'Inadequate' KGH children's services have improved, say health inspectors

The care children receive at Kettering General Hospital has improved months after health inspectors served a warning notice, a report has found.

Children and young people’s (CYP) services were rated as inadequate – the lowest rating possible – after a shocking December inspection found urgent changes needed to be made.

Care Quality Commission (CQC) inspectors were worried about a number of issues including sepsis treatment and staffing levels on the Skylark ward.

But, in a report released today (Thursday) after a fresh inspection in April, the CQC said it was satisfied that improvements had been made.

KGH chief executive Deborah Needham said: “We are extremely proud of the teams for the hard work that has gone into making and embedding improvements across the services, as noted by the CQC inspectors.

“The improvements that have been highlighted are testament to their dedication to improving patient care. Our priority is providing the best patient care possible, and we are delighted that those patients and families, who spoke to the CQC, reflected positively about the care they were receiving.

“We realise that we have not always got this right, and as I have previously said, I am truly sorry for this. I would like to assure our patients and families that we are fully committed to further improving our children’s services and ensuring the changes that we make are sustained.”

The unannounced visit saw inspectors assess the paediatric emergency department, paediatric assessment unit, Skylark ward and the neonatal unit to looked into how safe and well-led services were.

Because it was a focused inspection the services were not re-rated and the previous rating of inadequate remains for CYP services and requires improvement for paediatric urgent and emergency care.

CQC bosses had required KGH to make improvements in relation to medicines management, risk assessments, identification and treatment of sepsis, monitoring people’s fluids, safeguarding processes, learning from serious incidents and equipment and environmental risks.

Craig Howarth, the CQC’s deputy director of operations in the Midlands, said: “When we inspected services for children and young people and urgent and emergency care services at Kettering General Hospital, we were pleased to see the trust had made enough improvements to meet the warning notice we issued last December.

“During our previous inspection of CYP services our inspectors, trust employees and parents all had concerns that there weren’t enough staff to allow the service to safely care for the number of young people with complex health needs. However, during this latest inspection, we found improvements had been made and managers regularly reviewed and adjusted staffing levels and skill mix to keep children, young people and their families safe from avoidable harm and to provide the right care and treatment.

“In urgent and emergency care, the trust had improved processes to escalate concerns around people who showed signs of deterioration, meaning they were now receiving the timely care they need to keep them safe. Also, we saw improvements around safeguarding people from the risk of harm or neglect. Staff understood how to protect children, young people and their families from abuse, and worked well with other organisations to do so.

“Across both services, improvements had been made in the timing for testing and treating people for sepsis. Previously, staff didn’t always use their professional judgement when carrying out assessments, to consider factors that could have increased people’s risk. It was reassuring that staff now knew how to treat and deal with people at risk.

“Following the inspection, we fed back our findings to the trust leaders and they know the areas where we want to see them build on the improvements we’ve seen, ensure they remain embedded, and make further rapid changes. We’ll continue to monitor the trust to make sure people are safe while that’s happening and return to check on their progress.”

What did inspectors find when they looked at KGH’s CYP services?

- Managers and staff in charge had oversight of people where there were safeguarding concerns. Actions taken in response to safeguarding concerns were fully documented.

- Staff identified and quickly acted upon children and young people at risk of deterioration.

- Staff completed and updated risk assessments for each child and young person.

- Staff assessed a person’s risk of dehydration on admission and improvements were found in the monitoring of people’s fluid input and output.

- There were effective mitigations in place to maintain safe staffing levels on Skylark ward to manage the high vacancy rate for registered nurses. Managers reduced the number of beds available to maintain safe staffing levels.

- Staff followed systems and processes to prescribe and administer oxygen safely.

- Processes were in place to improve practice following incidents and monitor learning had been implemented.

- Parents felt their child was safe on the ward, and staff were in general responsive and had time to listen to them. Feedback from parents was generally positive about the service provided.

What did they find when they inspected urgent and emergency care?

- Assurance systems and processes were in place to safeguard children and young people from the risk of harm or neglect had improved.

- Records demonstrated improvements in nursing and medical staff completing safeguarding checklists.

- Staff routinely checked nationally approved child protection information sharing systems and trust alert systems when assessing safeguarding risks.

- Staff understood how to protect children, young people and their families from abuse, and worked well with the inpatient ward and other agencies in doing so.

- The use of facilities and premises had improved to keep people safe.

- Timeliness of observations had improved. Processes for escalating people who were unwell and those showing signs of deterioration had improved.

- Compliance with sepsis screening standards had improved.