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Inspection Summary


Overall summary & rating

Good

Updated 8 May 2014

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

Inspection areas

Safe

Requires improvement

Updated 8 May 2014

Effective

Good

Updated 8 May 2014

Caring

Good

Updated 8 May 2014

Responsive

Good

Updated 8 May 2014

Well-led

Good

Updated 8 May 2014

Checks on specific services

Medical care

Requires improvement

Updated 26 October 2016

Urgent and emergency services (A&E)

Good

Updated 26 October 2016

Neonatal services

Good

Updated 26 October 2016

Transitional services

Requires improvement

Updated 26 October 2016

Surgery

Good

Updated 26 October 2016

Intensive/critical care

Good

Updated 26 October 2016

End of life care

Outstanding

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.

Outpatients

Good

Updated 8 May 2014

The outpatients departments were kept clean and were regularly monitored for standards of cleanliness. There were sufficient numbers of suitably qualified staff to meet children and young people’s needs. The outpatient department made improvements to care and treatment where these had been identified via programmes of assessment or in response to surveys.

Children, young people and parents told us they felt they received compassionate care with good emotional support. They felt they were fully informed and involved in decisions relating to their treatment and care. People had their needs met although they were not always told why a clinic was delayed. Car parking availability at the main hospital site is currently poor. We found that outpatient services were well led. The service had a clear strategy and vision over the next few years as it increased appointment capacity and space to meet demand.

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.