Brighton General Hospital

We carried out this announced inspection over two days on 24 and 25 August 2021 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. Two CQC inspectors carried out the inspection, supported by a specialist professional advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Background

The Sussex children’s sexual assault referral centre (CSARC) is provided by Sussex Community NHS Foundation Trust (SCFT). The CSARC is situated on the site of Brighton General Hospital and is clearly signposted with the service name, without reference to the type of service to ensure discretion. Dedicated parking is available directly outside the CSARC.

NHS England and Improvement (NHSE/I) and the Sussex Police and Crime Commissioner (PCC) commission the CSARC. NHSE/I is the lead commissioner for the CSARC. The Sussex PCC is the lead commissioner for the children’s independent sexual violence advocate (ChISVA) service, which is provided by The Survivors’ Network, a community and voluntary sector organisation. The CSARC refer children to the ChISVAs for support throughout the court process, where appropriate. The Survivors’ Network was not in the scope of this inspection.

The CSARC provides a service to children in Brighton & Hove, East Sussex and West Sussex, up to and including the age of 13 years, who have experienced or are suspected of having experienced recent (within 21 days) or non-recent (longer than 21 days) sexual abuse. In addition, they see young people aged 14 to 18 years if they have additional needs that would make the CSARC the best place for them to be seen. The CSARC provides holistic health assessments, including forensic medical examinations when required.

The CSARC is open between 9am and 5pm for referrals, with doctors available between 10am and 4pm, 365 days of the year. Access is via police or social worker referral only. The staff team is led by a non-clinical service manager and a consultant paediatrician who is the clinical lead doctor. A vacancy for lead nurse had been recruited at the time of the inspection. There are a further 12 doctors, including ten paediatricians, one genito-urinary medicine (GUM) speciality doctors and one GUM consultant; and six nurses from the children in care (CiC) nursing team, fulfilling the CSARC rota. Each child is assessed by at least one doctor, plus a nurse who also offers crisis support, on weekdays and two doctors on bank holidays and weekends.

SCFT is responsible for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

During the inspection we spoke with the service manager, the clinical lead, the general manager, the head of nursing and governance, two doctors, two nurses and a ChISVA. No children or young people accessed the CSARC during the time we were onsite.

We examined the records of 10 children, all of whom were under the age of 14 years.

We left comment cards at the location in the week prior to our visit. No children had accessed the service during that time, so no comments were received. We reviewed feedback from a range of stakeholders, received by the CSARC.

We looked at policies and procedures and other records about how the service is managed.

Throughout this report we have used the term ‘patients’ to describe children and young people who use the service, to reflect our inspection of the clinical aspects of the CSARC.

Our key findings were:

• The staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding children and adults.
• The service had systems to help them manage risk.
• The service had thorough staff recruitment procedures.
• The clinical staff provided support, care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Established policies and procedures ensured effective multi-agency and multi-disciplinary working.
• The service had effective leadership and a culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The service asked staff, patients and stakeholders for feedback about the services they provided.
• The service staff had effective processes in place to deal with complaints positively and efficiently.
• The staff had suitable information governance arrangements.
• Areas seen during our inspection were clean and well maintained.
• The staff followed infection prevention and control procedures, which reflected published guidance.

The provider could make improvements. They should:

• Strengthen arrangements for onward referral to external services and follow-up, including emotional well-being and mental health support.