Alexandra Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We rated safe as good. The service made sure children and young people were safe from harm. Staff and managers ensured treatment and care was suitable for children, young people and their family and carers. There were enough competent staff available to care for children and young people. The service provided mandatory training in key skills to staff and most staff had completed it. Staff were trained to act quickly with children and young people who became more ill whilst at the hospital. Staff knew how to identify children and young people at risk of, or suffering, significant harm and worked with other agencies to protect them. The buildings where staff cared for children were clean and safe. Staff used well maintained equipment used to provide treatment.

This service scored 72 (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 collect enough information from patients about their experience of learning culture to express their views in this report.

Staff told us they received feedback from incidents and were able to give us examples of learning that they had received.

The wider children’s service held mortality and morbidity (this is the review of cases where people have particular diseases or have died) reviews monthly and included examples of good practice. Any learning identified at these meeting was shared with staff.

Children, young people, their parents and carers that we spoke with during the onsite assessment said they were happy with the outpatient service , including the information that was available to them about what to expect during the appointment. Staff explained everything to children and young people before doing anything such as taking blood samples and as a result, patients were not nervous. Young people and their parents said they had been given information about a follow up appointment.

Staff and leaders told us it was their aim to ensure pathways were around the needs of children, young people, their families, and carers. They gave us examples which included: “One Stop” outpatients appointments. In these appointments staff took blood tests from the child or young person on the same day as their outpatient appointment. This meant they missed less time from school or college and their parents or carers did not have to take additional time off work.

A dedicated transition team supported children and young people to transition between children’s and adult services.

A key stakeholder, the integrated care board told us they worked closely with the service including information sharing about long term conditions in children. They told us how the service collaborated openly. It also reviewed the effectiveness of existing care pathways and welcomed discussions around potential changes and improvement to children’s services.

Partners said they found the divisional management team put children and young people first. Pathways for children had been reviewed and improved including the availability of ‘hot clinics’ where children were offered a next day appointments based on clinical priority.

Partners told us about improved arrangements for children and young people with long term conditions and how their care and treatment was managed as they transitioned into adult services, confirming the implementation of a dedicated transition team.

Staff reviewed all outpatient appointments to make sure the most urgent patients were seen first. A process in place allowed staff to identify children and young people with additional needs. For example, autistic people or patients who were very anxious and may require additional support or time during their appointment.

Staff kept electronic records of each procedure such as blood samples being taken.

We did not collect enough information from patients about their experience of safeguarding to express their views in this report. However, children, young people, parents, and carers spoke positively about the service and were assured it was a children’s only outpatient clinic.

Staff knew how to identify children and young people at risk of, or suffering harm and worked with other agencies to protect them. Staff were able to ask for advice from senior leaders and the safeguarding team if they had a concern with a child's welfare.

Staff understood how to report abuse and how to make a safeguarding referral. Staff and the managers had a good understanding of involving other agencies, for example, police, the local authority and the trust safeguarding leads.

Most staff had completed training on how to recognise and report abuse for adults and children. All nurses were expected to complete safeguarding children level 3 as part of their mandatory training programme. Although not all staff had completed the annual training modules required, staff demonstrated the required knowledge and understanding to safeguard children and young people. Leaders monitored the number of staff that had completed training modules and escalated this information upwards as part of the governance process. In addition, leaders liaised with staff to ensure they were able to complete the training at the most suitable opportunity.

Safeguarding advice and support was available from the safeguarding team Monday to Friday 8.30-4.30. Outside these times there was a named doctor in the trust for children’s safeguarding.

Staff updated electronic patient records weekly by the safeguarding team to identify and alert staff about present and previous safeguarding concerns.

Managers attended a bimonthly safeguarding meeting to monitor systems and processes. Managers produced reports to present to the Chief Nurse about safeguarding quality and performance.

We did not collect enough information from patients about their experience of involving people to manage risks to express their views in this report.

Please refer to processes section below.

The service had processes in place to manage clinical risk and medical emergencies. All staff received training in identifying a deteriorating child with sepsis. Training included ensuring time critical interventions were implemented. Information about sepsis was included in an awareness poster displayed within the service.

