Southend University Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that children, young people their families and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of children, young people their families and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that children, young people their families could access care in ways that met their personal circumstances and protected equality characteristics. This is the first assessment for this service. This key question has been rated Requires Improvement.

This meant people’s needs were not always met through good organisation and delivery. There w not always continuity between services and children and young people did not always have timely access to care. However, young people and their families were involved in decisions about their care. The provide information for children and young people could understand. Families knew how to give feedback and were confident the service took it seriously and acted on it. The service was accessible, and staff supported reasonable adjustments. Children and young people received fair and equal care and treatment, however at times of high demand and short staffing levels the paediatric assessment unit might be closed. The service always works towards reducing health and care inequalities and used available resources to improve this.

This service scored 61 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Parents and families with children with food allergies said the staff had taken additional measures to support their nutritional requirements. They had given families a separate menu and were asked to double check for appropriate safe meal options. Young people told us they were listened to and staff took time to understand their worries and concerns.

We observed staff made sure children, and young people were at the centre of their care and treatment choices. Teenagers using the service had a good provision available that was age appropriate. For example, there was a designated room with TV, games consoles and older children’s activities and resources. There were good facilities for those receiving treatment for mental health and eating disorders.

Leaders told us they had seen a steady increase in the number of children attending in mental health crisis They told us they had recently improved facilities to safely accommodate children while they awaited a mental health bed. They worked with community partners during referral processes. They expressed concerns around the national shortage of appropriate bed space for those children in mental health crisis and that long inpatient stays had added additional pressure to in-patient wards.

We scored the service as 2. The evidence showed some shortfalls. There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Care provision on the in-patient ward and paediatric assessment unit fluctuated depending on how busy the service was. However, staff in these areas aimed for care standards to remain consistent.

Care provision and continuity for children and young people was not always consistent across all departments. For example, there was long waits for booked procedures dates or follow up appointments following clinic visits. Data reviewed following this assessment showed Southend had over 2441 children waiting for non-admission appointments. The service was not meeting the national outpatient appointment target of 18 weeks.

There was limited evidence leaders met regularly is discuss and addresses waiting times and performance of outpatient clinics. Based on national benchmarks Mid and South Essex NHS Foundation Trust (MSEFT) was a significant outlier for outpatients with poor productivity, value for money and patient experience.

We requested evidence of how the service monitored availability of children and young people’s medical note across services. Systems used to shared information with General Practitioners (GP) and other healthcare providers was inconsistent and the service did not have any monitoring measures in place to identify any gaps in access. Southend did have electronic care record systems, but it was not clear how this information was shared with GPs in a timely way.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information being provided was consistent across children and young people’s wards and departments. Parents and carers had been signposted to QR codes and notice boards for information. Families in the outpatient department had been given lots of information on their child’s long term medical condition and were well informed.

The service supplied appropriate, accurate and up-to-date information and was available in different formats and languages if requested. The service had an accessible information policy but did not relate specifically to children and young people. However, the play team used multiple formats and different languages to share and provide information. Displays were bright, engaging and meaningful.

We asked trust leaders for evidence how leaders were assured staff and processes were complying with the Accessible Information Standard. The NHS England (NHSE) Accessible Information Standard describes how NHS and adult social care services should identify, record, flag, share, meet and review people’s information and communication needs. This was not provided

We scored the service as 2. The evidence showed some shortfalls. The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

Young people and their families using the service said staff listened and supported individual’s needs. Parents and families told us clinical staff had included them in discussions and explained their child’s observation chart to support the rationale for diagnosis and treatment options. Families were encouraged to give feedback on care and suggest improvements to the service.

Staff on inpatient wards and the assessment unit told us they had good facilities to listen and support older children, with a dedicated private mental health room set back from the main ward. They also had access to a teenage room, with space to engage in a neutral nonclinical setting.

The neonatal unit gathered feedback from parents through surveys, but it was not always clear what actions had been taken in response to the survey results. Department surveys were not always utilised in other areas of the children and young people's service. However, these areas did gather feedback by using the national NHS Friends and Family Test survey.

