Southampton General Hospital

On this page

• 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.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

We have not awarded this service a score for Safe.

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

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The trust had a Patient Safety Incident Response Policy, which incorporated duty of candour, incident reporting and management. This set out the premise of having a ‘Just and Learning Culture’, where everyone was learning so they could improve as much as possible and provide the best care for patients. Additionally, the trust had a Patient Safety Incident Response Plan, which was available for public viewing on the hospital website. In relation to children and young people, the plan had a local approach to focus on unexplained deaths with some hospital involvement in the 12 months of age to the day before a young person’s 18 birthday. Neonatal deaths were not part of this, as they were investigated or reported differently. The planned response and expected improvement from incident reviews was stated. We found the trust reported incidents in line with expectations of the Patient Safety Incident Response Framework (PSIRF). This was focused on learning from incidents to provide safer care to patients. We saw Learning from Patient Safety Events (LfPSE) was part of the culture of safety. There had been 4 incidents reported into CQC via this route this past year, which related to children and young people. We saw for example, action taken related to tube feeding and safety checks.

There was a positive culture of reporting and learning related to adverse events or near misses, which recognised the importance of taking every opportunity to make improvements. Staff told us they knew how to report incidents and the system to do so was easy to access and use. There was a good awareness and understanding of the importance of reporting and of what to report. Most staff told us they received feedback from investigation of incidents, both internal and external to the service. However, some staff, especially in theatres and amongst doctors in training said they did not always get information on the outcome of a reported matter. For example, a doctor had reported a problem with the cap on a type of invasive device used for delivering medicines or fluids into the vein. They had not received an update on actions taken.

Staff took the opportunity to learn from the feedback they got from patients and their families too. Information was reviewed and any action needed was fully considered, including for example, service improvements, changes in practice and staff behaviour.

The General Paediatric and Children’s Emergency Department (CED) Learning from Events terms of reference, set out the frequency of meetings and purpose, as well as how cases would be identified. We saw there were formal discussions of learning from different types of adverse events at these meetings. The meetings included the creation of action logs with assigned responsible members of staff. Progress on these was followed up at future meetings. Learning was shared in different ways and included via a newsletter, which was sent to the general paediatric and CED teams and the Big4 weekly learning emails.

The trust also had a Quality, Education, Safety Together (QuEST) multiprofessional meeting, which was used to share learning from patient cases and events to teams and individuals. Information provided to us said quarterly reports fed into QuEST, with a focus on themes and learning from the patient safety team, complaints team and Child Deterioration and Death (CDAD). Favourable event reporting forms (FERF) were used to share learning.

All deaths of children (from birth up to the day before a young person’s 18th birthday) which happened within the Children’s Hospital or Emergency Department were reviewed through the Child Death and Deterioration (CDAD) panel. This panel had a clear multidisciplinary structure, with cases presented by the most appropriate consultant, and reviewed both deaths and episodes of significant deterioration. Each case was graded, with defined levels for further investigation, including escalation to a Patient Safety Incident Investigation (PSII) when required. The purpose of these reviews was to establish if treatment and care was appropriate or if there was any learning identified, such as changes in practices and local safety actions.

Deaths within Neonatal Services were managed through separate pathways, supported by a dedicated Neonatal Death Standard Operating Procedure. These included multidisciplinary review processes within neonatal governance structures, with any learning also shared regionally through the Neonatal Operational Delivery Network.

We reviewed several of the reviews which had been carried out and saw where action was needed, this had been indicated. This included for example, the pre-assessment pathway to be updated to include communication to the outreach team of complex child admissions.

The Duty of Candour (DoC) legislation requires healthcare organisations, including hospitals, to be open and honest with patients when things have gone wrong during care. This means being transparent about what happened, offering an apology, and explaining any investigations or actions being taken. Staff understood the duty of candour and gave examples where they had been open and honest about for example, cancellations of surgery. Information provided to us showed there had been 21 DoC events in the year 1 April to 1 December 2025.

