Kidderminster Hospital and Treatment Centre

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 assessed a total of 6 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was requires improvement. Our rating for this key question has improved and is now good.

This service scored 69 (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 Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Children, young people, their parents and carers we spoke with during the onsite assessment spoke positively about the information they had received about attending for day surgery including the admission booklet. Young people and their parents said staff explained everything during the preoperative meeting and as a result they were not nervous. Young people and their parents said they had been given post operative instructions and information about a follow up appointment. Parents said they were aware this was a theatre day for children and liked that it was just for children with no adults having surgery at this time.

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 not having to take additional time off work. The “Super Fridays” initiative meant only experienced paediatric staff worked with children having surgery at Kidderminster Hospital and Treatment Centre. Staff told us they were told about children and young people before they attended which was very helpful, any child with additional needs would be first on the theatre list to reduce their waiting time and anxiety. Computers were available for staff however during our inspection 2 qualified nurses said they were currently “locked out” and were unable to access children’s records. This meant there was a risk not all information would be available in a timely fashion.

After our visit to the hospital, we had a discussion with the organisation which planned and funded most NHS services in the area and another organisation which provided support and review of childrens services (partners). This was to establish how the service worked with partners to provide safe systems and pathways for children and young people and ensure continuity of care. Partners identified managers at the hospital welcomed their input to discuss and advise upon potential changes and improvement to children’s services and to review the effectiveness of existing care pathways. Partners said they found the divisional management team put children and young people first. Pathways for children had been reviewed and improved this included: “Super Fridays” day case surgery for children and young people at Kidderminster Hospital and Treatment Centre which included a paediatrician on site, paediatric nurses and a play therapist on site to support children coming in for surgical procedures. 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. Commissioners said GPs could speak to a consultant paediatrician to get advice about management of children. The consultants could advise GPs where to send children and young people for urgent care and treatment. If not urgent, the consultants could organise a specialist appointment Kidderminster Hospital and Treatment centre by a paediatrician.

Staff reviewed all referrals for day surgery at Kidderminster Hospital and Treatment Centre to make sure the most urgent patients were seen first. The pre assessment process allowed staff to identify children with additional needs. For example, autistic people or patients who were very anxious about their surgery and may require additional support prior to their appointment. Staff asked parents and carers to attend with their child before operations. Staff gave specific times when patients would be admitted. This meant patients had enough recovery time after their operation. For example children who were scheduled for tonsillectomies had their surgery in the morning to ensure they were sufficiently recovered to go home the same day. Staff used a safer surgery checklist based on national best practice before starting operations. This checklist helped reduce the risk of mistakes being made. As part of this, staff confirmed the patient’s identity and planned procedure. Staff kept detailed records of each operation, which included: the procedure undertaken, and post operative instructions. The children and young people service outpatient’s department promoted a ‘One stop appointment’ to ensure all required tests were undertaken as part of one outpatient appointment to reduce the number of outpatient visits.

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 theatre day and felt secure.

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 were aware of the escalation processes 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. In addition, the trust had staff within the safeguarding team to level 4 and level 5 children safeguarding to provide advice about any safeguarding concerns. 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 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. Supervision was provided regularly by the trust and was accessible to all paediatric staff. 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.

Children and their parents or carers said they were informed about any potential risk (and benefits) for their surgery and any follow up arrangements including any concerns they may have following their discharge.

Staff shared key information to keep children, young people, and their families safe when handing over their care to others. Information about risk and potential risk was discussed with other health professionals such as the diabetes team, theatre staff and their GP. Information about risk was shared with staff, staff we spoke with understood them. Information about risks were included in the daily safety huddle. Risk assessments about care were person-centred and regularly reviewed. We reviewed 10 sets of electronic and paper patient records and found that risk assessments included paediatric early warning scores (correctly used for the child’s age), admission assessment (includes health assessment) and past medical history had all been completed in line with national requirements and service policies.

The service had processes in place to manage clinical risk and medical emergencies. Staff assessed clinical risks when they received the referral for surgery from the GP. Staff reassessed patients’ risk at the pre surgery assessment and then on the day of the surgery. Assessments included checks on temperature, heart and pulse rate, neurological status, urine, bowel, and pain assessment to determine baseline information before their surgery. If a child or young person became very unwell whilst at this hospital, they would be transferred to Worcestershire Royal Hospital for specialist treatment. A nationally recognised paediatric early warning score was used to identify children and young people at risk of deterioration. Information provided by the trust identified no local audits were undertaken. All staff received training in identifying a deteriorating child with sepsis which included ensuring time critical interventions were implemented. Information about sepsis was included in an awareness poster displayed within the service.