The service had received 21 formal complaints in the last 12 month. Of those from paediatric outpatients, 33% were complaints about poor care from a doctor or consultant and in ward areas around 53% also related to poor care from a doctor or consultant. Complaints were not always dealt with in line with trust policy. For example, only 33% of complaints in the last 12 months had been responded to in line with Trust policy. Therefore, we were not assured that complaints and concerns were seen as an opportunity to drive improvement in a proactive and timely way.

We asked for evidence how the service formally listened to children, young people’s and their family’s voices. We were provided with the terms of references for the Trusts Autism working group set up in June 2024. These were monthly meetings attended by staff and parents. However, we were not provided with any reports or meeting minutes. The associated action log showed limited progress had been made since the group launch.

Senior trust leaders acknowledged they needed more engagement with children and young people using their services and would aspire to implement this in the future.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Families told us they said they had been offered equal access to care and services. For children and young people with additional medical / learning needs. families were offered a direct access into the paediatric assessment unit (PAU). This meant they could bypass accident and emergency to be seen by paediatric teams. We did not see evidence the service was monitoring care experiences of children and young people with direct access and how effective this process was a delivering timely care.

Staff told us they supported all families and children to access paediatrics services in a timely way. However, they recognised they were not meeting their outpatient waiting time target and further work was needed to see improvements.

We requested data on referral to treatment times (RTT) and any information on children and young people triage data. This information was collected trust wide. It showed 41% of the 7,785 children and young people waiting for treatment, 41% received this within 18 weeks of referral. The remaining 59% were over 18-week national target. The trust was consistently performing below the trusts national average. We also requested for evidence how they monitored any harm because of delays in RRT times. We were provided with a RTT harm review procedure but was not provided with any data or information show this process had been completed and what actions had been identified.

Data provided at time of assessment showed that in the last 12 months out of the 2,240 children and young people admitted to inpatient wards, 1.0 % of those were admitted to predominantly adult areas. We also requested any standard operating procedure for the admission of children and young people to adult wards. This was not provided. There was a lack of clear guidance for staff and oversight of admissions processes for children and young people in adult areas.

The service had ongoing concerns around how to manage children and young people who Did Not Attend (DNA) appointments. From November 2023 to October 2024, Southend had 2521 children who failed to attend their first appointment. This represented 10.3% of all new appointments. Leaders told us they had been working with an external text message service to review and improve attendance rates. We were not provided with details of how any actions taken had positively influenced DNA rates and its impact on equity in access for all.

We scored the service as 2. The evidence showed some shortfalls.

Care experiences were mostly consistent across departments. Families told us they would travel extra distance so their child could attend Southend as they had a positive care experience previously.

Staff told us they were concerned care experiences could differ particularly at night and weekends when staffing levels and skill mix were reduced. They said they were doing their best to provide consistent care, but at times found this increasing difficult and worried they were unable to deliver the good care and the outcomes they wanted all the time.

Evidence seen on assessment demonstrated that the service understood and met the diverse health and social care needs of the local community and was focused on delivering equitable care for all children and young people attending the services. For example, the play leads would attend all departments of paediatrics to assist all children and their family’s ensuring information and support was provided. They also arranged familiarisation visits for anxious children, to show them the ward environment and equipment prior to their planned admission.

We requested information how the trust monitored care experience and outcomes and how they used this information to drive improvement. We also requested for evidence to demonstrate how they reviewed equity in care considering the diverse population they serviced. We also asked for data on waiting times on arrival to outpatients and the proportion of waits longer than 30 minutes or if clinics started late and evidence of any meetings were all wait times were discussed and actions taken, this was not provided.

We were not assured the service had effective processes and monitoring in place to ensure all children and young people received equitable care and treatment whilst using the service.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

During our assessment we did not speak to any parents / carers of children who were on an end-of-life care pathway. The service did support children and families with complex life limiting conditions and staff did their best to support families and children during this emotional and stressful time.

Staff had policies and guidance to follow when supporting children, young people and their families through end of life and palliative care. The service used advanced decision making like Do Not Resuscitate orders (DNAR) and ReSPECT processes. The ReSPECT process creates personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices. These recommendations are created through conversations between a person, their families, and their health and care professionals to understand what matters to them and what is realistic in terms of their care and treatment.