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The children’s hospital within the trust was a tertiary service, which meant it took referrals from local and further afield, when children and young people required more specialised level of healthcare. This included treatment for complex and rare conditions, requiring a referral from primary or secondary care.

There were planned admissions for elective surgical procedures and medical reasons, including dialysis. Emergency admissions came via the Emergency Department (ED) and transfers in from district general hospitals. For the latter, a member of the medical team held the on-call bleep or the phone for the consultant. Referrals from GPs came via the single point of access into the Children’s ED. A general paediatric consultant covered the short stay area of ED and held a phone, enabling rapid contact.

Medical staff told us the coordination with children’s ED was good and there was a level of trust in the doctors in ED having assessed the patient properly and started initial treatment, so patients were managed and transferred safely. They added that this system was an improvement on the previous way of patients being admitted by GP, and reduced the risk of missing aspects of assessment, such as sepsis screening.

Patient flow was managed through close monitoring of discharges, including the times when beds would become available, the number of planned admissions and numbers of children and young people waiting in the ED for a bed. Electronic white boards were updated with information to help inform senior leaders about bed capacity. Three bleep holders visited wards and reviewed capacity, liaising with doctors about discharges. The advanced discharge team were used if there needed to be communication with the Integrated Care Board (ICB) about care packages.

The trust collected and reviewed data on emergency admissions with a length of stay greater than 20 days. They also monitored re-admissions with or without surgery, including emergencies. The readmissions to Paediatric Intensive Care (PICU) were discussed at the PICU monthly meeting and the weekly care group CDAD meeting. Cardiac cases were discussed at the Monday morning handover for E1-ward. This ensured information and learning was shared across all wards.

The Virtual Enhanced Care Group (VECG) recorded all mental health breaches within the hospital including children and young people. Breaches included for example, where the most appropriate place of care could not be achieved. All breaches were reportable to NHSE and included those people waiting in an acute bed for transfer to a mental health bed. The lead matron for mental health took a weekly snapshot of the patients who were medically optimised for discharge (MOFD) to report at a resilience call.

The service had a very well-developed transitional programme, which supported children to move forward into continuing treatment and care. This programme was supported by a well-constructed Management of Adolescent Transitional Care Policy. The service had fully recognised the importance of empowering the young person and their parents/carers in the transition period, ideally before reaching 19 years of age and ending at 23 years of age. We heard about and saw information on the ‘Ready Steady Go’ programme, which was designed to safely equip the young person with the skills and knowledge to manage their healthcare confidently and successfully in both paediatric and adult services. The programme started at age 11, for children with a long-term condition until they were successfully transferred to adult services, depending on the progress made by each young person and where appropriate, the care giver. We found there were very clear systems and approaches to enable coordinated transitions in as safe a way as possible, minimising any risks to the individuals where care provision changed.

There were occasions where children and young people with mental health needs required admission to the right facilities, but these were not readily available. The provision of Tier 4 Child and Adolescent Mental Health Services (CAMHS) beds was outside the control of the trust, as these were managed by other providers. The trust advised us there has been improvements year on year in how they managed CAMHS patients within the trust and there had been a reduction in waiting times for Tier 4 beds. We noted however, there had been 3 breaches in the decision to admit to Tier 4 Child and Adolescent Mental Health Services (CAMHS) bed between 1 April and 1 December 2025. Such breaches can mean the patient is not able to receive the right level of treatment and care, in the right place. The average number of days waiting for a suitable bed for these cases was 13. Tier 4 CAMHS provides highly specialist, tertiary-level care for young people with severe and complex mental health needs. Often, they required inpatient, intensive day care, or intensive community/outreach services, including specialised units for eating disorders, autism, or psychiatric intensive care, acting as the highest level in the CAMHS pathway. The difficulties experienced in managing mental health patients was not unique to the trust. They managed the challenges as best they could, given the limitations within the wider community.

