The Care Quality Commission has raised “serious concerns” about children’s services at Basildon and Thurrock University Hospitals Foundation Trust, branding them “completely unacceptable”.
The watchdog issued the trust with two warnings and ordered it to commission an independent investigation into paediatric services after an unannounced inspection prompted by a number of serious incidents.
The warnings were issued in relation to the essential standards, the care and welfare of service users and assessing and monitoring the quality of service provision.
Andrea Gordon, CQC deputy director of operations (regions), said: “What our inspectors found at the trust on 3 November was completely unacceptable.
“We have taken this action to assist in driving through improvements which have a positive impact on the people being cared for at the hospital.
“It is imperative that the trust now ensures it makes changes which are sustainable, embedded and maintained for the future.”
The inspectors found:
- although guidelines meant all children attending the paediatric ward were seen by a nurse within 15 minutes of arrival, staff confirmed some waited more than an hour to see a doctor;
- staff said there were often considerable delays in children receiving appropriate medical attention when concerns over their condition deteriorating were escalated to doctors after 5pm and at weekends;
- complaints had been made by staff about the lack of senior medical and nursing staff available on the ward and the inadequate skill mix of nursing and medical professionals on the children’s ward. Despite this CQC could find no evidence of any effective action having been taken;
- medicines that should have been discarded during their visit despite the trust having previously carried out an audit of expired medication;
- reports showing a significant drop in permanent paediatric consultants’ availability in the last few weeks but it was not clear what action had been taken with regard to this;
- the trust was found to be failing to plan and deliver care to meet the needs of children in a way that ensured their welfare and safety.
Basildon and Thurrock has until 13 January to make improvements.
If improvements are not made, the CQC has a range of enforcement powers which include restricting the services that a provider can offer, or, in the most serious cases, suspending or cancelling a service.
This is not the first time the CQC has warned the trust.
In July, it was told to make improvements in relation to the same two essential standards, but in relation to inspections of the accident and emergency department and adult wards.
When the CQC carried out its follow up inspections, in August and September, improvements had been made.
Ms Gordon added: “It is highly disappointing that the trust is again in breach of the same two regulations albeit in relation to different parts of the service it offers. That is why we have asked the trust to look deeper at its own processes, policies and procedures by commissioning an investigation.
The CQC will publish further details of the inspectors’ findings in a review of compliance on its website at a later date.
The specific charges
“[The] CQC has issued the warning notice to Basildon and Thurrock University Hospitals NHS Foundation Trust in Nethermayne, Basildon, Essex, requiring that action is taken to meet:
“Regulation 9, care and welfare of service users, and Regulation 10, assessing and monitoring the quality of service provision, Health and Social Care Act (Regulated Activities) Regulations 2010.”
In response, the trust said it had taken immediate steps to change the way it delivered some of its children’s services and that it had commissioned an independent investigation into paediatric services at the hospital.
Chief executive Clare Panniker said: “We are absolutely committed to improving the standards of care which we deliver to children. By commissioning a review of our paediatric services we can be sure we are looking at every area to best meet their [patients’] needs.”
The immediate changes made include:
- more senior staff being on duty at all times, especially out of hours
- a new, dedicated team of nursing staff with additional senior doctor presence in the Paediatric Assessment Unit
- the introduction of weekly unannounced spot checks to ensure clinical practice standards are being followed
- the re-issuing of guidance to all trust staff explaining how to report concerns they may have
Ms Panniker added: “We need to do better to ensure that every child who comes to Basildon Hospital gets good, high quality, safe care only by doing this will we address the CQC’s concerns.”