Southampton General Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that children and young people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence of staff taking every effort to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to Good. This meant people were supported and treated with dignity and respect; and involved as partners in their care.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

The evidence showed an exceptional standard. The service was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations with kindness and respect.

Parents we spoke with told us they had been given good information and support. They confirmed they would know how to report something, if they were unhappy or didn’t know what was going on. Patients said staff treated them well and behaved appropriately towards them. We spoke to 6 children and young people. As far as they were able to comment, their responses were positive about staff and how they were cared for. We spoke to 15 parents. They told us their experiences had been good, with “calm” nurses, regular checks and staff considering both their child’s needs and their own. One parent told us they were happy with the treatment in the children’s Emergency Department, even though it was very busy. Since coming to the ward, (via other wards), they said their child had been “well cared for.”

Our observations of staff when on the wards, units and in theatres gave us confidence in the staff’s interactions with patients, families and one another. At all times staff were kind, caring and courteous, providing a child friendly and compassionate service. Privacy was afforded, in the use of curtains around beds or using available rooms, where conversations needed to be more private. We saw staff providing reassurance and comfort when needed and using age-appropriate communications. Tactile approaches were used as needed and staff used facial expressions and calming words as they cared for patients and their respective families or carers. Some patients were well known to staff, and it was clear there was a bond between them. We observed a child who had been a long stay patient be discharged home, a moment which was both celebrated and emotional for all. One parent told us, “The nursing has been brilliant.” They added that they couldn’t fault anyone. Children who spoke with us told us the nurses were fine and good, doctors were ‘amazing’ and they felt looked after. A parent and child told us they had received good psychological support, and the play specialists were lovely.

Staff did their best to provide information in ways which could be understood by their patients and their families or carers. We heard staff explaining about medicines, pain management and how to mobilise safely with crutches for example. Patient records showed where parents were supported to understand and manage their child’s care, in advance of discharge.

The learning disability nurse and play specialists took every opportunity to create accessible information, including storyboards or pictures to help individuals with learning disabilities or who were neurodiverse. Often the nurse met with the patient and their parents or carers prior to coming into the hospital, so they could get to know them and understand how they would be able support the patient and immediate family at all steps of their journey.

Patient records we reviewed contained important information related to individual needs. This included for example, food preferences or intolerances. We saw staff cared for patients in ways which respected their personal needs and choices.

Staff maintained the confidentiality of information about patients. We saw staff handling written information with consideration of the need for privacy and confidentiality. Electric white boards, used to manage bed flow and other information were wall-mounted in the most suitable place on wards. Staff tried to make sure confidential discussions with patients and their respective families were held in private. We observed staff handing over confidential information between shift changes in ward offices. They were as discreet as possible when talking at the bedside. Doctors’ rounds, where each patient was reviewed, were carried out in as discreet a way as possible.

Safety huddles held on NICU included the review of patient observation charts and notes. These took place in each patient room, minimising confidential information being heard or seen by others.

The evidence showed an exceptional standard. The service treated people as individuals and was exceptional in how they made sure people’s care, support and treatment met people’s needs and preferences. The service took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Patients and their families were positive about their experiences and the way they were cared for. This included the way needs were met and the level of information given to them. Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. We saw there was a detailed menu available for children and young people to select from. The choice was varied. Special diets were catered for, and we saw information in patients records to indicate any sensitivities or allergy to food items. Dietitians were very involved in identifying nutritional support and reviewing progress with specialist feeds, when these had been required. Notes were updated to indicate progress.

The Hospital Liaison Team was available during daytime hours on weekdays. They were able to make reasonable adjustments for patients with learning disability and/ or autism. They offered support with transition from children to adult services too. There was a well-developed transitional approach for children and young people who would be moving into the adult pathway for ongoing care. Material related to this programme was very clear and easy to read.

The learning disability nurse told us they received direct referrals of children and young people who were coming into hospital. Referrals came from within the hospital, from community services and from special schools. Once received the nurse would arrange to meet with family, the patient and school representatives to understand if their needs were complex and how they may be met. This led to the development of a plan to ensure these needs could be met. For example, arranging early admission directly to the neurosurgery recovery, rather than the ward. They were then discharged from the same area, cutting out the general ward part of the journey. Preferred toys and visual aids were used to communicate in the best way for this patient.

There was a hospital communication booklet, available via the hospital website. This contained information on the various methods of communicating with individuals experiencing specific needs, such as related to hearing or sight loss. Pictures and symbols were clear and could be used by staff to engage in meaningful ways with patients and their families or carers. Information was clearly displayed in all ward areas about raising a concern or making a complaint. There was an escalation process for parents, patients or carers to seek a second opinion, if they did not feel listened to.

A range of information leaflets were available on the wards we visited. These were displayed in wall-mounted racks and included for example, information on safeguarding. Information could be translated, or provided in other formats such as easy read, large print, Braille or audio. This required a request via telephone or email to the Patient Support Hub. For patients and their families whose first language was not English, interpreting support was available for appointments and could be arranged when staying as an in-patient.

The palliative care team worked with staff, patients and their families to ensure their needs, wishes and choices were fully considered. Care planning for end of life was a priority for staff. They made sure the choice of where the individual and their family wished them to be as they neared the end of life was respected and that the required support was arranged. There was access to a 7-days-a-week team of chaplains. They provided support patients, their relatives, carers and staff.

