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Unsafe hospital staffing levels put children at risk – CQC report

East Kent Hospitals University NHS Foundation Trust is one of the largest hospital trusts in England.

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“Unsafe” staffing levels were putting children in two hospitals at risk, according to health inspectors.

East Kent Hospitals University NHS Foundation Trust was rated inadequate for children’s services by the Care Quality Commission (CQC), reports published on Wednesday said.

The trust is one of the largest hospital trusts in England, serving a population of around 695,000 people. Overall, it is still rated as requiring improvement.

The CQC carried out unannounced inspections in its children’s departments at the William Harvey Hospital (WHH) in Ashford and the Queen Elizabeth The Queen Mother Hospital (QEQM) in Margate in October.

It published its findings in two reports, one for each hospital – which both offer inpatient, day surgery and outpatient care for children as well as running premature baby units.

At WHH, staff said they worked beyond their contracted hours and missed lunch breaks due to “unsafe staffing levels”. Managers said the “biggest risk” on wards was insufficient staffing.

The hospital’s chief nurse told inspectors one of the biggest risks facing children’s services at the trust was recruiting and keeping staff – who, it was felt, were often attracted to work in London instead, the report said.

Inspectors found no nursing staff on duty in the children’s emergency department between 4pm and 2am, leaving patients to wait in the main A&E.

Of the QEQM, inspectors said: “Whilst we were on site, there were times when staffing had a significant impact on the running of the emergency department.”

Some patients were having to wait more than an hour to be handed over to the hospital by the ambulance.

Nurses told how they routinely missed breaks, had no drinks and worked “well beyond their contracted hours”, according to the report.

Some told inspectors they felt staffing levels were “unsafe” so worked longer shifts to help.

The children’s emergency department was not staffed overnight from 2am to 8am so casualties were sent to the main A&E, the report said.

When in the adult waiting area, they were at risk of being exposed to “volatile behaviour, inappropriate television programmes and unpleasant sights”.

Inspectors also raised wide ranging concerns over cleanliness and hygiene, safety of patients, record keeping, storing medicines and leadership.

Although Female Genital Mutilation (FGM) is thought to be rare in Kent, inspectors expressed concern that “very few” nursing staff understood the term or the statutory obligation to report it.

Staff were not trained nor had the resources to care for children with mental health conditions or learning disabilities at the hospitals, the reports said.

At QEQM, sometimes security staff were called in to handle children with mental health problems or even the police, otherwise parents were simply left to “cope”.

Staff said they were not trained in looking after children with learning disabilities and “just picked it up as they went along”, relying on parents for guidance, according to inspectors.

Guidelines for screening and treating children for sepsis were not being followed or understood by staff, the report said.

One staff member at QEQM told inspectors: “We can’t give every child that comes in with a high temperature and raised pulse antibiotics. It has to be down to professional judgment”.

Equipment was missing from resuscitation trolleys and medicines were not being kept at the right temperature at this hospital, the report said.

Concerns were also raised over how some staff treated anxious parents and senior figures had used “unfavourable stereotypes” in some cases, the report said.

Some nurses were seen carrying out duties without wearing gloves while a locum doctor did not wash their hands or wear protective equipment when examining a child with chicken pox, the report said.

Steps were not taken to separate children with potentially infectious illnesses from other patients – or clean down rooms after they had been examined.

Toys in the children’s emergency department were not cleaned for 14 days in October, according to records cited by the inspectors.

At WHH, inspectors said they witnessed staff using a stethoscope which was not cleaned between patients and could lead to germs spreading.

The CQC issued a string of recommendations on how the trust must improve at both hospitals.

Doctor Nigel Acheson, the CQC’s deputy chief inspector of hospitals, said: “It is clear that the children’s services at East Kent Hospitals University NHS Foundation Trust have been working under some pressure, apparently with no end in sight.

“We could not allow this to continue – and we used our enforcement powers to ensure that appropriate action is taken to protect young patients.

“I am pleased to report that since our inspection, the trust has assured us that the service has made significant improvement and we should be in a position to remove the conditions in the near future.”

The trust said it had taken “immediate action” and made “significant changes”, including increasing staffing levels and re-training staff as part of an “intensive 12-month improvement programme”.

It is also investing £250,000 to refurbish the oldest children’s ward at WHH.

Chief executive Susan Acott said: “Staff have worked quickly and thoroughly over the last three months, changing everyday working practices and how services are managed to make hospital services for children and young people safe and respond to the CQC’s feedback.”

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