Sheffield Children's NHS Foundation Trust

Updated 18 November 2022

• We rated effective, caring, responsive and well-led as good and safe as requires improvement.
• Sheffield Children’s Hospital was rated as good overall. Safe, effective, caring, responsive and well-led were all rated as good. All ratings were the same as the previous inspection with the exception of safe, which had improved one rating.
• At this inspection, we rated five out of the six services we inspected as good overall and one as requires improvement. In rating this trust, we took into account the current ratings of the five services not inspected this time.
• Since our previous inspection in 2016, transition services and child and adolescent mental health wards had undertaken some significant work and improved one rating from requires improvement to good overall.
• Our full inspection report summarising what we found and the supporting Evidence Appendix containing detailed evidence and data about the trust is available on our website .

Updated 26 October 2016

We rated effective, caring, responsive and well led as good. Safe was rated as requires improvement. We rated this service as good overall because:

• Staff were aware of their responsibility to report incidents, they knew how to report incidents, near misses and accidents and were encouraged to do so. Learning from incidents was shared between teams. However, it was hard for service leads to identify trends with regards to incidents as reporting was paper based.
• Safeguarding processes were in place and there was a dedicated safeguarding team in place. Practitioners received safeguarding training. However, we were not assured that the computer system kept children safe but relied on practitioner’s knowledge of the system.
• Care and treatment was evidence based with policies, procedures and pathways available to staff. There was good evidence of multi-disciplinary working. Staff were aware of their responsibilities with regards to obtaining consent.
• We observed staff treating people with compassion, kindness, dignity and respect. Feedback from children, young people and their families was positive.
• Services were planned to meet people’s needs and the needs of different people were taken in to account. Practitioners were aware of the needs of the local population.
• Leaders were approachable, supportive and encouraged staff engagement. However, some staff felt that there was not enough information given to them at an unsettling time, due to service redesign.
• Staff knew the trust vision and values. Governance systems were in place to ensure delivery of good quality care.

However:

• Health visitor caseloads exceeded recommendations and not all areas were offering a face to face antenatal contact to all mothers as part of the core offer.
• There was no consistency across the trust with regards to records. There was a risk that practitioners did not have access to information in a timely manner.

Updated 18 November 2022

We carried out this unannounced inspection because we had concerns about the quality of services.

We inspected three wards for Children and Young People.

• Sapphire Lodge – a mental health ward for young people aged between 13 and 18 years old with mental health problems. The ward was commissioned for 12 beds, there were 10 beds open at the time of our inspection.
• Emerald Lodge – a nine bed mental health ward for Children and Young People aged between 8 and 13 years old with mental health problems
• Ruby Lodge – a seven bed mental health ward for Children and Young People aged between 8 and 18 years old with mental health problems and learning disabilities.

Our rating for the service remained the same. We rated the service as good. However, we did rate the safe key question requires improvement, the reasons for this are set out below;

Despite a national staffing crisis and some vacancies within the service, staffing was managed well. Daily safety huddles looked at staffing across the unit and deployed staff to where they were needed most. Lodges were clean. Staff followed infection control policies including those related to Covid-19.

Since our last inspection, the nasogastric room had been relocated to an empty bedroom. This gave Children and Young People needing to be fed via a nasogastric tube more privacy and dignity. Despite this, the room was not soundproofed, this meant that other patients did at times become distressed due to the noise and anticipation of this procedure.

Risk assessments were kept up to date and contained key information to manage risk safely. Staff had completed and kept up to date with mandatory training. The environment was in keeping with the needs of young people and was decorated and furnished to suit their needs.

Feedback from Children and Young People and their carers was mostly positive. Children and Young People felt that staff cared for them and made them feel safe on the lodges. Carers told us that staff involved them in their loved one's care and kept them up to date. Some carers felt that communication could be improved.

Leaders within teams had a background in child and adolescent mental health services. Staff felt proud to work as part of the service and told us they were a supportive team who cared for each other as well as the Children and Young People in their care. Staff were supported to improve their knowledge and skills via specialist training and were encouraged to progress their careers.

However,

We found that some blanket restrictions remained in place. This included locking of most doors to communal areas on Emerald and Sapphire Lodges. On Emerald Lodge we found that key rooms such as the female lounge and quiet rooms were locked. Although staff were happy to unlock the doors when Children and Young People wanted to go in, Children and Young People did not have free access to these spaces. In comparison, Ruby Lodge had all rooms unlocked with the garden open for Children and Young People to access.

