The Children's e-Hospital

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Children’s e-Hospital on 26 February 2019 as part of our inspection programme.

The Children’s e-Hospital is a digital service which provides advice, care and treatment to parents of children aged 0 to 18 years who have a paediatric medical condition. The service is accessible via the service website and video consultations are undertaken.    

The registered manager is Dr Baljinder (Tim) Ubhi. 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 2088 and associated Regulations about how the service is run. 

Our findings in relation to the key questions were as follows: 

Are services safe?  

We found that this service was providing safe care in accordance with the relevant regulations.

Specifically:

• Arrangements were in place to safeguard people, including arrangements to check patient identity.
• Prescribing was in line with national guidance.
• Risks were assessed and action taken to mitigate any risks identified.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations. Specifically:

• Patients were assessed in line with guidance. Treatment plans were individualised and developed using protocols.
• Following patient consultations, information was appropriately shared with the patient’s own GP in line with guidance.
• Information was available for parents to support the health and wellbeing of their child.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations. Specifically:

• Feedback from service users was extremely positive about the service and care they received.
• Parents were involved in decisions about their child’s care and treatment.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations. Specifically:

• The service had been established in recognition of a need for parental support with children who may be experiencing symptoms indicative of PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus) or PANS (Paediatric Autoimmune Neuropsychiatric Syndrome).
• Consent was obtained appropriately.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations. Specifically:

• The service had clear leadership and governance structures
• Patient information was held securely.

We saw an area of notable practice:

• The clinician provided unique specialist support to parents of children who experienced PANDAS and PANS, who had found difficulty in obtaining a diagnosis and accessing appropriate care and support for their child.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care