Date Published: 13 March 2009

NHS hospitals making mixed progress on meeting needs of children

NHS hospitals are making mixed progress on ensuring staff are properly trained and have the specialist skills necessary to provide good quality care for children.

The Healthcare Commission today (Friday) publishes a report detailing progress by 154 NHS acute trusts since it reviewed services for children in hospital in 2005/06.

The 2005/06 review showed that services were generally good when children were inpatients in specialist paediatric services. But there was a need for significant improvement in the care of children being treated in other settings.

This latest report focuses on emergency and day case settings, looking at the areas that the Commission had previously highlighted as particular concerns. Results for each trust across 19 indicators of performance are published alongside the report.

The Commission said that although some trusts had improved, overall progress was mixed.

* Child protection: The Commission found that while more trusts now meet basic guidelines for training staff at least every three years in child protection, there remains significant room for improvement. For example, 71% of trusts now meet guidelines to train anaesthetists, an improvement of 48 percentage points. However, in one in five trusts training of nurses does not meet guidelines and 42% of trusts failed to update consultant surgeons every three years. Looking across all indicators for all trusts, 32% of scores are categorised as "consistently high performing", 39% of scores are "improved"; 9% "deteriorated" and 20% are "consistently low performing".

* Managing children's pain: More trusts are now meeting guidelines to train nursing staff to assess children's pain and administer pain relief, but again, significant improvement is still required. For example, 65% of trusts now meet guidelines to train emergency care nurses to assess children's pain, an increase of 12 percentage points. However, almost two-thirds of trusts did not train enough nurses in day case settings to administer pain relief to children, including 14% of trusts that had deteriorated in performance. Looking across all indicators for all trusts, 37% of scores are categorised as "consistently high performing", 21% of scores are "improved"; 14% "deteriorated" and 27% are "consistently low performing". These findings are consistent with other reviews, including the Commission's recent review of organisations providing urgent and emergency care.

* Life support: The Commission said that trusts have made very limited progress in training staff in providing life support to children. 94% of trusts are still failing to provide sufficient training in basic resuscitation and emergency life support to surgeons. 74% of trusts are failing to provide this to emergency care nurses, including 14% that deteriorated. Looking across all indicators for all trusts, 11% of scores are categorised as "consistently high performing", 15% of scores are "improved"; 11% "deteriorated" and 63% are "consistently low performing".

* Maintaining skills of surgeons and anaesthetists: The Commission also expressed concern that a high proportion of surgeons and anaesthetists carrying out procedures on children may have insufficient experience of the specific needs of young children. It is recommended that anaesthetists should perform at least 20 consultations with children each year and surgeons should perform at least 100 consultations with children each year, in order to maintain this specialist skill. 74% of trusts performed poorly or had deteriorated when measured against recommendations to maintain the skills of anaesthetists. 64% of trusts performed poorly when measured against recommendations to maintain the skills of surgeons. Looking across all indicators for all trusts, 13% of scores are categorised as "consistently high performing", 15% of scores are "improved"; 9% "deteriorated" and 63% are "consistently low performing". However, the watchdog acknowledged that maintaining sufficient experience can be particularly difficult in rural areas where fewer procedures are carried out but there are arguments for doing them as locally and as quickly as possible.

The Commission said the findings do raise questions about the safety and configuration of services that trusts should investigate. However, they do not in themselves provide sufficient information to say whether a particular service is unsafe.

Anna Walker, the Commission's chief executive, said:

"Our follow-up review of children's hospital services shows there have been improvements but more work is clearly needed. We are particularly concerned about training in child protection. It is absolutely vital that NHS staff working with children know how to recognise signs of child abuse and know what to do if they see it. Experts involved in this review have recommended that training in child protection be increased from every three years, to every year. We agree with this and will be discussing the guidance with the relevant Royal Colleges.

Another area of concern is that some surgeons and anaesthetists appear to be performing procedures on children without meeting the recommended levels of work to maintain their skills. There may be good reasons for this, but the figures need exploring in greater depth. Hospital trusts, strategic health authorities, Monitor and PCTs all need to review the figures relevant to their services and assure themselves there are no problems."

She added:

"Children are not 'mini adults'. They can't always articulate their symptoms or level of pain and some illnesses that affect children are rarely seen in adults. That's why it is so important that staff are equipped with the skills and training they need to assess and treat children."

The Commission said that some trusts did not meet the recommended level of performance because they had failed to keep adequate records of training. It stressed that keeping proper records was vital to ensuring that trusts know the training needs of staff and can design training programmes to meet those needs.

The Commission has worked with 77 trusts - those failing to meet required thresholds in more than 55% of the indicators - to ensure they produce action plans for improvement. Implementation will be overseen by primary care trusts that commission services, strategic health authorities and Monitor in the case of foundation trusts.

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