The Care Quality Commission
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Sheffield Children's Hospital

Overall: Good read more about inspection ratings

Western Bank, Sheffield, South Yorkshire, S10 2TH (0114) 271 7317

Provided and run by:
Sheffield Children's NHS Foundation Trust

All Inspections

Other CQC inspections of services

Community & mental health inspection reports for Sheffield Children's Hospital can be found at Sheffield Children's NHS Foundation Trust. Each report covers findings for one service across multiple locations
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9 and 10 July 2019

During a routine inspection

We carried out this announced inspection on 9 and 10 July 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was carried out by two children’s inspectors and a specialist professional advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Background

The children's sexual abuse referral centre (SARC) is part of the child assessment unit located in Sheffield Children’s NHS Foundation Trust (SCNFT) in South Yorkshire and Bassetlaw. As the service is provided by SCNFT, the trust is responsible for meeting the requirements on the Health and Social Care Act 2008, and the associated regulations about how the service is run.

The service is co-commissioned with NHS England and the four Yorkshire and Humber Police and Crime Commissioners. The provider is contracted to provide a child sexual assessment service for delivery of child sexual assessment services for children and young people aged 0-16 years old or 16-18 years old (up to their 19th birthday) if the young person has additional needs or where deemed to be clinically appropriate for both acute (up to 14 days of the alleged incident) and non-recent (after 14 days since the alleged incident) cases.

At the time of the inspection the service was not commissioned to offer a 24-hour service. The service is delivered on an appointment-based system and the provider accepted referrals from Monday to Friday from 9am to 6pm and there was an advisory on-call service available from 6pm to 9pm. The service is commissioned to operate a weekend service from 10am - 6pm on Saturdays and 11am - 4pm Sunday and Bank Holidays, to accept referrals for children from the neighbouring West and North Yorkshire SARCs.

The staff team include a named nurse for safeguarding children, the SARC manager, four health care support workers and six consultant forensic paediatricians who worked as forensic paediatricians. During our inspection we spoke with the named nurse for safeguarding children, the SARC manager, two health support workers and three forensic paediatricians one of whom is a licentiate member of the Faculty of Forensic and Legal Medicine. Children and Young People’s Independent Sexual Violence Advisors (ChISVAs) are based off site and are separately commissioned. Children and young people have access to two part time psychologists who are separately employed by Child and adolescent mental health services (CAMHS).

We reviewed the care and health records of 14 children and young people who had used the service and the records for the management of medicines. We checked four staff recruitment files, minutes of meetings, audits, and information relating to the management of the service. During our visit we toured the premises and observed a peer review meeting.

Comment cards were sent to the service prior to our visit and we received four responses from children and their relatives. Throughout this report we have used the term ‘patients’ to describe children and young people who use the service to reflect our inspection of the clinical aspects of the SARC.

Our key findings were:

  • The service had systems to help them manage risk, however some policies required updating.
  • The staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • The provider followed the trusts recruitment policy, however this did not indicate how often DBS checks were renewed.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
  • The clinical staff provided patients’ care and treatment in line with current guidelines, however there was a lack of follow up arrangements for patients ongoing care.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • The appointment/referral system met patients’ needs.
  • The service had effective leadership, however audits needed to be improved to evaluate the effectiveness of the service.
  • Staff felt involved and supported and worked well as a team.
  • The service asked staff and patients for feedback about the services they provided.
  • The service staff dealt with complaints positively and efficiently.
  • The staff had suitable information governance arrangements.
  • The service appeared clean and well maintained.
  • The staff had infection control procedures which reflected published guidance.

There were areas where the provider could make improvements. They should:

  • Review the risks associated with DBS checks.
  • Follow up two week referrals to the Children and Young People's Independent Sexual Violence Advisors. (ChISVAs).
  • Improve governance arrangements to evaluate the effectiveness of the service.
  • Improve policies and procedures to reflect the day to day operations of the SARC.

14 -17 and 30 June 2016

During an inspection looking at part of the service

Sheffield Children’s NHS Foundation Trust is one of four dedicated children’s hospital trusts in the UK. It provides integrated healthcare for children and young people from the local population in Sheffield and South Yorkshire, as well as specialised services to children and young people nationally.

We inspected the trust between 14 and 17 June 2016. We undertook an unannounced inspection at the emergency department on 30 June. We previously inspected the Sheffield Children’s Hospital in May 2014 and rated it as good overall.

At this inspection we followed-up areas identified as requiring improvement or not rated at the previous inspection. We have rated the individual areas we inspected. We did not review the overall rating for the hospital as the inspection was focused on specific areas only.

We inspected the following core services:

  • Urgent and Emergency Services
  • Medical Care
  • Surgery
  • Critical Care
  • Neonatal Services
  • Transitional Care

We did not inspect outpatients and diagnostic services or end of life care at this inspection.

In the inspection in May 2014, we identified that the trust must ensure the hospital cover out of hours was sufficiently staffed by competent staff with the right skill mix, particularly in the Emergency department. We also identified the trust must ensure consultant cover in critical care was sufficient and that existing consultant staff were supported while there were vacancies in the department and that the process for ongoing patient review for general paediatric patients, following their initial consultant review, must be reviewed to ensure there were robust processes for ongoing consultant input into their care. We found that at this inspection, all these areas had been addressed.

