Sheffield Children's Hospital

Updated 28 November 2019

Updated 26 October 2016

Updated 8 May 2014

Children and their families were given the choice as to whether they received end of life care in hospital, at the hospice or at home and all of the patients in the previous twelve months had their preference achieved by the commitment of the staff and multidisciplinary working.

Cleanliness, infection control and hygiene procedures were followed. There were facilities in the bereavement suite and emergency department for people who had recently lost loved ones. There were effective systems for prescribing and administering medicines to patients on the end of life care pathway.

We found that patient records were completed appropriately and the views of the child and the family were fully taken into account when it came to the issue of consent to limitation of treatment agreements.

There were advanced treatment plans which took into account a patient’s individual prognosis and systems for reacting to critical clinical events.

We found that care and treatment was evidenced based and followed accepted standards and professional guidance. There was good multidisciplinary team working in palliative and end of life care services. When it came to responding to the needs of a diverse multicultural population this was done to a high standard.

With regard to whether the service was well-led we found that palliative and end of life care services, and the service offered by the bereavement suite, were outstanding. Staff we spoke with exhibited an understanding of the vision and strategy of their services. The views of patients, families and staff were taken into consideration. There was also a climate of innovation and improvement.

Updated 26 October 2016

Updated 26 October 2016

Updated 16 July 2019

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. The service had suitable premises and equipment and looked after them well.
• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary. The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the trust policy and procedures when a patient could not give consent.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff provided emotional support to patients to minimise their distress. Staff involved patients and those close to them in decisions about their care and treatment.
• The trust planned and provided services in a way that met the needs of local people. The service took account of patients’ individual needs. The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
• Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
• The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
• The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively. The trust was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However:

• The service had overdue follow up appointments in outpatients.
• The service had cancelled clinics within six weeks in the previous six months.
• Staff in outpatients did not receive regular safeguarding supervision.
• Records were not always completed to the required standards. For example, the visibility of safeguarding alerts lacked consistency in recording, next of kin was not always recorded, person accompanying the child was not recorded in five records, one consent form did not have the child’s name and there was no evidence of the voice of the child in records.
• The toy cleaning log did not document all cleaning of the toys in outpatients.
• Although staff understood how and when to assess whether a patient had the capacity to make decisions about their care and staff could describe Gillick competency, MCA and DoLS training did not become mandatory for staff until 2019 and only two members of staff had completed MCA competency training

Updated 16 July 2019

Our rating of this service stayed the same. We rated it as good because:

• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

• The service provided care and treatment based on national guidance and evidence of its effectiveness.
• The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• The service had systems and processes in place to ensure that the needs of local people were considered when planning the service delivery.
• Managers at all levels had the right skills and abilities to run a service providing high-quality sustainable care.
• The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

However:

• The service did not follow best practice when prescribing, giving, recording and storing medicines. We found inconsistent practice across wards regarding the management of medicines.
• Staff training compliance failed to meet trust targets for completion of mandatory training in key skills.
• Staff training compliance failed to meet trust target for Safeguarding Adults level 2 and Safeguarding level 3 training.
• The trust had not developed separate training for Mental Capacity Act and Deprivation of Liberty Safeguards.
• The number of staff within surgery who had received an appraisal was below trust compliance targets.
• Not all complaints were investigated, responded to and closed in line with policy.

Updated 16 July 2019

Our rating of this service improved. We rated it as good because:

• The transition team co-ordinator had implemented a multidisciplinary meeting for young people who had complex health needs and had the services of three consultants or more. This has led to improved communication between staff and robust care plans with a lead professional identified.
• Since our last inspection patient electronic records had been developed. These included a tab which identified those patients with a transition plan.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
• All staff in the transition team had received mandatory and safeguarding training which included the Mental Capacity Act (MCA) Deprivation of Liberty Safeguards (DoLs) and consent
• The transition team had developed an electronic live transition plan. This would ensure all young people in the transition process could be identified in the hospital which we did not observe at our last inspection
• Young people were treated according to national guidance, including those from the National Institute for Health and Care Excellence (NICE) and Royal College of Paediatrics and Child Health.
• Policies and procedures were based on national guidelines.
• We saw that transition pathways had been put in place in specialities and with the overarching initiative of Ready, Steady, Go.
• Sheffield Children’s Hospital now evidenced strong partnership working across Sheffield and focussed on improved pathways and integration through the commissioning of services for young people.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• The service planned and provided services in a way that met the needs of local people.
• Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care and the transition team was well established since our last inspection.
• Since our last inspection, the service had developed a strategy and policy for what it wanted to achieve and workable plans to turn it into action.

However:

• There was no lead nurse for learning disabilities at the hospital site, so that advice for staff planning care for young people who had a transition plan and a learning disability was limited.
• Although the service had started work on a database of young people in transition using information from the new electronic record system, it was not yet fully operational.

Updated 16 July 2019

Our rating of this service stayed the same. We rated it as good because:

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Although the scope to maintain privacy was limited by the environmental shortcomings of the department, privacy was maintained as far as possible by medical and nursing staff as they administered care and treatment for the patient.
• Staff involved patients and those close to them in decisions about their care and treatment, including those who required support for their mental health needs.
• Patients requiring extra assistance with care and treatment were identified during their initial assessment and staff ensured they accessed support services.
• Patients could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.
• A primary care service was co-located in the emergency department and had been implemented effectively.
• A clear leadership structure was in place which staff we spoke with could explain. Managers at all levels had the right skills and abilities to run a service providing high-quality sustainable care.
• The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service used a systematic approach to improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
• The service had enough staff and made sure staff were competent for their roles.
• Staff kept themselves, equipment and the premises clean.
• The department’s paediatric clinical guidelines had been adopted by other NHS trust emergency departments. The department had taken a number of steps to improve the management of sepsis.

However:

• The emergency department easily became overcrowded when it was busy. When the acute assessment unit was operating to capacity, privacy and dignity could be compromised.
• Assessments were not always completed in a timely manner for patients who presented with mental health concerns.
• The effectiveness of the safeguarding checklist was weakened because it was not always used consistently.
• Facilities for patients who required a hoist or to support hearing impaired families were limited.
• Children with infections were not isolated whilst waiting.
• Some of the facilities were not child-friendly.
• Clinical staff did not receive mandatory training in how to recognise and provide a first response to patients with mental health needs.
• Although we saw evidence of regular checks undertaken by staff, some resuscitation equipment stocks were out of date and equipment stocks were not routinely rotated.
• Whilst the department worked closely with other children’s hospitals nationally and compared informally, specific benchmarking of audit and performance results with other paediatric services was not undertaken.
• Planning to meet the needs of patients with a learning disability and the needs of patients with complex needs and their families required development.
• It was unclear what measures were planned to improve mental health liaison. The emergency department did not provide a psychiatric liaison service.