Royal Manchester Children's Hospital

We had not previously rated this hospital. We rated it them as good because:

• The services mostly had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff gave patients enough food and drink to meet their needs and improve their health.
• Staff cared for patients with compassion and provided emotional support to patients to minimise their distress. This was child- centred and age appropriate. There were some outstanding examples of caring provided at the hospital.
• There was a strategy and hospital-wide agreed framework for transition to adult services with aspirations for better coordination linked to the overarching “our family caring for yours” values approach. Some clinical areas, for example oncology, burns, diabetes and respiratory medicine, had already developed robust transition pathways.
• Staff understood their role in recognising and preventing potential abuse.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. All the areas we visited were clean and tidy.
• The service made the most of the premises available to them and all areas were bright and welcoming, with a variety of child-friendly decorations in every part of the hospital.
• The services had systems in place that ensured that medicines were administered and stored safely.
• The services took account of patient’s individual needs. Young people’s education was delivered at the well-equipped hospital school. There were play leaders and play specialists who worked alongside nurses, doctors and other members of the multi-disciplinary team to ensure that children received the interventions needed in the most appropriate and child-friendly way, whilst also being fully aware of the child’s needs.
• We saw examples where the service took a proactive approach to understanding the needs of patients’ individual needs. They treated all children in their care as individuals and adopted individualised plans of care and treatment using tailor made packages of care.
• The services had experienced leadership who ensured a quality service was delivered and was sustainable.

However;

• Nursing records within the children’s clinical decision unit were not completed in line with required standards. Risk assessments for child and adolescent mental health patients were not completed in line with the departments referral pathway.
• The emergency department premises were not suitable for the number of patients attending the department. A plan to redesign and increase the size of the department had been agreed and was due to commence in 2019.
• We found that although staff could access other members of staff for advice or support, there was no regular, formal safeguarding supervision for staff at the hospital.
• The trust did not have a nurse on each shift on each medical ward that was APLS/EPLS trained, so this did not meet the standards set out by the Royal College of Nursing (2013). Plans were in place to address this.