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Improvement framework for children and young people’s services launched by regulator

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A detailed review by senior nurses has identified “common themes” where trusts that are struggling with poor ratings for services for children and young people can look to improve.

Trusts that have received poor ratings on children and young people’s services have been urged to improve nurse staffing levels and their incident reporting and learning from serious incidents.

“This framework gives trusts a clear insight to what good and outstanding care looks like and how it can be achieved”

Ruth May

Health service providers have also been told to improve senior leadership for children and young people’s services, following scrutiny by NHS Improvement.

In particular, each trust in England should develop a strategy for ensuring young patients were fully involved with the care they received, to help reduce future problems, stated the regulator.

Its nursing directorate has conducted a review of Care Quality Commission reports for trusts that received a “requires improvement” or “inadequate” rating for children and young people’s services.

In the first review of its kind, NHS Improvement looked at just over 100 CQC reports of trusts with lower ratings to “identify common themes of poor practise or areas for improvement”.

The review highlighted four overarching areas that appeared to be the “root cause of the poor ratings” – staffing, serious incidents, leadership and strategy – noted NHS Improvement.

For example, low staffing levels were highlighted in 15 out of 20 CQC reports on trusts reviewed in the NHS Midlands and East region.

“Ensuring safe, effective, high quality services for children and young people must be a priority”

Ellen Armistead

Nurse staffing levels were found to be below those recommended in the most recent Royal College of Nursing guidance in 13 and a high number of medical staff vacancies were also found in three.

According to the 2013 RCN guidance, there should be at least two registered children’s nurses at all times in all inpatient and day care areas, and a minimum of 70:30% registered to unregistered staff.

In addition, 13 of the Midlands and East reports highlighted a “poor culture” of incident reporting or “inadequate processes” for reporting back to staff involved in the incident and learning from them.

Meanwhile, 10 indicated that staff did not have the right training or skills to undertake their role and nine cited a lack of strategy for children and young people, with four mentioning no executive lead for this age group.

However, the regulator noted that even in trusts rated “requires improvement” or “inadequate” most children and young people’s services were deemed to be “good” for being caring.

In the wake of the assessment by senior nurses at the regulator, they have also drawn up a new improvement framework for children’s and young people’s services that has been launched by NHS Improvement today.

The framework highlighted “what has gone wrong with clear guidance on what they can do to resolve some of the underlying issues”, said a spokeswoman for the regulator.

The new document set out a “clear and concise” framework for trusts to follow and also included links to best practise examples that could help them on their “improvement journey”, she added.

For example, the framework stated that it was important that trusts had the “right staff with the right skills in the right place and at the right time”.

It also cited improving incident reporting and learning from serious incidents, noting that trusts would only reduce the risk of similar events occurring by working out what went wrong and why.

In addition, it said trusts should “utilise” their executive lead for children and young people, which they are now required to have, to ensure the needs of children and young people are a “priority”.

Meanwhile, the executive lead for children and young people at the trust should lead on developing a strategy that ensures patients are fully involved in their care and the development of the service.

NHS Improvement

Nurse staffing shortage is ‘top priority’ for regulator

Source: Kate Stanworth

Ruth May

Ruth May, executive director of nursing at NHS Improvement, said: “Children and young people’s services are vital to the health of the nation, if we get care for the younger generation right, this will reduce the problems they, and the NHS, face in future.”

She said: “This framework, developed on the back of a detailed review of CQC reports by NHS Improvement, gives trusts a clear insight to what good and outstanding care looks like and how it can be achieved.”

Ellen Armistead, the CQC’s deputy chief inspector of hospitals, said: “Ensuring safe, effective, high quality services for children and young people must be a priority.

Ellen Armistead

Ellen Armistead

Ellen Armistead

“We know from our inspections that many hospital trusts are providing good or outstanding care for children and young people, but that there is clear scope for improvement in those where we have identified concerns,” she said.

She added: “We welcome the development of this framework and we hope trusts will use it, together with the findings of CQC’s inspection reports to help them take action to drive up quality in the services they provide for children and young people in the future.”

Common themes that appear to be the root cause of poor ratings:

  • Nurse staffing levels: it is important that trusts have the right staff with the right skills in the right place and at the right time
  • Incident reporting and learning from serious incidents: trusts will only reduce the risk of similar events occurring by working out what went wrong and why
  • Leadership: trusts should utilise the role of their executive lead for children and young people, which they are now required to have, to ensure that the needs of children and young people are a priority for their organisation
  • Children and young people’s strategy: the executive lead for children and young people at the trust should lead on developing a strategy that ensures patients are fully involved in their care and the development of the service
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