Core service: Children & Young People...2016/07/13 · 3 20160222 Independent healthcare core...

1 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)

Inspection framework: independent acute hospitals

Core service: Children & Young People

This includes all services provided for children up to the age of 18. Legally, the definition of a child is a person up

to the age of 18. On occasions16 and 17 year olds may be inspected under adult services if the independent

hospital policy specifies services are provided to this age group under adult services. Ensure adult service

inspectors are aware of the policy exception.

There may be staffing exceptions in relation to this age group. This includes inpatient wards, surgery, outpatients

and end of life care along with the interface with maternity services. However, it does not include care provided in

the emergency department, which is covered under the urgent and emergency core service.

Areas to inspect*

The inspection team should be provided with a list of all areas in the hospital where children and young people (CYP) might be seen and treated. Some of these will be CYP specific areas, some areas where both CYP and adults are seen and treated and some may be predominantly adult environments where CYP might be seen on occasion. If time allows, an initial walkabout of as many areas as possible should take place to provide an overarching sense of the CYP


service. It will not be feasible to visit every area where CYP will be seen and treated. There are some areas that should always be inspected and some where a sample of areas will need to suffice. This should be considered alongside data/surveillance to identify areas of risk for further focused inspection. It will be necessary for the CYP team to consider how it needs to work with the other core service teams to ensure that issues related to CYP are addressed elsewhere ( e.g. by outpatient and surgery teams) when necessary and appropriate, for example where young people are seen in predominantly adult areas. N.B. It is recognised that not every independent hospital will have separate children or young person’s ward/s. In many cases CYP will be admitted to an individual room within the main nursing ‘floor’ in a similar way to any other patient being admitted to an independent hospital. Although such rooms will be appropriately equipped and furnished according to the person’s age and needs.

Children’s pre-assessment clinic (pre-admission clinics)

Children’s inpatient wards or rooms

Children’s surgery (anaesthetic room, theatre & recovery)

Children’s outpatients (sample only)

Neonatal Unit, Special Care Bay Unit (SCBU ) & Paediatric Intensive Care Unit (PICU)

Palliative & End of life care

Selection of areas which are not specific to CYP (and are not covered by any of the above) including: imaging (particularly x-ray and CT);

Hospital Play Service

Transition Services (transition clinics, adolescent wards and spaces dedicated to adolescents and young people)

Facilities for Parents

Level Definitions of Neonatal Units

0 Patients whose needs can be met through routine/basic care.

1 Units provide Special Care but do not aim to provide any continuing High Dependency or Intensive Care. This term includes units with or without resident medical staff.

2 Units provide High Dependency Care and some short-term Intensive Care as agreed within the network


3 Units provide the whole range of medical neonatal care but not necessarily all specialist services such as neonatal surgery.

Interviews/focus groups/observations

You should conduct interviews of the following people at every inspection:

Children and young people who use services and those close to them

Medical practitioners that treat children less than 16 years as out patients

Nursing lead for CYP

Hospital Matron or Head of Clinical Services

Resident Medical officer (RMO)

Safeguarding lead?

You could gather information about the service from the following people, depending on the staffing structure:

Named safeguarding lead

Children’s specialist nurses from a range of specialities

Play specialists

Hospital paediatric anaesthetic lead holding practising privileges - for a perspective of how CYP are looked after in the hospital

Radiologist holding practising privileges – for a perspective of how CYP are looked after in the hospital

Hospital pharmacist - safety requirements are very different to that for adults

Paediatrician with practising privileges

MAC (Medical Advisory Committee) representative (If treating children, there should be a MAC representative) for children’s care

AHP staff

Healthcare Support Workers

Support staff egg. Ward managers, porters, receptionists, admin etc.

Lead for complaints

Recovery staff responsible for leading or co-ordinating the recovery services for CYP

Theatre lead for CYP

Resuscitation officer or lead for the hospital

Medical practitioners holding practising privileges that treat and admit children less than 16 years. For example ENT and orthopaedic consultants and paediatricians


Service-specific things to consider

We have identified a number of specific prompts for this core service that are set out below. Inspection teams should use these together with the standard key lines of enquiry and prompts. These are not intended to be a definitive list or to be used as a checklist by inspectors.

Links to useful documents/ further reading:

Neonatal Toolkit:

http://www.bliss.org.uk/improving-care/care-standards/toolkit-for-high-quality-neonatal-services/

British Association of Perinatal Medicine (BAPM), Standards for Hospitals providing Neonatal and High Dependency Care


*Indicates information included in the inspection data pack.

Safe

By safe, we mean people are protected from abuse* and avoidable harm.

*Abuse can be physical, sexual, mental or psychological, financial, neglect, institutional or discriminatory abuse.

Requires further investigation:

Never Events involving CYP

Serious Incidents involving CYP

Reports to NRLS re moderate and above incidents In patient admission of children under 3 years of age. (to a

hospital that does not have a specialist paediatric unit).

Data to be considered when making judgements:




Key lines of enquiry: S1 & S2

S1. Are lessons learned and improvements made when things go wrong?

S2. What is the track record on safety?

Report sub-heading: Incidents

Generic prompts Professional standard Additional prompts

What is the safety performance over time, based on internal and external information?

How does safety performance compare to other similar services?

Do staff understand their responsibilities to raise concerns, to record safety incidents, concerns and near misses, and to report them internally and externally?

Have safety goals been set? How well is performance against them monitored using information from a range of sources?

Are people who use services told when they are affected by something that goes wrong, given an apology and informed of any actions taken as a result?

When things go wrong, are thorough and robust reviews or investigations carried out? Are all relevant staff and people who use services involved in the

Never Events should be investigated using the Revised Never Events Policy Framework

SI`s should be investigated using the Serious Incident Framework 2015. (Surgical SIs include SIs in anaesthesia)

Never Events: “Never events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.”

The criteria within the Serious Incident Framework describes the general circumstance in which providers and commissioners should expect Serious Incidents to be reported.

How does the CYP service respond to national patient safety alerts?

How does the service review mortality and morbidity? How effective are the arrangements?

http://www.england.nhs.uk/ourwork/patientsafety/never-events/


http://www.england.nhs.uk/ourwork/patientsafety/serious-incident/





review or investigation?

How are lessons learned, and is action taken as a result of investigations when things go wrong?

How well are lessons shared to make sure action is taken to improve safety beyond the affected team or service?

Report sub-heading: Safety Thermometer


Is a paediatric specific safety

thermometer (or equivalent) in use?

Key line of enquiry: S3

Are there reliable systems, processes and practices in place to keep people safe and safeguarded from abuse?

Report sub-heading: Mandatory training


Do staff receive effective mandatory training in the safety systems, processes and practices?

Providers should have regard to the statutory guidance ‘Working Together to Safeguard Children’.

This guidance references the intercollegiate document Safeguarding Children and Young People: Roles and competencies for Health Care Staff published in March 2014, which sets out that all clinical staff working with children, young people and/or their parents/ carers and who could potentially contribute to assessing,

Do all staff who are responsible for the assessment and treatment of children have refresher training (it is stipulated in the intercollegiate document).

With regards to sepsis training: - Is there a policy for sepsis

management and are staff aware of it?

- Have staff had training for sepsis?