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately.

The trust had separate safeguarding policies which related to children and adults. These policies referenced relevant national guidance. The detail within the policies gave clear guidance to staff about their responsibilities and actions to be taken if they were concerned a patient had been subject to possible abuse. We saw there were procedures for staff to follow when they had concerns of a possible safeguarding matter. An electronic reporting system was used with separate areas for children and young people, distinct from adults. This was reviewed daily. The safeguarding team also met every day to review caseloads and what needed to be actioned. The service referred safeguarding concerns to the local authority and were involved in case meetings as required.

Staff had access to safeguarding training for adults and children at levels 1, 2 and 3, depending on their role. The trust monitored completion of this training, which in addition to the trust induction, was to be undertaken every 3-years. Completion rates for level 3 children’s safeguarding ranged from 54.9% in children’s services to 61.20% in the Neonatal Unit. The latter related to the recent employment of several new nurses, and they were going through their induction, which would include safeguarding training. An action plan had been developed to improve uptake, and safeguarding training was on the risk register, with regular reviews on the progress.

The content of safeguarding training was under review, to reflect the revised national guidance. At the time of our visit, training was delivered on-line to clinical staff. Whilst face to face training was available to doctors, they could join on-line too. Divisional education leads were responsible for overseeing attendance and completion of training. There had been a focus on reflective learning and safeguarding debriefs were held with staff. This was said to have helped staff to be more confident in approaching safeguarding leads for advice and support.

The service had a named nurse for safeguarding children and a lead doctor. The consultant was not involved in all safeguarding cases but was made aware of them where necessary, and heard some cases of higher concern, such as abandoned children. We were told by the safeguarding leads they had good links with multi-agencies, including the local authority, the police and the Integrated Care Board, (ICB).

Wards and units were visited most days by the safeguarding team, where they asked staff if there were any possible worries or concerns about children and young people. They also liaised directly with the mental health team, as needed. A weekly Child and Adolescent Mental Health Services, (CAMHS) took place and safeguarding representation from the trust also attended this.

We heard staff handing over information related to safeguarding to colleagues, and we saw information recorded in patient records, where there had been a safeguarding action.

Wards and units within the children’s service were secure and could not be accessed directly. Visitors were required to buzz the reception desk and provide their details. Any safeguarding instructions related to the child or young person were identified in their notes.

We saw reported information on the numbers of safeguarding matters raised via the services information sharing forms, since 1 April to 1 December 2025. There had been 3147 events raised by the Emergency Department where concerns had been identified and where information sharing with the community health teams and/or social care teams would be of benefit to the child or family. There was a triage process to identify red flag events, indicating a safeguarding concern, which either resulted in a safeguarding record being raised or the information being added to an existing safeguarding record.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff involved children, young people and their families or carers at each stage of their pathway. They made sure those individuals understood the treatment and care they were given, and any risks were identified and acted upon. The trust was involved in the pilot of ‘Martha’s Rule.’ This is a patient safety initiative to support the early detection of deterioration by ensuring the concerns of patients, families, carers and staff are listened to. Concerns could be escalated via a well-advertised route, which included seeking a second opinion. This was via the ‘Calls 4 Concern’ process. The Child Health group monitored how many children and young people were escalated, including whether this was because of deterioration, not related to deterioration or a complaint.

Staff had access to policies and procedures to support them with assessing risk of harm and deterioration of patient’s conditions. Where risks were identified during the patient assessment, these were managed safely. For example, the risk of a blood clot happening because of reduced mobility following surgery. For young people over the age of 16 years, the adult Venous thromboembolism (VTE) protocol was followed. All elective patients were pre-assessed by a nurse and then streamed to either an advanced clinical practitioner or anaesthetist. If they thought the patient was likely to trigger a risk, for example a long procedure or immobilised post-surgery, they would aim to reduce risks pre-operatively. This may include advising a young girl to come off contraception, being taken for menstrual cycle reasons.

