Nuffield Health Brentwood Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

As part of the assessment, we looked at 5 care records. In each record, children’s individual needs were discussed at the face-to-face pre-assessment appointment. Children were able to visit the hospital for a tour prior to admission. Staff had written prompts to ask both children and their parents or guardians to help discuss concerns and safe treatment.

The children and young people’s lead nurse told us that any complex needs would be highlighted during the pre-assessment stage and if additional advice was required this would be escalated with the service.

We were told that all surgical services were consultant-led and cases were reviewed either by a consultant surgeon or consultant anaesthetist.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. All clinical staff were sent a safety bulletin every month with details of updates to corporate and clinical policies.

The children and young people’s policy documentation was based on relevant NHS England, Royal College of Nursing, Royal College of Surgeons and National Institute for Health and Care Excellence (NICE) guidance.

We saw that clinical guideline updates were discussed at governance meetings.

The hospital staff performed a range of audits to demonstrate staff compliance with policies. These included consent, Paediatric Early Warning Score (PEWS), hand hygiene and medication audits.

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. We observed strong working relationships between medical staff and nursing staff that were centred on the needs of the patient. They supported each other to provide safe care. Staff held regular and effective multidisciplinary meetings to review patients and improve their care. We reviewed CYP forum and service minutes this was well attended by staff across the hospital and provided clear updates on performance and management of risk and safety alerts.

We saw evidence that the needs of children and young people at the service were discussed at daily safety huddles.

Where appropriate consultants provided written letters to other services, we reviewed written correspondence sent to GP practices; this included a record of medical problems identified, treatment and medications.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service had relevant information promoting healthy lifestyles and support on the wards and units. We saw a range of resources on offer to help children and young people build resilience and mindfulness. The service had written advice to help support their treatment journey.

The service offered a kids menu with a range of main meals and options for vegetarians and vegan options. The menu included fresh vegetables such as garden peas and green beans as side options.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Managers and staff carried out a comprehensive programme of repeated audits to review patient outcomes. Managers used information from the audits to improve care and treatment. Managers shared outcome data with staff and areas of improvement were checked and monitored. The service analysed children and young people’s outcome data, such as inpatient and outpatient activity, unplanned returns to theatre, unplanned transfers to other hospital and avoidable cancellation on the day of surgery to monitor trends and improve the quality of the service.

Staff made sure children, young people and their families consented to treatment based on all the information available. The service had child-friendly information available for a range of procedures.

All staff we spoke with understood the importance of ensure that people fully understood was they were consenting to and the importance of obtaining consent before they delivered care or treatment. We saw evidence of a surgical procedure being postponed due to an anxious child. The procedure was rescheduled and the staff allowed extra time to support the patient to ease their concerns.

Staff made sure children, young people and their families consented to treatment based on all the information available. Consent forms referenced up to date legislation and staff clearly recorded consent in the children and young people's records.

Staff understood Gillick Competence and Fraser Guidelines and supported children who wished to make decisions about their treatment. Gillick competency and Fraser guidelines help people who work with children to balance the need to listen to children's wishes with the responsibility to keep them safe. When practitioners are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is 'Gillick competent' or whether they meet the 'Fraser guidelines'.

Staff received training in understanding Gillick competencies and understood when to gain consent from a parent or child. Consent forms included the competency principles which staff had to co-sign.

We saw clear processes to record consent, and our review of medical records showed that all had consent recorded. Patient records were regularly reviewed to audit appropriate consent. We saw audit results for the past 3 months were above 90% and met Nuffield targets.