Children services in one of Kent’s largest health trusts have been rated inadequate, with young people being placed at risk.

East Kent Hospitals University Foundation Trust had unsafe children’s wards and was severely understaffed.

The Care Quality Commission (CQC) investigated Ashford’s William Harvey (WHH) and Margate’s Queen Elizabeth the Queen Mother Hospitals (QEQM) after patients and staff raised concerns.

Dr Nigel Acheson, CQC’s deputy chief inspector said the trust had been “working under some pressure, apparently with no end in sight.”

Susan Acott, the trust’s chief executive, said the workforce has been bolstered and wards improved since the unannounced October inspection.

Poor infection control

People were at risk of cross-infection of contagious diseases because of poor equipment at QEQM.

Inspectors witnessed a toddler with chicken pox running among other children and a locum doctor treating them without gloves or washing their hands.

Dirty trolleys were discovered and toys had not been cleaned for 14 days in October, records showed.

Resources for children with mental health problems were insufficient to keep patients or staff safe.

Inspectors also saw nurses treating babies without washing their hands.

A catalogue of significant failings were also uncovered at WHH. A stethoscope was used on babies without being cleaned between patients risking the spread of germs.

Logbooks indicating when equipment had been cleaned were incomplete and a resuscitation trolley was damaged and sticky to touch, inspectors reported.

One staff member neglected wearing clean gloves and aprons, despite them being readily available between wards.

The report adds: “During our inspection, all but one staff member cleaned their hands between patients and before and after clinical tasks.”

Mismanaged drugs

In the children’s emergency unit medicine fridge temperatures were not recorded on 49 days between October and August, at QEQM.

On numerous occasions the fridge exceeded the maximum eight degrees C temperature.

Medics couldn’t be assured medicines were safe after the temperature soared to 13 degrees C on at least three occasions.

In the resuscitation bay drawers were left unlocked containing intravenous fluids, risking unauthorised tampering.

Patients were found to be at risk of “serious consequences in an emergency” after intravenous saline and potassium solutions were stored together in similar bags.

Two expired injection pens - used to manage severe allergic reactions – were discovered in the Rainbow Ward.

A drawer containing saline solution and potassium solution were stored closely together in similar bags similar bags.

A total of 32 medicine incidents were reported between April and September at WHH.

Of these errors, 59% were down to poor administration, 6% due to dispensing issues and 34% were wrongly prescribed.

Patient records were discovered in unlocked trolleys inside the corridors

“We saw four pages of medical records for one patient filed in another patient’s notes.

“This was escalated to the nurse in charge who took immediate corrective action,” the report says.

Struggling staff

At night children were often made to wait in the same emergency department areas as adult patients, sometimes drunk or exhibiting volatile behaviours at QEQM.

Inspectors were concerned about reports of a sometimes abrupt and judgemental attitude shown by administrative and senior staff.

Senior staff used unfavourable stereotypes when describing parents, particularly those from specific areas.

A receptionist even accused a parent of lying about not being triaged.

The report also describes a doctor who wanted to examine a baby but had no space to do so.

At WHH children’s emergency department there were no healthcare assistants or support staff to help with cleaning trolleys or taking observations.

During the inspection one nurse told inspectors they had not been able to attend the relevant training.

Another reported being placed in charge despite having not received the relevant training.

“One nurse was not confident about undertaking this role but had been encouraged as it was a development opportunity.

“Emergency clinicians with responsibility for the care of children had received limited training in how to assess risk and immediately manage children’s mental health needs and support their family/carers,” the report adds.

Inadequate

As a result of the inspection children’s services in both hospitals have been rated Inadequate overall.

The service was rated Good for caring, Requires Improvement for being effective and responsive and Inadequate for being safe and well led.

There has been no change to the trust’s overall rating which remains Requires Improvement.

Throughout both reports inspectors recognised staff working under pressure interacted well with babies and children.

Parents were often complimentary about the healthcare received.

In the Special Care Baby Unit at QEQM parents reported staff were very supportive.

Dr Nigel Acheson, CQC’s deputy chief inspector said: “It is clear that the children’s services at East Kent Hospitals University NHS Foundation Trust have been working under some pressure, apparently with no end in sight.

“We could not allow this to continue - and we used our enforcement powers to ensure that appropriate action is taken to protect young patients.”

Susan Acott, trust chief executive said: “Staff have worked quickly and thoroughly over the last three months, changing everyday working practices and how services are managed to make hospital services for children and young people safe and respond to the CQC’s feedback.

“We immediately addressed concerns raised by the CQC that are highlighted in today’s report, including recruiting more specialist children’s staff, implementing a thorough regime of daily safety checks and improving the environment children are cared for within, particularly in our emergency departments.”