At this inspection, our key findings were as follows:

  • The trust had taken action to address most areas identified at the inspection in May 2014. However, the trust had made insufficient progress in developing transition services since our last inspection. The trust directors recognised there was further work to do.
  • There was an open culture within the organisation. Challenge was encouraged by executives and non-executive directors. However, the trust was not meeting all the requirements under the duty of candour.
  • There were some staff shortages, however additional posts had been approved in principle by the Board and recruitment was underway.
  • Incidents were reported and investigated and lessons learned. The trust was planning to introduce an electronic incident reporting system which would improve capability to analyse themes.
  • Infection prevention and control policies were effective. There had been no cases of MRSA reported since 2008. All reported cases of Clostridium difficile between April 2015 and March 2016 were unavoidable.
  • Feedback from people who used the service and those who are close to them was mostly positive about the way staff treated people.
  • There was evidence of public engagement, however it was recognised by the trust, that there needed to be a more systematic approach; there was no patient and public involvement strategy in place.
  • Services were planned and delivered to meet the needs of people.
  • There were no mortality outliers at the trust.
  • Staff did not always take a proactive approach to safeguarding, particularly in the emergency department.
  • The trust was in the process of building work to provide new accommodation for some of the wards, accident and emergency and outpatients. The aim was to provide an environment to better meet the needs of children, young people and their families.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure there are effective governance systems in place to capture, respond, and learn from transition related complaints and incidents
  • Ensure that sufficient numbers of staff have appropriate training in the Mental Capacity Act.
  • Ensure there is an effective clinical audit system in place to monitor transitional care provision.
  • Ensure all children are appropriately assessed for safeguarding risks.
  • Ensure that staff undertake and document appropriate risk assessments to promote safe care.

In addition the trust should:

  • The trust should implement sepsis tool documentation to enable early intervention for febrile patients.
  • The trust should implement the use of the paediatric early warning system for all children who attend the department to enable early intervention for deteriorating patients.
  • The trust must ensure that staff undertake and document appropriate risk assessments to promote safe care.
  • The trust should ensure that there is a consistent and robust approach to the assessment and planning of transitional care.
  • The trust should ensure that a consistent approach is adopted to the completion and storage of transition medical records.
  • The trust should ensure that steps are taken to create and maintain a transition database to allow patients in transition to be identified.
  • The trust should ensure that staff dealing with transitional patients have appropriate knowledge and training around transition care.
  • The trust should ensure that its transition pathway is considered in conjunction with community and mental health services.
  • The trust should ensure that an appropriate gap analysis is conducted to identify any gaps in its transition service provision against the applicable guidance from the national institute of health and care excellence.

Professor Sir Mike Richards

Chief Inspector of Hospitals

7-9 and 22 May 2014

During a routine inspection

Sheffield Children’s NHS Foundation Trust is one of four dedicated children’s hospital trusts in the UK. It provides integrated healthcare for children and young people from the local population in Sheffield and South Yorkshire, as well as specialised services to children and young people nationally.

Sheffield Children’s Hospital has been a foundation trust since 1 August 2006. They employ around 3,000 staff. They treat around 30,000 children and young people admitted to hospital as inpatients or day cases and more than 164,000 attending outpatient clinics or being treated in emergency department.

The trust has three locations registered with the Care Quality Commission. These include Sheffield Children's Hospital, Becton Centre for Children and Young People, and Ryegate Children's Centre. The trust also runs the Embrace retrieval service for the region.

The trust was in the process of a new hospital build due to be complete in 2016, which aims to improve privacy and dignity of patient with increased number of single rooms and larger bed space areas. It also aims to increase the recreational and support facilities for children and young people and their families.

We carried out this comprehensive inspection as part of the pilot phase for the methodology adapted for dedicated children’s hospitals. Sheffield Children’s Hospital NHS Foundation Trust was rated as medium risk in the CQC’s intelligent monitoring system. The inspection took place between 7 and 9 May 2014 and an unannounced inspection took place on 22 May 2014. We did not inspect the Children’s and Adolescent Mental Health Services (CAMHS) provided by Sheffield Children’s Hospital.

Overall, this hospital was rated as good. We rated it good for being caring, effective, being responsive to patients’ needs and being well-led, but improvement was required in providing safe care.

We rated palliative care and end of life services as outstanding and A&E, surgery, critical care, neonatal services and outpatients as good. However we rated medical care and transitional services as requiring improvement.

