- Inspectors visited in October after receiving “concerning information from members of the public and staff”
- CQC finds services had been working under pressure “apparently with no end in sight”
- But trust has made improvements since inspection and services rated “good” for caring
Children’s and young people’s services at a major acute trust have been rated “inadequate” after concerns from staff prompted the Care Quality Commission to carry out an unannounced inspection.
The CQC visited Queen Elizabeth, the Queen Mother, Hospital in Thanet and the William Harvey Hospital in Ashford, both run by East Kent Hospitals University Foundation Trust, in October after receiving “concerning information from members of the public and staff” about the emergency departments and children’s inpatient wards.
The children’s services were rated “inadequate” for being safe and well led, although were rated “good” for caring. The CQC also used its enforcement powers to impose conditions of the trust’s registration requiring regular reporting on staffing and other matters (see box below).
The CQC’s deputy chief inspector of hospitals Nigel Acheson said the services had been working under pressure “apparently with no end in sight”. But he added the trust had made significant improvements since the inspection and the conditions could be removed soon.
Among the CQC’s major concerns were:
- “Inconsistent and incomplete data” meant the board was falsely assured about the safety of the care provided. The inspectors saw incidents – including one where a sick child was “lost” to electronic tracking after booking in – which should have been reported and were not;
- Children’s needs were not always being met because staff were stretched beyond capacity and staffing did not meet national recommended standards. At both sites, children were sometimes left waiting too long for treatment and had to wait in adult areas at night. This potentially exposed them to volatile behaviour and “inappropriate television programmes”;
- Some staff at QEQM said they were not listened to and reported bullying;
- Paediatric early warning scores were not always used effectively and children at risk of deterioration were not always recognised or monitored appropriately. Children with a high PEWS score were not being properly assessed as at risk of sepsis. Many guidelines were out of date and staff had not been told how to access updated ones;
- Children who were potentially infectious were not always isolated. Medicines management and control was poor, equipment was not always clean or adequately marked as such, and it was not clear that resuscitation equipment was always fit for purpose and ready for use;
- Inspectors saw receptionists being offhand with parents and one tell a mother she was lying. Senior staff used “unfavourable stereotypes” when discussing parents, and senior and operational staff argued in front of the inspectors about the correct pathway for children moving through the department;
- There was a lack of suitable accommodation for children and young people with mental health problems and staff did not have sufficient training in dealing with mental health crises; and
- The trust did not have a clear vision or strategy for the services, and did not identify or adequately react to issues which threatened the delivery of safe and effective care.
Trust chief executive Susan Acott said: “We immediately addressed concerns raised by the CQC that are highlighted in [the] 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.”
The trust was taken out of quality special measures in 2017. A CQC inspection last May rated the provider as “requires improvement” overall, and identified some concerns about paediatric care but did not look at young people’s services as a separate core service at that point. The trusts overall rating has not been affected by this more recent inspection.
The trust provides children’s services at other sites but does not have inpatient beds at these. These sites, along with clinics and community services, were not inspected.
CQC enforcement powers
The CQC used its enforcement powers to require the trust to provide:
• Weekly reports with numbers of paediatric staff, patients under the age of 18, and any incidents reported by the child health division;
• Reports every four weeks giving audit figures for paediatric early warning scores, medicines, use of resuscitation trolleys, and sepsis. The reports must show how clinical outcomes are being audited, monitored and acted upon;
• Fortnightly reports on current risks on the child health division risk register; and
• Reports every four weeks on the current training rates for all staff who provide care and treatment to patients under the age of 18.
In addition, the trust was told it must not use adult trolleys for patients under the age of 18 unless a risk assessment has been undertaken and documented to minimise any risk of harm.