All paediatric staff completed Paediatric Intermediate Life support or European Paediatric Life Support (EPLS).

Staff used national best practice before undertaking any procedures like allergy testing including, making sure they had the right staff, drugs and equipment so that they could deal with any problems that might happen. This helped reduce the risk of complications or delays in treatment.

Risk assessments about care were person-centred and regularly reviewed. We reviewed 10 sets of electronic and paper patient records and found that admission assessment (includes health assessment) and past medical history had all been completed in line with national requirements and service policies.

Children, young people, their parents and carers spoke positively about the environment of the children’s outpatients department which provided a child friendly and safe space.

Staff and leaders told us how they had received training to use equipment. Practice educators supported them when changes to equipment was made.

Staff cared for patients in a safe environment. The children’s outpatient department was a secure area for only children (with their parents/ carers). The service had suitable equipment for children and young people including resuscitation equipment and distraction aids such as toys. Staff kept all corridors and fire exits clear and clutter free. Staff stored oxygen, medical gases, and clinical waste appropriately.

Electrical equipment we saw had portable electrical appliance test (PAT) stickers to show when it had been safety tested and the next date a test was due.

The service had effective arrangements in place to monitor the safety and upkeep of the premises including fire alarm and water temperature testing. Trained staff serviced and maintained equipment in line with national requirements and the service maintenance schedule.

Staff rotated stock, and daily checks were carried out on emergency equipment such as resuscitation trolleys and defibrillators. A resuscitation trolley was available in the department and was accessible so staff could respond as quickly as possible in the event of an emergency.

Children, their parents and carers we spoke with during the inspection told us although staff were busy, they were kind and thorough and they felt supported by them.

Staff told us that they felt the service had enough staff to meet the needs of children and young people. Staff were able to describe how they supported people who were anxious and frightened which included altering the schedule of the appointments and using play to help them understand and overcome their fear.

During the inspection we saw that staff worked as a team to ensure children and young people received the care and treatment they needed. The team on duty within the outpatient department included a dedicated paediatric nurse and a health care assistant with paediatric training.

Paediatric staffing was mainly based at the acute site and worked county wide.There was one staff rota for both the acute children’s ward and Kidderminster Hospital and Treatment Centre to identify where staff would be working on identified days. There was also a rota in place for the countywide children’s outpatients service to identify which hospital staff would be working in on identified days.

All staff received a full induction tailored to meet the needs of the children and young people.

Most staff had received and kept up to date with their mandatory training. The mandatory training was comprehensive and met the needs of children, young people, and staff.

Managers monitored mandatory training and alerted staff when they needed to update their training. Mandatory training was also monitored through directorate performance review meetings to ensure the service was compliant with trust targets.

The service had a process for carrying out appraisals. The trust target for appraisals was 90%, compliance for the paediatric directorate was 92% as of 31 August 2024. Information provided by the trust demonstrated that learning and development opportunities for staff are discussed during annual appraisals. To help the wider trust understand what staff think about learning and development opportunities, leaders planned to send a staff survey with specific questions about learning and development to all staff within the children’s service in October 2024. The results would be used to make a learning and development action plan.

A practice educator supported the learning and development needs of staff and provided additional training and assessment to confirm they were competent in key skills.

We did not collect enough information from patients about their experience of infection prevention and control to express their views in this report.

Staff that we spoke with during the inspection told us that regular cleaning schedules were carried out.

We were able to see that cleaning schedules were followed during the inspection; the service was clean and clutter free. A daily cleaning schedule form was completed. We saw staff observing bare below the elbow and hand washing in line with national guidelines. Posters displaying the 5 steps to hand hygiene were located throughout the service so that staff, patients and carers could follow them.

The service had a process in place for managing clinical and domestic waste as well as sharps which we observed was followed during the inspection. A hand hygiene policy was available and easily accessible to staff and hand hygiene audits were carried out each month.

Information contained in meeting minutes from the service demonstrated that a trust wide cleaning compliance audit was undertaken in May and September 2024. Information provided by the service showed that between that time the service scored between 95 and 100% compliance. Information about activity levels and patient types were used to inform the cleaning and audit schedules needed in the service.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.