Sheffield Children's 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 assessed 5 quality statements under this key question.

We found safeguarding arrangements were embedded throughout the service, supported by strong clinical leadership, effective multi-agency working, and clear governance processes to protect children and young people from harm. The premises were well maintained, secure and designed to support the delivery of safe forensic and clinical care. Effective environmental controls and access to hospital emergency support helped to promote patient and staff safety.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

The judgement for Learning culture is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe systems, pathways and transitions is based on the latest evidence we assessed for the Safe key question.

The service had comprehensive safeguarding policies and procedures in place to support staff in recognising, reporting and responding to concerns about abuse. All staff had completed safeguarding training appropriate to their role and demonstrated a good understanding of their safeguarding responsibilities.

The service was co-located within the trust’s Safeguarding Support Unit (SSU), which provided specialist medical assessments for children and young people where concerns relating to abuse or neglect, have been identified.The Clinical Team Lead for the service held Designated Doctor for Safeguarding Children responsibility for NHS South Yorkshire Integrated Care Board. Also within the SARC team were Named Doctors for Safeguarding Children for the Trust and specialist safeguarding nurses.

We reviewed patient records and found evidence of effective safeguarding practice. Clinical documentation was detailed, and clearly identified risks of harm, vulnerabilities and safeguarding actions required to protect children and young people. Child protection reports were completed in line with Royal College of Paediatrics and Child Health (RCPCH) standards and were produced in all cases reviewed. Reports were routinely shared with relevant professionals, including investigating police officers, social workers, general practitioners and other healthcare professionals, to support effective multi-agency safeguarding arrangements.

SARC and child protection cases were subject to peer review 3 times each month through the SSU.

Staff described positive and well-established working relationships with police and children's social care partners. They told us there were effective processes in place to share information and participate in multi-agency discussions to ensure children and young people were protected from harm.

Safeguarding governance was supported through supervision and oversight arrangements. The SARC manager received regular supervision from the trust’s head of safeguarding, and safeguarding performance was monitored through quarterly reports from the safeguarding committee submitted to the trust’s executive board and NHS England.

The Trust also had a Freedom to Speak Up Guardian and Freedom to Speak Up Champions who provided staff with an independent route to raise concerns, seek advice and speak up about issues affecting patient safety and quality of care,

The judgement for Involving people to manage risks is based on the latest evidence we assessed for the Safe key question.

The SARC was located within the hospital and benefited from the trust’s established estates and facilities management arrangements. Essential health and safety checks, including fire safety inspections, portable appliance testing and equipment maintenance, were undertaken routinely by the hospital estates team, helping to ensure the environment remained safe and fit for purpose. SARC staff also completed regular flushing of water outlets to reduce the risk of legionella contamination.

The premises had been designed to meet ISO15189 and forensic science regulatory standards, supporting the preservation of forensic integrity and minimising the risk of cross-contamination. Access to the unit was appropriately controlled, with measures in place to prevent unauthorised entry.

The forensic examination room was secured when not in use and the service maintained an audit trail of staff accessing the area. Appropriate safety measures were in place within patient areas. For example, bathroom doors could be opened from the outside in the event of an emergency, such as a patient collapse. Although furnishings had not been specifically designed to be anti-ligature, the service had completed a ligature risk assessment to manage identified risks.

Staff had access to dedicated facilities for donning and removing personal protective equipment (PPE). A shower facility was available to enable staff to decontaminate between cases where there was a risk of cross-contamination, including cases involving linked individuals.

Medical consumables were stored in a dedicated secure storeroom used exclusively for clinical supplies to maintain forensic standards and reduced the risk of contamination.

The service had suitable arrangements in place to respond to medical emergencies. Staff were trained in paediatric basic life support. Emergency equipment, including a ligature cutter, was readily available and subject to regular checks. Staff also had immediate access to the co-located hospital's emergency response and resuscitation teams. This meant additional clinical support could be obtained quickly in the event of a medical emergency.

The service had sufficient numbers of appropriately qualified, skilled and experienced staff to meet the needs of children and young people accessing the SARC.

