Southend University Hospital

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• 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 looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation. This was the first assessment for this service. This key question has been rated Good.

The service had good learning culture and staff said they could raise concerns. Incidents were investigated and information shared effectively to staff locally. There were not always enough staff with the right skills, qualifications and experience to manage the demand on the service. Learning and education did not always happen due to low staffing and demand on the service. Children and young people were protected and kept safe; staff understood risk and were supported locally to managed it. The facilities and environments were bright, inviting and met all young people’s and their family’s needs. The service did not always ensure that medicines and treatments were safe to meet people’s needs, capacities, and preferences by enabling them to be involved in planning, including when changes happened.

This service scored 59 (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 2. The evidence showed some shortfalls. The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Young people and their families using the service were able to raise concerns and were signposted to give feedback and make suggestions on improvements.

Staff told us they reported incidents well locally and nursing leaders told us they were prompt at identifying areas of learning and took a positive approach to incident management. However, staff told us learning and education could often be postponed due to wards and departments being busy. Senior education leads were utilised to backfill shortfalls in staff, limiting their ability to provide live skills and drills training. Some bank staff were not always aware of learning from incidents and had not received all their updated training.

We requested evidence of incident management and identified lessons learnt, this was not provided. We also requested evidence of morbidity and mortality review meetings, this was not provided, therefore we were not assured the appropriate actions were being taken following safety incidents.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services

Young people and their families using the service told us transition into children and young people services was not always smooth. For example, moving from the children’s emergency department to the ward could take a long time, however, once admitted they were better informed of planned care. They told us staff told them what was going to happen and why. Families in the outpatient department also told us care processes were effective and clear and experienced good care pathways.

The service had guidance and procedures in place for transition of care between paediatric departments. However, staff told us safe care pathways and systems were not as effective due to lack of capacity, high acuity and demand on the service. At times when they were short staffed the paediatric assessment unit had been closed. Staff also raised concerns over the lack of bed space and was worried children may be discharged too early to free up a bed. They said this was a risk and could potentially increase readmission rates. Evidence reviewed showed the over the previous 12 months the service at readmitted 297 children and young people within 30 days of discharge.

Healthcare partners told us they had clear pathways for referrals into their external services and staff had guidance and processes to follow. Partners received and shared feedback on care pathways from young people and their families but were unsure how this was used to improve care within Southend Hospital. Community mental health partners met with leaders daily to discuss care plans and said this was beneficial and assisted continuity with care outcomes.

Healthwatch Essex had received concerns from children and their families around unclear pathways for ADHD and autism care. Concerns raised over unclear communication particularly if care involved multiple departments.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They did not always share concerns quickly and appropriately.

Staff told us they received annual training for safeguarding. Evidence reviewed showed good compliance rates for safeguarding supervision; however, bank staff were not always compliant with safeguarding training. It was not always clear when children were admitted to adult areas that staff caring for them were appropriately child safeguarding trained. We requested evidence of guidance or procedures for staff to follow went children and young people were admitted to adult wards; this was not provided. Therefore, we were not assured leaders had good oversight of any associated safeguarding risk.

Staff and leaders told us safeguarding would be identified and indicated on care records using a red stamp. This would enable staff quick reference and a reminder that safeguarding concerns had been identified. Staff said these processes worked well. There was safeguarding leads within children and young people services and staff were well supported to raised concerns and seek advice.

Staff told us there had been an increase in safeguarding referrals due to a surge of children and young people with mental health needs and that processes were often delayed whilst awaiting an available referral bed. However, they did have a designated mental health room that minimised risk of self-harm. Staff told us they were better equipped to support and safeguard children whilst awaiting a referral bed.

We requested safeguarding children meeting minutes for the last three months following the on-site assessment. The Trust were unable to evidence quarterly system led meetings that occurred. We did not see evidence site leaders met to discuss safeguarding cases and associated risks. Policies relating to safeguarding were not always tailored for children and young people, meaning staff lacked clear guidance to keep children and young people safe. For example, the service had a patient abscond policy, however, this was adult focused and offered little guidance to staff around children who may try and leave a ward or department.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff said they had good support and structures in teams to manage risk. However, at night and weekends they lacked senior support. We requested evidence to show how low staffing numbers were escalated and managed, this was not submitted. Staff told us ward managers would be on call for advice and escalation, this was not paid, however, mangers told us it was required to ensure safety 24/7. This communication channel lacked oversight of risk and safety and relied on senior staff being available to answer messages promptly. There was no auditing of this chat group, and we were not assured it was a safe and effective method to escalate risk linked to agreed policy and procedures.

Families and children said staff had mostly involved them in discussions about care. Families in the outpatient department with children with long term medical conditions said staff had discussed symptoms, things to look out for and when to seek medical help.