Required surgical safety checks at each stage of the patient journey through anaesthetics and the operating room had been completed. This was in line with the 5-steps to safer surgery programme.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. The Situation, Background, Assessment, and Recommendation (SBAR) tool was used to provide a structured way of assessing and transferring important information, often for a patient handover or when a clinician needs to escalate a clinical problem. We reviewed 8 patient records, and all showed evidence of staff assessing the physical well-being of each child and young person. A national observation tool was used to record measures of for example, pulse rate, respirations, temperature and pain scores. Observation tools were age appropriate and were known as the National Early Warning Score 2 (NEWS2) and National Paediatric Early Warning Score (NPEWS). Our review of documents showed staff completed scores on these assessment tools correctly.

There was a clear escalation process, which staff understood and they could follow when patient measures indicated deterioration. The trust had a Critical Care Outreach Team (CCOT), who could be requested by ward staff. In addition, there was an emergency process for calling out the need for an urgent emergency response, such as in the event of a cardiac arrest. Staff told us the team were very helpful, and they felt able to call upon them when needed. Monitoring data on the use of the CCOT showed that most responses lasted between 30-60 minutes of the respondent’s time. Most requests were made by nurses, with more ‘general clinical concern’ calls at night. The High Dependency Unit requested the most activity from the CCOT.

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.

We visited Neonatal Intensive Care Unit, (NICU) Paediatric Intensive Care Unit, (PICU) and the following wards, G2, G3, G4, E1, Piam Brown and The John Atwell- children’s day ward. There were some notable matters related to the environment in a few areas. These were well known to the executive team and improvements were dependent on having enough funds, at a time when cost cutting measures were in place. This included lack of bed space on the day ward and Piam Brown. There were 2 cubicle spaces within Piam Brown which were specifically designed and appropriately arranged with input on infection control measures to accommodate 2 patients. Temperature control in NICU, a lack of natural light and crowding was said to be a concern by staff working there. However, we were advised by the trust that the lighting in the NICU reflected the importance of having a controlled environment, suitable for maintaining the safety of neonates. This included having controlled, moderate lighting levels during the day and reduced lighting at night to support appropriate circadian rhythm development.

In the PICU staff had experienced water leakage in the stock room and there had been a leak in the reception area, which was managed with a temporary tube drainage system, routine monitoring and measures to protect stock from damage. This leakage was an historical estates matter and was managed through established governance and escalation processes, including daily PICU huddles and monthly estates review meetings with senior leads, ensuring real-time oversight, monitoring, and mitigation of risks impacting safety and capacity. There was a lack of capacity to manage all patients needing dialysis, resulting in some having to go elsewhere. The latter was identified on the service risk register and there were arrangements in place with other providers to manage these patients, when required.

The service had active and progressing mitigation plans in place to improve capacity, patient flow, and service sustainability. There was a trust estates plan, which detailed work completed and work still to be done related to the environment. There were specific service development plans, with business cases in progress to support both workforce and estate expansion in line with increasing demand. We saw for example, insufficient paediatric day care facilities and paediatric critical care capacity was on the programme. The project brief and initial assessment had been completed and fees approved to appoint architects to work up the designs for these.

Ward G3 had been refurbished and had 6 en-suite bathrooms, larger patient bays and pull-down carer beds, allowing parents to have a comfortable overnight stay next to their child. Parents had access to a parent’s room, providing a space for them to relax, connect to other parents and rest. Each bay was fitted with medical hoists, allowing the clinical teams to move patients more independently and safely. The ward also had a purpose-built rehabilitation room, previously patients had to use a shared space.

Equipment items had service dates attached and all items we checked were in date, except for one portable suction machine. Safety checks on anaesthetic, airway management and theatre equipment had been completed routinely in the children’s theatres. Equipment checks had been carried out on items on both the Neonatal Intensive Care Unit, Paediatric Intensive Care Unit. We saw checks had been completed on specialist dialysis equipment. Electrical equipment had been safety checked, with most equipment having been given a sticker, which detailed when it was next due for servicing. Single use, disposable items of equipment were available in all areas and kept securely and safely.

