East Kent Hospitals has made significant changes to hospital care following CQC inspection

13 February 2019

East Kent Hospitals has made significant changes to hospital care for children and young people and has begun an intensive 12-month improvement programme following an inspection in October 2018 of children’s services at William Harvey Hospital, Ashford, and Queen Elizabeth The Queen Mother Hospital, Margate, by the Care Quality Commission (CQC).

The Trust has taken immediate and thorough action to ensure hospital services are safe and responsive to the needs of children and young people. These actions include:

• Increasing staffing levels for children’s services
• Implementing a new, daily safety checklist across all hospital areas caring for children and young people
• Re-training staff.

It has also begun a 12-month intensive improvement programme for children’s services.

“Staff have worked quickly and thoroughly over the last three months, changing everyday working practices and how services are managed to make hospital services for children and young people safe and respond to the CQC’s feedback,” said Trust Chief Executive Susan Acott.

“We immediately addressed concerns raised by the CQC that are highlighted in today’s report, including recruiting more specialist children’s staff, implementing a thorough regime of daily safety checks and improving the environment children are cared for within, particularly in our emergency departments.

“The CQC has announced today that it is assured we have already made significant improvements.

“The CQC has recognised that our staff are caring and compassionate, and we know, from the way staff have transformed the quality of our maternity services, for example, that we can achieve quick and sustainable staff-led change here in East Kent Hospitals, and that’s exactly what we intend to do over the next 12 months for children’s and young people’s hospital services.”

Sarah Vaux, Chief Nurse of the East Kent Clinical Commissioning Groups, agreed: “Last week we sent a team to visit the services that the CQC inspected and to see the changes that have been made. We were pleased to see improvements within all the areas of children and young people’s services highlighted by the CQC. Staff talked about the improvements they had made to date and plans for further and continued improvements for families.”

In October, the Trust restructured from four, large clinical divisions into seven smaller care groups, led by clinicians not managers. It is addressing the governance issues raised in the CQC’s report, to ensure risks are recognised and responded to quickly and appropriately, and they are reported to the Trust’s Board of Directors consistently.

The CQC’s findings

The CQC inspected services for children and young people provided at the William Harvey Hospital, Ashford, and Queen Elizabeth The Queen Mother Hospital, Margate, on 23, 24 and 25 October 2018. These services include the children’s ward at each hospital, the emergency departments and operating theatres. In its report, the CQC rated children’s services ‘good’ for caring, but the overall rating for children’s services in the two hospitals is ‘inadequate’. The Trust is currently reporting its progress and its compliance in staffing and safety standards to the CQC weekly.

The CQC also inspected the Neonatal Intensive Care Unit at Ashford, and the special care baby units at both hospitals where they reported staff were very caring and supportive.

“In its report, the CQC recognises the consistently high numbers of families who would recommend the care they have received at our hospitals to friends and family,” said Susan. In our latest satisfaction survey (November 2018), 100% would recommend our children’s wards to friends or family.

“On behalf of the Trust Board, I would like to thank all the children’s teams who work hard to provide this level of caring service to patients and their families,” said Susan.

“I would also like to praise the hard work of the teams behind the examples of good practice the CQC noted in its report, including the innovative system for identifying children with learning disabilities, staff understanding of their safeguarding responsibilities, how well staff interact with babies and keep them calm, and the caring practice of providing special child bereavement memory boxes for families in the emergency department, purchased by our hospital charity.   

“Every child deserves excellent care in hospital, and we are committed to transforming services for all children, young people and their families.”

Action the Trust has taken

Immediate measures the Trust has taken to ensure hospital services are safe and responsive to the needs of children and young people include:

Increased staffing levels

We have improved staffing levels in our emergency departments for children’s services at both hospitals to ensure services are safe and children and young people are well-cared for. We have filled a number of vacant posts in both hospitals since the date of inspection, including four children’s nurses, two emergency department children’s nurses, one neonatal nursery nurse, two doctors and two child safeguarding practitioners.

