Improvement review

Services for children in hospital

Management Summary

Services for children in hospital May 2005 1

Healthcare Commission

Services for children in hospital

Summary

Assessment
Children access local, child-appropriate hospital services provided by staff experienced and trained in the
care of children.

Review criteria (see figure 1)

• Children have access to child specific services
• Children have access to care local to their homes
• Services are staffed by appropriate levels of trained staff
• Staff have child-specific training
• Staff have the opportunity to maintain their skills

Rationale
High numbers of children access hospital services, but there are currently inequalities in children’s ability to
access child focused hospital services locally.

Not all children are cared for in services with staff skilled and experienced in care of children. This is a higher
risk in specialties other than paediatrics.

Ensuring access to child-specific local services and at the same time ensuring those services are staffed by
child-trained staff presents a challenge for many trusts and networks of trusts. This is seen as a key priority
by those leading children’s hospital services.

Unit of assessment
Acute hospital trusts in England

Services covered
• all inpatient beds used by children
• all A/E departments that children access
• emergency and elective surgery (surgeons, anaesthetists and elective list management)
• ambulatory care (not including MIUs; including walk-in centres only where they are run by an acute
trust)
• out patient departments
• medical day case/day surgery facilities
• adult ITUs in which children are cared for

Assessors
Healthcare Commission

Implications for trusts

Time taken to complete the returns will depend on the number of sites at which trusts provide services for
children. Indications from our pilot are that it takes up to 15 hours to collect the data, over a period of 4
weeks. Most of the data is held locally in systems such as PAS or surgery systems

Services for children in hospital May 2005 2

Healthcare Commission

Services for children in hospital

Summary

Figure 1 – high level view of the assessment framework

Outcome level Criteria level Sub - criteria level

Children get access to

child specific care

Children get access to

care near their homes

There are sufficient staff

Good outcomes of, and good to operate a safe service
experiences of hospital care

Staff are appropriately

child-trained

There is sufficient throughput of

cases for staff to maintain skills
Staff can maintain their
skills
There are arrangements in place
(e.g. refresher training, rotations)
for isolated trusts that have low
throughput of child cases

Types of data collected

Very few outcome measures of general hospital care are available, and those that are are ambiguous in their
interpretation (e.g. overall mortality rates and admission rates).

We are consequently collecting data on proxies for good outcomes: whether children access child-specific
services, whether services are provided locally, staffing levels and staff training, and service throughputs
(see notes pages).

These areas have been cited as critical to good outcomes and good experiences of care in the NSF hospital
standard. Furthermore patient representative bodies, professional bodies and trusts with which we have
worked have indicated these are key building blocks to the delivery of good hospital care, on which delivery
of the full NSF standard can be built.

Services for children in hospital May 2005 3

Healthcare Commission
Services for children in hospital
Children can access local, child-appropriate hospital services provided by staff
experienced and trained in the care of children
Criteria, questions and information (CQI) framework
Criteria
1: Children access child-
specific care
2: Children can access local
care
3: Services have an
appropriate level of child-
trained staff
- There is an appropriate
level of cover:
4: Services have an
appropriate level of child-
trained staff
- Staff are trained to an
appropriate level
5: Staff can maintain their
skills
5.1 There is an
appropriate level of
throughput of child cases
5.2 If throughput is low,
and if consolidation with
other services is not an
option, the trust has
arrangements in place to
ensure services are safe
We will also be collecting information on critical incidents but this will not feed into assessment scores.
Services for children in hospital
Questions
#1 What proportion of children
treated by the trust (across the
range of services) access child-
specific services?
# 2 Do environments meet
relevant Health Building Notes
standards
#1 What is the geographical
spread of elective and emergency
services open to children?
#1 Is there a sufficient level of
nursing/medical/
anaesthetist/surgeon/ play
staff/pain team cover?
#1 Are staff trained according to
professional recommendations?
#1 Is there a sufficient level of
throughput of child cases per
service to enable staff to maintain
their skills?
#2 What arrangements are in
place so staff can maintain skills?
May 2005
Information
What percentage of children treated by the
trust access child-only services per annum;
what % children are in child-specific beds at
a particular date?
- Comparison across trusts
Do environments meet standards or not?
- Self- report against standards
Spread of activity (including outreach
activity) at different service locations
(postcodes)
- Comparison across trusts
Staffing levels per patient/per service. Level
of cover on emergency rotas.
- Compared to professional
recommendations
- Comparisons across trusts
Training records.
- Compared to professional
recommendations
- Comparisons across trusts
Throughput of cases per service, per
headcount of staff.
- Compared to professional
recommendations
- Comparisons across trusts
Range of initiatives in place/ extent of use
by different staff groups.
- Comparisons across trusts
4
Healthcare Commission

Services for children in hospital

Scope
The themes covered in this review are as follows:

Access - children have access to local child-specific services

Child-capable services - services are staffed by people with child-specific training, and who have the
opportunity to maintain their skills

The following theme will be covered in the minority of trusts that will receive ‘plan improvement’ visits:

Governance - children’s services receive support to develop and improve from within the trust

Organisations covered by this review:

All NHS acute hospital trusts in England will be covered by the review.

Service types included in the review of children’s hospital services*:

• all inpatient and high dependency beds that are used by children, in and outside paediatric areas
• all A/E departments that children access
• emergency and elective surgery (surgeons, anaesthetists and elective list management)
• ambulatory care (not including MIUs; including walk-in centres only where they are run by an
acute trust)
• out patient departments
• medical day case/day surgery facilities
• adult ITUs in which children are cared for

Staff groups covered in the review are:

• registered nurses and other nursing staff
• paediatricians, anaesthetists, surgeons
• play specialists and assistants

Services not covered in this review are:

• neonatal Intensive Care Units

• special Care Baby Units
• Paediatric Intensive Care Units (PICUs)
• all services registered under the Care Standards Act 2000

This review does not cover neonatal care because (1) neonatal care is subject to different
recommendations and, often, different management arrangements and delivery locations to non-neonatal
care and (2) the scope of this review needs to be manageable. PICUs were excluded as they are covered
so comprehensively in the PICANET audit.

* - these were amended after consultation with pilot sites and our national reference group: outpatients, day care and ambulatory
care were included.

Services for children in hospital May 2005 5