Children, young people, their parents and carers were mainly positive about the environment of the children’s outpatients department which provided a child friendly and safe space. Parents appreciated only children had surgery on identified days Some parents commented the waiting area was small and cramped for the number of people but said staff worked quickly to admit and prepare children for theatre and this was soon resolved.

Staff confirmed environmental audits were undertaken and any required actions needed. Staff said they received training to use equipment.

Staff cared for patients in a safe environment. The theatre suite was an enclosed area with only children (with their parents/ carers) on the dedicated children’s surgery days. Staff controlled access to the operating theatres to keep children and young people safe.

The service had effective arrangements in place to monitor the safety and upkeep of the premises including fire alarm and water temperature testing. Equipment was serviced and maintained in line with national requirements and the service maintenance schedule. 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. Stock was rotated appropriately, and daily checks were carried out on emergency equipment such as resuscitation trolleys and defibrillators. A resuscitation trolley was available in recovery and was accessible so staff could respond as quickly as possible in the event on an emergency within the theatre suite.

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. One parent told us about the flexibility of staff to accommodate their child’s anxiety.

The service had appropriate staffing levels and skill mix to meet children and young people's needs. Staff said there were sufficient staff and they received training to be competent to meet children’s needs. On the children and young people’s theatre days there was a consultant paediatrician on site who had completed Advance Paediatric Life Support (APLS) and 2 staff with EPLS which included an anaesthetist and a paediatric nurse. Information provided by the trust identified the trust target of 90% of staff completing mandatory training. This target was not always met for safeguarding adults and safeguarding children training at levels 2 and 3; Safeguarding adults level 2, 116 staff required this training, of this, 99 staff had completed it (85%). Safeguarding adults level 3, 4 staff required this training, of this, 3 staff had completed it (75%). Safeguarding children level 2, 56 staff required this training, of this, 48 staff had completed it (86%). Safeguarding children level 3, 95 staff required this training,o f this, 85 staff had completed it (88%). The children and young people’s theatre days always had a consultant paediatrician on site should a child become unwell. The consultant paediatrician remained on site until the last child had returned from theatre.

During the inspection we saw whilst staff were busy, they worked as a team to ensure children and young people received all required care both before and after they went to theatre. The team on duty for the paediatric surgery day included paediatric nurses, healthcare assistants, theatre staff, which included a paediatric anaesthetist, a play therapist and consultant paediatrician. We saw how paediatric nurses and the play therapist supported a very anxious child. Staff changed the list around in response to their distress. Staff gave support to reduce the patient’s anxiety. The patient only went to theatre when they, their parent and staff were completely assured they were relaxed and had fully consented to go to theatre.

Paediatric staffing were 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. The dedicated children and young people’s theatre days were staffed with paediatric nurses a play therapist and consultant paediatrician and paediatric anaesthetist to ensure children received appropriate care. Paediatric nurses were allocated depending on the number and type of surgery using a recognised paediatric staffing tool. Paediatric nurses rostered to work on the children’s theatre days were experienced and had received additional training (Essential Skills training) and had previously shadowed other experienced nurses. 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. All staff received a full induction which was 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 effective appraisals. The trust target for appraisals was 90%, compliance for the Paediatric Directorate was 91.5% as of 31 August 2024 (taking account for staff on long term sickness absence and maternity leave).

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff involved children, their parents and carers in discussions about their medicines and helped them understand how to manage their medicines safely. Children, their parents and carers knew what to do and who to contact if their condition did not improve or they experienced any unexpected symptoms.

Staff received regular training and assessment on medicines management, and felt confident managing the storage, administration and recording of medicines. Staff followed protocols to ensure children and young people safely received all their prescribed medicines. Staff told us they were made aware of any medicine allergies the child or young person may have within their electronic patient records and patient assessment.

Staff managed medicines safely and regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and controlled drugs. Staff returned expired or unwanted medicines to pharmacy for destruction. Medical gases, such as oxygen, were safely stored and the required safety risk assessments were completed.

Medicines were supplied by the pharmacy at one of the other hospitals within the trust. Staff checked and recorded availability of medicines at the end of every shift and ordered additional medicines when needed. There were suitable processes for staff to follow for the safe storage, administration (which included medicines to take home). Children who had any medicine allergy had a red hospital wristband that included their medicine allergy, we saw this during our assessment. The prescribing of antibiotics was undertaken appropriately under the trusts antimicrobial policy. Staff assessed children and young people's pain using a recognised tool and gave pain relief in line with individual needs and best practice. The trust had effective systems to manage and respond to safety alerts and medicine recalls.