Children not always safeguarded from harm at Dudley hospital's specialist emergency department, watchdog says

Care Quality Commission (CQC) inspectors visited the paediatric ED at Russells Hall Hospital after concerns about children and young people who attended the site.

A report found the Dudley service did not have enough staff to "care for patients and keep them safe" with understanding of safeguarding being "varied" between staff.

It said: "Systems were not always effective to ensure children and young people were protected from abuse and improper treatment. Staff had training on how to recognise and report abuse, however they had not all completed it.

"Staff did not always safeguard children at risk of, or suffering, significant harm. There was a safeguarding children’s policy in place which explained the roles and responsibilities of staff. However, staff did not always follow this.

"Additionally, there was a bruising and injuries in non-mobile children and imaging for children with suspected non-accidental injuries standard operating procedure in place. The trust also provided staff with some additional training around non-accidental injuries in children. Training dates were also in place to provide training around non-accidental bruising."

Meanwhile they found there was a lack of "professional curiosity evident" within the records, and a lack of a proactive approach to safeguarding for children with known vulnerabilities.

No ratings were given at this inspection therefore the overall ratings for Russells Hall Hospital and The Dudley Group NHS Foundation Trust remain requires improvement.

Following the inspection, the trust provided a comprehensive action plan with evidence addressing how they would respond or had already responded to the concerns.

Charlotte Rudge, CQC’s deputy director of operations in the Midlands, said: "When we inspected the paediatric emergency department at Russells Hall Hospital, we found some areas that needed improving to ensure children and young people who attend the department receive appropriate care and their needs are met. How staff were implementing safeguarding policies was our biggest concern.

"There was a safeguarding children’s policy in place which explained roles and responsibilities. However, staff didn’t always follow this which could place young people at risk. The understanding of policies and how to follow them was varied with some staff able to articulate how they’d manage concerns and others were unable to give examples.

“This included when a child was known to be vulnerable, there was a lack of awareness in how to assess or treat them while safeguarding them effectively.

"It was concerning that nursing staff shortages resulted in shifts operating without the required staffing levels. While many NHS services and those in the wider care sector also face staffing challenges, the trust must find ways to minimise the risk this poses to people in its care.

"It was positive, however, that leaders were proactive in recruiting new nursing staff and had developed recruitment events as well as inviting prospective staff for tours of the hospital and creating interactive videos for prospective applicants.

"It was also good that the trust was planning an 18-month conversion programme that could be offered to registered nurses wanting to convert to being registered children’s nurses.

"We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made and sustained so children and young people visiting the department receive a good standard of care."

Meanwhile staff regularly completed multi-agency referral forms, the trust ensured staff had a 100 per cent compliance rate for DBS checks, and a training package for paediatric staff and managing mental health in children's services was being developed. The paediatric emergency department saw 23,607 children last year, the CQC report added.

Diane Wake, chief executive of the Dudley Group NHS Foundation Trust, said: "We welcome feedback from the Care Quality Commission (CQC) following their unannounced inspection of our paediatric emergency department in February. We are working with the CQC to address their concerns and make sustained improvements to ensure children and young people are safe in our care.

"Where issues and concerns were raised with the Trust, we took immediate action and provided assurance to the CQC of these immediate actions.

"We have improved safeguarding training compliance which now stands at 100 per cent among nursing staff in the department. Our safeguarding team visits the department daily, daily safeguarding audits have been implemented and awareness sessions have been held for staff on professional curiosity.

"We are holding regular recruitment events to attract staff to join our Trust to help address some of our workforce challenges around nursing shortages. More than 850 people attended our New Year, new career event in January and we have another recruitment event planned for April. We also hope to increase the number of registered children’s nurses through our 18-month conversion programme."