- Do they know of the Trust’s

http://www.workingtogetheronline.co.uk/documents/Working%20TogetherFINAL.pdf

http://www.workingtogetheronline.co.uk/documents/Working%20TogetherFINAL.pdf

https://www.rcoa.ac.uk/system/files/PUB-SAFEGUARDING-2014_0.pdf


planning, intervening and evaluating the needs of a child or young person should be trained to level 3 in safeguarding.

Sepsis policy?

Report sub-heading: Safeguarding

Are the systems, processes and practices that are essential to keep people safe identified, put in place and communicated to staff?

Is implementation of safety systems, processes and practices monitored and improved when required?

Are there arrangements in place to safeguard adults and children from abuse that reflect relevant legislation and local requirements? Do staff understand their responsibilities and adhere to safeguarding policies and procedures?

Providers should have regard to the statutory guidance ‘Working Together to Safeguard Children’. (2015)

This guidance references the

intercollegiate document Safeguarding

Children and Young People: Roles and

competencies for Health Care Staff

published in March 2014, which sets

out that all clinical staff working with

children, young people and/or their

parents/ carers and who could

potentially contribute to assessing,

planning, intervening and evaluating

the needs of a child or young person

should be trained to level 3 in

safeguarding.

Guidance for physicians on the

detection of child sexual exploitation.

RCP 2015

Multi-agency statutory guidance on

female genital mutilation 2016

Does the service ensure that all staff are trained to appropriate level set out in the Intercollegiate Framework and are familiar with Government guidance ‘Working Together to Safeguard Children’?

Are staff able to access a named or designated professional (internal or external) for advice at all times 24 hours a day?

Is there an identifiable lead responsible for co-ordinating communication for children at risk of safeguarding issues?

Do staff have an awareness of CSE and understand the law to detect and prevent maltreatment of children?

How do staff identify and respond to possible CSE offences? Are risk assessments used/in place?

What safeguarding actions are taken to protect possible victims of CSE? Are timely referrals made? And is there individualised and effective multi-

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/419595/Working_Together_to_Safeguard_Children.pdf



https://www.rcplondon.ac.uk/update/new-guidance-physicians-help-tackle-child-sexual-exploitation



https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/512906/Multi_Agency_Statutory_Guidance_on_FGM__-_FINAL.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/512906/Multi_Agency_Statutory_Guidance_on_FGM__-_FINAL.pdf



This multi-agency guidance on female genital mutilation (FGM) should be read and followed by all persons and bodies in England and Wales who are under statutory duties to safeguard and promote the welfare of children and vulnerable adults. It replaces female genital mutilation: guidelines to protect children and women (2014).

The above guidance should be considered together with other relevant safeguarding guidance including(but not limited to):

Working together to safeguard

children: HM Gov. 2015

FGM Mandatory reporting of FGM in

healthcare

https://www.gov.uk/government/news/doctors-and-nurses-required-to-report-fgm-to-police

agency follow up?

Are leaflets available about CSE with support contact details? What wider safeguarding protocol/guidance is in place - how are safeguarding issues talked about, who manages them, are lessons learned etc.?

Is there a chaperoning policy in place for children and young people? Are staff aware of and understand this policy?

If a child/young person is identified as

being on a child protection plan, what

systems are in place to ensure the

correct information is shared and

actions put in place

What is the hospital abduction policy?

How well are staff aware of policies

with regards to restricted visitors? Are

there protocols in place for children

with safeguarding concerns?

Report sub-heading: Cleanliness, infection control and hygiene

How are standards of cleanliness and hygiene maintained?

Are reliable systems in place to prevent and protect people from a healthcare-associated infection?

Is implementation of safety systems,

NICE QS61 statement 3: People receive healthcare from healthcare workers who decontaminate their hands immediately before and after every episode of direct contact or care.

How does the service educate CYP and parents on infection control practice?

Hand hygiene audit results?



https://www.gov.uk/government/publications/fgm-mandatory-reporting-in-healthcare

https://www.gov.uk/government/publications/fgm-mandatory-reporting-in-healthcare




https://www.nice.org.uk/guidance/qs61/chapter/quality-statement-3-hand-decontamination


processes and practices monitored and improved when required?

Report sub-heading: Environment and equipment

Does the design, maintenance and use of facilities and premises keep people safe?

Does the maintenance and use of equipment keep people safe?

Do the arrangements for managing waste and clinical specimens keep people safe? (This includes classification, segregation, storage, labelling, handling and, where appropriate, treatment and disposal of waste.)



All equipment must conform to the relevant safety standards and be regularly serviced in accordance with manufacture guidance. Electrical equipment must be PAT tested.

Resuscitation drugs and equipment, including an appropriate defibrillator, will be routinely available at all sites where children are to be anaesthetised

Standards for Children’s surgery – The Royal College of Surgeons, 2013.

Is specialist equipment for all age ranges cared for in the hospital including that required for resuscitation available and fit for purpose?

Are there up-to-date standard

operating procedures in place

specifically for services for CYP?

Is there a dedicated recovery area?

(not mandatory)

Where children are anaesthetised, are

resuscitation drugs, and equipment,

including an appropriate defibrillator

available? (mandatory)

Report sub-heading: Medicines

Do arrangements for managing medicines, medical gases and contrast media keep people safe? (This includes obtaining, prescribing, recording, handling, storage and security, dispensing, safe administration and

NICE QS 61: People are prescribed antibiotics in accordance with local antibiotic formularies.

Are allergies clearly documented in the prescribing document used?

Is the child’s weight clearly documented and are all prescriptions appropriate for the child’s weight? Are nursing staff aware of policies on

https://www.rcseng.ac.uk/publications/docs/standards-in-childrens-surgery/@@download/pdffile/rcs_standards_for_childrens_surgery_2013.pdf


https://www.nice.org.uk/guidance/qs61/chapter/quality-statement-1-antimicrobial-stewardship


disposal.)



administration of controlled drugs as per the Nursing and Midwifery Council – Standards for Medicine Management?

Is analgesia guidance appropriate for children readily available for appropriate staff to access?

What are the processes for pain scoring for any child undergoing a surgical procedure?

Are there local microbiology protocols for the administration of antibiotics and are prescribers using them?

What SLAs exist (if required) for the provision of pharmacy support?

Report sub-heading: Records

Are people’s individual care records written and managed in a way that keeps people safe? (This includes ensuring people’s records are accurate, complete, legible, up to date and stored securely).



Records are clear, accurate and legible. All concerns and actions taken as a result are recorded. Information relevant to keeping a child or young person safe is recorded and available to other clinicians providing care to them. GMC guidance

Is there a system in place to ensure

that medical records generated by staff

holding practising privileges are safely

managed / integrated into the hospital

record for the CYP?

Are admission notes legibly

documented in keeping with GMC

guidance?

Are nursing assessments and records

in line with guidance/ standards for

nursing / AHPs?

http://www.nmc-uk.org/Documents/NMC-Publications/238747_NMC_Standards_for_medicines_management.pdf



http://www.gmc-uk.org/guidance/ethical_guidance/13427.asp



http://www.nhsprofessionals.nhs.uk/download/comms/cg2%20-%20record%20keeping%20clinical%20guidelines.pdf



How are risks to people who use services assessed, and their safety monitored and maintained?

