Prior to this inspection concerns were raised with us that standards of quality and safety were not being met in the theatre department. We undertook a focused inspection in this area and across a number of wards within the surgical division. We did not include all areas of the Trust as part of this responsive review.

We found that all patients admitted to the Trust had their individual needs assessed on admission. We talked to patients, families and staff and found overall care was patient centred and their individual preferences and choices were taken into account in delivering the care provided. We found the ward areas to be clean, tidy and well maintained. Some comments were from patients and their families included

"I can't fault it, the nurses are amazing. Nothing is too much trouble, they are really

approachable. I've asked them the same thing lots of times and they are so patient. They explain everything to me. They have made a bad experience good. They arranged our stay at Ronald McDonald and have arranged for me to see a district nurse here. When I leave at night I know she is safe."

"Everything is fine, staff are attentive, know him well and what he needs and care for him like I do – so much so, I am happy to leave and go home. Staff are supportive of me too.”

"It has been a very emotional time but they are as supportive as they can be."

"I can't fault it, the nurses are amazing."

"Nothing is too much trouble."

We reviewed the staffing levels across each of the areas we visited and whilst overall staffing numbers on the ward areas were satisfactory, we found inconsistent numbers of staff to meet the needs of patients as a result of higher demand and staff sickness at the time of the inspection. We found staffing levels to be inadequate in the theatre department specifically.

We were concerned to find that staff working in the theatre suite had not followed published research and guidance at all times. These matters included best practice and checks and maintenance checks that should have been in place for essential equipment.

Prior to our inspection we were notified of a number of concerns relating to the support that staff were given by the Trust with particular reference to the theatre department. We found that significant improvements were needed to ensure staff were properly trained, supervised and supported at work.

We found that corporate systems and processes for quality assurance and improvement were in place. However the local implementation and monitoring of these processes in the theatre department was poor.

Prior to our visit, concerns had been raised with us regarding low staffing levels and the lack of availability of essential equipment on the High Dependency Unit at Alder Hey Children's NHS Foundation Trust. During our inspection, we spoke with staff in a variety of roles, as well as reviewing relevant documentation and observing the care and support provided to patients on the ward. We found that there was enough equipment to promote the health and wellbeing of people who use the service and there were enough qualified, skilled and experienced staff to meet people’s needs.

This was a scheduled inspection and during our visit we followed up an outstanding area of non-compliance identified at our last inspection, for which an improvement action was set. We visited three wards and the child protection unit during our visit and spent time speaking with patients and their families, as well as staff at a number in a number of roles.

We spent time speaking with nine patients and their relatives and invited them to share with us their experience and views. People we spoke with were mainly positive about their experience at Alder Hey Children’s NHS Foundation Trust Children’s NHS Foundation Trust. One patient we spoke with told us, “Everyone is brilliant” and a parent told us “This hospital is absolutely fantastic”. Patients and their families told us they had been given information at an appropriate time and in a way they could understand.

During our time spent on ward areas we saw staff treated patients, and their families, with respect and dignity. Parents we spoke with described staff at the hospital as “kind and gentle” and “caring and supportive”. People told us that if they had any concerns, they felt able to raise them with staff.

Staff we spoke with told us they felt well supported and we saw that progress had been made in the provision of staff support, as well as in the uptake of mandatory training across all staff groups.

During our inspection we visited two ward areas. We asked patients and their parents if they felt supported to make decisions about the care and treatments they had received. We were told they were given both written and verbal information to support their consent decisions. Medical and nursing staff explained procedures in a clear and understandable way, this included conversations about the risks involved for patients. We were told that staff were ‘honest about everything’ their understanding was ‘tested’ by staff and they were ‘encouraged to ask questions about the risks’. In particular we were told on the surgical ward that their consultant had spent a long time discussing the risks associated with their surgery and they welcomed this.

Parents told us the needs of their children were well met. They said they were satisfied with the support they had been given and that their child had always been treated with dignity and respect. We asked them to give us examples of this and they told us conversations and examinations were always undertaken in private, parents and children were given ‘time and space’ to make decisions and staff always explained what they were doing in a ‘respectful manner’.

Parents told us that they had ‘confidence’ in the nursing and medical staff. They said they had a ‘named nurse for each shift’ and ‘they had received fantastic care’. They told us staff were ‘well trained’, they ‘communicated well and they enabled parents to be involved in all aspects of care’.

Our rating of services stayed the same. We rated them as good.

We did not aggregate the diagnostic services at this inspection as it was an additional service which was inspected with outpatients before.

A summary of services at this hospital appears in the overall summary above.