Surgical instrumentation was available and was managed in accordance with required safety processes from pre-use, through preparation and removal via the clean to dirty route. Staff told us since the surgical equipment processing service had moved it took longer to get items they needed, which could cause delays. We were told equipment failure or non-availability accounted for 4 operations having to be cancelled in the period 1 April to 1 December 2025. However, the trust advised us that the performance around instrumentation turnover had improved, with minimal impact on paediatric surgery services.

Bed areas were supplied with oxygen and other essentials, such as suction, emergency call bells and patient call bells. Bathrooms and toilets had protective covering to cords, which were a potential ligature risk.

The trust had a specialist sleep service supporting both paediatric respiratory and neurological pathways, which introduced home-based sleep studies for selected conditions. There was recognition that the growth in this service meant more equipment was needed to meet demands. For example, we saw there was a lack of equipment needed to carry out the required number of home sleep studies, resulting in an 8-month wait. This had been placed on the risk register and it was recognised that this was a developing service, with active plans to expand provision.

There were several different waste management bins for staff and general use, ensuring waste was separated and disposed of safely.

The evidence showed some shortfalls. The service did not always make sure staff completed the required safety related training. Staffing gaps in some areas of the services led to delays for patients.

There was a trust-based induction, which had a completion rate of 95.2% for the Child Health Division. New staff also had a local induction to the children’s services, according to the area in which a new member of staff was to work. Induction included completing statutory and mandatory training. This included learning disability, health and safety, infection control and resuscitation training. We received information on the number of nursing and allied health professionals who had completed mandatory training in the past year. Subjects had to be completed once only, yearly, or every 2 or 3-years. For Neonatal staff non-completion rates were seen in 7 subjects. This included for example, information governance -not completed by 22.10%; Mental capacity and deprivation of liberty safeguards -32.4%; practical moving and handling at 36.5% and basic life support at 30.20%. The trust told us the lower rates in this department were because there had been 22 new staff join the team and they were going through a 9-month induction programme. These subjects were expected to be completed over this time.

Compliance rates with mandatory training in nursing ranged from recently introduced Oliver McGowan at 26.60%; level 3 safeguarding at 67.60%, up to Health and safety, which was at 99.80%. Non-medical staff training completion rates ranged from 12.50% for advanced radiation safety at 17% and for safeguarding adults (introduced in 2025) up to 99.70% for health and safety. Overall, there were 14 subjects not completed to the target level of 85%.

There were 16 subjects not completed to the target by medical consultants. This included basic life support with use of automated electrical device (50.80%), safeguarding children level 3 at 36.70% and mental capacity level 3, which was at 43.30%. We were told the strikes had impacted on available time for training, and if there was no improvement, study leave would be delayed.

Information provided to us indicated that statutory and mandatory training was reviewed as part of the appraisal process and included as a specific section for discussion.

The trust told us safe staffing was managed through management processes, which included having a matron of the day as a bleep holder. They had continuous oversight of staffing levels and skill mix across all areas. This meant they could make adjustments based on patient needs and activity levels. Any vacancy gaps were shared across areas, ensuring flexibility in workforce use and to maintain staff levels safely. Staffing and patient safety was reviewed formally at daily safety huddles, with escalation routes enabling rapid decision-making and actions being made.

Staffing numbers on wards was displayed, including when there were any reduced roles on the shift, compared to the expected numbers. Staffing levels could be adjusted to manage risks and the case mix of patients, including those who needed additional support. The member of staff with responsibility for each shift shared the workload out with the team and escalated where additional staff were required and had not been filled by regular staff. Whilst we found there were enough staff to keep people safe during the assessment period, we were told of the staffing vacancies. These included 24.49 whole time equivalent (WTE) Band 5 staff nurses; 3 WTE clinical nurse specialists and in children’s theatres and recovery, the vacancy rate for registered staff was 9.79% WTE and 4.58% for non-registered WTE staff.