Report sub-heading: Assessing and responding to patient risk


Are comprehensive risk assessments carried out for people who use services and risk management plans developed in line with national guidance? Are risks managed positively?

NICE QS3 statement 1: All patients, on admission, receive an assessment of VTE and bleeding risk using the clinical risk assessment criteria described in the national tool.

On admission, children and young people are to be weighed with minimal clothing to allow for accurate calculations of drugs. It is important that dual weight checking of the child takes place. RCN 2013, Standards for the weighing of infants, children and young people in the acute health care setting.

Children and young people should also have their height recorded. The current edition of the Children’s British National Formulary (BNF) must always be used for drug calculations.

The hospital should be able to demonstrate clear emergency treatment calculations or a quick reference document. Such as Resuscitation Council’s Paediatric Emergency Treatment Chart

Does the hospital have an admission policy setting out safe and agreed criteria for admission of children and is this in line with professional guidance? For example RCN 2014

If the hospital admits children under three years of age or children with underlying medical conditions is there a specialist paediatric unit appropriately staffed?

For children who are admitted, who has carried out the pre-operative assessment? This should be the Registered Children’s Nurse (RCN). For older children (16-17) may have this delegated to a RGN who is competent in pre-assessment of this age group if this is stated in the hospital policy.

Identify procedures in place should any risks be identified requiring children’s service intervention?

Are risks to children individually assessed and documented according

https://www.nice.org.uk/guidance/qs3/chapter/quality-statement-1-vte-and-bleeding-risk-assessment

http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_088215

https://www.rcn.org.uk/__data/assets/pdf_file/0009/351972/003828.pdf




http://www.resus.org.uk/pages/PETchart.pdf

http://www.resus.org.uk/pages/PETchart.pdf

http://www.rcn.org.uk/__data/assets/pdf_file/0005/571289/004580.pdf


A paediatric early warning tool should be used post-operatively, to monitor the child’s condition and detect early signs of deterioration Guidance on the provision of paediatric anaesthesia

services 2015, RCoA

Facilities should be available to provide short-term high dependency care in the event of a child becoming critically unwell. A policy should be in place regarding stabilisation and transfer to a specialist children’s intensive care facility. Caring for Children and young people. Guidance for nurses working in the independent sector, RCN

In the period immediately after anaesthesia the child should be managed in a recovery ward or post-anaesthesia care unit on a one to one basis, by designated staff with up-to-date paediatric competencies, particularly resuscitation. A registered children’s nurse should be directly involved with the organisation of the service and training in this area. A member of staff with advanced training in life support for children should always be present. Guidance on the provision of paediatric anaesthesia

services 2015, RCoA

Patients and their families are given clear information on discharge from the

to the complexity of their condition rather than strictly on their age bands?

What risk assessment tools are available, have they been applied and actions taken as necessary?

Is there use of PEWS or neonatal EWS (or equivalent)/ escalation process).How is compliance monitored? Is there appropriate scoring for different age groups?

If there is escalation / transfer policy for a seriously unwell child? Is this reported as an incident? What is the arrangement for transfer if child required urgent critical care? How is the child kept safe until transfer? For example: IHAS Critical care Transfer for Patients January 2015 Are these reported as an incident and how are they monitored?

How often are high dependency Children and young people (i.e. those that need HDU) cared for outside of a dedicated critical care level 3 unit, a HDU or post anaesthetic extended care unit (PAECU)? Where does this take place and what is the nurse to child ratio?

What SLAs exists in the event of a

deteriorating patient requiring a blue

light transfer to an NHS Trust?

How does the service ensure

http://www.rcoa.ac.uk/document-store/guidance-the-provision-of-paediatric-anaesthesia-services-2015









http://aiho.org.uk/policy-and-publications/aiho-publications/forum-publications/critical-care-forum?view=docman

http://aiho.org.uk/policy-and-publications/aiho-publications/forum-publications/critical-care-forum?view=docman


service and are able to make contact with a healthcare professional for advice and support following discharge. Standards for Children’s surgery – The Royal College of Surgeons, 2013.

RCEM Clinical Standards for Sepsis

compliance with the 5 steps to safer

surgery, World Health Organisation

(WHO) surgical checklist including

marking of the surgical site)

Is there a dedicated recovery area?

(not mandatory – but must have child

appropriate equipment if recovering

children (including resuscitation

equipment)

In hospitals where CYP are nursed in

private closed rooms, how does the

service ensure that CYP are

appropriately supervised kept safe at

all times when they don’t have a

parent/carer visiting?

How does the service ensure that there

is appropriate 24-hour emergency call

or hotline arrangements in place

following discharge, for those services

that carry out day surgery?

What arrangements are in place for

emergency transfer of a deteriorating

child? (Is this to an NHS hospital?)

Is there a clear evidence of use of a screening tool for sepsis in all admission areas?

Is evidence of use of a sepsis bundle for the management of sepsis? Does this incorporate:




http://www.rcem.ac.uk/Shop-Floor/Clinical%20Standards/Sepsis

http://www.nrls.npsa.nhs.uk/resources/?EntryId45=92901

http://www.nrls.npsa.nhs.uk/resources/?EntryId45=92901


A safe and effective escalation process?

Use of Modified Early Warning Systems (MEWS) or National Early Warning System (NEWS) including Paediatric Early Warning Systems /scores (PEWS)

Has the treatment been delivered within the recommended sepsis pathway timelines? E.g. Time to Antibiotics

Report sub-heading: Nurse staffing

How are staffing levels and skill mix planned and reviewed so that people receive safe care and treatment at all times, in line with relevant tools and guidance, where available?

How do actual staffing levels compare to the planned levels?

Do arrangements for using bank, agency and locum staff keep people safe at all times?

How do staff identify and respond appropriately to changing risks to people who use services, including deteriorating health and wellbeing, medical emergencies or behaviour that

Where services are provided to

children there should be access to a

senior children’s nurse for advice at all

times throughout the 24 hour period. A

senior qualified children’s. Royal

College of Nursing guidance on

Defining staffing levels for children and

young people’s services

Where there is specialist children’s wards, children’s intensive care, there is a minimum of 70:30 registered to unregistered staff with a higher proportion of registered nurses. (RCN – Defining staffing levels for CYP) – This includes Day surgery. At least one of such nurse must hold valid

What processes are in place to identify staffing requirements when children are admitted to the hospital?

Do all children under 16 receive direct care from an RCN?

If there are exceptions and young people are cared for by RGNs, how are the risks mitigated?

Is there a registered children’s nurse onsite who is responsible and accountable for the whole of the child’s pathway? This is defined as the planning, delivery and oversight of the child’s care. It does not mean one RCN in each department but one across the






challenges?

How do arrangements for handovers and shift changes ensure people are safe?

APLS/EPLS skills (DH, 2004; RCN 2004; RSENG, 2007). Royal College of Nursing guidance on Defining staffing levels for children and young people’s services

pathway.

For dedicated children’s wards, is there a minimum of 70:30 registered to unregistered staff with a higher proportion of registered nurses?

How is appropriate staffing applied?

How frequently does the hospital use agency staff?

What systems are in place to monitor agency/locum staff training compliance?

