Southend University 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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.
This was our first assessment we rated this key question Requires Improvement.
Young people and their families were involved in assessments of their needs. Staff reviewed these assessments taking account of young people’s communication, personal and health needs. Staff worked with local charity organisations to assist in providing additional funding and resources of the paediatric departments at Southend Hospital. Staff involved parents and carers in decisions about their child’s care and treatment.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Young people and their families told us individual needs were assessed and were included in these discussions. Children with additional, complex and mental health needs were reviewed to identify any additional support and reasonable adjustments during care. For example, children with special dietary and/or sensory requirements were supported with food choices and play leads would ensure they received play therapy support. Families were positive about arrangements for food and drink. One shared “staff have gone out of their way to get different foods that they will eat”.

Staff we spoke with said the play leads in paediatrics did a fantastic job and met the needs of children and their families. Nurses told us if a child needed support, they would liaise with the play team who were always on hand. The play team used a personalised hospital passport that was designed to capture all elements of a child’s needs, from eating, washing, like and dislikes. This enabled staff to pre-empt any potential stresses for the child and provide a very individual experience to their care delivery.

The service had audit processes in place to monitoring nutrition and hydration requirements and an action plan to drive improvements, however this did not cover all elements of concern raised from audits. Although the passport and reasonable adjustment card system was used to inform staff about children and young people’s additional needs was in place its usage was low with only 8 passports logged at Southend.

We asked for evidence how the trust monitored care for children with additional needs and any associated actions plans. The service provided an overview of actions to be taken in relation to national recommendations, but did not provide evidence of any current monitoring processes. However, there were local systems in place that ensured children’s needs were captured.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver children and young people’s care and treatment with them and their families.

Families told us staff were knowledgeable about care and treatment delivery. They said staff really understood neurodiversity, mental health and complex needs. Staff ensured care was delivered in a way that supported their child’s needs.

Staff told us they were trained and used nationally recognised paediatric observations system to record children’s vital signs. The paediatric early warning score and paediatric sepsis screening tool were used by staff across all areas of paediatrics. Monthly audits carried out to monitor these tools showed consistent compliance. On review of care records during assessment we found good documentation and escalation of early warning paediatric scores.

Staff raised concerns that at times of high demand they found it difficult to complete and record regular and timely observations to meet patient’s clinical needs in line with trust policy and national guidance. There had been a delay in updating policies against updated national guidance with no clear timeframes or completion date for this work. This meant staff would not always have access to the most up to date guidance and methodology around paediatric care.

Staff also raised concerns over the lack of staff in speciality areas, such as the diabetic and sickle cell services. They shared the challenges of recruitment and filling vacancies; this issue was included on the Trust’s risk register. Staff were looking at online technology to see if there were any other approaches which might assist them with effectively managing increasing caseloads. They were also working with system partners but funding available was limited.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Parents and carers told us staff within the service worked well together. They said there was good communication between teams and said care was joined up and safe. Staff also told us nursing and medical teams within paediatrics work well together.

However, some staff told us other departments were not always as supportive. At times of high demand and pressure across the whole hospital some departments did not share staff and support the paediatric wards.

Some staff also told us Southend hospital did often work in silo. Developing guidance and improvement programmes. They were keen to share learning and good practice, but the trust did not always have embedded structures to support this. Evidence reviewed showed there was not always clear lines of communication between all Children and Young People Services across the trust. There was limited meetings and shared learning platforms to facilitate better cross site working.

Trust leaders had not implemented interprofessional standards within children and young people's services. Interprofessional standards are a clear description of the expected values and behaviours within a service, when healthcare professionals from different disciplines are working together. The creation of these standards allows leaders to monitor how teams are working together and take action to address any areas of concern. This was not in place at the hospital.

Some community partners also told us there could be improvements made in communication and team working between services. Community mental health services often held a coordination role to progress care for children and young people and worked closely with the safeguarding leads at Southend. Capacity pressures on wider community services meant children would often present to in mental health crisis, which often was not the most appropriate location for their care.

We scored the service as 3. 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, reduce their future needs for care and support.

Parents and carers said staff looked after both the physical and emotional wellbeing of their children. Staff used play and activities to reduce anxiety and stress. Staff told us they would often have therapy animals visit the wards which they said children really enjoyed. Families on the neonatal intensive care unit told us they were given support for their wellbeing and signposted for additional support if needed.

Staff told us they did their best to support all young people using their service. This could be challenging at times of high service demand and staff shortages. Staff told us the play leads formed a vital role in providing a holist approach to care and they enabled children to better cope and manage their emotional wellbeing. Play leads kept records and evidence of children and families they supported and could see a positive impact on care experiences and wellbeing.

However, this information was not always collated by the trust and monitoring of regarding children and young people’s physical and mental health was sporadic and inconsistent. There was no clear focus and workstream dedicated to this aspect of paediatric care. Due to the wards location there was no direct access to outside space or play area, however, play teams would accommodate children and young people’s physical needs when needed.

We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Local nursing leaders told us they had processes in place to audit care records to identify themes to monitor care delivery standards. Any identified areas of improvement would have associated action plans with clear timeframes of completion. There had been a particular focus on the management of sepsis and escalation processes trust wide. Staff told us there had been refresher training around sepsis and were supported by leaders to monitor outcomes and implement any identified improvements in care delivery.

We requested current evidence of any national benchmarking data collected in relation to babies, children and young people services. Reports provided were not current and associated action plans had not all been completed. There was a low compliance rates with national audits and data were not always submitted to monitor outcomes and support learning. Leaders told us there had been a lack of admin support and ongoing data issues that had caused this delay.

National audits, particularly in healthcare, offers several benefits, including improving patient care, identifying areas for improvement, and benchmarking performance against national standards. These audits can also influence funding decisions and demonstrate commitment to quality improvement.

Limited progress had been made by the service to improve low compliance, and we were not assured they had effective systems in place to monitor and benchmark care outcomes to drive improvement.

We scored the service as 2. The evidence showed some shortfalls. The service did not always tell people about their rights around consent and the service did not always provide staff with the right tools to support consent decisions.

Young people and their families told us that staff discussed and explained procedures and treatments and always gained consent from parent or carer.

Play leads helped plan admissions and children’s diagnostic appointments to assist families to understand procedures and minimise stress and anxiety. For example, if a child needed sedation prior to an MRI, play leads and nursing staff contacted families and offered a pre-procedure visit, where they could talk through with the use play.

Staff were aware of the need for informed consent when discussing assessments and treatment plans with families and carers. However, staff did not always have available guidance around paediatric care and consent.

The service had a generic consent policy which lacked information and relating to children and young people, and did not give staff guidance on what to do if treatment was being refused. They also lacked oversight of consent processes; they did not carry out any audits on mental capacity and consent assessments. Therefore, there was a failure to demonstrate current processes were effective and robust and in patient’s best interest.