The Children's e-Hospital

Updated 28 November 2019

The Children’s e-Hospital is a digital service which operates from Prospect House, High Street, Bramham, Wetherby LS23 6QQ. The service was founded in 2015 and registered with CQC in August 2018, to deliver the regulated activity of treatment of disease, disorder or injury.

The service predominantly provides remote clinical advice and support to parents of children from birth to 18 years, who have a paediatric medical condition. Parents can access the service by telephoning or emailing using details provided on the website Appointments can also be booked via the website or by speaking with the patient coordinator.

Support and advice are provided particularly for the parents of children who experience Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) and Paediatric Autoimmune Neuropsychiatric Syndrome (PANS).

PANDAS is a condition with symptoms such as tics, obsessive compulsive disorder (OCD), deterioration in handwriting, eating disorders and behaviour regression, which are exacerbated or brought on by a common bacterial infection called Group A streptococcus. PANS is a clinical syndrome which may be caused by non-infectious or infectious triggers. Symptoms can appear suddenly with a rapid shift in a child’s behaviour relating to OCD or severely restricted food intake and can include anxiety, aggression, sensory or motor abnormalities, sleep disturbance or incontinence.

In addition, the service provides information and support for parents of children who have a cow’s milk protein allergy. Via the service website, parents can access information regarding a range of childhood conditions, such as eczema, colic, bedwetting, seizures, self-harm and provides first aid advice.

The clinical director provides the service and is supported by the patient treatment coordinator. The provider also contracts the services of an additional consultant paediatrician and allergy specialist and other paediatric health professionals. To support governance, development and delivery of the service, there is a Medical Advisory Group (MAG), a parents’ steering group and a board of trustees. The consultant paediatrician has close working links with other paediatric clinicians, the UK PANDAS Physicians Network and PANS PANDAS UK.

How we inspected this service

Before the inspection, we reviewed information from the provider, their website and other information received by CQC.

On the 19 September we visited the premises at Prospect House, High Street, Bramham, Wetherby LS23 6QQ, where the online service is operated from. On the 24 September we visited the premises at 10 Harley Street, London W1G 9PF, where face-to-face consultations were commencing that same day.

During the inspection we reviewed documents and observed both environments from where the service was delivered. We also spoke with the registered manager/clinical director and the parent of a child with PANDAS.

To get to the heart of patients’ experiences of care and treatment, we ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

Updated 28 November 2019

We carried out an announced comprehensive inspection at The Children’s e-Hospital on the 19 and 24 September 2019, as part of our inspection programme to rate independent health providers. We carried out this inspection under Section 60 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014, as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations.

The Children’s e-Hospital is a digital service which provides advice for parents along with care and treatment for children aged from birth to 18 years who have a paediatric medical condition; particularly for the parents of children who experience Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) and Paediatric Autoimmune Neuropsychiatric Syndrome (PANS). The service is accessible via the website. Video consultations are available for parents and their children with either a consultant paediatrician or a paediatric dietician as appropriate. At the time of our inspection, the service was commencing face-to-face consultations with the consultant paediatrician, as an alternative option for parents. We visited the location where video consultations are carried out and the location where face-to-face consultations were going to be undertaken as an additional part of service provision.

The clinical director is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, about how the service is run.

At this inspection our key findings across all the areas we inspected were as follows:

• There were clearly defined and embedded systems and processes in place to support safeguarding and risk management.
• Medicines were prescribed in line with appropriate guidance and evidence-based practice.
• Parents of the children who accessed the service were provided with information to support the delivery of safe care and treatment.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Parents and children were supported and treated with dignity and respect and involved as partners in their care.
• Satisfaction rates from parents was consistently high.
• The leadership, governance and culture of the service were used to drive and improve delivery of high-quality, person-centre care.
• There was evidence of strong collaboration with other colleagues, agencies and service users to improve services for children and their parents.
• There was a strong focus on continuous learning and improvement.
• The service was committed to finding innovative ways and improvements to deliver care, treatment and support for parents, whilst also raising awareness with other health care professionals, including GPs.

We saw areas of outstanding practice:

• The provider had used their knowledge, skills and experience to develop the service, in order to meet the individual needs of patients due to a perceived lack of service provision relating to PANDAS and PANS.
• Patients, via the Parent Steering Group, were pivotal in the development of the service.
• The service worked with other organisations to develop national pathways relating to PANDAS and PANS.
• There was compassionate, inclusive and effective leadership, with the clinical director demonstrating the high levels of experience, capacity and capability needed to deliver excellent and sustainable care.
• The service invested in innovative and best practice information to support service delivery and raise awareness in other clinicians and health care agencies.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care