last updated:
- 30 May 2017
Notes to editors
The Chief Inspector of Hospitals, Professor Sir Mike Richards, leads significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. By the end of 2015, CQC will have inspected all acute NHS Trusts in the country with its new inspection model. Whenever CQC inspects it will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?
The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.
This report describes our judgement of the overall quality of care provided by this trust. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations.
The overall trust, individual hospitals and individual services within those hospitals have been given one of the following ratings (on a four point scale): Outstanding, Good, Requires Improvement, or Inadequate.