Royal Surrey County Hospital

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

We found a service that had an open and honest culture, where incidents were used as an opportunity to learn. Staff went above and beyond to ensure that neuro-diverse children had their needs addressed to enable them to receive care and treatment with minimal distress. Staff understood their role and responsibilities regarding safeguarding children and young people, their carers and families. Medicines were stored, prescribed, administered and destroyed in line with legislation and best practice. Managers had effective systems in place to ensure staffing numbers and experience kept children and young people safe. Managers monitored training completion to ensure staff competencies were safe.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Support and advise was readily available. Parents supporting children receiving chemotherapy could seek guidance and advise through a messaging services, which was available 24 hours a day 7 days a week. A mother of a child with complex needs had been given dedicated support aimed specifically at their and their child’s needs to help prepare their child for a safe, managed hospital admission.

Staff understood their role and responsibilities in reporting incidents and concerns, including near misses. Staff we spoke with stated they were given the time to report incidents, they were not rushed and so had the opportunity to report all concerns in detail. knew how to use the online reporting systems and demonstrated this to us.

Staff described the learning culture as open, stating incidents were used as an opportunity to learn, rather than blame or finger point.

Staff advised us they were kept informed of investigation updates when they were involved in an incident. Learning was discussed at daily ward meetings, monthly team meetings as well as online and via newsletter.

Learning was shared with departments outside paediatrics that worked with children, including day surgery, the emergency department, theatres and recovery. In addition to this, monthly mortality and morbidity meetings were well attended and identified learning points which were shared amongst the paediatric team as well as teams who cared for children outside of paediatrics. There were formal training sessions where new learning was identified. For example, band 7 away days were arranged to support leadership.

Staff advised us that the estate was one of their risks, mainly the size of space they had to provide a service. This was acknowledged and documented by managers who were taking actions for improvement. This demonstrated managers were aware of on ward risks, and systems for communicating risk were effective.

The service had effective systems in place to monitor incidents and performance. The governance midwife attended a weekly meeting to review incidents. Staff attending were allocated incidents to review and ensure they were investigated and closed effectively, in line with policy and procedure. The practice development nurse, matron and ward sisters also attended these meetings to implement any immediate learning. All Maternity and Newborn Safety Investigations (MNSI) were reviewed at a weekly Executive Safety meeting.

These processes supported managers to maintain oversight of incident themes. In April 2024, the trust had seen an increase in the number of paediatric incidents involving child mental health. In response, managers completed an internal debrief and working with the local Integrated Care Board (ICB) and local mental health trust created a business plan to further increase mental health support. The business plan included a Head of Nursing for Mental Health and the creation of an enhanced care team. This trust-wide team supports paediatric patients admitted as a result of mental ill-health. This was still ongoing at the time of assessment.

The service engaged with networks to enable system wide learning and implementation of practice changes within both the Royal Surrey and the local network.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients shared with us how they felt their children were safe and things were well managed. One parent told us how this was particularly true when they accompanied their child to and then left them in the operating department.

Staff understood their role and responsibility in recognising signs of abuse and reporting safeguarding concerns. All staff we spoke with knew who their safeguarding lead was, how to make a referral and where to seek further advice and guidance should they require it.

All staff we spoke with stated that post referral they were supported by managers and given the opportunity to debrief. Staff advised us they were referred to the trust’s well-being network if they required further support.

Updates and learning from referrals was available via the safeguarding newsletter. Debriefs from more complicated cases were reviewed during supervision and training. The trusts safeguarding supervision team competed deep dives and scenario training.

The services safeguarding lead held a daily morning meeting to review urgent referrals and requests. They also met with external partners such as Child and Adolescent Mental Health Services (CAMHS), local authorities, police and schools etc on a weekly basis.

The safeguarding lead and chief nurse reviewed referrals every month to ensure they were compliant with guidelines and ensure all policies and pathways were still in line with best practice. In addition to this the safeguarding lead held a monthly meeting with CAMHS to review clinical pathways.

Safeguarding supervision was completed regularly throughout all clinical areas. This included bi-monthly safeguarding peer review for paediatricians. Learning from sessions were shared to all staff members. The service had systems in place to ensure supervision occurred at all levels within the trust, this was evidenced via the services records.

Mandatory completion rates for safeguarding adults and children met the trust benchmark. On average, 93% of doctors, 94% of nurses and 100% of admin and clerical staff had completed their appropriate level of safeguarding adults and children training. The level of training completed for each staff group was in line with the Intercollegiate document on safeguarding guidance. Training included details on how to recognise female genital mutilation, Gillick and Fraser guidelines and child sexual exploitation.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff worked together as a team to care for children, young people and their families. All the staff were said to be caring while working hard to deliver high quality care and everyone was supportive.

