NHS Trusts that provided care to Baby Peter have improved systems to ensure children are protected

9 June 2010

But trusts must continue to drive improvement in a handful of areas, says regulator.

The Care Quality Commission (CQC) today (Wednesday) published a report showing the four trusts that provided NHS care to Baby Peter have improved systems to safeguard children.

Peter had contact with health professionals at North Middlesex University Hospital NHS Trust (NMUH) and Haringey Teaching Primary Care Trust. Both trusts commissioned paediatric services provided by Great Ormond Street Hospital for Children NHS Trust (GOSH). He also attended on one occasion the Whittington Hospital NHS Trust.

In May 2009 CQC published its review of the healthcare given to Peter by the four trusts. It found systemic failings and, despite some progress, more work needed to be done to ensure adequate systems were in place to safeguard children. CQC made five recommendations to address these shortfalls.

CQC says the trusts have made significant progress, but some trusts must: improve attendance at case conferences; improve collection and sharing of information between services; and continue to monitor paediatric staffing levels.

CQC carried out a follow-up review to assess whether its recommendations have been implemented. The review included: interviews with staff; an analysis of documented evidence submitted by the trusts and a review of a progress report produced by NHS London (the Strategic Health Authority).

The regulator found that of the five recommendations, the trusts have ‘met’ three and ‘almost met’ two. CQC said all trusts have demonstrated that the leadership and management of services is sufficient to drive the remaining improvements needed.

It said the trusts should:

• Monitor staff vacancies regularly to ensure a sufficient number of appropriately qualified paediatric staff are in place, in line with established guidelines.
• Implement a system to monitor and improve attendance of clinical staff at multi-agency case conferences.
• Continue to improve the quality of data collection and information sharing between health and social services teams.

Cynthia Bower, CQC’s chief executive, said: “It is clear these four trusts have committed to improving the systems in place to safeguard children, and they have made huge strides in addressing the problems we identified in our initial review last May.

“The trusts must now maintain the momentum and continue to drive the remaining handful of improvements needed.

“They must make sure there are enough appropriately trained staff to care for children and continue to build on the progress already made in improving systems to share information with social services teams. It is also vital that clinical staff attend child protection case conferences to ensure all services involved in protecting children are working together and sharing crucial information. The importance of this must not be underestimated.

“We will continue to review progress closely through our programme of ongoing monitoring of compliance across the NHS.”

CQC’s follow-up review looked at progress against each of the five recommendations it made last year. The trusts met three of the recommendations. CQC found:

All trusts have ensured staff are clear about child protection procedures and received safeguarding training to a level appropriate to their role.

All trusts have outlined their current and future training programmes to ensure staff are clear about child protection procedures. They monitor uptake of training by members of staff and there is a mechanism in place at all trusts to follow up on staff that fail to attend.

GOSH has reviewed the adequacy of consultant cover at St Ann’s Hospital, Haringey.

GOSH reviewed the service at St Ann’s and took the decision to conduct all child protection medical assessments at NMUH, as it recognised St Ann’s was too isolated as an outpatient unit. In addition, GOSH has now moved the paediatric medical staff base from St Ann’s to NMUH. CQC supports this move and will monitor changes closely.

All trusts have established clear communication and working arrangements with social services. In particular, there is no delay in establishing contact between agencies once a safeguarding referral has been made to social services.

All four trusts have made significant improvements to the referral system and how they work with social services, and now have the necessary policies and guidance in place to enable staff to make an appropriate safeguarding referral. There has been an increase in referrals from health visitors, hospital staff and nurses, which indicates a greater knowledge of safeguarding issues and improved links with Haringey children’s services.

Although this recommendation has been met, CQC notes that the IT system which enables health professionals to share information with social services, could be strengthened further. The trusts are addressing this.

CQC says the trusts ‘almost met’ the remaining two recommendations and must continue to drive improvement in these areas. It found:

Haringey PCT and NMUH has worked with GOSH to improve the number of appropriately qualified paediatric staff available when required, but they must continue to monitor staffing arrangements to ensure staffing is sufficient.

The posts of named and designated nurse and doctor for safeguarding have been filled at each trust. Haringey PCT has also appointed a lead GP for safeguarding and a named nurse for primary care.

But the staffing levels of community paediatrics at St Ann’s, Haringey, ranges from 70% and 91% of the recommended total staffing establishment. This fluctuation is due to staff joining, leaving and changing their hours. The vacancies, where possible, are currently being covered by the use of locum paediatric medical staff, but CQC says vacancies need to be monitored carefully, and the trust must continue to recruit.

The number of available posts for health visitors at Haringey PCT has increased to 34, and there are 25.6 in post. There are currently 8.4 full time equivalent vacancies, but more posts have been offered to candidates yet to take up their roles. The trust should continue to drive up the numbers of health visitors.

At NMUH, the number of staff across all specialities has increased but the number of vacancies is still high at 12%. The trust must continue to recruit to these posts.

NMUH has sufficient qualified and experienced staff in place in its A&E department. However, there is only one paediatric nurse on duty at night. Although this is not uncommon, it is described as a ‘weakness’ by an external review of the A&E department carried out in September 2009. CQC notes that the trust plans to recruit additional children’s registered nurses for A&E to increase the number at night.

Attendance at case conferences at Haringey and NMUH is still poor and must be addressed.

At NMUH, between August and December 2009, medical professionals attended less than half of case conferences where their presence was requested (11 of 24). CQC says consultants must improve attendance.

At Haringey PCT, an external report in December 2009 showed that pressures on the service mean it is not always practical for medical staff to attend 100% of case conferences. However, the report said the trust should develop a policy on attendance at case conferences to help guide decisions on priority of attendance. An external consultant has now been appointed at Haringey to take this forward. CQC says the trust must ensure this happens.

CQC will continue to monitor progress closely through its ongoing monitoring programme under the new regulatory system, which came into effect on 1 April 2010.

Ends

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to editors

In January and February 2010, the Care Quality Commission (CQC) took part in a joint inspection of safeguarding services in Haringey, carried out in conjunction with Ofsted and HM Inspectorate of Constabulary. The aim of the inspection was to assess progress made by services across the borough in relation to how well they are working together to protect children. CQC’s role was to look specifically at the NHS trusts providing services in the area.

The evidence gathered during this process fed into the follow-up report published by CQC today (8 June 2010).