Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service provided safe care for children, young people and their families. We saw an established learning culture at the service. There were a variety of ways staff stayed informed and shared learning. Regular parent and carer feedback forums and young person involvement forums were in place. Staff worked well with partners and went the extra mile to support teachers including providing safeguarding supervision for them. The service had a dedicated transitions lead to assist and plan a patients transfer into adult services. Patients had comprehensive care and treatment plans in place which showed extensive family involvement in managing risks. Children’s centres were clean and provided age-appropriate toys and books in the waiting areas. Staff had all appropriate training in place and managers encourages staff development through promoting additional training and completing training needs analysis to identify opportunities.

This service scored 88 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We saw evidence of an established and embedded learning culture.

Staff we spoke with described a variety of ways in which they stayed informed and looked at learning following feedback from parents and carers.

There were regular parent and carer feedback forums and a young person involvement group in place.

The nursing team had regular, ringfenced time to facilitate monthly professional development and training sessions where specific issues and experiences were shared, and specialist training was delivered. Managers had completed a specialist training needs analysis across all disciplines, completed elements included talking mats training, advanced clinical assessment (Paediatric), advanced communication skills and many more.

Whilst the trust wide quality group had paused for redesign to take place, managers within the service had continued to provide monthly updates around governance and learning. This included what had gone well, the top three reported risks, you said we did, and topic of the month.

We saw posters in the communal areas which celebrated success and several “you said, we did” posters on notice boards.

We saw evidence that staff received monthly clinical and managerial supervision, recorded on the electronic system. We also saw evidence of timely debriefs following significant events such as the death of a child.

We saw well established relationships with both internal and external partners. Staff, parents and young people told us of a significant amount of collaboration between the teams and schools and local authorities to ensure patients received appropriate care.

Staff we spoke with said they had good access to services at the acute hospital including paediatricians.

The team contributed to the local integrated care board transition network to establish priorities and barriers to providing services for young people approaching adulthood.

The service had a dedicated transitions lead, they had developed a preparing for adulthood/transition operational framework. We saw a dedicated website developed with and for young people to provide information in an easy to understand and meaningful way to enable them to make informed decisions about their health and future.

All staff we spoke with were able to demonstrate how they would identify and raise a safeguarding issue. They also told us how they would support families throughout the process.

Staff and leaders told us they followed the “Think Family” approach. This approach recognises and promotes the importance of a whole-family approach which is built on the principles of working with people to identify wider needs which extend beyond the individual they are supporting.

Staff received regular specific safeguarding supervision as well as additional safeguarding training. The service was innovative in ensuring collaboration in safeguarding approaches across disciplines as staff provided supervision for teachers and other school staff to discuss issues and formulate plans collaboratively.

We observed a safeguarding escalation meeting where staff had identified significant safeguarding concerns regarding a young person who had been referred to the service from the acute hospital. The team reviewed the information and raised a provider-to-provider concern and ensured agencies were aware and verified that appropriate action was taken.

The trust had a safeguarding policy in place, we saw a notice board which was dedicated to safeguarding and the team had identified safeguarding leads.

All patient care and treatment records we reviewed were fully comprehensive and had updated risk assessments in place. The records showed extensive family involvement which included preferences and how risks were managed collaboratively. We also saw evidence of “safety netting calls” whereby actions were agreed with families if their child’s condition failed to improve, changes or if they had further concerns about their child’s health in the future.

The parent and carers we spoke with told us the children’s centre was always warm and welcoming. They told us children had access to age-appropriate toys and books in the waiting rooms as well as music to listen to.

We observed all communal areas to be appropriately furnished, and the centre had a wide range of clinical and therapy rooms which were decorated with bright and colourful murals.

The children’s centre was visibly clean, and staff told us they took pride in the cleanliness of the building.

A toy cleaning rota was in place and audits of cleanliness were displayed for staff and visitors to see.

The service had sufficient staff to meet the needs of children, young people and their families.

The service comprised of specialist groups of practitioners working in a multi-disciplinary way to provide care that wrapped around the patient and family. These included, children’s nursing, children’s physiotherapy and occupational therapy, speech and language therapy, community training team, phlebotomy and rapid response service.

Managers ensured staff had regular supervision, training and appraisals.

Compliance rates for mandatory training was 92%. Compliance rates for both managerial, clinical and safeguarding supervision was 91% and appraisal rates were 90%.

Staff we spoke with said managers encouraged them to undertake additional training and completed a training needs analysis to identify opportunities.

Managers told us there were low vacancy and turnover in the service. However, they told us there had been an increase in demand, which was included in the service business plan.

Whilst managers acknowledged vacancy levels were low, they expressed frustrations of delays associated with each internal staff variation needing to be presented at the trust vacancy control panel.

Managers ensured infection prevention control audits were completed. The results including any actions taken were displayed on notice boards throughout the building.

We saw staff adhered to infection control principles and practices. Handwashing posters were in toilet areas.

Parents we spoke with told us staff used personal protective equipment when carrying out home visits.

Whilst no medication was stored on site, staff were required to administer patients’ own medication in their home. Staff followed the trust policy on safe administration of medicines and had undergone specialist training as required.