Chief Inspector of Hospitals rates Alder Hey Children’s NHS Foundation Trust as Good following ‘significant improvements’

England's Chief Inspector of Hospitals has found ‘significant improvements’ at Alder Hey Children’s NHS Foundation Trust and has rated services provided by the trust as Good after a follow up inspection by the Care Quality Commission.

Alder Hey Children’s NHS Foundation Trust was rated as Good overall. The trust was rated as Outstanding for providing services that were caring, and Good for providing services that were safe, effective responsive and well led

Alder Hey Hospital was rated as Good overall. The trust’s inpatient Child and Adolescent Mental Health Services (CAMHS) received a rating of Good. CAMHS in the community were rated as Requires Improvement.

During the inspection in June 2015 the team of inspectors and specialists including doctors, nurses, managers and experts by experience visited Alder Hey Hospital, and community based CAMHS provided by the trust. The inspection was carried out in order to follow up on concerns that had been highlighted during a previous trust wide inspection in May 2014 including a shortage of nurses, a lack of senior doctors on the high dependency unit, and long waiting times for outpatients. Visiting inspectors looked specifically at critical care, outpatients and diagnostic imaging services and services for young people transitioning to adult services. They also looked at the safety of medical care and surgery.

Full reports on the services that were reviewed as part of the inspection are available on this website.

Alder Hey Children’s NHS Foundation Trust is one of four dedicated children’s hospital trusts in the UK. It provides integrated healthcare for children and young people from the local population in Liverpool and the surrounding North West area, as well as specialised services to children and young people nationally. The trust cares for around 270,000 children, young people and their families.

Inspectors found that the trust had responded positively to the findings of CQC’s previous inspection and significant improvements had been made in a number of areas. In particular, the trust had worked hard to recruit over 80 new nursing staff and remained active in securing additional nurses on an ongoing basis. Medical support for the High Dependency Unit (HDU) had also improved as the trust had taken action to address the previous lack of senior doctors within the unit.

Inspectors observed that the trust’s senior team was providing clear leadership to its staff and the culture of the organisation was positive across all services. Staff morale and engagement had improved and staff felt included in plans for the transfer of services to a new purpose built hospital in early October.

Inspectors found that the trust had improved its systems to make sure that patients’ medical records in the outpatient department were available when needed. Also, the trust had improved its arrangements for when children and young people move between services for their care, including how it works with other providers and commissioners.

The trust’s CAMHS were good overall with caring rated as Outstanding. The care being provided was centred on the child and delivered safely and effectively. However, staff vacancies within the trust’s community CAMHS meant that staff were carrying high caseloads and patients could experience delays following referral to the service. This is an area that CQC has asked the trust to remedy.

Also, in the trust’s outpatient and diagnostic imaging departments, inspectors found that the recording of risks in some departments was not up to date and staff told inspectors that lessons learnt from the investigation of reported incidents were not always shared to prevent recurrence. However, inspectors noted that the trust had undertaken a great deal of activity to improve its wider risk management arrangements. This had included seeking the help of an external risk management consultant and implementing actions in response to internal audits to ensure better outcomes for patients. Inspectors found that although the outpatient department had improved overall, there were still elements of patient information that could be improved in terms of availability of information in different languages and format for patients and families whose first language was not English.

Patients received care and treatment in a clean environment and staff followed good practice guidance in relation to the control and prevention of infection, although hand hygiene practice and the completion of cleaning schedules required improvement in the outpatients and diagnostic departments.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“The trust has made significant improvements across the board and staff should be proud of what they have achieved. We saw that staff across the organisation were passionate about their work and committed to delivering and securing the best for the children and young people they cared for.

“We were particularly impressed by the work undertaken to improve transitional services for young people. The benefits to patients were clearly evident with young people being well supported to access appropriate services as they moved in to adulthood.

“The compassion and care shown by staff was outstanding, particularly in critical care and inpatient child and adolescent mental health services and the trust’s senior team had made good progress in developing an integrated organisation with staff working better together across teams.

“We did, however, also see some areas where the trust needed to make improvements. The trust has told us they have listened to our inspectors’ findings and we are confident that the executive team, with the support of their staff, will work to deliver these improvements on behalf of all of their patients. We will return in due course to check on the progress that they have made.”

The inspection found some areas where the trust must make improvements, including:

• The trust must ensure that departmental risk registers are kept up to date and reviewed appropriately.
• The trust must improve its risk management processes in the outpatient and diagnostic imaging departments at Alder Hey Hospital and provide appropriate training for those delegated to manage risk.
• The trust must take action to improve the overall waiting time from referral to assessment in community CAMHS and ensure that there are effective systems in place to monitor the risk of people waiting to be seen.
• The trust must ensure that learning from incidents and complaints is shared with staff to prevent recurrent issues.
• The trust must ensure that correct hand hygiene measures are in place and that people are aware of and using the correct techniques.

The reports which CQC publish today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.

On Tuesday 22 December 2015 the Care Quality Commission presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.

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