Analysis

Children’s services: NHS regulator issues guidance following 96 failed CQC inspections in England

While the RCN has welcomed NHS Improvement guidance following Care Quality Commission inspections in April 2017, the college believes the advice on staffing and skill mix should be mandatory

While the RCN has welcomed NHS Improvement guidance following Care Quality Commission inspections in April 2017, the college believes the advice on staffing and skill mix should be mandatory

 


The neonatal staffing document has ten recommendations, including 
reviewing skill mix regularly. Picture: Alamy

Concerns about nursing shortages and leadership quality dominate guidance from an NHS regulator on improving the state of children’s services.

NHS Improvement issued the guidance after reviewing 96 NHS services for children in England that had failed inspections by the Care Quality Commission (CQC) by April 2017. It found that 54 inpatient services fell short of expected standards and, when reinspected, only two had improved, while four had further deteriorated.

54

children’s inpatient services rated as inadequate or needing improvement
(Source: CQC April 2017)

NHS Improvement says that while most children and young people’s services are rated as good for caring, few are rated as good for being ‘safe or well-led’. It has responded to the findings by publishing a new framework to address four main areas where trusts have been struggling in CQC inspections.

Failing to reach sufficient standards

Nursing shortages and incident reporting dominate the reasons that services are failing to reach sufficient standards. For example, in reports on 20 trusts in the Midlands and east of England, 15 cited low staffing levels. Of these, 13 specified too few nurses and three to a shortage of doctors.

‘There is a big issue about leadership and ensuring that there is a children’s nursing voice and perspective at board level’

Fiona Smith

The framework seeks to help senior nurses address issues about nurse staffing levels, incident reporting and learning from serious incidents, leadership and the development of a children and young people’s strategy.

The Improvement and Assessment Framework for Children and Young People’s Health Service (NHS Improvement 2018a) was published at the end of February as concern continued to mount about NHS pressures and insufficient nursing staff across all health settings.

Nursing leaders and senior children’s nurses welcomed the framework for providing a much-needed focus on children’s services.

13

NHS trusts in the Midlands and east of England identified a shortage of nurses
(Source: CQC April 2017)

Emphasising children’s services

RCN professional lead for children and young people Fiona Smith said children’s services often fail to get the attention from senior leaders they need. The framework emphasises the importance of children’s services being discussed and considered by trust boards.

‘It will be extremely helpful for children’s services and assist with staff at a local level to get their services onto board meeting agendas and to highlight the key things that need to be addressed,’ she says.

‘There is a big issue about leadership and ensuring that there is a children’s nursing voice and perspective at board level.’

‘Any tool or framework for improvement which can help service leaders at all levels to help find solutions is to be welcomed’

Katrina McNamara

The section for nurse staffing levels says that services must have the right staff, with the right skills in the right place at the right time, according to the National Quality Board (NQB) in 2016.

To meet this, the framework says senior nurses should consider if they are using evidence-based workforce planning, professional judgement and comparing staffing with peers, as set out in the NQB report: Supporting NHS Providers to Deliver the Right Staff, with the Right Skills, in the Right Place at the Right Time.

Mandatory training, recruitment and retention

Senior nurses should also look at:

  • Whether mandatory training is happening.
  • If staff are working as a multi-professional team, and are being told to consider recruitment and retention.

Senior staff should also look at whether their team is using productive working and eliminating waste, efficient deployment and flexibility – and minimising the use of agency staff.

The Association of British Paediatric Nurses’ honorary secretary Katrina McNamara says: ‘Many services, regardless of their specialty, are struggling with restricted financial and staffing resources. Any tool or framework for improvement which can help service leaders at all levels find solutions is to be welcomed.

‘So often the day-to-day business of modern healthcare squeezes out the opportunity to share best practice and share what works. This framework aims to share different approaches and solutions.’

Focal points for senior nurses

The NHS Improvement framework asks senior nurses to look at areas including:

Nurse staffing

  • Are staff working as a multi-professional team?
  • Is evidence-based workforce planning being used?
  • Is the use of agency staff minimised?

Incident reporting and learning from serious incidents

  • Are families and patients routinely involved in the investigation process?
  • Are services using skilled analysis to move the focus of the investigation from acts or omissions of staff to identifying underlying causes?

Senior leadership

  • Develop a strategy for children and young people that is led by the executive lead for this area.
  • Ensure that children and young people are always asked about their experience of the services they use.
  • Wherever children and young people receive care, are they protected from harm and abuse in a supportive and age-appropriate environment?

Source: NHS Improvement Resources 

 

The framework follows the publication by NHS Improvement of two separate draft documents on safe and sustainable staffing for neonatal care and children and young people's services in November 2017. Both state that the overall staffing requirement should be calculated using professional judgement together with appropriate workforce tools.

They are among several staffing guides published for different services by NHS Improvement. But there has been criticism – including from the RCN – that these are not mandatory requirements.

13

recommendations on determining safe staffing requirements for children’s and young people’s wards
(Source: NHS Improvement 2018b)

Annual staffing review

The report for children’s and young people’s wards has 13 recommendations for determining staffing requirements. These include an annual staffing review and factoring into the establishment that all children and young people should have access to a registered children’s nurse 24-hours a day.

The neonatal staffing document has ten recommendations, including reviewing skill mix regularly and that all neonatal units should input data into the electronic patient record BadgerNet to enable national benchmarking.

‘By using a triangulated approach, we are able to define what safe and effective staffing levels should be in children and young people’s settings’

RCN

While the RCN welcomed the publications, the college said the main problems with staffing levels is the shortage of nursing staff for recruitment. The college had responses from 37 members for the children’s wards document and, while just over half (53%) said it was a useful resource, 72% thought nurse staffing levels would stay about the same.

Main barriers

The response said: ‘For our members, the difficulty recruiting registered nurses and the financial constraints preventing any increases to the nursing establishment were thought to be the main barriers to effectively implementing any guidance or resource on nurse staffing.’

The RCN said that its own guidance should continue to be used. ‘We feel our guidance goes further than this resource in demonstrating that, by using a triangulated approach together with evidence and professional consensus, we are able to define what safe and effective staffing levels should be in children and young people’s settings.

‘Our professional guidance should still be used and not be replaced or undermined by this new overarching resource.’


References


Erin Dean is a freelance health writer

 

 

 

 

 

 

 

 

 

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