There may be permanent staff or

regular bank staff employed at the

hospital

Where children are cared for under

adult services, is there access to a

senior children’s nurse for advice

during the child’s admission?

What systems/procedures are in place to access advice after discharge as required if there is no RCN on duty in the hospital?

Where business/corporate policies are in place, who is responsible for monitoring policy compliance?

Does the service demonstrate collaboration with the local NHS children’s service network (areas may vary).






Identify the role of the business/corporate designated person responsible for children’s services.

How does the hospital access the designated person for advice?

Where hospitals admit children there is

at least one member of medical or

nursing staff on duty with a current

advanced children’s life support

course.

Report sub-heading: Medical staffing

How are staffing levels and skill mix planned and reviewed so that people receive safe care and treatment at all times, in line with relevant tools and guidance, where available?

How do actual staffing levels compare to the planned levels?

Do arrangements for using bank, agency and locum staff keep people safe at all times?

How do staff identify and respond appropriately to changing risks to people who use services, including deteriorating health and wellbeing, medical emergencies or behaviour that challenges?

How do arrangements for handovers and shift changes ensure people are

For Elective surgery – Access to a paediatrician and senior children’s nurse to advise on care should be available on call when children are being treated or seen, for example in cases of children requiring on-going care following resuscitation, to advise on safeguarding issues. Standards for Children’s surgery – The Royal College of Surgeons, 2013.

Guidance on the provision of paediatric anaesthesia

services 2015, RCoA

The on-going care of inpatients/postoperative patients is managed by consultant surgeons, with support from consultant paediatricians where necessary, on children’s wards staffed by registered children’s nurses

How is medical staff cover and availability organised and is it compliant with RCPCH and BAPM guidelines? If not how are risks are mitigated?

Is every CYP admitted to a paediatric department with an acute medical problem seen by a consultant paediatrician (or equivalent) within the first 24 hours? (Please note - Most independent sector hospitals carry out elective surgery. Confirm admission criteria for the hospital.)

Is there is a named consultant (or equivalent) paediatrician responsible and available for liaison and advice immediately, and can attend within 30 minutes. (N.B. Only where children are admitted with an acute medical or








safe? and senior surgical trainees (or equivalent competencies) Standards for Children’s surgery – The Royal College of Surgeons, 2013.

When a child undergoes anaesthesia, the anaesthetist must be assisted by staff (operating department practitioners and anaesthetic nurses) with paediatric skills and training Guidance on the provision of paediatric anaesthesia

services 2015, RCoA

surgical problem.)

How does the service ensure that there is access to a consultant paediatrician or appropriate expert advice as required (for CYP admitted for surgery)? What are the provider’s arrangements for assuring medical practitioners’ competence?

- What are the processes for granting and reviewing of practising privileges, and the medical appraisal and revalidation process?

- What systems does the provider’s governance have over these processes and what is the role of the MAC in this?

How does the provider assure itself of the appropriateness of any occasional or infrequent practice, including where a procedure is not carried out as part of the consultant’s NHS practice, and the risk controls around this?

What are the risk controls and assurance in place for exclusively private consultants?

How does the service ensure that the anaesthetist is always available postoperatively if required? How quickly are they able to attend?









How well are potential risks to the service anticipated and planned for in advance?


Report sub-heading: Major incident awareness and training

How are potential risks taken into account when planning services, for example, seasonal fluctuations in demand, the impact of adverse weather, or disruption to staffing?

What arrangements are in place to respond to emergencies and major incidents? How often are these practised and reviewed?

How is the impact on safety assessed and monitored when carrying out changes to the service or the staff?

In cases where there is a dedicated

and comprehensive CYP service that

admits non elective acute medical

children and young people including

those with exacerbation of existing

medical conditions, is there evidence

that winter management plans

specifically include CYP (e.g. to cover

bronchiolitis season).

In cases where there is a dedicated

and comprehensive CYP service that

admits non elective children and young

people Is there evidence that summer

management plans (especially

hospitals near the coast) address the

needs of CYP?

Does the service have tested back up emergency generators in place in case of failure of essential services?


Effective

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.


NRLS incidents*

STEIS Serious Incidents*

STEIS Never Events*

Complaints College of Emergency Medicine (CEM) self-assessment

checklist which services can use to measure their standards


Nursing staffing levels including skill mix *

Medical staffing levels (including OOH)

Agency use (Nursing and Medical) The total number of children treated by the hospital over a rolling

year, and numbers of each type of procedure undertaken in each department, where relevant

The total number of children treated, and numbers of each type of procedure undertaken, by the treating consultant, including consultant anaesthetists, across both their NHS and independent practice

The CPD record of the treating consultant in respect of the care of the child

Appraisal and revalidation of the treating consultant, including how it takes account of children’s care and outcomes across both NHS and independent practice.

Key line of enquiry: E1

Are people’s needs assessed and care and treatment delivered in line with legislation, standards and evidence-based guidance?


Report sub-heading: Evidence-based care and treatment

How are relevant and current evidence-based guidance, standards, best

'You're Welcome', the Department of Health's quality criteria for young

Which accreditation schemes are participated in (e.g. You’re Welcome

https://www.gov.uk/government/publications/quality-criteria-for-young-people-friendly-health-services


practice and legislation identified and used to develop how services, care and treatment are delivered? (This includes from NICE and other expert and professional bodies).

Do people have their needs assessed and their care planned and delivered in line with evidence-based, guidance, standards and best practice? How is this monitored to ensure compliance?

Is discrimination, including on grounds of age, disability, , gender, gender reassignment, pregnancy and maternity status, race, religion or belief and sexual orientation avoided when making care and treatment decisions?

How is technology and equipment used to enhance the delivery of effective care and treatment?

Are the rights of people subject to the Mental Health Act (MHA) protected and do staff have regard to the MHA Code of Practice?

people friendly health services.

Unicef statements to assist services in the implementation of Baby Friendly standards.

(DH), Baby Friendly (Unicef), BLISS baby charter) and what action has been taken as a result? (For independent providers that do not currently participate in an accreditation scheme, a lead time to set this up would be required.)

Are local or corporate audits carried out to ensure policy compliance e.g. documentation.

Where are the results reported and how are actions taken forward?

Who is responsible for ensuring policy compliance and updates?

Report sub-heading: Nutrition and hydration

How are people’s nutrition and hydration needs assessed and met?

Is age appropriate nutrition provided?

Do staff have access to a dietician with special expertise in CYP nutrition?

Report sub-heading: Pain relief

How is the pain of an individual person

Is there an MDT approach to pain

http://www.unicef.org.uk/BabyFriendly/

http://www.unicef.org.uk/BabyFriendly/


assessed and managed? management e.g. following paediatric surgery. Is there a MDT approach to pain management (as appropriate) following surgery?

Identify any pain management processes in place.


How are people’s care and treatment outcomes monitored and how do they compare with other services?


Report sub heading: Patient outcomes

Is information about the outcomes of people’s care and treatment routinely collected and monitored?

Does this information show that the intended outcomes for people are being achieved?

How do outcomes for people in this service compare to other similar services and how have they changed over time?

Is there participation in relevant local and national audits, benchmarking, accreditation, peer review, research and trials?

