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Hertfordshire trust told to up game on children’s safety

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East and North Hertfordshire NHS Trust was told to take urgent action to address safety risks after a series of “serious incidents” on a children’s ward, a report from regulators has revealed.

It took immediate steps in response to concerns raised by Care Quality Commission inspectors, who said the trust had not acted fast enough to “ensure children were protected from avoidable harm”.

“The trust’s staff have worked hard to address the matters raised at the time of the inspection”

Ellen Schroder

Overall, the organisation was rated “requires improvement” following the CQC inspection in October last year. Failure to act on lessons learnt from serious incidents and reduce risks “in a timely manner” was one of the key issues highlighted by the inspectors.

“Although there were robust systems in place to manage risks these were not always effectively implemented,” said the CQC report.

It stated: “Opportunities to prevent or minimise harm were missed and feedback was not always provided on incidents reported. Staff did not always report incidents appropriately, and learning from incidents was not always shared effectively.”

The inspectors highlighted a number of incidents in children’s services, including three serious incidents reported on Bluebell children’s ward at the Lister Hospital between June 2015 and October 2015.

While the trust had identified learning from the incidents, inspectors found not everything had been done to mitigate risks.

“Issues relating to high vacancies, staffing levels and the lack of skills and competencies to care for poorly children, along with the high level of clinical activity on Bluebell ward were not being addressed in a timely way to ensure children were protected from avoidable harm,” said the report. “Following our inspection, the trust took urgent actions to address this.”

Other areas of concern included urgent and emergency care services at the Lister, which were rated “inadequate”.

“Nursing staff told us they did not always feel equipped with the skills to care for these patients”

CQC report

The trust was failing to consistently meet the four-hour target for referral, discharge or admission of patients and the triage system in the emergency department “was not sufficient to protect patients from harm or allow staff to identify those with the highest acuity”.

Patients were “not always treated with dignity and respect” and infection control practices were not always followed in the department, added the inspectors’ report.

When it came to overall nurse staffing levels, inspectors found these were variable but “in almost all areas, patients’ needs were being met”.

At the time of the inspection, the overall nursing vacancy rate was 15% – higher than the 10% average for the region.

Nursing staff vacancy rates were 12% in medicine, 16% in surgery, 8% in the women and children’s division and 8% in cancer services.

East and North Hertfordshire NHS Trust

Hertfordshire trust told to up game on children’s safety

Hertford County Hospital

The trust’s board report for September 2015 showed 11 out of 12 medical care wards had nurse staffing vacancies ranging from 13% to 40% on the acute medical unit.

Inspectors found some patients with specialist care needs were being cared for on wards where staff may not have the right training.

“Some patients were cared for on wards outside of their specialist care group – nursing staff told us they did not always feel equipped with the skills to care for these patients,” said the report.

“We found that this group of patients were not always reviewed by a consultant when they should have been. However the trust took urgent action to address this,” it said.

Overall, the trust was rated “good” for caring and inspectors identified many examples of good and excellent care.

The children’s community nursing service, children’s continuing care specialist nursing team, specialist health visitors, community paediatrics and the school nursing service were “creative and innovative in finding solutions to the complex care and support needs of children and young people” said the report.

Inspectors also flagged up the trust’s award-winning diabetes team made up of specialist nurses and doctors, which provides a seven-day-a-week outreach service targeting high-risk patients.

And they identified outstanding work in the trust’s ophthalmology department where nurses had undertaken specific training to carry out eye injections.

East and North Hertfordshire NHS Trust

Hertfordshire trust told to up game on children’s safety

Nick Carver

The report states the trust’s director of nursing is recognised as a “strong leader” and inspectors noted the fact the organisation supported Nursing Times’ Speak Out Safely campaign “in encouraging any staff member who has a genuine patient safety concern to raise this within the organisation at the earliest opportunity”.

Trust chief executive Nick Carver said the organisation had expected an overall rating of “requires improvement”.

“At this stage in the trust’s development, that is a fair assessment overall but it masks a degree of variation between our services,” he said.

In its response to the inspection report, the trust emphasised the fact more than two thirds of the areas reviewed by the CQC were rated “good” or better.

The trust’s new chair Ellen Schroder, who took up her post at the start of this month, said the organisation had made immediate changes in the wake of the inspection.

East and North Hertfordshire NHS Trust

Hertfordshire trust told to up game on children’s safety

Ellen Shroder

“It is clear that since last October, the trust’s staff have worked hard to address the matters raised at the time of the inspection. Further improvements have been planned and are taking place,” she said.

“We must remember that there is also a great deal to celebrate with our staff who work so hard every day to ensure our patients receive high quality care at all times,” she added.

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