Southampton General Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question as good. At this assessment the rating has remained. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

Patients had their needs assessed and reviewed so they could ensure they received the best outcomes. We looked at 8 patient records and several observation tools used to monitor patients. We also followed the patient journey of two children from admission through theatres and back to the ward, which helped us to see how well their needs were assessed. We found staff completed a full health assessment of the patient and care plans set out what was required for each patient and how their needs would be met. They were personalised and holistic, and staff updated them as things changed. Most ward records contained a full assessment of the patient including any actual or possible risks. However, we found there were some gaps in records, which included missing dates, times and some sections had not been completed where a signature was required. For example, moving and handling and the ‘WETFLAG’ assessment. The WETFLAG assessment is used for calculating emergency equipment and medicines based on a child’s weight. Documentation completed for each patient journey we followed was clear and detailed. Information demonstrated consideration of the patient’s safety and wellbeing. However, a document which was for parents and related to minimising infections during their child’s stay was not completed in all records we looked at.

Patient records also showed information about their dietary needs, fluid intake, as well as any foods they could not have due to sensitivity or allergy. Where patients needed nutritional support via tube feeds, this was recorded, alongside information and reviews from dietitians. Staff recorded when tube feeds were given.

Children and young people with a learning disability or who were neurodivergent were referred to the learning disability nurse as early as possible, who then met with them prior to admission or during their outpatient appointment. This allowed them to develop a rapport with the person and identify specific needs, as well as how these could be met. A detailed plan of care was then developed, along with their hospital passport, which included managing any risks. We heard examples of how this approach had been used for different patients, with positive outcomes.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Policies and procedures reflected professional practice and guidance. Staff participated in clinical audit, benchmarking and quality improvement initiatives. They collected and reviewed outcome data for children and young people in a range of areas, including diabetic care, asthma, congenital heart disease and cystic fibrosis. We saw the service also looked at admission and re-admission rates, for example, emergency readmissions within 30 days following a tonsillectomy. For the most recent reported period of quarter 3 2024/25 data showed 4.5% of paediatric patients (0-16 years) were readmitted as an emergency, following a tonsillectomy under the care of an ear, nose and throat (ENT) surgeon. This was slightly higher than the benchmark of 4.4%. However, the trust had reported an improvement in performance against this metric in the past 12 months. Most recent data on re-admissions within 30 days following tonsillectomy (0-16 years) showed, out of 88 surgeries, there had been 6 secondary post-surgical bleeds, of which 5 were treated without the need for more surgery.

We asked the trust what the rate of unplanned returns to theatre was for the period April 2025 to October 2025. Out of 2123 cases, there were 17 elective returns and 56 emergency returns. This represents 0.8% and 10.9% respectively. Readmission rates for the period November 2024 to October 2025 for surgical and medical children and young people was 416 (8.60%), of which 72 were surgical patients and 344 medical.

Senior nursing role holders spoke about the importance of providing support for their teams. Appraisals were done each year and there were catch up discussions on a more frequent basis. This was done to ensure their staff were heard, that any concerns were addressed and what could be done to make their working life better. The use of 'High Fives' was a valuable way of giving positive feedback to staff and this boosted morale and job satisfaction. Managers used a range of ways to share information with staff. This included for example, newsletters, notice boards and via the ‘Big4. ’ This is a means of sharing 4 key messages with staff directly.

The percentage of child health staff who had received an appraisal in the last 12 months was 320 (65.74%) and for medical staff out of 130 (77.40%). Within neonates 116 or 65% of staff had been appraised up to 2 December in the rolling year. The target rate was 85% and the trust reported that the system only recorded appraisals once all paperwork was complete. Approximately 12% of completed appraisals were not yet reflected on the system. Actual completion was estimated at 75–80%.

Managers identified the learning needs of staff from their everyday discussions and via the appraisal process. They provided them with opportunities to develop their skills and knowledge. A member of staff who worked on the Medical Ward told us they had been given a competency book, so it was clear what they needed to do to work towards to career progression.

Patients had treatment and support from an experienced and skilled workforce who worked together for the benefit of their outcomes. As well as doctors and nurses, there was access to and involvement of advanced clinical practitioners, palliative care staff, physiotherapists, occupational therapists, speech and language staff, dietitians, play specialists and teachers. We saw physiotherapist, play specialists and teachers engaging with patients.