How is information about people’s outcomes used and what action is taken as a result to make improvements?

How do National clinical audits/

confidential enquiries results compare with other comparable providers?

Has practice changed as a result? How does their surgery results compare with national benchmarks such as Dendrite and BAPS audits?

Do they have regular audit meetings to discuss their compliance?


Are staff involved in activities to monitor and improve people’s outcomes?


Do staff have the skills, knowledge and experience to deliver effective care and treatment?


Report sub heading: Competent staff

Do staff have the right qualifications, skills, knowledge and experience to do their job when they start their employment, take on new responsibilities and on a continual basis?

How are the learning needs of staff identified?

Do staff have appropriate training to meet their learning needs?

Are staff encouraged and given opportunities to develop?

What are the arrangements for supporting and managing staff? (This includes one-to-one meetings, appraisals, coaching and mentoring, clinical supervision and revalidation.)

How is poor or variable staff performance identified and managed? How are staff supported to improve?

There should be a fully resourced acute pain service (APS) that covers the needs of children. Analgesia guidance appropriate for children should be readily available and pain scoring using validated tools appropriate to developmental age should be performed routinely on any child who undergoes a surgical procedure. Paediatric Prescribing Tool. Top Tips. RCPCH, London 2012

Surgeons and anaesthetists demonstrate evidence of appropriate resuscitation training to a level appropriate to their role and clinical responsibility (in accordance with Resus Council UK and Royal College (Surgeon and Anaesthetists) guidelines.

Consultants undertaking no surgical interventions are not required to have evidence of PBLS. Hospital/corporate policies reflect requirements.

How is the provider assured that staffing is appropriate and that the providers’ policies around this areas is implemented in practice and governance?

Do all anaesthetists / theatre/ recovery staff who may care for CYP have up-to-date competencies?

Are staff trained in pain management for children?

- What pain guidance is in place?

- What pain assessment tools are in place for CYP?

- Are the tools used routinely?

There is evidence of monitoring of resuscitation training recorded in the clinicians practice privilege files as appropriate.

What are the arrangements for

http://www.rcpch.ac.uk/system/files/protected/page/Paediatric%20Prescribing%20Tool.pdf

http://www.rcpch.ac.uk/system/files/protected/page/Paediatric%20Prescribing%20Tool.pdf



Surgeons and anaesthetists should not undertake paediatric procedures on an occasional basis


At least one member of medical staff in each clinical area (ward/department) will be trained in APLS/EPLS depending on the service need. Royal College of Nursing guidance on Defining staffing levels for children and young people’s services

The on-going care of inpatients/postoperative patients is managed by consultant surgeons, with support from consultant paediatricians where necessary, on children’s wards staffed by registered children’s nurses and senior surgical trainees Standards for Children’s surgery – The Royal College of Surgeons, 2013.

(or equivalent competencies)

granting and reviewing practising privileges?

What risk controls and assurance is in place for exclusively private consultants?

What are the arrangements to ensure

staff working under practising

privileges on an occasional or

infrequent basis are competent and

skilled to carry out care and treatment

that they provide for CYP?

Are there links to local NHS hospitals

in place? E.g. rotational posts across

independent and NHS hospital

services could help ensure both the

staffing levels, up-to-date relevant

experience and educational

opportunities.

Are there arrangements in place to make sure that local healthcare providers are informed in cases where a staff member is suspended from duty? IHAS/NHS Employers: Guidance for employers on sharing information about a healthcare worker where a risk to public or patient safety has been identified July 2013

Are there corporate/hospital policies in place that detail resuscitation training












http://www.nhsemployers.org/~/media/Employers/Documents/SiteCollectionDocuments/Guidance%20on%20sharing%20information%20on%20healthcare%20workers%20July%202013.pdf






requirements?

Are surgeons and anaesthetists able to demonstrate appropriate training for resuscitation to a level appropriate to their role and clinical responsibility (in accordance with Resus Council UK and Royal College (Surgeon and Anaesthetists)? (Consultants undertaking no surgical interventions are not required to have evidence of PBLS.)

There is evidence of monitoring of resuscitation training recorded in the clinicians practice privilege files.

Have staff in the department received training on sepsis

- Screening - Management - Trust policy

Where failure in the sepsis protocol has been identified have staff been given support and education?


How well do staff, teams and services work together to deliver effective care and treatment?


Report sub-heading: Multidisciplinary working

Are all necessary staff, including those in different teams and services, involved

For Elective surgery – Access to a paediatrician and senior children’s

How do (nurses, doctors, clinicians and non- clinical staff work together across


in assessing, planning and delivering people’s care and treatment?

How is care delivered in a coordinated way when different teams or services are involved?

Do staff work together to assess and plan ongoing care and treatment in a timely way when people are due to move between teams or services, including referral, discharge and transition?

When people are discharged from a service is this done at an appropriate time of day, are all relevant teams and services informed and is this only done when any ongoing care is in place?

nurse to advise on care should be available on call when children are being treated or seen, for example in cases of children requiring on-going care following resuscitation, an to advise on safeguarding issues. Standards for Children’s surgery – The Royal College of Surgeons, 2013.


Guidance on the provision of paediatric anaesthesia

services 2015, RCoA

Consultants work within the limits of their professional competence and where there are unexpected circumstances requiring that they act beyond their practised competences, support is available from colleagues within the service network (description of support) Standards for Children’s surgery – The Royal College of Surgeons, 2013.

the other services within the hospital?

Are there specific pathways between services for CYP and the rest of hospital (other specialities as appropriate)?

Are there arrangements in place between other hospitals (e.g. if necessity of transfer).

Within the organisation

Is there access to paediatric pharmacy

advice 24/7?

How do adult and CYP services work

together to manage transition as

appropriate?

Are there paediatric MDT meeting and

ward rounds? (N.B. This may be

unlikely for elective surgery).

Is there access to physiotherapy

services (and OT where necessary) for

those requiring services post-surgery?

What (if any) additional relevant

competencies, training or CPD do

those treating CYP have in place?

Is there qualified play specialists

available in areas that CYP will be

seen and treated e.g. wards, outpatient

clinics, radiology etc.? (Not mandatory

for elective surgery)

- Is external play specialist










advice available? - Are play specialists/services

available to CYP staying in hospital for more than 5 days?

What play/distraction can be accessed by CYP and their families during the admission?

How does the service ensure that the objectives of The Academy of Royal Colleges Guidance for Taking Responsibility: Accountable Clinicians and Informed Patients has been implemented?

Is there a named medical clinician and named nurse responsible for the patient during their stay in hospital. Are all team members aware of who has overall responsibility for each individual’s care?

With other organisations

What access is there to advice from specialist paediatric services in and out of hours and is this sufficient?

Report sub-heading: Seven-day services

When CYP are admitted, there is

access to diagnostic services such as x-ray, ultrasound, computerised tomography (CT), magnetic resonance imaging (MRI), echocardiography, endoscopy and pathology?

http://www.aomrc.org.uk/doc_view/9765-taking-responsibility






Do staff have all the information they need to deliver effective care and treatment to people who use services?


Report sub-heading: Access to information

Is all the information needed to deliver effective care and treatment available to relevant staff in a timely and accessible way? (This includes care and risk assessments, care plans, case notes and test results.)

