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Provider: Alder Hey Children's NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 8 July 2020

Our rating of the trust stayed the same. We rated it as good because:

  • We rated effective, responsive and well-led as good. We rated caring as outstanding and safe as requires improvement.
  • We rated all seven services we inspected as good. This included improvements in the overall rating in three core services. In rating the trust, we took into account the current ratings of the five services not inspected this time.
  • Across the trust we found that children had good outcomes because they received effective care and treatment that met their needs.

  • We found that children’s’ needs were met through the way services were organised and delivered.

  • We saw evidence that people were truly respected and valued as individuals and were empowered as partners in their care.

  • We noted improvement in the leadership and culture, which were used to drive and improve the delivery of high-quality person-centred care.

However:

  • Although we found the trust’s services largely performed well, it did not meet some legal requirements relating to the safe domain, meaning we could not give it a rating higher than requires improvement in this domain.
  • We found some risks which had not been identified by the trust’s internal governance structure. We escalated this to the trust at the time of the inspection, who took appropriate action.
Inspection areas

Safe

Requires improvement

Updated 8 July 2020

Our rating of safe stayed the same. We rated it as requires improvement because:

  • We found issues in core services that are reported under the safe domain that resulted in a breach of our regulations by the provider.
  • We had concerns that some risks that could affect groups of patients in an area/ all patients were not consistently risk assessed and appropriately mitigated. We addressed these issues with the trust at the time of the inspection. They took immediate action to mitigate the risks. Fridge temperatures were not always recorded daily, and the forms used did not prompt staff to record the minimum and maximum temperatures, so we could not be sure that the fridges’ correct temperature was always maintained. There was no algorithm or escalation instructions in place if the temperature went out of range.

However:

  • Staff understood how to protect children from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • The service controlled infection risk well. The service used systems to identify and prevent surgical site infections. Staff used equipment and control measures to protect children, themselves and others from infection. They kept equipment and the premises visibly clean.
  • Across most services, the design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff generally managed clinical waste well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon children at risk of deterioration.

Effective

Good

Updated 8 July 2020

Our rating of effective stayed the same. We rated it as good because:

  • Staff across the trust provided care and treatment based on national guidance and best practice. Managers checked to make sure staff followed guidance.
  • Staff monitored the effectiveness of care and treatment. They used any findings to make improvements and achieved good outcomes for children.
  • Staff gave children enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • Staff assessed and monitored children regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave pain relief to ease pain.
  • Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit children and their families. They supported each other to provide good care.
  • Staff supported children and young people to make informed decisions about their care and treatment. They followed national guidance to gain consent. They knew how to support children and young people who lacked capacity to make their own decisions or were experiencing mental ill health.

However:

  • Staff told us that the trust did not carry out audits on consent. In some records we reviewed decision making relating to consent was not clear. We escalated this to the trust at the time of our inspection.

Caring

Outstanding

Updated 8 July 2020

Our rating of caring stayed the same. We rated it as outstanding because:

  • Children were respected and valued as individuals and were partners in their care. Staff were fully committed to working in partnership with people.
  • There was a person-centred culture within services and children’s’ needs were valued by staff. There was positive feedback from children and their relatives.
  • Staff continued to respond compassionately to help and support children.

Responsive

Good

Updated 8 July 2020

Our rating of responsive stayed the same. We rated it as good because:

  • The trust planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The trust was inclusive and took account of children’s’ individual needs and preferences. Staff made reasonable adjustments to help children access services. They coordinated care with other services and providers.
  • Most people could access the trust’s services when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge children were mainly in line with national standards.
  • It was easy for people to give feedback and raise concerns about care received. The trust’s services treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The services included children in the investigation of their complaint.

However:

  • The percentage of cancelled elective operations for non-clinical reasons at the trust was higher than the England average, however the service performance was comparable to other specialist children’s hospitals.
  • Did not attend rates were continually higher than the England average.
  • Across all core services we inspected we found that complaint responses were not provided in the timescales set out in the trust’s policy.