Staff were experienced, qualified and had the right skills and knowledge to meet the needs of the patient group. Managers ensured staff received the necessary specialist training for their roles. Staff we spoke with said they had access to additional training for their roles. This included for example, an external renal course, internal critical care and ‘sun’ course. There were competencies for staff to meet in order to look after patients having dialysis. Staff had opportunities to rotate onto different ward areas to develop new skills, and educational specialists were available to support and assess skills at ward level.

Staff told us they had access to additional training and development opportunities, some of which included on-site learning and training from practice development nurses. A member of nursing staff on E1-Cardiac Ward said training on the ward was taken seriously. There were 3 practice educators on the ward and staff had support from these staff members to gain and update skills and competencies. Medical staff took an active approach to developing junior doctors in training. We saw a more senior doctor teaching junior doctors on the Cardiac Ward.

We spoke with a member of the paediatric critical care outreach team who explained how bed capacity sometimes meant patients who would usually be in the High Dependency Unit (HDU) went onto the ward. This had required the upskilling of the team, and practice educators had worked hard to make this happen. There was access to trust policies and procedures to support new staff and when needed. Additionally, there were pathways of care for various specialties, which helped staff to follow best practice.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff shared information about patients at effective handover meetings within the team. We attended a handover from night to day staff on two wards. Information was shared in a meaningful way to enable the day staff to plan the delivery of care to their patients, as well as knowing if there had been any worries or changes in the patient’s condition. The need for any investigative tests or arrangements for discharge was shared too. Other ways staff shared information related to patients included board rounds, safety huddles, and bed flow reviews. We saw various handover meetings taking place, including safety huddles, child health meetings, doctor’s rounds. Staff from various disciplines were involved as needed. Information was shared in a clear manner, and everyone had the chance to contribute to discussion.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives by involving them and their parents/carers in discussing immediate and longer-term needs. Information was provided in an age-appropriate way to children and young people, and independence was encouraged to be as independent as possible. Care planning considered personal needs and where there was a need for education and support for a particular care need, this was stated. For example, training around tube feeding and home dialysis. Information was provided about the importance of healthy diet and managing specific conditions.

The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The service was able to show significantly better outcomes for children and young people. The trust provided a range of surgical outcome data for us to review, which included information related to more complex procedures not always done in other district general hospitals. For example, closure rates of colostomy on children and young people. There had not been any readmission rates within 30 days of this surgery against a 12% average rate for England. Colectomy (removal of part of the large bowel) for Crohn’s Disease in children and young people under 17 years old had a higher laparoscopic (minimally invasive) approach to surgery, with a rate of 86% versus England average of 64%. The 30-day re-admission rate was nil, versus 11% for the national rate across England.

We noted the trust saw a higher rate of complicated appendicitis, (55%) versus 38% for the England average and despite this the minimally invasive (laparoscopic) rates for surgical management of this was higher (93%) than the England average (91%). Laparoscopic surgery can result in better outcomes for patients including less post operative pain, smaller scars and a faster recovery time.

Children and young people’s outcomes were reported into the governance groups, and we saw an example of the report to the Quality Committee for April 2025. This highlighted by way of example successes in Paediatric Respiratory Medicine related to Cystic Fibrosis, Asthma and the Paediatric non-respiratory sleep service. They also reported on gastroenterology and diabetes successes and Paediatric Cardiology- congenital heart disease, noting survival rates had not yet been published for 2023-25 for the latter. Areas for additional focus and action plans were also described in the report.

There was access to diagnostic facilities including, x-rays, scanners, blood testing and other investigations. Results were communicated back to wards and departments for review by clinical and medical staff. Some testing equipment was available on wards, such as for checking blood sugar levels, electric weighing, monitoring oxygen levels and managing medicines.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

Consent processes were formalised in a trust policy, which was accessible to staff. Staff took all practical steps to enable patients to make their own decisions. We heard staff asking permission from their patients before giving medicines or before mobilising. Parents were involved in consent processes where children were not of an age to make such informed decisions. Patient records showed information, including risks and options had been given, as part of the consent process. Consent forms had been signed and dated.

The learning disability nurse and ward champions made sure full consideration was given to young patient’s capacity to consent as well as their parents. An example was shared with us of how the learning disability nurse had ensured written information was provided in the right format for a parent to understand, and how they were able to translate medical information into a more simplified way. Advocates for the patient and or relatives could be arranged, and the learning disability nurse could also assume this role.