When people move between teams and services, including at referral, discharge, transfer and transition, is all the information needed for their ongoing care shared appropriately, in a timely way and in line with relevant protocols?

How well do the systems that manage information about people who use services support staff to deliver effective care and treatment? (This includes coordination between different electronic and paper based systems and appropriate access for staff to records).

Primary care colleagues receive timely and accurate discharge information in order to support the patient in primary care Standards for Children’s surgery – The Royal College of Surgeons, 2013

Is there a system in place to ensure that medical records generated by staff holding practising privileges are available to staff (or other providers) who may be required to provide care or treatment to the patient?

Does the service ensure use of Personal Child Health Record (PCHR) (referred to as red books) and recognised growth charts. Does the service require or encourage parents/guardians to bring these books to each hospital appointment or admission in order to facilitate sharing of child health records and hospital admissions?

How is discharge communicated to GPs? How soon after discharge does this occur?

Are care summaries sent to the patient’s GP on discharge to ensure continuity of care within the community (as appropriate)?





Is people’s consent to care and treatment always sought in line with legislation and guidance?

Generic prompt s Professional standard Additional prompts

Report sub-heading: Consent, Mental Capacity Act and DOLs

Do staff understand the relevant consent and decision making requirements of legislation and guidance, including the Mental Capacity Act 2005 and the Children Acts 1989 and 2004?

How are people supported to make decisions?

How and when is a person’s mental capacity to consent to care or treatment assessed and, where appropriate, recorded?

When people lack the mental capacity to make a decision, do staff make ‘best interests’ decisions in accordance with legislation?

How is the process for seeking consent monitored and improved to ensure it meets responsibilities within legislation and follows relevant national guidance?

Do staff understand the difference between lawful and unlawful restraint practices, including how to seek authorisation for a deprivation of liberty?

Is the use of restraint of people who lack mental capacity clearly monitored

It is very important that staff looking after children and young people understand the issues of consent. Prior to any treatment or procedure, the consent of the child or young person (where possible) and the child’s parents or carers must be obtained.

2014 Royal College of Nursing: Caring for children and Young people: Guidance for nurses working in the independent sector.

Confidentiality and consent policies processes are in line with current department of health guidelines. Members of staff that come in contact with children and young people are trained in these areas and routinely make this clear to children, young people and their families. Department of Health, You’re welcome: Quality criteria for young people friendly health services, 2011

GMC | Consent: patients and doctors making decisions together

http://www.medicalprotection.org/uk/resources/factsheets/england/england-factsheets/uk-eng-consent-the-basics

Is there a consent policy specific to CYP in place?

Is there a CYP specific consent form used?

Does the policy contain information for staff on Gillick competency and other issues around consent?

How are CYP engaged (age and developmentally appropriate) in the consent process?

How are the needs of older young people and their parents addressed in the consent and information sharing process?

How do staff acquire further advice on difficult or contentious consent issues?

How do staff apply the Mental Capacity Act (2005) to those aged 16 and over?

What information about consent is shared with the CYP and families (as appropriate) about consent?

What if parents are not thought capable of providing consent?

o Include consenting for operative





https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216350/dh_127632.pdf




http://www.gmc-uk.org/guidance/ethical_guidance/consent_guidance_index.asp

http://www.gmc-uk.org/guidance/ethical_guidance/consent_guidance_index.asp





for its necessity and proportionality in line with legislation and is action taken to minimise its use?

procedures


Caring

By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.


Complaints


Key line of enquiry: C1

Are people treated with kindness, dignity, respect and compassion while they receive care and treatment?


Report sub-heading: Compassionate care

Do staff understand and respect people’s personal, cultural, social and religious needs, and do they take these into account?

Do staff take the time to interact with people who use the service and those close to them in a respectful and considerate manner?

Do staff show an encouraging, sensitive and supportive attitude to people who use services and those close to them?

Do staff raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes?

How do staff make sure that people’s privacy and dignity is always respected,

Registered nurses working with children will need additional training, education and supervision to demonstrate competence in:

- understanding and upholding the rights of children, young people and their families in all areas of the health care system

- communicating with children and young people to understand their needs, involving them and their parents/carers in decision making and facilitating children to care for themselves as much as they are able or wish to

- assessing children and young

Observed staff/ patient interactions – including whether privacy and dignity, confidentiality preserved, timely response to buzzers

If a child is left alone for any length of

time, what security measures are in

place and what supervision of the CYP

is in place (age appropriate)?

Do staff respect the privacy and dignity

of patients at all times?

Do staff respect confidentiality at all times?

Do staff demonstrate a sensitive and

supportive attitude to


including during physical or intimate care?

When people experience physical pain, discomfort or emotional distress do staff respond in a compassionate, timely and appropriate way?


people in terms of their clinical needs based upon knowledge of their different levels of physical and emotional maturity and development

- recognising actual and potential physical health and mental health problems and deterioration in health status

Royal College of Nursing guidance on Defining staffing levels for children and young people’s services

There must be frequent communication with the family throughout the hospital stay, at all times ensuring patient privacy and confidentiality.

Standards for Children’s surgery – The Royal College of Surgeons, 2013

CYP/parents/carers?


Are people who use services and those close to them involved as partners in their care?


Report sub-heading: Understanding and involvement of patients and those close to them

Do staff communicate with people so that they understand their care, treatment and condition?

Do staff recognise when people who

Children and families are involved in the decision to operate and the consent process.

Standards for Children’s surgery – The

Do staff communicate appropriately with children and young people and their relatives?

Is information and support provided in








use services and those close to them need additional support to help them understand and be involved in their care and treatment and enable them to access this? (This includes language interpreters, sign language interpreters, specialist advice or advocates.)

How do staff make sure that people who use services and those close to them are able to find further information or ask questions about their care and treatment?

Royal College of Surgeons, 2013

a child friendly format to help CYP make decisions about or agree to care and treatment (including consent/assessment).

How are CYP and parents involved in care plans? [Ask parents if their child has a care plan, were they involved in developing it, is it current, do they understand it?].

Can older children talk to a clinician without a parent present? In cases where the patient will be responsible for full or partial cost of care or treatment, are there appropriate and sensitive discussions with relevant people about cost?


Do people who use services and those close to them receive the support they need to cope emotionally with their care, treatment

or condition?


Report sub-heading: Emotional support



Do staff understand the impact that a person’s care, treatment or condition will have on their wellbeing and on those close to them, both emotionally and socially?

Are people given appropriate and timely support and information to cope emotionally with their care, treatment or condition?

What emotional support and information is provided to those close to people who use services, including carers and dependants?

Are people who use services empowered and supported to manage their own health, care and wellbeing and to maximise their independence?

How are people enabled to have contact with those close to them and to link with their social networks or communities?

Children are assessed with regard to their emotional needs as well as their physical needs. Distress is minimised and parental access is encouraged e.g. to anaesthetic and recovery area.


Are staff witnessed to be providing emotional support? Do staff support children when they are scared/ upset?

Are periods of rest/sleep acknowledged and minimal disturbances made to the child/parent/carer?

Do staff show compassion and a prompt response to pain/distress/upset?


Do staff demonstrate a sensitive and supportive attitude to CYP/parents/carers?