The most up to date version of the ligature risk assessment for Sapphire Lodge was not available on the lodge when we requested it. We were given a risk assessment from 2019 which did not include new rooms that had been added since then. However, we did later receive a copy of the 2022 risk assessment. This was available electronically for staff. There had not been a permanent Consultant Psychiatrist in post on Ruby Lodge for over one year. There had been locum cover during this time, but these had sometimes been for short periods which meant a lack of stability for Children and Young People in relation to their care. The Locum consultant at the time of our inspection had been in post for a longer period.

Agency staff did not always have access to the electronic records system. This meant that they did not always have access to all relevant information about Children and Young People when they were on shift.

The electronic supervision recording tool did not accurately reflect the level of supervision and support staff told us they received. Although figures appeared low, it was acknowledged this was due to the recording system rather than a lack of support for staff. All staff we spoke to felt well supported and accessed supervision both formally and informally on a regular basis.

Updated 18 November 2022

Sheffield Children’s Hospital NHS Foundation trust provides specialist mental health services for children and young people across Sheffield and the wider region.

The community child and adolescent mental health service (CAMHS) is made up of nine teams. These include mainstream CAMHS, the specialist eating disorders and treatment team (SEDATT), learning disabilities and mental health, healthy minds, primary mental health, forensic CAMHS and multi-agency psychological support for looked after children. The teams work across different geographical locations. These include Beighton, Centenary House, Albion House, Gibson House, Star House, Amber Lodge and the Acute Hospital site.

The teams provide assessment and treatment for children and young people up to 18 years old with mental health conditions, learning disabilities, autism and/or emotional and behavioural difficulties. The service operates between Monday and Friday 9am until 5pm. Staff work with patients and their carers at a range of locations including schools, homes and in clinic.

The trust also provides a day unit and outreach service for children and young people at the Becton Centre. Amber Lodge is a regional unit and accepts referrals from child and adolescent mental health services throughout South Yorkshire. It provides services for children and young people aged between five and 11 years old who have severe and complex mental health problems.

The trust established the Supportive Treatment and Recovery (STAR) team in 2015. The team operates between 8.30am and 9.30pm seven days per week. This team provides assessment and brief intervention sessions to children and young people who present to the accident and emergency department with concerns for their mental health. The team also provide community intensive treatment. This is commissioned for typically three sessions per week for up to eight weeks.

The trust also established a health based place of safety for young people aged 16 to 17 in 2015. A health based place of safety is a place at a hospital where people are taken by the police or ambulance service for mental health assessment when they have been found by the police to appear to be suffering from a mental disorder and in need of immediate care or control. This must be necessary in the interests of the person or for the protection of others. The health based place of safety is situated at the Becton Centre alongside the child and adolescent mental health wards.

As part of this inspection we visited the following locations;

• Centenary House

• Beighton community centre

• Sheffield Treatment and Recovery (STAR) team at Sheffield Children’s Accident and Emergency

• Becton Centre health-based place of safety.

Our rating for this service stayed the same. We rated the service as requires improvement. The reasons for this rating are set out below;

• Children and young people waited a long time to access the service, clinicians had high caseloads which had an impact on their ability to provide safe care.
• The service did not always ensure that children and young people received a physical health check at their initial appointment.
• Staff did not always complete mandatory training.
• The trust did not always ensure that staff were safe in their role because policies, procedures and training in; management of violence and aggression lone working, and incident response were unclear.
• There was not a clear process in place to support young people who were leaving the service and not making a transition to adult services.
• Where there were gaps in delivery the service did not maintain adequate communication with young people, their carers or other agencies.
• Appointments that were cancelled by the service were not always re-appointed.
• Parents told us that they were concerned about the lack of urgent out of hours provision where their option was limited to attending the accident and emergency department.
• There were some areas of good governance which were not entirely effective.

However;

• Staff were described as patient and insightful.
• Parents were grateful for flexibility given in appointment arrangements and the variety of settings in which these could take place.
• The STAR team had expanded their remit to include all mental health presentations which improved access to mental health services for the wider community.
• The risk assessments carried out were comprehensive and also included crisis plans which were shared with all those involved in the care of the child or young person.
• The trust had made a number of improvements to the service and were taking an innovative approach based on continuous improvement.