'Dysfunctional' hospital units put children at 'very serious risk'

Child patients faced a "very serious risk" of increased deaths and deterioration of their conditions due to failings at a hospital, according to an independent report.

Staff shortages, poor culture and 'inadequate' nursing skills were identified at Kettering General Hospital's (KGH) children's and young people's paediatric and urgent care services.

Independent consultants Ibex Gale, which conducted the investigation, also said a "them and us" culture had also developed between departments.

The NHS trust which runs the hospital said it was "committed to creating the best service possible for our patients, families and colleagues".

Ibex Gale was brought in to conduct what is known as a patient safety culture review following "serious concerns" from staff, patients, and parents.

Inquest findings and patient safety incidents also prompted the trust board to take action.

The consultant's report highlighted workforce shortages and inexperienced staff who told the investigators they were overwhelmed by demand.

Staff described an "unhealthy culture that creates an environment where stress, negativity, and dysfunction become the norm".

"The perceived staff shortages, and the concerns raised regarding the inadequacy of agency/trust adult nurses' paediatric skills and experience, create a very serious risk of increased mortality and morbidity for patients," the report continued.

Ibex Gale described a disjointed culture with low psychological safety, where staff felt reluctant to put forward ideas, offer suggestions or have challenging conversations.

An environment with psychological safety is one where people feel comfortable expressing themselves without worrying about negative consequences, according to the Royal College of Nursing.

The report also highlighted a lack of collaboration between staff at the Skylark children's ward and the paediatric emergency department.

This affected safety, it said, and contributed to "a lack of collective responsibility for patients".

The BBC had previously exposed failings at Skylark Ward.

Families shared concerns about care at the unit and said staff had ignored symptoms of serious illnesses, sometimes with fatal consequences.

The Care Quality Commission (CQC) is also considering a criminal prosecution following the death of Chloe Longster.

The 13-year-old from Market Harborough in Leicestershire, died from pneumonia and sepsis in November 2022, one day after being admitted to the ward.

Her death was contributed to by neglect, according to a coroner, and the hospital admitted it had failed to deliver the care Chloe deserved.

The report authors said only 36% of the relevant staff members had engaged with the review, despite the period for them to do so being extended.

This equates to just 77 out of a possible 212.

In a survey conducted as part of the review, just 55% of staff said they were confident the trust was delivering safe paediatric services.

Demand was outstripping the skilled paediatric workforce and estate resources, the report added.

The University Hospitals of Northamptonshire NHS Foundation Trust, which operates Kettering General, said it had instituted a series of measures to improve safety and performance.

These included:

• A twice-daily "safety huddle" where senior nurses, medical teams and operational staff meet to discuss safety

• Multidisciplinary monthly simulation training for medical and nursing staff, strengthening team collaboration and clinical capability and practising dealing with difficult clinical scenarios

• Listening Events to improve staff and patient experience

• Senior nurse away days "to support improved working between the children's ward and paediatric emergency department"

• Making the leadership more visible

• More patient engagement, "ensuring their voices shape care delivery, safety improvements, and service design"

The University Hospitals of Northamptonshire chief nurse, Julie Hogg, said: "As part of our improvement work, we commissioned a review to look into how we could improve our culture within the service, to have a positive impact on patient safety".

She added: "The report identified a number of areas that we need to improve, and our new Children and Young Person's leadership team is focusing on working with colleagues, and listening to our patients, to make and embed the changes swiftly and effectively."

Ms Hogg said they had accepted all of the recommendations, which "will inform a comprehensive improvement plan".

"This plan will be tracked through governance structures and reported publicly to ensure transparency and accountability.

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