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Nurses take lead on improving paediatric services at troubled trust

External review reveals 'serious concerns' and changes needed at Walsall Healthcare NHS Trust.

Nurses are helping lead an action plan to improve paediatric services at an NHS trust placed in special measures by the Care Quality Commission (CQC).

Walsall Healthcare NHS Trust commissioned an external review of its children’s services including the neonatal unit which was presented to the trust board earlier this month.

The trust was placed in special measures in January after a damning CQC report flagged up high workloads and low morale among staff and suggested improvement was needed in a number of areas including paediatric services.

Structure changes
The review, by the Royal College of Paediatrics and Child Health (RCPH), found a ‘number of serious concerns’ and stated that although there was excellent nursing leadership there was an overreliance on advanced nurse practitioners in the neonatal unit. The review also highlighted nursing staff shortages due to trust restructuring.

It recommended that one nurse should always be present in the neonatal unit intensive care room to detect changes in the condition of infants and that the nurse in charge should not have a patient caseload to ensure effective supervision of junior staff and oversee activity in the unit.

In paediatrics the trust should increase nurse staffing to reduce the risk of overstretching the nursing team.

More robust

The review also looked at 6 cases between 2006-15 but concluded there was no one specific theme or individual emerging as a problem.

Since the review, the trust has appointed 4 new neonatal nurses along with additional support posts in the unit and has changed its processes for responding when things go wrong so that they are more robust.

Trust medical director Amir Khan said: ‘We want to be open about areas for improvement and involve our staff, patients and their families in developing sustainable improvements.

‘Our matrons, consultants and advanced neonatal nurse practitioners are leading on this action plan and we are making significant progress.’

Staff shortfall

Research by premature and sick baby charity Bliss last year found two thirds of NHS neonatal units do not have enough nurses, with an estimated shortfall of 2,140 nurses across the UK.

RCN children and young people professional lead Fiona Smith said that a key element of improving neonatal and paediatric care across the board was recruiting students to the profession and retaining existing staff.

‘Students need to be able to gain experience in neonatal and paediatric environments. In terms of retaining existing staff it can be a very pressurised environment and I have seen good practice case studies where nurses are given time out on secondment or to work on rotation to recharge.’

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