Do parents feel confident leaving the ward and their child’s care with the staff on the ward at the time?

How do staff support CYP with long term or complex conditions? Are there child psychologists (as appropriate)? What support is available for parents and others close to the child who have received bad news?

Responsive




By responsive, we mean that services are organised so that they meet people’s needs



Children’s A&E attendances

A&E Attendances by age groups

A&E waiting times for 0-16s Ask for:

Average length of time in CAU

Key line of enquiry: R1

Are services planned and delivered to meet the needs of people?


Report sub-heading: Service planning and delivery to meet the needs of local people

Is information about the needs of the local population used to inform how services are planned and delivered?

How are commissioners, other providers and relevant stakeholders involved in planning services?

Do the services provided reflect the needs of the population served and do they ensure flexibility, choice and continuity of care?

Where people’s needs are not being met, is this identified and used to inform how services are planned and

Families should be involved in wider decisions on service organisation Standards for Children’s surgery – The Royal College of Surgeons, 2013

Children and young people’s experience of health services are captured as part of service development, monitoring and evaluation Department of Health, You’re welcome: Quality criteria for young people friendly health services, 2011

Steps have been taken to ensure that service provision, environment

What engagement and involvement of

children and young people and their

families has there been in the design and

running of the services? Is there a

children’s and/or a parents/carers panel or

advisory group?

What steps have been taken to ensure

areas where CYPs are treated are safe

and suitable for the age group?

What environmental risk assessments are undertaken?

Are there separate areas for children and









developed?

Are the facilities and premises appropriate for the services that are planned and delivered?

and atmosphere are young people friendly (at the same time as being welcoming to all service users, regardless of age). The environment means the atmosphere created by physical arrangements as well as staff attitudes and actions. Department of Health, You’re welcome: Quality criteria for young people friendly health services, 2011

adolescents - how are the needs of adolescents/young people met? How is their experience on an adult ward? Is it considered? Were CYP and/or parents aware of the facilities they were coming to e.g. single rooms/mixed ward?

What percentage of CYP are seen in

predominantly adult based areas (e.g.

outpatients department) - how are the

needs CYP and parents met whilst in

these areas e.g. is there a separate

waiting area, is there a play area etc.?

[Note – outpatient team to consider this

also]

Do children and young people who are

seen in a largely adult area have the

same experience as those being seen in

CYP only environments? Are waiting

times kept to a minimum for CYP? Can

CYP keep in touch with their friends and

family while in the hospital e.g. access to

Facebook etc.?

What facilities are available for parents

and relatives e.g. accommodation,

refreshments etc.?

How does the service work with other

health (community paediatrics services,

CAMHS, GPs, health visitors, practice






nurses and midwives etc.) and social care

providers/social services/education

providers to meet the needs of CYP in the

area?


Do services take account of the needs of different people, including those in vulnerable circumstances?


Report sub-heading: Meeting people’s individual needs

How are services planned to take account of the needs of different people, for example, on the grounds of age, disability, gender, gender reassignment, pregnancy and maternity status, race, religion or belief and sexual orientation?

How are services delivered in a way that takes account of the needs of different people on the grounds of age, disability, gender, gender reassignment, pregnancy and maternity status, race, religion or belief and sexual orientation?

How are services planned, delivered and coordinated to take account of

Is there coordination of appointments for

children with complex needs/ multiple diagnoses? (N.B. CYP with complex needs and multiple diagnoses are infrequently admitted to elective surgery units.) How are the needs of children and young people being met:

o of a variety of ages

o with long-term health conditions

o in receipt of end-of-life care

o with learning disabilities

o where English is not their/ and/or


people with complex needs, for example those living with dementia or those with a learning disability?

Are reasonable adjustments made so that disabled people can access and use services on an equal basis to others?

How do services engage with people who are in vulnerable circumstances and what actions are taken to remove barriers when people find it hard to access or use services?

their parents first language

o Looked after children

o Child protection orders

What adjustments are made for children

with mental health needs requiring acute

care, and whose behaviour could be

challenging.

How are appointments managed, for

example to take account of schooling?

How does discharge planning meet the

needs of CYP with long term or complex

conditions? (N.B. CYP with complex and

/or long term needs are infrequently

admitted to elective surgery units.)

What reasonable adjustments are made

for a child that might struggle with the

hospital environment?


Can people access care and treatment in a timely way?


Report sub-heading: Access and flow

Do people have timely access to initial assessment, diagnosis or urgent treatment?

What is the admitting pathway to

paediatric service?

Is there a paediatric assessment


As far as possible, can people access care and treatment at a time to suit them?

What action is taken to minimise the time people have to wait for treatment or care?

Does the service prioritise care and treatment for people with the most urgent needs?

Where there is an appointments system, is it easy to use and does it support people to access appointments?

Is care and treatment only cancelled or delayed when absolutely necessary? Are cancellations explained to people, and are people supported to access care and treatment again as soon as possible?

Do services run on time, and are people kept informed about any disruption?

unit/short stay unit? Is the length of time children spend in the unit measured?

How long do children wait for their

operations? How is this monitored?

Are children prioritised on lists to be first?

Access to psychiatric services as appropriate (adult and child)

Is there a local service agreement for CAMHS/ psychiatric liaison? Is there access to urgent / next day clinics?


How are people’s concerns and complaints listened and responded to and used to improve the quality of care?


Report sub-heading: Learning from complaints and concerns

Do people who use the service know how to make a complaint or raise

The service provides children and young people with appropriate

Is there a child friendly complaints process appropriate for CYP of different


concerns, are they encouraged to do so, and are they confident to speak up?

How easy is the system to use? Are people treated compassionately and given the help and support they need to make a complaint?

Are complaints handled effectively and confidentially, with a regular update for the complainant and a formal record kept?

Is the outcome explained appropriately to the individual? Is there openness and transparency about how complaints and concerns are dealt with?

How are lessons learned from concerns and complaints, and is action taken as a result to improve the quality of care? Are lessons shared with others?

information in a variety of languages and formats including leaflets so they can make comments, compliments or complaints. Department of Health, You’re welcome: Quality criteria for young people friendly health services, 2011

ISCAS: Patient complaints adjudication service for independent healthcare

age ranges to easily access and use?

Is there a child-friendly format inpatient patient satisfaction survey/ friends and family test, suggestion boxes etc.

Is there a breakdown of complaints/feedback broken down by age of patient

References:

Patient complaints adjudication service for independent healthcare





http://iscas.org.uk/






Well-led

By well-led, we mean that the leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.



GMC National Training Scheme Survey 2013 - paediatrics

Breakdown of complaints/trends for CYP service

PALS data related to CYP

Key line of enquiry: W1

Is there a clear vision and a credible strategy to deliver good quality?


Report sub-heading: Vision and strategy for this service

Is there a clear vision and a set of values, with quality and safety the top priority?

Is there are a robust, realistic strategy for achieving the priorities and delivering good quality care?

How have the vision, values and strategy been developed?

Do staff know and understand what the vision and values are?

Do staff know and understand the strategy and their role in achieving it?

Is progress against delivering the

Are staff working within CYP services aware of the hospitals’ strategy for children’s services?

