The Care Quality Commission (CQC) has found improvement is needed in the children and young people’s (CYP) services run by Kettering General Hospital NHS Foundation Trust, after an inspection in December sees their rating move down from requires improvement to inadequate.
CQC carried out an unannounced focused inspection after receiving information of concern regarding the safety and quality of CYP services at Kettering General Hospital. The inspection included the paediatric assessment unit (PAU), Skylark ward and the neonatal unit.
CQC also inspected the paediatric emergency department (PED) in urgent and emergency care (UEC) services.
As well as the service’s overall rating dropping, how safe and well-led they are, has declined from requires improvement to inadequate. How effective and responsive services are, were not reviewed at this inspection and remain rated as requires improvement. Also, caring was not included in this inspection and remains rated as good.
The rating overall for UEC services remains rated as requires improvement, it also remains requires improvement for being well-led. The rating for safe has dropped from requires improvement to inadequate. Being responsive and effective were not looked at during this inspection and remain rated as requires improvement. Caring was not reviewed at this inspection and remains rated as good.
Kettering General Hospital remains rated as requires improvement overall.
Due to concerns found at this inspection, CQC has taken enforcement action and served the trust with a warning notice regarding people’s safety and safeguarding issues. This requires them to make immediate improvements, and the trust has provided CQC with an action plan outlining how it intends to address the areas of concern outlined in the warning notice.
Charlotte Rudge, CQC deputy director of operations in the midlands, said:
“When we visited Kettering General Hospital, we found leaders understood the priorities and issues the services faced. However, some leadership roles were vacant impacting on the trust having effective oversight on the safety and quality of care people were receiving which was putting them at risk. These concerns resulted in CQC taking urgent action and issuing the trust with a warning notice to highlight areas where they must make immediate improvements.
“We found the trust had ineffective systems in place to assess and treat people at risk of sepsis. Staff didn’t ensure people received a timely assessment to determine if they were at risk of sepsis. Also, if they were at risk, they didn’t always receive treatment as quickly as they should have to help prevent them from coming to harm. We were informed of an incident where someone who developed sepsis hadn’t had a sepsis screen for over seven hours after arrival at the hospital which is totally unacceptable. Since the inspection, the trust has started to make changes to improve this.
“Inspectors found safety issues in both services we visited. The environment didn’t always keep people safe. For example, the layout of Skylark ward didn’t always support the safe management of people with mental health conditions or challenging behaviours. Most cubicles were close to each other, which meant it was easy for people to go in other people’s rooms and access equipment left lying around, which could put people at risk of harm.
“Also, there were concerns with the environment in the paediatric emergency department. The space wasn’t appropriate to manage the number of attendances, particularly at times of increased demand. For example, inspectors saw corridors and walkways full of children and parents or carers waiting to be seen. In an emergency, this could have impacted on staff not being able to effectively care for someone in urgent need of attention.
“Following the inspection, we reported our findings to the trust so its leaders know what urgent improvements must be made to keep people safe. We’ll inspect these services again to assess whether improvement have been made. If there’s insufficient progress or if people are at immediate risk of harm, we won’t hesitate to take further enforcement action.”
In services for children and young people (CYP), inspectors found:
- Not all staff had completed mandatory training including in the highest level of life support
- There was not enough nursing or medical staff, and they didn’t always effectively identify and quickly help people at risk of deterioration
- The service did not always control infection risk well
- The service did not always use systems and processes to safely prescribe, administer, record and store medicines
- Staff did not always feel respected, supported and valued. The service did not always have an open culture where people, their families and staff could raise concerns without fear
- Staff did not always have regular opportunities to meet, discuss and learn from the performance of the service. Leaders and teams did not use systems to manage performance effectively
- Risk assessments to continually identify ward based risks were not always effective. Actions to reduce the impact of risks were not always in place. The service did not always collect reliable data and analyse it.
However:
- Processes were in place to safely manage people requiring a higher level of care
- Plans were in place to cope with unexpected events. Data or notifications were consistently submitted to external organisations as required.
In urgent and emergency care (UEC) services inspectors found:
- The service did not always have enough nursing staff and support staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment
- The staffing levels and environment impacted staff ability to deliver high standards of care
- Medicines were not always administered on time
- Staff were not always clear about their roles and accountabilities. Leaders and staff did not always actively and openly engage with people and staff
- Processes to improve quality and performance were not yet embedded into the PED
- Staff did not always keep detailed records of people’s care and treatment. Also, records were not always clear or easily available to all staff.
However:
- The service had enough medical staff working specifically in the PED to keep people safe from avoidable harm and to provide the right care and treatment. Also, managers regularly reviewed staffing levels
- Managers investigated incidents and shared lessons learned with the whole team and the wider service.