Our key findings were as follows:

  • All staff working at the hospital were extremely proud to work for the hospital and dedicated to their work.
  • The culture was found to be open and transparent with an evident commitment to continually improve the quality of care provided.
  • The executive team were well known throughout the hospital and some members of the team did regular walkabout, and the medical director still worked clinically in the A&E department.
  • The care provided throughout the Hospital was consistently found to be compassionate and demonstrated dignity and respect with good examples of providing emotional support to children, young people and their families or carers.
  • Staffing out of hours (OOH), particularly within the A&E department was not always sufficient. The trust was in the process of presenting a paper on OOH cover to increase the number of consultants available and strengthen the OOH cover at the hospital.
  • The nurse staffing tool used by the hospital was developed specifically by the Chief Nurse to take into account national standards and other factors specific to the needs of each ward and agreed levels for each shift were agreed with the ward manager as a basis for recruitment and ongoing staffing.
  • The end of life care service demonstrated a clear commitment to always meet the preferences of patients on an end of life care pathway.
  • The accuracy of statutory and mandatory training data was not consistent between the central database and those records held locally at the wards. Staff reported this was due to them reluctance to rely on the central database at it was often inaccurate.
  • The hospital was clean and infection prevention and control measures were found to be good in the majority of areas, although a few staff were found to not comply with being bare below the elbows.
  • The flow throughout the hospital was in the majority good and they had a high rate of day case activity to prevent children and young people having to stay in hospital. They were also starting to work with other providers to develop pathways to keep care closer to home.

We saw several areas of outstanding practice including:

  • Outstanding practice was found to be evident in end of life care, in particular their leadership and responsiveness to patients wishes and preferences on an end of life care pathway.
  • The commitment and dedication of all staff and the transparent and open culture.
  • The tool used for nurse staffing was developed by the chief nurse and agreed staffing levels were decided in a collaborative manner with ward managers to ensure all aspects of specialism and acuity were taken into account.
  • The care and commitment provided in the A&E department was found to be excellent and the trust had consistently met the A&E 4 hour target for the previous twelve months.
  • There was a drive to deliver care closer to home and reduce unnecessary admissions.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure the hospital cover out of hours is sufficiently staffed by competent staff with the right skill mix, particularly in A&E.
  • Ensure consultant cover in critical care is sufficient and that existing consultant staff are supported while there are vacancies in the department.
  • Review the process for ongoing patient review for general paediatric patients following their initial consultant review to ensure there are robust processes for ongoing consultant input into their care.

In addition the trust should:

  • Review and standardise risk management and governance processes to ensure the local processes are consistent to ensure there are robust processes from board to ward.
  • Review the current training matrix for statutory and mandatory training and improve the recording system so that there is a comprehensive record of compliance which is consistent with local and trust wide records.
  • Review the processes for transition services in all specialties and ensure that a robust system is in place for all specialties as relevant
  • Ensure all medical discharge summaries are sent to GP practices in a timely manner to ensure ongoing care is maintained
  • Ensure there is provision of consultant ward rounds at weekends across all areas.
  • Monitor and review the impact of not having an outreach team to ensure the current provision meets the needs of all patients.

Professor Sir Mike Richards

Chief Inspector of Hospitals

16 October 2012

During a routine inspection

We carried out a routine scheduled inspection of this service. We visited the hospital and spoke with managers and key individuals about aspects of the organisation and running of the hospital. In addition, we visited two wards and spoke with some patients and their parents about the care and treatment they (or their child) were receiving. We spoke with some nursing staff about working at Sheffield Children's Hospital. We observed interactions between patients, their parents and nursing staff.

Staff spoken with said that assessments of needs were always undertaken so that important information was available to them. They told us that they received good support and training so that they could do their jobs well.

All of the parents spoken with confirmed that they had been involved in discussions about their child's care and treatment. They told us that nursing staff and doctors kept them informed and they felt included in any decision making. Children and young people spoken with said that staff always spoke to them and asked them their opinion. Children, young people and parents felt that privacy and dignity was respected by staff, and staff explained things in a way they could understand. Young people told us they felt safe in the hospital. Similarly, parents of children told us that staff were attentive and that there was always enough staff to assure them that their child was safe. All of the children, young people and their parents spoken with said that they had no worries or concerns, but they felt able to talk to staff if they had.

Without exception, people spoke very positively about the support, care and treatment they (or their child) received. They said that nurses and doctors were always polite and respectful. People's comments included; 'The nurses are wonderful. I know that (my child) is safe and I can have a break knowing that they are in good hands.' 'The staff are very helpful and always there if I need to ask anything.' 'All the staff are friendly. I can talk to them about anything. Even if they are really busy they take time to talk to me.' 'They (staff) give good care and attention. They are very supportive and respectful.' 'The nurses explain things to me as well as my mum and dad. They make sure I understand.'

2 November 2011

During a routine inspection

All children, young people and parents who we spoke to, told us they were very satisfied with the quality of service provided. They were complimentary about the care and treatment they had received from all staff and described staff as: 'approachable and friendly and they could ask for anything', 'very good and very helpful', and 'they always come to check I am okay and are always around if I need them'.

Children, young people and parents felt that privacy and dignity was respected by staff, and staff explained things in a way they could understand. They told us that staff were 'very good and respectful' and 'very good at explaining things'. Young people were particularly pleased that staff talked to them as well as their parents.

Young people told us they felt safe in the hospital. Similarly, parents of children told us that staff were attentive and that there was always enough staff to assure them that their children were safe.