We asked for information on the number of cardiac surgery cancellations from 1 April to 1 December 2025, as staff had told us about staff shortages. Data provided to us showed that of these, 20 related to staffing, including 9 due to not having expert perfusionist cover, 8 due to consultant unavailability and 3 due to lack of theatre staff. In the same period, 4 lists were lost due to the lack of skill mix required to operate.

There was a shortage of adequately trained and competent neonatal nurses within NICU, due to national shortages. This was on the risk register and was managed using overtime or agency staff, as per agreed staffing standards. However, several new staff had recently joined the team and were going through their induction. Other areas where staffing was not as expected had been identified and had separate risk register entries. There was a lack of funding for specialist dietitian for epilepsy related ‘Ketogenic Dietary Therapy.’ Staff told us staffing of this service had not increased for over 10 years, at 0.5 WTE, which did not consider annual leave or sickness and how that may impact on patients. Ketogenic Dietary Therapy (KDT) is a medically supervised, high-fat, low-carbohydrate, adequate-protein diet used to help control seizures. The trust advised that this staffing figure reflected the established service set up and the service was managed to ensure patient safety and prioritise.

The risk register identified the lack of Child and Adolescent Mental Health Service nurses, of which there were 2, but no ward based mental health nurses. The trust advised us children and young people with mental health needs were supported by registered children’s nurses, alongside agency Registered Mental Health Nurses (RMNs) where required, with additional oversight and support provided by the CAMHS Liaison Team. We found that complex patients had individualised care plans, supported through ward-based link nurses, multidisciplinary input, with matron oversight to ensure safe and appropriate care delivery. However, staff reported lack of consistency in same agency staff could impact on the level of engagement in therapeutic interventions as these staff changed.

Within cardiology and cardiac surgery there was a lack of advanced clinical practitioners, (ACP) with 1.8 WTE covering Monday to Friday on E1 Ward and the warfarin clinic. The workload of this person included for example, pre-assessment of children having surgery, cardiac catheters, medicines, and day case admissions. They also supported the medical team and the management of patient deterioration. They provided training, support and advice to patients both on E1 and at home across the network. In the absence of this person for annual leave or sickness presented a risk of delays to treatment, impacted flow leading to delayed admissions to the ward and delayed discharges. However, the trust advised us that whilst the level of resource presented operational challenges, it had been recognised within the trust’s risk register, and measures were in place to manage this. A formal business case was in progress to increase ACP provision, reflecting both service demand and the strategic aim to strengthen advanced practice within the division.

Staff were aware of cost cutting measures, including those related to staffing levels and not replacing some roles once vacated. Staff said there was, for example, a lack of weekday cover from doctors and nursing staff in Specialist Paediatric Palliative Care. In addition, we were told there was a lack of commissioned out of hours Specialist Paediatric Palliative Care support, when compared to adult services. However, the trust advised regarding this that at the time of inspection, there were no vacancies within the funded specialist paediatric palliative care team, and staffing levels were consistent with the commissioned service model. Previously vacated posts were being progressed through the recruitment processes in line with organisational procedures. They added that any limitations in service capacity reflected the commissioning and funding arrangements for specialist paediatric palliative care, alongside wider national challenges in workforce supply for highly specialised roles.

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.

There was access to infection prevention and control (IPC) team members and ward areas had link staff to ensure practices were to the required standard. The IPC team could be contacted for advice or support and a member of staff working in the NICU told us they sought advice on a case-by-case base.

