Alder Hey Children's Hospital

Updated 19 April 2021

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

• We rated effective, responsive and well-led as good. We rated caring as outstanding. We rated safe as requires improvement.
• We rated the five hospital core services we inspected overall as good at this inspection. We improved the overall rating of outpatients and surgery at this inspection.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• Patients were supported, treated with dignity and respect, and were involved as partners in their care.
• Across most services, patients’ needs were met through the way services were organised and delivered.
• The leadership, governance and culture promoted the delivery of high-quality person-centred care.

However:

• Although we found the hospital’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 that across most areas, people were protected from avoidable harm and abuse.

Updated 21 June 2018

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

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

Updated 21 June 2018

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

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

Updated 8 July 2020

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

• The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, attended to nutrition and hydration needs appropriately, and gave them anticipatory pain relief when they needed it. Managers made sure staff were competent. Staff worked well together for the benefit of children and young people, supported them to make decisions about their care, and had access to good information.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
• The service planned care to meet the needs of local people, took account of children and young people’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children and young people and the community to plan and manage services and all staff were committed to improving services continually.

However:

• At the time of inspection, the substantive palliative care consultant was absent, therefore; there was no set on-call rota in place.

Updated 5 October 2017

• There was a positive culture of incident reporting at ward level and there was evidence of learning and changes in practice following incidents. Staff felt supported by their immediate team colleagues and by senior managers.

• Staffing levels and skill mix was planned, implemented, and reviewed to keep children and young people safe.

• Consultants took part in a ‘Consultant of the week’ rota and were present in the hospital during times of peak activity.

• Age dependent pain assessment tools were in use and analgesia was available to children who required it.

• The environment was suitable and welcoming to meet the needs of children and young people and their parents and carers. Services were planned and delivered to meet the needs of local area, the North West of England, North Wales and the Isle of Man.

• We found consent to treatment was clearly recorded in the records we reviewed. We observed staff interacting with patients and their relatives with kindness, dignity and respect. Parents and patients told us they were included in decisions about their care and were kept well informed. The patients and parents we spoke with were extremely positive about the care they received and one parent told us “the staff are like a family, we will miss them when the treatment finishes”.

• The trust had achieved 100% compliance with all cancer waiting times for the period April 2016 to March 2017 except for one month where they achieved 88%.

• There was a clear vision which was aligned with the trust vision to provide ‘a healthier future for children and young people’ which was underpinned by a set of values. We observed staff demonstrate the set of values when they were delivering care.

• There was a process in place to enable the performance, safety, and quality of the service to be reported and reviewed. Risk registers were held at ward and clinical business unit level with a process to escalate risks to keep children and young people free from harm.

Updated 8 July 2020

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

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse. The service controlled infection risk well. Staff assessed risks to patients and acted on them and kept care records securely. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients sufficient nutrition, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised their parents how to support them to lead healthier lives, supported families to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped their parents to understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for patients’ families to give feedback. Children could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The design of the premises did not maintain the security of children and their families at all times. The service had not minimalised potential security risks to babies due to the design or the premises and security systems used.
• The numbers of nurses with a recognised neonatal qualification was not in line with recognised standards.
• There were omissions in medical records.

Updated 8 July 2020

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

The trust’s outpatient’s department consists of services based within a new hospital building. The department includes clinical specialities including physiotherapy; phlebotomy; dental; occupational therapy; ear, nose and throat; fracture; cardiology; respiratory; cystic fibrosis; and ophthalmology. It also includes a general paediatric clinic.

The department has administrative functions such as medical records, transcription services, and booking and scheduling. These services are based within the old estate next to the new hospital.

We plan our inspections based on everything we know about services including whether they appear to be getting better or worse.

We inspected the outpatient department between 21 and 23 January 2020. Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity. As part of the inspection we reviewed information provided by the trust about staffing, training and monitoring of performance.

During the inspection the inspection team visited three floors of the outpatient department within the new building, and some of the administrative functions within the old estate. The inspection team spoke with 14 children and young people and carers who were using the service, and 32 staff members including managers, consultants, reception staff, play specialist, nurses, healthcare assistants and administrative staff. We reviewed 16 patient records.

Updated 8 July 2020

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

• The service had enough nursing, medical, theatre and support staff to keep children and young people safe and mandatory training levels were mostly achieved. Safeguarding processes were in place and staff knew how to recognise and report abuse. The service controlled infection risk well and kept the premises visibly clean. The design, maintenance and use of facilities, premises and equipment kept people safe. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed children and young people safety incidents well.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
• The service planned care to meet the needs of local people, took account of children and young people individual needs. The service made it easy for people to give feedback and investigated and learned from complaints. Waiting times from referral to treatment and arrangements to admit, treat and discharge children and young people were in line with national standards.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with staff and the patient community to plan and manage services and all staff were committed to improving services continually.

However:

• Agency staff induction was not always evidenced. Theatre staff did not always follow safety standards when conducting the count out. The checklist used in theatres was not compliant with ‘National Safety Standards for Invasive Procedures’ (NatSSIPs). Fridge temperatures were not always recorded or escalated appropriately. Some patient group directions (PGD) were past their review date. Staff did not have oversight of ward attenders on ward 4a.
• Staff did not always follow consent best practice following a capacity assessment. The service did not currently audit consent processes.
• Children were required to wait in the waiting room before their surgery in pyjamas or surgical gowns. This may not always respect their privacy or dignity.
• The service did not have enough play specialists to meet the need of all children and young people. The percentage of cancelled elective operations for non-clinical reasons at the trust was higher than the England average. The department was not meeting the trust target of 25 working days to investigate and close complaints.
• Staff felt there was not always opportunities provided for career development. Staff in day case area did not feel supported due to a recent organisational change.

Updated 23 December 2015

At our previous visit in May 2014 we found that transitional services required improvement. In June 2015, we returned to inspect the whole service. We saw that there had been significant improvements since our last inspection. We found that the trust had a co-ordinated trust wide strategy for planning and delivering transition services which supported young people. There were excellent examples of transition pathways for young people with specific long-term needs. There was a commitment from the trust to further develop existing partnerships with health and social care providers of adult services. Since our last inspection, the trust had appointed a designated transition nurse and named medical consultant. As a result, progress had been made in developing over-arching policies and procedures relating to transition arrangements for young people with complex needs. These were due to be formally rolled out across the trust shortly after our inspection. There was clear leadership, vision and a desire to use research and audit programmes to share good practice and identify gaps in transition and use this to improve outcomes for young people. There was evidence of patient, public and staff involvement in shaping policies and procedures related to transition.

Updated 8 July 2020

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

• The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good clinical care records. They managed most medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
• The service planned care to meet the needs of local people, took account of children and young people’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
• Leaders ran services well and supported staff to develop their skills. Staff understood the service’s vision and values. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children and young people and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The service did not have robust governance arrangements for risk assessments, stock control and toy cleaning schedules.
• Mandatory training compliance was below the trust target in some modules. In relation to nurse staffing, in five out of 11 modules the 90% target was not achieved. For medical staffing, the trust’s target was not achieved in seven out of eight modules.
• Waiting times from referral to treatment and arrangements to admit, treat and discharge children and young people were not always in line with national standards.