Improvement review into services for children in hospital
A number of public inquiries into health and healthcare have identified failings in arrangements to protect and promote the welfare of children.
The Healthcare Commission has a special statutory duty to “pay particular attention to the need to uphold the rights and welfare of children”. Our commitment to safeguarding children is also set out in our vision. The improvement review of the quality of healthcare for children in hospital is one part of this vision.
The improvement review of services for children in hospital was based on aspects of the hospital standard of the National Service Framework for Children, Young People and Maternity Services, published by the Government in 2003. The national service framework sets the standards for services across health, education and social care for children and their families over the next 10 years.
The improvement review looked at services received by children throughout hospitals – not just in paediatric departments. It focused on those areas in which healthcare organisations (trusts) should have already made improvements. In particular, we asked:
- are children treated in environments that are child friendly, specifically dedicated to children or on children’s surgical lists?
- are services available at a number of locations which are close to patients’ homes?
- do services have appropriate cover from a range of staff? For example, nurses, play staff, pain teams and those able to provide emergency life support?
- are nursing, surgical, anaesthetist and paediatric medical staff trained in a number of essential or desirable skills for caring for children in hospital?
- are services organised so that staff who come into contact with children can maintain their skills, by seeing sufficient numbers of cases involving children?
National findings
The review found that some parts of the NHS need to do more to deliver consistent high quality care for children. It showed that the quality of care provided to children in inpatients’ services was good, with 71% of trusts scoring good or excellent and almost all children (99%) treated in children-only wards. It also showed that trusts have made a number of improvements to hospital environments to meet the needs of children. However, the review found that trusts are not systematically training staff across the hospital so that all services can meet children's needs. The review found that many trusts are not meeting quality standards for child protection training, pain management, communication and play. Although at the majority of trusts the quality of medical and surgical care does not raise concerns, some risks were identified at a minority of trusts.
Read our full report: Improving services for children in hospital (pdf 1003kb) (opens new window)
Follow up
We have worked with the 10% weakest performing trusts from this review to develop action plans to address areas of poor performance. We have been monitoring their progress against these action plans with strategic health authorities.
We have also followed up with the 18% of hospitals with insufficient cover to provide life support in serious emergencies. The majority of these hospitals now have appropriate arrangements in place (or, in some cases, have closed services to children).
Our local assessment managers will also carry out ongoing follow up work as part of the annual health check. Trusts will also be expected to take account of the results in their future declarations of compliance with the Government's core standards.
Detailed results
All organisations received a detailed report, highlighting where they have performed well and where they can improve. Explore the detailed results for the review below.
Results of the review for each organisation, in alphabetical order by organisation name (pdf 54kb) (opens new window)
Results of the review for each organisation in the London area (pdf 42kb) (opens new window)
Results of the review for each organisation in the Midlands and East England area (pdf 44kb) (opens new window)
Results of the review for each organisation in the Northern England, Yorkshire and Humber area (pdf 46kb) (opens new window)
Results of the review for each organisation in the South and South West area (pdf 38kb) (opens new window)
Access the full detailed results of the review, including underlying data (opens new window)
To view the detailed results, you will need to download free 'Instant Atlas' software. If you need help using the software, click on ‘HELP’ in the report or read the accompanying guidance.
Instructions on how to install Instant Atlas software (pdf 21kb) (opens new window)
Help on how to use the interactive report (pdf 261kb) (opens new window)
Child health mapping project
To promote continued improvement, the Healthcare Commission will collect key information from trusts annually from 2006/2007, through the Child Health, CAMHs and Maternity mapping project based at Durham University. This data will be used to develop 11 performance indicators relating to the areas most in need of improvement, chosen from the broader set of indicators that we used in the improvement review. In addition to allowing us to identify improvements made, the indicators will contribute to our assessment of performance in relation to standards. We will also use them to target further activity and during improvement planning.
All of the trusts who participated in the improvement review must submit the data we require to the child health mapping project website at: www.childhealthmapping.org.uk (opens new window). The data must be submitted between 1 November 2007 and 28 February 2008.
Full details are available on the above website.
Process and methodology
Management summary (pdf 38kb) (opens new window)
Framework of assessment (pdf 83kb) (opens new window)
Membership of the review reference group, and participants in the review piloting process (pdf 26kb) (opens new window)
Further information
If you would like more information about the review, please contact our helpline on 0845 601 3012.
More information on the Healthcare Commission's work in relation to children
Most reports on this site are PDF files, to view any PDF file you will need Adobe Acrobat Reader.