Alder Hey Children’s hospital: too slow to change?
An unannounced inspection of Alder Hey Children’s hospital in Liverpool has found “potentially unsafe” staff shortages, essential equipment missing from the operating theatres, emergency alarms not working, and a failure to carry out proper safety checks.
A report from the Care Quality Commission also reveals high staff sickness levels, leading to cancelled operations and operations that often over ran, which meant staff had to work extra and longer hours.
The report, which follows an unannounced inspection carried out last December, said that the staff shortages “meant that patient welfare and safety was at increased risk”.
Malcolm Bower-Brown, CQC’s regional director for the north, said that the problems identified at Alder Hey “are very worrying”.
Last month, Channel 4 News revealed that one of the trust’s own executives had issued a safety warning following an internal review of the operating theatres.
A leaked copy of the review by the director of nursing Gill Core said that “the level of risk is such that urgent action needs to be implemented to avoid an adverse outcome or serious incident”.
That report, which was presented to the Trust board in December, said that safety shortcuts “have created high risk activity” and that there was a limited reporting of incidents – that is near-misses and mistakes.
Now the CQC has said that the Trust failed to meet four of the five national standards it reviewed. It has passed its findings to Monitor and NHS England.
Safety
The inspection followed a direct approach to CQC by concerned theatre staff. And today’s CQC report does find that there were safety issues.
The report says that there were examples of events that should have been reported as an incident or near misses and staff had not recognised this or reported it appropriately.
The inspectors said: “This is an important issue as applying the learning from such events can reduce the risk of the events happening again.”
They found that the emergency department call alarm system was faulty in the day surgery theatres.
They said: “We were told that the alarms had become unreliable at the start of recent building works to refurbish one of the theatres and since then the alarms did not function correctly all of the time.”
And they discovered that essential items of equipment such as capnography (for monitoring airways) was not in place and that on one anaesthetic machine the medical air and oxygen cylinders were beyond their expiry dates. The inspectors said this showed us again that checks were not being made.
Staffing
The report also highlights staffing problems, which had also been a central theme in the earlier director of nursing review. The CQC said that staff concerns related to “leadership, high stress levels and a feeling of not being listened to”.
Inspectors said this was discussed at the time with senior managers who were aware of the problems.
The CQC said initiatives been introduced, but only recently and had not yet had any real impact on staff.
In fact, as Channel 4 News has previously reported, a 2010 internal psychological review of the operating theatre department revealed high stress levels among staff, including concerns of self-harm and suicide.
Managers were described as “bullying.. intimidating.. coercive.. aggressive.. hostile.. vindictive”.
There have also been concerns raised by whistleblowers, as far back as 2009, about the way the theatre departments at this children’s hospital operate.
Neither their concerns, which have been reported directly to the CQC, nor the 2010 psychological review, are mentioned in today’s report.
The trust board, including the chief executive and the chairman, have repeatedly refused to be interviewed by Channel 4 News. Instead, we were given a statement from Louise Shepherd, the chief executive.
She said that she would like to reiterate that “there is no evidence that patients have been harmed as a result of these concerns and we remain confident that we are providing a safe service for our children and young people”.
Ms Shepherd said the CQC report does raise some questions about the steps the hospital needs to take to ensure patient safety although she adds that “the safety of patients is our highest priority”.
“There are multiple steps we take to ensure the safety of our patients throughout the duration of their care. This means that if one step is ever missed then other steps are always in place to ensure patient safety is upheld.”
On the wellbeing of staff, she said that it was of “paramount importance”.
What she does not say, is why these issues are still being raised by staff nearly four years after the internal review, and five years after the whistleblowers highlighted concerns?
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