Well-led

Good

Updated 8 July 2020

Our rating of well-led stayed the same. We rated it as good because:

  • There was an experienced leadership team with the skills, abilities, and commitment to provide high-quality services. Managers recognised the training needs of staff at all levels and worked to provide development opportunities for the future of the organisation.
  • At inspection we found that there was a clear vision set out for the trust, describing where the organisation will be in four years’ time, which was closely linked with the Health and Care Partnership for Cheshire and Merseyside based on PLACE based care. The vision and values were at the heart of all the work within the organisation
  • The trust’s strategy was directly linked to the vision and values. The trust involved clinicians, children and groups from the local community in the development of the strategy and from this had a clear plan to provide high-quality care with financial stability.
  • All staff we spoke with during the inspection were passionate about what they did and proud about the work they completed. Leaders had a shared purpose and wanted staff to deliver and succeed at providing the best care for children.
  • The trust had a clear structure for overseeing performance, quality and most risks. The trust’s devolved governance structure gave them greater oversight of issues facing the services.
  • Managers and staff shared holistic information on service quality and sustainability. This embraced information technology and consisted of a range of sources of information including monthly reports, dashboards, staff and children’s experience.
  • The leadership team worked well with the divisional leads and encouraged divisions to share learning across the trust. Services were developed with the full participation of those who use them, staff and external partners as equal partners.
  • The trust’s staff were committed to continuously engaging commissioners, service users and staff to both hold them to account against delivery of their priority areas and to help them identify new areas for each year of the strategy.
  • The trust actively sought to participate in national improvement and innovation projects. Senior staff told us and we saw evidence that innovation was a strategic objective within the trust’s strategic plan.
  • The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training and research. The trust had recruited the highest number of children and young people to research studies (over 44,000 since the inception of the National Institute for Health Research (NIHR) Clinical Research Network (CRN)).

However:

  • We found risks within divisions that had not been appropriately mitigated. These had not been identified by the trust’s internal systems and processes. We escalated these to the trust at the time of our inspection and these issues were immediately addressed.

Checks on specific services

Child and adolescent mental health wards

Good

Updated 8 July 2020

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

  • The service provided safe care. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the children and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward team included or had access to the full range of specialists required to meet the needs of children on the wards. Managers ensured that these staff received training and appraisals. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
  • Staff treated children with compassion and kindness, respected their privacy and dignity, and understood the individual needs of each child. They actively involved children, families and carers in care decisions. Consideration was given to children‘s care after they were discharged and the service offered extensive support to carers to ensure they could support children after discharge from the service.
  • Staff planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service was well led, leaders had the skills knowledge and experience to perform their roles, staff felt respected and valued and performance and risks were managed well.

However:

  • The ward environment was not well maintained. There were a number of maintenance jobs that had not been completed. There were infection control risks on the ward that had not been identified. We found equipment that was out of date. Checks on equipment were not up to date. Cleaning records were poor and did not provide assurances of regular cleaning and clean stickers were not in use.
  • There were no personal emergency evacuation plans to provide guidance to staff around the evacuation of individual children. We raised this and personal emergency evacuation plans were put in place by the second day of our inspection.
  • Clinical supervision levels were low at 54%, staff received other methods of supervision but these were not always recorded and it was not clear whether staff were receiving the level of supervision they needed.

Specialist community mental health services for children and young people

Good

Updated 8 July 2020

Our rating of this service improved. We rated it as good because:

  • The service provided safe care. Clinical premises where children and young people were seen were safe and clean. The number of children and young people on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each child the time they needed. Staff managed waiting lists well to ensure that children and young people who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of children and young people. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of children and young people. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
  • Staff treated children and young people with compassion and kindness, respected their privacy and dignity, and understood the individual needs. They actively involved children, young people and families and carers in care decisions.
  • The service was easy to access. Staff assessed and treated children and young people who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
  • The service was well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly.

Community health services for children, young people and families

Good

Updated 21 June 2018

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

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