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, according to a report by the Healthcare Commission (now replaced by the Care Quality Commission).
The watchdog examined the progress of 154 NHS acute Trusts since 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. The Commission said that although some Trusts had improved, overall progress was “mixed”. 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. In addition, 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. The Commission added that Trusts have made very limited progress in training staff in providing life support to children. Ninety-four per cent of Trusts are still failing to provide sufficient training in basic resuscitation and emergency life support to surgeons. Seventy-four per cent of Trusts are failing to provide this to emergency care nurses. The watchdog 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. Seventy-four per cent of Trusts performed poorly or had deteriorated when measured against recommendations to maintain the skills of anaesthetists. Sixty-four per cent of Trusts performed poorly when measured against recommendations to maintain the skills of surgeons.