The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment, and wellbeing.

Staff supported children and young people to be involved in discussions and about the treatment and care needs, as age appropriate. Parents and carers were involved in discussions with staff about their child’s level of independence and needs. We heard from one child who was looking forward to being able to manage their dialysis at home, rather than coming into hospital. We saw staff explaining aspects of care to children and giving them the chance for questions. Choices were given about diet and preferred play activities. The service also gathered feedback from children and young people, and we saw several examples of this feedback including what action had been taken in response. For example, more appropriate cutlery, opening times of playrooms and the discharge process. The Experience of Care Team also collected feedback information, which included evidence of comments about feeling involved and being listened to. We saw from information provided that the feedback from young people demonstrated good examples of how the staff helped them to be as independent as possible, helped with confidence building and involved choices.

The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

We saw staff on ward areas were able to respond to the immediate needs of patients in most situations. They did their best to make adjustments when patients had needs associated with autism. We saw staff were able to recognise the psychological distress of patients and how they made changes to reduce the impact on the patient and the other people on the ward. However, we spoke with a parent of a child who needed their pain relief changed from oral to a more direct route via their vein. A request had been made for this, but a delay occurred due to the need for a suitably trained nurse not being available on the ward to give the items intravenously. This caused unnecessary discomfort to the patient but was resolved by a nurse coming from another ward to give the medicine.

Patient records reviewed across the 2 days, showed risks assessments had been mostly completed. Specific needs required to minimise or manage these, had been identified and actioned. They did this by continuously assessing and reviewing the condition of the patients and adjusting as needed. Where the patients’ condition showed a deteriorating picture, based on the results of nursing assessment, this was escalated to the right people for action.

Staff in NICU told us there were lead consultants for specialities, including for example, intensive care, high dependency and transportation between other hospitals. Access to the right expertise helped staff to make sure risks to patients were escalated to the right person/s.

Children and young people with cancer were expected to have access to out of hours support from some members of the Paediatric Oncology team (subject to a decision to 'go on-call'). This team was overseen by the on-call paediatric oncology consultant and reflected part of the NHS England Service Specification for paediatric oncology, that: "End of life care should include access to 24-hour palliative care support, provided in partnership with paediatric palliative care services, so there was 24-hour, 7-day care for the child and family at home. We were told there were difficulties in covering the service with less staff than was needed. This resulted in not all calls for advice getting a response out of hours and symptom management not always being best managed. These concerns were identified on the risk register, and 3 actions had been identified to address the situation. The trust advised that the service was not fully commissioned or funded for 24/7 specialist paediatric palliative care provision, despite the increasing demands. However, they said there were arrangements to support safe care delivery. This included specialist input from oncology CNS teams providing 24/7 on-call support where required, consultant and senior clinical oversight from specialty teams, and flexible use of senior nursing leadership to maintain service continuity.

Feedback from patients and families was collected by the Experience of Care Team. We reviewed many of the comments, finding these were very good or good. For example, “The staff, consultant and everyone who took care of my son were excellent and explained everything to my son in a way that he could understand.” Another comment specific to PICU was, “The care and attention we received in PICU has been outstanding, so attentive and caring.”

The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centered care.

The trust had an inclusion and belonging strategy covering the years 2023-26, which set out 5 key themes. In our discussions with staff, most spoke about feeling valued, respected and treated fairly, with equal opportunities for personal development and career progression. A small number of theatre staff were unhappy that some perks had been taken away as a cost cutting measure and there had been changes in payment for some work. This made them feel less valued and impacted on morale. The executive team were aware of this.

Staff in several areas told us they did not have enough staff, and some positions had not been replaced after becoming vacant. This created additional pressure and, in some cases, impacted on staff’s ability to undertake the required work. For example, in theatres we were told some cancellations had happened due to reduced staff availability and payment for overtime having been reduced. Information from the trust showed this was a rare occurrence. There was only one learning disability nurse in children’s services, which made it feel very pressurised and challenging at times. We were told the palliative care team and play specialist staffing numbers was being reduced, which was impacting on workload and pressures, as well as the desire to do their best for patients. However, the trust advised these reductions were not happening in the palliative care staffing levels, and any gaps would go through the recruitment process.

Many staff had worked in the hospital for a long time. Those who spoke with us shared positive feedback about their ward areas, theatres and specialised units, including their colleagues. In general, we were told it was a good place to work, and staff felt they could deliver high-quality care and meet the needs of their patients. Good teamwork and support was mentioned by several staff as being a positive factor to their job satisfaction. One healthcare worker told us that everyone was really encouraging and willing to give you a hand or help you out. They added “I love the different variety of patients and how diverse it is, in case of the case load of patients, it’s a really great learning opportunity because of that.” We observed happy and calm atmospheres in all areas, despite being busy.

Staff had access to support for their own physical and emotional health needs through an occupational health service, as well as through a trust-commissioned staff psychology service, which offered individual and team interventions. The service offered therapy to individuals who had experienced trauma at work or had difficulties connected to work. They also have access to a ‘one-stop-shop’ information site via the staff intranet pages. Wellbeing champions also offered support and guidance to staff. Doctors had access to a rest room, which was equipped for drinks, food storage and relaxation. However, we were told there was no provision for staff to breast feed in children’s service. The trust provided a response to this and advised there was a suitable, single-occupancy, lockable parent feeding room available near Children’s Outpatients.