All areas we visited appeared to be visibly clean. Domestic staff carried out their cleaning practices in accordance with cleaning schedules displayed and we observed such activity on wards. We saw the standards of cleaning were assessed and good scores had been met. Cleaning records were up to date and demonstrated the ward areas were cleaned regularly. Furnishings were visibly clean and suitable for use. Fabric curtains around beds were replaced during our visit, part of routine changes.

We saw that when shared bathrooms had been used by patients, used towels were left on the floor, as there was no place to put them. This point was also raised with us during conversation with a parent. They felt they could not be assured the room was suitably clean. This was fed back to the ward manager for action.

Staff were seen to wash their hands or use hand disinfectant in between contact with patients. There was a good supply of hand gels at ward entrances and throughout wards. The use of aprons and gloves to reduce cross contamination was seen as routine practice. Hand washing and drying facilities were readily available. We saw staff follow safe practices when preparing medicines for intravenous access and during the administration. Staff were seen following correct aseptic practice when attaching patients to dialysis.

Dialysis equipment in use on G4 was seen being cleaned and prepared for the next patient. Technical equipment used in Paediatric and Neonatal Intensive Care was checked and cleaned before and after use. In operating theatres staff used the facilities correctly an in line with expected standards. There were separate areas for storage of clean instruments and other required items, as well as setting up the required equipment for surgery. Hand cleaning and preparation was safely carried out. Dirty and used equipment was accounted for and removed to the dirty/contaminated area for processing. Clinical waste was handled in accordance with infection prevention standards. Soiled bed linen was handled safely and managed in line with best practice.

Isolation signage was displayed on the entrance doors to single bedrooms, when needed. Staff were seen following safe practices before entering and after leaving the room. We saw a deep clean had been carried out after a patient was discharged, which was in line with best practice.

Most equipment we checked was clean and ready for use. Some ward items, including monitoring devices did not have any label to suggest when they had been cleaned. One electronic device on top of a resuscitation trolley was dusty. A parent who spoke with us commented on the use of oxygen finger monitors and how these were not cleaned by staff after each use on patients. This was fed back to the ward manager.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

The trust told us the Child Health department had one of the highest rates of reported medicine errors across the hospital. The trust said this may have been because of the complexity of prescribing in children, where preparations and doses varied according to age and weight. Higher reporting reflects a culture where reporting of errors was encouraged and the process for reviewing such errors was managed in a blame free manner.

During our visit we saw staff mostly followed good practice in medicines management. Medicines were received by ward and department staff before storing safely. There were secure access storage facilities with temperature controls where required for some medicines. Controlled drug medicines were stored safely, and records were completed as to their use and disposal, when not fully used.

There were electronic medicine records, which enabled staff to have good oversight of each patient’s prescription, when medicines were required, the route to be given and for recording after administration. We saw staff follow correct procedures when preparing medicines, the safety checks before giving and the completion of the process. Staff had access to the right equipment to support the delivery of medicines in a safe manner. This included syringe minders for intravenous medicines, purple syringes, diabetic syringes and nebulisers.

There was a ward-based pharmacy service Monday to Friday, and the electronic system highlighted children newly admitted and high-risk medicines. Pharmacy staff aimed to speak to parents on the wards. They could also access Hampshire Isle of Wight and Dorset GP records to gain information. In addition, pharmacy staff could also contact GPs. Pharmacy staff looked at medicine reconciliation, to ensure they had an accurate and complete list of a person's current medicines and compared it against the medicines prescribed in the hospital. The checking of medicine charts and reviewing of medicines brought in with patients helped with this.

For patient discharges, pharmacy reviewed and screened discharge prescriptions. If a specific medication was prescribed, pharmacy discussed this with family so it could be supplied from hospital or home care. Electronic whiteboards were used to indicate when medicines were needed as part of patient discharge. This enabled the pharmacy team to have quick information and prepare items as soon as possible. Ward staff told us the turnaround for take home medicines was about 4-hours; however, they could request a rapid 1-hour supply for a simple item. Wards also had some prepared packs, which could be labelled and provided in accordance with the prescription.