Alexandra Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We rated effective as good.

Staff worked in line with national standards and evidence based care. This meant children and young people received good quality care. Staff worked together as a team to ensure children and young people received safe care and treatment. Staff supported children and young people to make informed decisions about their care and treatment. The service did not always provide children with timely access to some services which delayed treatment.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Children, young people, parents and carers spoke positively about the service and the staff and were confident with the care they received. Children and young people received care, treatment and support that was evidence-based and in line with good practice standards

Staff worked with national guidance and evidence-based practice to deliver treatment. Staff had access to up-to-date policies and procedures.

Through our discussions with staff and leaders and review of children and young people’s records it was clear staff followed professional guidance.

The service had a process for reviewing and updating and sharing best practice guidelines used within the children and young people’s service. Divisional meeting minutes demonstrated that best practice guidance had been considered and approved.

N/A

Children, young people, their parents and carers told us they received a good level of care as part of their treatment pathway. This included the initial referral from their GP or dentist, the contact with the pre-assessment nurses and with the staff in children’s outpatients.

Children and young people received person-centred care, and families were supported when moving between services.

Staff shared key information to keep children, young people, and their families safe when handing over their care to others. Information about risks and potential risks to patients was discussed with other health professionals such as the diabetes team, theatre staff and their GP.

Partners spoke positively about the service including work it had undertaken with schools that did not allow smart phones meaning that children were unable to monitor blood glucose in real time. The service worked closely with the schools to enable the young people to use the monitoring technology they needed.

A specialist transition team had oversight of the transfer of children’s care to adult services. Staff followed established and effective pathways for transition for diabetes, respiratory, epilepsy and urology. Adult and children’s teams worked closely together to enable the adult team to get to know patients and ensure the young person’s needs continued to be met. The diabetes team communicated with leads within the community and communicated collaboratively and effectively within multi-disciplinary teams.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not collect enough information from people about their experience of monitoring and improving outcomes. However, people told us staff worked collaboratively with them when assessing, reviewing and undertaking procedures.

Staff told us they could see when patients with chronic illnesses attended regular outpatients’ clinics, they managed their health better.

Staff and leaders monitored children and young people,s experiences and results to identify where improvement was required. The paediatric service provided information to national audits which included the National Paediatric Diabetes audit and had demonstrated care and treatment had been improved

The service had recognised that there was no funded phlebotomy service for children which had meant there was a 3 plus month wait for children needing blood tests. This was recognised in the strategy work for the wider children’s directorate and sat as a risk upon the local risk register, plans were being developed to develop a dedicated phlebotomy role.

Quality improvement huddles have been introduced to the service as part of the – we listen, learn and lead initiative. Patient feedback audits had been started to make sure that children’s opinions are captured on how to improve the service.

Information provided by the service demonstrated that people could not always access the service when they needed it. The average wait from referral to first outpatient appointment for surgery was 132 days. The longest waiting time was for oral surgery (318 days). The shortest wait from referral to first outpatient appointment was for breast surgery (13 days).

Children were provided with information about the procedure as part of the consent process. We saw during the inspection that information was shared with children and their parents or carers before any procedure was carried out. This including taking a blood sample and monitoring heart rate and oxygen levels.

Staff that we spoke with understood Gillick competence (the judgement of a child’s ability to make decisions about consent) used to support children and young people in making decisions about their care and treatment.

The trust used 2 consent forms for children which were dependent on the age and understanding of the child. Children and their parents or carers were seen by a surgeon who explained the operation and risks. The consent form was signed as part of this consultation at outpatients.

Older children (under 16s) could if they wished to, sign to consent to the procedure alongside their parents or carer. Young people between 16 and 18 provided written consent to their surgery, with an explanation of the surgery provided including risks and benefits.

The trust told us audit of consent forms were undertaken county wide.