Two more children’s nurses are joining the children’s ward at William Harvey Hospital shortly.  The Trust is reviewing the total number of staff allocated to each ward.

We now have children’s nurses in our two emergency departments 24/7, which means children and young people attending our emergency departments are cared for by nurses who are expert in these patients’ needs.

Thorough new, daily safety checks

We have implemented a new daily safety checklist across all hospital areas caring for children and young people, including the emergency departments. This gives full assurance that thorough checks are carried out every day on the fundamentals of care, including medicines storage, cleanliness of equipment and safe medical and nursing staffing. The outcomes of the daily checks are discussed at daily staff ‘safety huddles’ on the wards and clinical departments, and action taken. They are also reported to the chief nurse daily. 

Staff re-trained on early signs of deterioration

We have updated our guidelines for staff on how to monitor sick children to recognise the early signs of a child becoming more unwell. We are re-training all children’s nurses on the children’s wards, operating theatres and emergency departments using these updated guidelines and new staff undertake this training when they begin work at the Trust, too.  

While there have been no serious incidents at the hospitals relating to the identification or care of a deteriorating child, the revised guidance and re-training will ensure every member of staff caring for sick children follows the same national procedures and standards.

Improved emergency department care for children and young people

In our emergency departments, we now have 24/7 children’s nurses, so children and young people can be assessed and wait in dedicated children’s areas.

Senior doctors and nurses are reviewing the way children and young people are assessed, diagnosed and treated in the emergency departments, to cut down the time children need to wait.

We are looking at how we can provide an isolation area for children with communicable diseases, eg, chicken pox, in the children’s emergency department at Margate.

Ensuring risks are recognised and responded to quickly and appropriately

In October, we restructured the Trust from four, large clinical divisions into seven smaller, care groups, led by clinicians not managers. Each care group now meets monthly with the Chief Operating Officer, Chief Nurse and Medical Director to review quality, risk and governance within their services. The monthly reports then go to the Board of Directors’ Quality Committee every month for scrutiny by Board members, including Non-executive Directors. The Quality Committee reports to the Board in public monthly.

This restructure and reporting framework brings a new level of clinical assurance to the Board on the quality, risks and governance of services.

In addition, the Trust is taking longer-term measures to improve services as part of a 12-month transformation plan, including:

Improving hospital services for children and young people with mental health needs

We are mapping our current practice against best practice standards, so we can take the right actions to improve how we assess and care for children and young people who are brought to our hospitals to wait for the mental health crisis service. Over the next 12 months we will focus on further mental health training for staff caring for these patients, and we are also assessing how we can provide a more appropriate environment for these patients to wait in to give them more privacy.

Under the NHS Long Term Plan, the NHS in England is making a commitment to invest in expanding access to community-based mental health services to meet the needs of more children and young people, and ensure children and young people experiencing a mental health crisis will be able to access the support they need.

Making our hospitals more child-friendly

We are investing £250K this financial year to redesign and redecorate Padua Ward – our oldest children’s ward - at William Harvey Hospital. This will create a ward environment and layout more suitable for children’s care, and provide more privacy for children on the assessment unit.

We are changing how we organise planned operations so children do not have to fast before their procedure for longer than absolutely necessary, and making sure children have the choice of wearing their own PJs or an operating gown on their way to the operating theatre. These are examples of small but important ways in which we can organise our services around the needs of each child.  

Working with staff to transform the culture of children’s services

This month, we begin a 12-month intensive improvement programme to foster a culture of excellence and best practice within the hospital children’s and young people’s services. This programme is based on our successful BESTT programme (Birthing Excellence Success Through Teamwork), which saw rapid, radical, staff-led change in our maternity service.  In its 2018 report on the Trust, the CQC commented that “it was notable that the maternity department had made great strides to drive learning, improve patient outcomes and inspire innovation” and cited a number of examples of outstanding practice.