NHS System-wide Paediatric Observations Tracking (SPOT) Programme
HSIB recommends that the Chair of the NHS System-wide Paediatric Observations Tracking (SPOT) Programme ensures that the Association of Ambulance Chief Executives, community NHS 111 providers and primary care services are integral members of the NHS SPOT Programme.
We are currently scoping Phase 2 of SPOT, which includes the emergency services: ambulance services, NHS 111, emergency departments and Accident & Emergency. In early 2022 we will continue to engage with relevant stakeholders. A working group will be assembled, and the Association of Ambulance Chief Executives and NHS 111 providers will be represented. Our chair, who is the Paediatric Lead and Trustee at the College of Paramedics is currently liaising with one of the representatives for the ambulance services.
Response received on 7 March 2022.
NHSX
HSIB recommends that NHSX develops national standards describing the electronic deployment of the NHS System-wide Paediatric Observations Tracking (SPOT) e-PEWS (the digital version of the Paediatric Early Warning Score tool), in collaboration with the NHS England and NHS Improvement SPOT Programme. This should include specifications for data capture, calculation of the score and escalation status, and also the display of the information and connectivity with other digital systems.
Initial messaging standards for the SPOT score have already been incorporated into the national standard observation data set by NHS Digital. The Digital Child Health and Maternity programme is currently moving into NHS England and NHS Improvement as part of the merger with NHS X. It is anticipated that the programme will continue to work with the NHS England and NHS Improvement SPOT programme team to prioritise the resourcing of appropriate digital updates and support as the programme progresses.
Actions planned to deliver safety recommendation:
- We aim to launch the inpatient paper PEWS in early 2023. Rollout will be gradual and incremental over the coming years. By: early 2023. Resources in place: SPOT Programme. Other dependencies: Royal College of Paediatrics and Child Health (RCPCH)/Royal College of Nursing (RCN) support on dissemination and alignment. They are partners in the programme so well sighted.
- Selected hospitals are currently testing the PEWS and the testing includes digital and paper sites. By: Paper-based sites, October 2021-October 2022. Digital sites, October 2021 and we will continue to test until a specification is agreed. Resources in place: SPOT Programme. Other dependencies identified: digital transformation programme plans.
- Digital systems are still evolving and are impacted by wider digital ambitions for the NHS. Therefore, uptake and rollout digitally is dependent on wider funding and specifications. By: evolving over 2023. Resources in place: SPOT Programme. Other dependencies identified: digital transformation programme plans.
Response received on 20 October 2022.
NHS System-wide Paediatric Observations Tracking (SPOT) Programme
HSIB recommends that the Chair of the NHS System-wide Paediatric Observations Tracking (SPOT) Programme ensures that any resources produced include examples of children and young people with non-white skin showing signs of serious illness.
NHS England and NHS Improvement will be carrying out an impact assessment as part of the pilot study for in-patient use of paediatric early warning system (PEWS). Factors that may affect diversity and inclusion of the implementation of PEWS will be examined and reviewed for amendments if necessary, specifically focusing on key issues such as parent language. Attention to these issues may also be addressed in associated training and education. A Task and Finish Group has been established to develop all training content. This approach will also be part of subsequent phases and rollout to wider system solutions by 2022/2023.
Response received on 7 March 2022.
Association of Ambulance Chief Executives
HSIB recommends that the Association of Ambulance Chief Executives works together with the ambulance services to share best practice in relation to paediatric training, education resources, frequency and types of training, and that it collates and shares areas of best practice.
We convened a meeting of the national education network for ambulance education leads (NENAS) to present the report and findings/recommendations and subsequently we sent a survey to each ambulance service via the NENAS.
We asked what paediatric training is currently provided to existing staff and to which staff groups, what types of education resources are used and the frequency and types of training.
The results were reviewed, collated, presented, discussed and shared at a NENAS meeting on 16 February 2022. Although variation was identified, all services did have paediatric training in place.
Further work will now take place, led by NENAS with input from the ambulance lead paramedic group and the national ambulance service medical directors group (NASMeD) to consider what is best practice and potentially recommend a minimum standard for paediatric education in ambulance trusts for existing staff and new staff.
We are also liaising with the College of Paramedics and are aware of work they are proposing around future curriculum guidance and standards of education for the future ambulance workforce.
Actions planned to deliver the safety recommendation:
- Survey sent to ambulance trusts to gather information on paediatric education for existing staff. Surveys all completed by 11 February 2022.
- Survey results reviewed, collated, presented, discussed and shared at a NENAS meeting. Completed 16 February 2022.
- Gather views of education and lead paramedics of what best practice in paediatric education should be for existing staff, whether this is currently in place and agree if minimum standards should be developed by end March 2022. A decision has not yet been made of whether a minimum standard of education should be agreed nationally for existing staff.
- Agree minimum standard of paediatric education in ambulance trusts for existing staff by end June 2022, subject to agreement as per above.
- Issue to ambulance trusts a best practice statement and minimum standard for paediatric education for the existing workforce by end of September 2022. Subject to decisions as above and agreement by ambulance chief executives.
Response received on 8 March 2022.
College of Paramedics
HSIB recommends that the College of Paramedics works with partners and higher education providers to develop, agree and implement standards for paediatric education for the future ambulance service workforce.
The College of Paramedics welcomes the recommendation raised in this report and thanks the HSIB for striving to improve care in the paediatric population. In order the meet the safety recommendation, the College of Paramedics will work closely key stakeholders, especially the Association of Ambulance Chief Executives (AACE), to achieve the following actions:
At point of the next paramedic undergraduate curriculum guidance review, the College of Paramedics will carefully examine the section on the assessment and management of children, and consider appropriate changes based on the outcome of this report.
The College of Paramedics will continue to work closely with Health Education England to provide e-learning content for all paramedics.
The College of Paramedics is currently reviewing the foundation-preceptorship programme for newly registered paramedics. The e-learning component of this programme will incorporate further paediatric material including a recommendation to complete the Spotting the Sick Child programme and links to further resources such as the Health Education England Paediatrics in Urgent and Emergency Care (UEC) Learning Resource. The College of Paramedics will ensure that we consult with patients (or their parents / caregiver) to ensure that the lived experience of out-of-hospital paramedic care / treatment is better understood, which will positively influence the design of the foundation-preceptorship programme.
Finally, the College of Paramedics will ensure that our future paediatric education material is also representative of people with darker skin tones. This will be by incorporating learning based on the Mind the Gap Handbook of Clinical Signs produced by Malone Mukwende and colleagues.
Actions planned to deliver the safety recommendation:
- At the next undergraduate curriculum guidance review, examine the section on the assessment and management of children and consider appropriate changes based on the HSIB Recognition of The Acutely Ill Infant report, by 1 January 2023. A review of the curriculum guidance is commencing early 2022, with a planned completion date prior to the new year.
- The College of Paramedics will continue to work closely with Health Education England to provide e-learning content for all paramedics, by 1 July 2022. Additionally, review of existing content forms part of refresh of project. An independent reviewer with paediatric expertise is being tasked with review and update of the paediatric sessions.
- College of Paramedics is reviewing the foundation-preceptorship programme for newly registered paramedics. The e-learning component of this programme will incorporate further paediatric material including a recommendation to complete the Spotting the Sick Child programme and links to further resources such as the Health Education England Paediatrics in Urgent and Emergency Care (UEC) Learning Resource, by 1 September 2022. Additionally, existing content to be extended to include learning needs of all newly registered paramedics. An independent reviewer with paediatric expertise is being tasked with review and update of the paediatric sessions.
Response received on 4 March 2022.