Client: Great Ormond Street Children’s Hospital (GOSH) and other UK Hospital Trusts


–Description: The PANDA (Paediatric Acuity & Nursing Dependency Assessment) system enables nursing management on acute children’s wards to estimate safe nursing requirements by shift based on patient needs as defined in an underlying safe nursing model. It also enables hospitals to support claims for funding from their Clinical Commissioning Group (CCG) based on acute care provision on non-acute wards:

  • –Collates data on the UK Paediatric Critical Care Minimum Data Set (PCCMDS) to allow accurate charging of high dependency care,
  • –Provides data on staff training needs based on patient need,
  • –Is designed specifically for paediatric hospital care, rather than adapted from an adult care model.

PANDA calculates safe staffing levels by assessing patients against 84 ‘care categories’ to determine patient acuity levels. Care categories were derived from guidance on Department of Health (high dependency care in children) and the PCCMDS. Four additional categories were recommended following peer review by nursing experts to ensure PANDA was a holistic tool reflective of both general and specialist paediatric hospital populations. PANDA identifies the appropriate ‘nursing dependency’ category from the standard categories based on guidance on paediatric nurse staffing from the Royal College of Nursing. It complements annual safe nursing care establishment planning via tools like the Safer Nursing Care Tool (SNCT) by ensuring compliance with safe care levels for each shift, identifying resource, skill and capability gaps which unaddressed, may compromise patient care and guidance.


  • Monitor the dependency of children
  • Ensure the correct number of staff available per shift
  • Ensure the correct mix of skills to meet actual care needs
  • Charge commissioners for high dependency and intensive care patients

Take-up: the system was developed and is distributed and supported in partnership with GOSH. It is in use across 7 NHS England Trusts serving approx. 500+ beds. There is an active user group chaired by GOSH.

–Future: integration with patient and nursing data, improved reporting and potentially AI to deliver more accurate and consistent risk assesments.

–Impact:  Generated £10m plus in additional funding for one trust from its Clinical Commissioning Group (CCG). Has improved resource-sharing across wards, highlighted competency shortages and improved confidence of nursing staff that they are meeting needs of high dependency patients in their care.

See GOSH PANDA tool for an overview and video.