- How is this communicated? - How often are CYP strategy

and development meetings held?

- Who attends these?

How are developments monitored? Is the strategy/development in line with business/corporate recommendations and overall best practice for CYP?


strategy monitored and reviewed?


Does the governance framework ensure that responsibilities are clear and that quality, performance and risks are understood and managed?


Report sub-heading: Governance, risk management and quality measurement

Is there an effective governance framework to support the delivery of the strategy and good quality care?

Are staff clear about their roles and do they understand what they are accountable for?

How are working arrangements with partners and third party providers managed?

Are the governance framework and management systems regularly reviewed and improved?

Is there a holistic understanding of performance, which integrates the views of people with safety, quality, activity and financial information?

Are there comprehensive assurance system and service performance measures, which are reported and monitored, and is action taken to improve performance?

A senior children’s nurse is involved in the planning and development of children and young people’s service provision and works in collaboration with local NHS children’s services. A senior qualified children’s nurse is a nurse that holds a children’s nursing qualification, also has a master’s degree in an appropriate health/social care related subject, with a minimum of five years’ full time experience in uninterrupted clinical practice.

Royal College of Nursing guidance on Defining staffing levels for children and young people’s services

In all centres admitting children, one consultant should be appointed as lead consultant for paediatric anaesthesia. Typically they might undertake at least one paediatric list each week and will be responsible for co-ordinating and overseeing anaesthetic services for children, with particular reference to

Is there a senior lead for the CYP service? Is this person a member of the hospital management team/MAC? Are children’s issues discussed at MAC meetings including implications and decisions for children’s services?

When did the senior hospital team last

receive a report on safeguarding

children?

What exposure does this service get at

the highest senior level within the

hospital? At integrated governance

level, Medical Advisory Committee or

other?

Do staff members know what their

governance structure is? Are all staff

designation and senior staff

encouraged to be involved in the

departmental governance?

How does the hospital





Are there effective arrangements in place to ensure that the information used to monitor and manage quality and performance is accurate, valid, reliable, timely and relevant? What action is taken when issues are identified?

Is there a systematic programme of clinical and internal audit, which is used to monitor quality and systems to identify where action should be taken?

Are there robust arrangements for identifying, recording and managing risks, issues and mitigating actions?

Is there alignment between the recorded risks and what people say is ‘on their worry list’?

teaching and training, audit, equipment, guidelines, pain management, sedation and resuscitation. Guidance on the provision of paediatric anaesthesia

services 2015, RCoA

Arrangements to ensure indemnity insurance is held in accordance with The Health Care and Associated Professions (Indemnity Arrangements) Order 2014

Revalidation and annual appraisals for medical practitioners are in line with those set out in the GMC guidance. Employers in the independent sector will need to have the right systems in place locally to support the appraisal and revalidation process.

NICE QS 61: Organisations that provide healthcare have a strategy for continuous improvement in infection prevention and control, including accountable leadership, multi-agency working and the use of surveillance systems.

The Health Care and Associated Professions (Indemnity Arrangements) Order 2014

manager/director ensure staff working under practising privileges have an appropriate level of valid professional indemnity insurance in place?

Are roles and responsibilities of the Medical Advisory Committee set out and available?

How does the provider make sure those medical practitioners involved in CYP care and treatment in the independent sector, inform their appraiser of this in their annual appraisal and maintain accurate information about their personal performance in line with national guidance on appraisal for doctors?

How does the hospital manager ensure that consultant holding practising privileges have an appropriate level of valid professional indemnity insurance in place? . i.e. Arrangements to ensure those staff working under practising privileges hold appropriate indemnity insurance in accordance with The Health Care and Associated Professions (Indemnity Arrangements) Order 2014

How does the hospital manager ensure that consultants who invite external staff (for example their own private nurse) to work with them or on their own in OPD undergo appropriate checks as required by Schedule 3 of




http://www.legislation.gov.uk/uksi/2014/1887/pdfs/uksi_20141887_en.pdf



http://www.gmc-uk.org/Revalidation_guide_for_indepdent_sector_england_march_2012_.pdf_48380884.pdf


the HSCA Regulated Activity Regulations?

Are roles and responsibilities of the Medical Advisory Committee set out and available?

What are the governance procedures for managing and monitoring any SLAs the provider has with third parties?


How does the leadership and culture reflect the vision and values, encourage openness and transparency and promote good quality care?


Report sub-heading: Leadership of service

Do leaders have the skills, knowledge, experience and integrity that they need – both when they are appointed and on an ongoing basis?

Do leaders have the capacity, capability, and experience to lead effectively?

Do the leaders understand the challenges to good quality care and can they identify the actions needed address them?

Are leaders visible and approachable?

Do leaders encourage appreciative, supportive relationships among staff?

Within hospitals providing surgical services for children, there must be a designated children’s lead reporting to the board. The lead is responsible for managing quality assurance.


How is the leadership of CYP services organised locally?

Who is routinely involved in the service organisation?

What support is available from hospitals managed by larger companies?

Identify any medical and/or nursing leads both locally and nationally (if appropriate to corporate/company hospitals)

How are issues about the service raised?




Are there any barriers to raising issues or concerns?

Is there a system in place to ensure people using the service are provided with a statement that includes terms and conditions of the services being provided to the person and the amount and method of payment of fees.

Report sub-heading: Culture within the service

Do staff feel respected and valued?

Is action taken to address behaviour and performance that is inconsistent with the vision and values, regardless of seniority?

Is the culture centred on the needs and experience of people who use services?

Does the culture encourage candour, openness and honesty?

Is there a strong emphasis on promoting the safety and wellbeing of staff?

Do staff and teams work collaboratively, resolve conflict quickly and constructively and share responsibility to deliver good quality care?

Are arrangements for advertising or

promotional events in accordance with advertising legislation and professional guidance?

Is there a system in place to ensure people using the service are provided with a statement that includes terms and conditions of the services being provided to the person and the amount and method of payment of fees.


How are people who use the service, the public and staff engaged and involved?



Report sub-heading: Public and staff engagement

How are people’s views and experiences gathered and acted on to shape and improve the services and culture?

How are people who use services, those close to them and their representatives actively engaged and involved in decision-making?

Do staff feel actively engaged so that their views are reflected in the planning and delivery of services and in shaping the culture?

How do leaders prioritise the participation and involvement of people who use services and staff?

Do both leaders and staff understand the value of staff raising concerns? Is appropriate action taken as a result of concerns raised?

Are there any CYP patient forums (not

mandatory)?


How are services continuously improved and sustainability ensured?


Report sub-heading: Innovation, improvement and sustainability

When considering developments to Is leadership of innovation,


services or efficiency changes, how is the impact on quality and sustainability assessed and monitored?

Are there examples of where financial pressures have compromised care?

In what ways do leaders and staff strive for continuous learning, improvement and innovation?

Are staff focused on continually improving the quality of care?

How are improvements to quality and innovation recognised and rewarded?

How is information used proactively to improve care?

improvement and sustainability at a local or (as appropriate) corporate/company level? How is this communicated and shared?

Core service: Children & Young People...2016/07/13 · 3 20160222 Independent healthcare core...

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Transcript of Core service: Children & Young People...2016/07/13 · 3 20160222 Independent healthcare core...