Staff advised us they felt the number and qualification mix of staff ensured that children and young people were kept safe. Rotas were planned 12 weeks in advance and demonstrated staffing numbers were in line with national guidance. The matron and paediatric sister attended daily trust wide meetings to review staffing gaps within the next 48 hours.

The Learning Disabilities and Autism Nurse supported regional and national best practice including supporting the development of several national tools. For example, the national competency framework for acute learning disability nurses, diagnostic pathways for learning disability, an emergency care plan tool, communication toolkit to support young people with learning disabilities to be able to understand and make decisions about their Advance Care Plans/Symptom Management Plans and Reasonable Adjustment Admission and Theatre care plans. This nurse also sat on several national forums which identified and promoted best practice for patients with learning disabilities and autism.

The Consultant Neonatal Nurse, provided holistic assessment of babies and enables early identification of any feeding or medical issues.

Babies received direct access to the Neonatal Outreach Team, as well as open access to Hascombe Ward. Therefore, if parents had concerns regarding their babies’ welfare, they brought their baby directly to the children’s ward, bypassing GP and Emergency Departments. This additional support led to a significant reduction in mortality rate from 14% to 0% of those babies who would now be in the Neonatal Outreach cohort.

The service provided a home phototherapy that enabled babies to be safely discharged to the home environment earlier to receive home phototherapy.

There was a supportive and caring culture. Staff took a flexible approach putting the children first, for example, when staff from Hascombe Ward were not available to collect children from recovery, recovery staff accompanied them to the ward. There was a sense of calm and respect for each other.

The service ensured there were effective training systems in place to promote safety. At the time of the inspection, two nurses were undertaking their Advanced Clinical Practitioner training – one within paediatric epilepsy.

Neonatal and paediatric simulation sessions were undertaken within clinical environments on a monthly basis. Managers ensured all staff attended the neonatal simulation sessions over each 6 month period. Training included technical skills, such as the insertion of intraosseous needles, a needle used for infusion of medical therapy and testing, as well as non-technical skills.

The Neonatal Outreach Team visited babies discharged from the Special Care Baby Unit and Transitional Care Unit in the home environment to provide additional support, care and early identification of clinical issues. As a result, the re-admission rate of this cohort of babies had decreased from 14% to 10% with a decreased length of stay during re-admission.

The team also provided resuscitation training to parents of babies born prematurely and education regarding safe sleep, feeding and maternal mental health.

The services inductions were developed to support different roles as well as to help staff coming to work for the trust from abroad. The service managers worked with the trust employment team to develop an induction that included information about living and working in the UK, for example, setting up a bank account and finding accommodation. Agency workers also had specific induction plans which we saw.

Mandatory training was a mix of face to face and online. Topics included health and safety, manual handling, infection control, equality and diversity and information governance. The services completion rates were in line with the trust benchmark. There were systems in place to enable managers to monitor mandatory training completion and ensure staff had sufficient time to complete training before it expired.

All staff within the service were required to complete a Disclosure and Barring Service. Managers monitored these and we saw audits that ensured compliance with national standards.

Managers monitored sickness and vacancies via a risk register that was updated quarterly. Staffing levels are reviewed twice daily to ensure safe staffing based on acuity of the ward. The service used bank staff to ensure actual staffing levels met national standards and was reviewing well-being initiatives to decrease the sickness rate. Vacancy data showed the service required 6.78 Full Time Equivalent in nursing, managers were implementing the international nursing recruitment drive in response to the data.

The Special Care Baby Unit (SCBU) and Hascombe Ward were supported by a multi-disciplinary team – SCBU had access to a psychologist and speech and language therapy. Hascombe Ward and outpatients has access to paediatric psychology, paediatric physiotherapy and dieticians.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Parents, children and young people received medicines on time and as requested. Staff were quick to react when pain was noted and checked to ensure the efficacy of the pain relief.

Staff advised us they were provided sufficient time and resources to prescribe and administer medicines. Staff stated that a pharmacist was available on the ward 24 hours a day, 7 days a week.

There was a pharmacist on the wards every day to support staff, review medicine management and complete audits. A recent antimicrobial audit demonstrated 100% compliance.

Staff were observed taking care when administering medicine, and following the principles of safe administration of medicines.

Medicines were stored securely, in temperature controlled locked storage.

Controlled drugs were stored, administered, documented and destroyed in accordance with Home Office requirements.

Patient records were well documented and clearly showed what medicines had been administered and when. Patient notes clearly documented regular review of medicines to ensure their efficacy and whether the patient experienced any side effects.

Staff understood how to use the online medicines system as well as the antimicrobial stewardship micro guide. The services system had an inbuilt review process for microbials every 72 hours. The online system ensured all allergies were recorded and would not allow staff to progress the file until these were recorded.

The children and young people outpatient’s department still used paper prescriptions; however, they were in the process of moving to an electronic system.