Staff told us they considered families concerns as well as clinical observations when assessing children. Staff said they were confident to escalate clinical concerns if a child deteriorated. We also saw evidence of safe and appropriate escalation of observations and assessment in care records.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Families and their children said the environment was excellent “very inviting for children”. Families on the neonatal unit said, “it’s really calm, doesn’t feel like a hospital, homely and welcoming”. They told us everywhere was visibly clean and tidy and it felt like departments had been purposely built, “great toys and facilities” for all children and young people. Also, families said there was robust security system on the outpatient department which made them feel their children were safe.

During our assessment we found inpatient and outpatient areas to be visibly clean, bright and inviting for children. They had child accessible bathrooms and play equipment for children and young people of all ages. The inpatient ward also had a designated mental health room that be purpose built for young people in mental health crisis, with its own allocated toilet and shower.

Staff told us they were very proud of the facilities available on the ward and the units. They said their play team were “amazing” and they made sure children had variety of toys tailored to their needs, space to play and quiet spaces if needed. The ward also had a separate area for teenagers with more age-appropriate games and resources. There was a recently refurbished mental health room, which had been designed to minimise the risk of self-harm and had its own allocated bath and shower.

As part of our assessment, we requested evidence of current environmental risk assessments in all children and young people areas. This was provided however some risk assessments had been completed after our onsite assessment and some lacked associated action plans. This showed there was some gaps in environmental risk management.

make sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. However, staff worked together to provide safe care that met individual needs.

Families told us staff were polite and caring, as well as, supportive and knowledgeable when they asked questions. They said communication was good and staff took time to speak to children and give reassurance. Staff in the paediatric assessment unit were very attentive and kept checking on families and people told us staff had been “fantastic at every stage of care”. Families did see that staff very busy but knew they would be there if they needed them.

Staff told us the play teams had an important role and positive impact throughout the paediatric service. They coordinated and collaborated with all colleagues across departments and kept children and young people’s wellbeing at the forefront of care delivery.

Some staff said the nursing skill mix was at times a concern. Staff told us many of the nurses were newly qualified, which meant they were limited in what they could do without senior supervision. Senior staff were limited as to what support they could offer and at times they said this impacted on risk management and safety. However, the service had processes in place for new starters that involved shadowing and peer support that was monitored.

Staff told us some wards and units often were short staffed and at times the service did not always make sure there were enough qualified, skilled and experienced staff to deliver care. The service had shared they had some shortages in medical staffing, but posts were due to be filled in the next few months. Nursing staff vacancies were also high at 17.6% which was above the trust target of 11.5%. However, staff told us if areas were short of specialist nurses and nursing mangers would clinically support when busy, but this would impact on their ability to carry out their other clinical responsibilities.

We requested information around staffing rota’s showing staff planned and actual numbers on shifts. This was not provided. We also asked for evidence of escalation processes and action taken to mitigate staffing gaps. Evidence provided did not demonstrate clear management and oversight of staffing and skills gaps.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Wards and department entrances all had signage for hand washing procedures and infection prevention control measures. Areas appeared clean and bright. Toilets were accessible and bins were emptied regularly. Staff washed their hands and used hand gel prior to care and treatment.

Families using the service told us staff were good at infection control, one said “really hot on infection control”. Families in the neonatal intensive care unit said staff had reminded them to wash hands on entry and given clear advice and instruction on infection risks.

Play staff said they had a strict process for disinfecting the toys after each use and kept clear audits of deep clean processes. The service had allocated staff responsible for domestic cleaning of the departments and wards across paediatrics. Cleaning systems and processes were in place; to manage infection risks and the service had an overarching infection prevention policies and guidance for staff. Infection prevention control audits showed some good areas of compliance but there were some gaps in reporting.

We scored the service as 3. The evidence showed good standards. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did involve people in planning.

Clinical pharmacy services, medicines advice and supply were available from the pharmacy team. An on-call pharmacist was available outside of core working hours. Staff told us that out of hours pharmacy support could be better.

Staff told us that they had received competency assessed medicines management training including sepsis management training. Staff told us that they were encouraged to report incidents and learning from incidents were shared widely.

Medicines were stored safely and securely, including controlled drugs (CDs) and CD stationaries. Ambient room and fridge temperatures were monitored regularly.
Controlled drugs were stored in line with legislation and records of administration were mostly completed in line with guidance.

The service had a process for obtaining relevant patient history; however staff we spoke to did not have access to nationally held patient summery care records (SCR) via system One widely used within the Trust. The service used paper prescriptions throughout the Trust, and this is yet to be harmonised. Different prescription charts were used in the three hospitals.

The service had medicine management policies and guidance for staff to follow. Medicine management audits for inpatient areas showed good compliance.