At the time of our inspection, the service employed 7 forensic paediatric consultants, 5 crisis workers, 2 support workers and a nurse manager. Staff told us that staffing levels were sufficient to meet demand and maintain a responsive service for children and young people. They reported that patient care and critical forensic examination timescales had not been compromised because of staffing shortages.

The service was staffed by a skilled and experienced clinical workforce. All consultant forensic paediatricians were registered with the General Medical Council and held Membership of the Royal College of Paediatrics and Child Health. Five consultants had achieved Licentiate Membership of the Faculty of Forensic and Legal Medicine in Sexual Offences Medicine demonstrating specialist expertise in forensic medical practice. Six consultants had also completed the Forensic and Medical Examination in Rape and Sexual Assault course. All consultants had received training in statement writing and court skills to support their role in criminal justice processes.

Recruitment processes were robust. We reviewed the personnel files of 3 recently appointed staff members and found that appropriate pre-employment checks, including identity verification, references and Disclosure and Barring Service (DBS) checks, had been completed before staff commenced employment. The service had also recently renewed DBS checks for all staff to ensure their continued suitability to work with children and young people.

The service had a structured induction programme for new staff, which included both role-specific training and the trust’s mandatory training requirements. Staff told us they felt well supported when joining the service and were given sufficient time to develop the knowledge and skills required for their role. However, the service did not routinely assess and document ongoing competency once staff were established in their roles. This limited the provider's ability to demonstrate that staff continued to possess the knowledge, skills and competencies required to deliver care in line with current national standards and forensic practice guidance.

Staff received regular supervision and annual appraisals, often supported by trained psychologists. Those we spoke with described these processes as meaningful and supportive, providing opportunities for reflection and discussion of complex cases.

The provider had comprehensive infection prevention and control (IPC) policies and procedures in place to support the safe delivery of care and the maintenance of forensic integrity. Records demonstrated that staff were up to date with mandatory IPC training and understood their responsibilities for maintaining a clean and safe environment.

There were established cleaning and monitoring processes. Daily, weekly and monthly cleaning tasks were completed, and the premises were subject to a monthly deep clean. Regular trust led IPC audits were undertaken to provide assurance that standards were being maintained and to identify opportunities for improvement.

To support forensic standards, environmental DNA monitoring was carried out twice yearly by an external specialist company. This provided assurance that cleaning processes were effective in removing residual DNA and minimising the risk of contamination within the forensic examination area.

Cleaning equipment and materials were stored separately from forensic consumables, reducing the risk of cross-contamination. However, we identified that the same mop was used to clean both the patient toilet and the forensic examination room. This did not align with best practice for infection prevention and created a risk of cross-contamination between areas.

During our inspection we found that all areas of the SARC, including the waiting area, toilet facilities, storage areas and corridors, were visibly clean and well maintained. The forensic examination room had been designed to support effective infection prevention and forensic practice. It was fitted with sealed flooring, coved edges and smooth, non-porous work surfaces, enabling thorough cleaning between examinations. Handwashing facilities within the examination room met required standards.

Following each examination, crisis workers completed a comprehensive cleaning process to ensure the room was safe for subsequent use and to remove any potential DNA contamination.

Medicines management arrangements were safe and well organised.

The service benefited from access to the trust’s on-site pharmacy, which ensured the timely availability of medicines commonly required within the SARC, including emergency contraception and HIV post-exposure prophylaxis (PEP). Clinicians could also prescribe medicines for the treatment of conditions such as scabies and head lice when clinically indicated.

Most medicines were stored securely within the trust’s pharmacy department. However, Hepatitis B vaccinations were held within the SSU to ensure they were readily available. These vaccines were stored appropriately in a dedicated medicines refrigerator, and staff monitored and recorded fridge temperatures daily to provide assurance that medicines were within the required temperature range and safe for use.

Staff maintained accurate records of all medicines supplied to patients. Clinical records included details of medicines administered, together with batch numbers, enabling full traceability. We reviewed patient records and found this documentation was completed consistently. Records also demonstrated that clinicians routinely assessed the need for HIV PEP and emergency contraception and prescribed these medicines in line with current national guidance.

Staff also provided patients with helpful information leaflets relating to commonly prescribed medicines.

Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts and other relevant notices were disseminated through the trust’s pharmacy team, ensuring staff were informed of any actions required to maintain patient safety.