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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
2 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
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 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
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
4 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
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
http://www.bliss.org.uk/improving-care/care-standards/toolkit-for-high-quality-neonatal-services/
*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:
5 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
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?
6 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
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
Generic prompts Professional standard Additional prompts
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
Generic prompts Professional standard Additional prompts
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
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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-
8 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
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?
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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.)
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?
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
10 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
disposal.)
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?
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).
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?
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?
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Key line of enquiry: S4
How are risks to people who use services assessed, and their safety monitored and maintained?
Report sub-heading: Assessing and responding to patient risk
Generic prompts Professional standard Additional prompts
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
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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
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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:
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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
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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).
16 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
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
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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?
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Key line of enquiry: S5
How well are potential risks to the service anticipated and planned for in advance?
Generic prompts Professional standard Additional prompts
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?
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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.
Requires further investigation:
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
Data to be considered when making judgements:
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?
Generic prompts Professional standard Additional prompts
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
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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
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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.
Key line of enquiry: E2
How are people’s care and treatment outcomes monitored and how do they compare with other services?
Generic prompts Professional standard Additional prompts
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?
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Are staff involved in activities to monitor and improve people’s outcomes?
Key line of enquiry: E3
Do staff have the skills, knowledge and experience to deliver effective care and treatment?
Generic prompts Professional standard Additional prompts
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
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Standards for Children’s surgery – The Royal College of Surgeons, 2013.
Surgeons and anaesthetists should not undertake paediatric procedures on an occasional basis
Standards for Children’s surgery – The Royal College of Surgeons, 2013.
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
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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?
Key line of enquiry: E4
How well do staff, teams and services work together to deliver effective care and treatment?
Generic prompts Professional standard Additional prompts
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
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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.
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
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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?
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Key line of enquiry: E5
Do staff have all the information they need to deliver effective care and treatment to people who use services?
Generic prompts Professional standard Additional prompts
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)?
Key line of enquiry: E6
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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
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for its necessity and proportionality in line with legislation and is action taken to minimise its use?
procedures
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Caring
By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.
Requires further investigation:
Complaints
Data to be considered when making judgements:
Key line of enquiry: C1
Are people treated with kindness, dignity, respect and compassion while they receive care and treatment?
Generic prompts Professional standard Additional prompts
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
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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?
Do staff respect confidentiality at all times?
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?
Key line of enquiry: C2
Are people who use services and those close to them involved as partners in their care?
Generic prompts Professional standard Additional prompts
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
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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?
Key line of enquiry: C3
Do people who use services and those close to them receive the support they need to cope emotionally with their care, treatment
or condition?
Generic prompts Professional standard Additional prompts
Report sub-heading: Emotional support
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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.
Standards for Children’s surgery – The Royal College of Surgeons, 2013
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 respect confidentiality at all times?
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
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By responsive, we mean that services are organised so that they meet people’s needs
Requires further investigation:
Data to be considered when making judgements:
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?
Generic prompts Professional standard Additional prompts
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
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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
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nurses and midwives etc.) and social care
providers/social services/education
providers to meet the needs of CYP in the
area?
Key line of enquiry: R2
Do services take account of the needs of different people, including those in vulnerable circumstances?
Generic prompts Professional standard Additional prompts
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
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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?
Key line of enquiry: R3
Can people access care and treatment in a timely way?
Generic prompts Professional standard Additional prompts
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
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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?
Key line of enquiry: R4
How are people’s concerns and complaints listened and responded to and used to improve the quality of care?
Generic prompts Professional standard Additional prompts
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
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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
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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.
Requires further investigation:
Data to be considered when making judgements:
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?
Generic prompts Professional standard Additional prompts
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?
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strategy monitored and reviewed?
Key line of enquiry: W2
Does the governance framework ensure that responsibilities are clear and that quality, performance and risks are understood and managed?
Generic prompts Professional standard Additional prompts
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
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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
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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?
Key line of enquiry: W3
How does the leadership and culture reflect the vision and values, encourage openness and transparency and promote good quality care?
Generic prompts Professional standard Additional prompts
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.
Standards for Children’s surgery – The Royal College of Surgeons, 2013
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?
44 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
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.
Key line of enquiry: W4
How are people who use the service, the public and staff engaged and involved?
45 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
Generic prompts Professional standard Additional prompts
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)?
Key line of enquiry: W5
How are services continuously improved and sustainability ensured?
Generic prompts Professional standard Additional prompts
Report sub-heading: Innovation, improvement and sustainability
When considering developments to Is leadership of innovation,
46 20160222 Independent healthcare core service guidance for children and young people V2.03 (Published on internet July 2016)
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?