Chief Inspector of Hospitals rates Great Ormond Street Hospital for Children NHS Foundation Trust as Good

The Chief Inspector of Hospitals has rated Great Ormond Street Hospital for Children NHS Foundation Trust as Good following an inspection by the Care Quality Commission (CQC).

Great Ormond Street Hospital for Children NHS Foundation Trust is one of four dedicated children's hospital trusts within the UK, and is the largest paediatric centre in the UK for intensive care, cardiac surgery, neurosurgery, cancer services, nephrology and renal transplants.

A team of inspectors which included specialist advisors and experts by experience visited the trust over a period of several days during April and May 2015. Inspectors rated Great Ormond Street Hospital for Children NHS Foundation Trust as Outstanding for providing effective and caring services, Good for providing safe treatment and Requires Improvement for providing responsive and well-led services.

The inspectors visited trust core services, including medical care, child and adolescent mental health services, surgery, diagnostic imaging, transitional services, outpatients and end of life care.

Since the inspection, the trust alerted the CQC team to problems regarding the reliability of their patient information systems. The publication of the CQC report during summer 2015 was therefore delayed while the trust undertook an assessment of the impact upon patients. A thorough investigation has been completed and the CQC team is satisfied that the necessary action to address this issue has now been taken.

Full reports for the inspection have been published on the CQC website.

CQC inspectors observed an open and transparent trust culture, with a trust wide approach in place across day and night services to ensure continuous treatment of sick children, 24 hours a day, seven days a week. Parents and children were kept fully informed about their treatment, with children and young people involved in decisions about their care as much as possible.

Staff worked well together in the pursuit of excellent care, which was in evidence across many departments. The thorough reporting of incidents was fully embraced by all members of staff; and all incidents were investigated with opportunities for learning shared across the trust.

Several trust departments had completed refurbishments or rebuilds, resulting in facilities that were modern, child friendly and promoted excellent patient care and patient dignity. Although some wards had not yet been refurbished, the trust recognised that the environment needed improving and work was ongoing at the time of the inspection.

End of life care was embedded in all clinical areas of the trust and was not seen as the sole responsibility of the palliative care team.

However, the trust reported a large backlog of patients waiting for more than 18 weeks for surgery. In response to the issue, a number of initiatives had been put in place to help reduce waiting times including scheduling of extra clinics and surgical intake had been staggered to four times a day in order to reduce delays to patients.

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

“Since our inspection, the trust alerted us to problems regarding the reliability of their patient information systems, which had the potential to affect patients waiting for non-emergency treatment but whom required high-levels of care due to a likelihood of complications. The trust completed an investigation in order to determine the impact upon patients, and we are satisfied that the necessary action to address this issue has now been taken.

“During our inspection, we saw a culture of providing excellent care with compassion and commitment from all staff throughout Great Ormond Street Hospital, which was fully appreciated by patients, their families and carers. The children and young people we met were extremely positive about the treatment they received and parents told us they were very happy with the standards of care provided by trust staff.

“Staff demonstrated a strong practical grasp of the Duty of Candour. In the event of things going wrong, staff were very open, expressed full apologies when that was appropriate and offered full support to parents, children and carers.

“End of life and palliative care was of a particularly high standard. The team were passionate about continually improving the service, and provided training programmes for nurses and GPs from hospitals and surgeries around London.

“Although we found many examples of compassionate care the trust has recently identified a large backlog of patients waiting too long for surgery. I know that the trust has introduced initiatives to tackle this. I am confident that the trust will give this the priority it deserves.”

Inspectors observed several areas of outstanding practice, including:

• Clinicians from various services delivered specialist training on physical health issues for child and adolescent mental health service (CAMHS) staff. In return CAMHS staff provided training and expertise to other departments, including treatment for patients with learning disabilities and autism. The trust had developed a pocket-sized guide to help all staff providing care to children with learning disabilities.
• As one of the UK’s specialist hospitals for children, the trust is developing ground breaking guidance to share with clinical colleagues within the wider medical community.
• The Feeding and Eating Disorders Service received 100 per cent approval in the latest Friends and Family test with 93% of people saying they were extremely likely to recommend the service.
• CAMHS introduced a screening tool for mental health problems and the psychological medicine team conducted a study to improve the understanding of the patient experience, diagnosis, treatment and outcomes regarding non-epileptic seizures in children.
• The critical care department conducted excellent mortality and morbidity meetings, with robust safety monitoring processes in place for all patients.
• The pharmacy services team provided monthly reports of prescribing errors; daily checks and screenings of all electronic prescriptions and text messages for patients when prescriptions were available for collection.

The inspection identified a number of areas for improvement including:

• The trust must ensure that there are clear arrangements for reporting transitional care service performance to the board.
• Ensure that referral to treatment (RTT) data and processes are robust and that staff comply with the trust's patient access policy in all cases.
• There must be greater uptake of training relevant to each division to reach the trust's own target of 95% of staff completing their mandatory training.
• The trust must ensure that, particularly in critical care, communication between senior nurses and senior medical staff is enhanced and that the contribution of nursing is fully reflected in the hospital's vision.

The Care Quality Commission will present 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.

Ends

For further information please contact Yetunde Akintewe, CQC Regional Engagement Manager, on 07471 020 659. For media enquiries, journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. For general enquiries, please call 03000 61 61 61.