University 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

The service monitored children and young people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent. People had enough to eat and drink to stay healthy.

However, people were not always involved in assessments of their needs. Staff did not always review assessments taking account of people’s communication, personal and health needs. Staff did not always work with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services.

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.

People’s experience

Feedback from patients and families was generally positive. People told us staff assessed the needs of their child well and included those of the family in planning care.

Feedback from staff and leaders

Staff told us there was a lack of mental health trained staff to provide support for children in crisis on ward 14 where all children and young people stay if they require mental health support. The ward manager told us they were picking up clinical hours to support the staff during challenging times on the ward.

Staff shared examples where they had supported patients with psychological and emotional needs. For example, the service had made a social services referral due to a child needing additional social care support. The staff supported both the child and the parent, despite this being a challenging situation. However, staff on ward 14 told us they had struggled to support children in crisis, and this had been ongoing for a long period of time.

The service had urgent/next day clinics, including a rapid access slot at the beginning of every general paediatric clinic. This was implemented in 2021 due to the requirement of some children needing to be seen in clinic following an emergency attendance with a paediatrician.

Observation

We reviewed 18 care records and found 16 of them reflected the physical, health and wellbeing and communication needs were assessed and documented. The new electronic patient record (EPR) system being implemented at the time of the inspection and a built-in auditing system produced real time data and highlight to staff when care plans needed to be reviewed and updated. However, 2 care records we reviewed were not completed or reviewed in full on ward 14.

Records showed children and young people had regular reviews by their multidisciplinary teams.

We observed ward rounds where doctors were speaking with patients, discussing their care and treatment and the future plans.

Processes

Patients and their families told us their individual needs had been appropriately assessed and were fully understood. However, we observed a child in crisis had not had their needs assessed effectively and there were significant gaps in their care plans and risk assessments.

People’s experience

Children and their families told us they received information and advice about their health, care, and treatment. They were given the most up to date information about current best practice and had their individual needs assessed before deciding on their care plan options.

Feedback from staff and leaders

Staff told us they had access to up-to-date policies, procedures and tools which enabled them to follow national guidelines.

Staff told us they were actively involved in audits monitored the quality and standards of the care provided to children and young people. This included but was not restricted to national data collection programme for epilepsy, asthma, COPD, and diabetes. The service also conducted internal audits including paediatric early warning scores (PEWS), consent, documentation, and medicines management to ensure children and young people were receiving a good standard of care.

Staff were confident in using risk assessment tools helped them identify risks and prevented deterioration. For example, all staff we talked with were competent in the use of PEWS and pain score monitoring. The service continuously audited PEWS scores and ensured all episodes of clinical deterioration was responded to quickly.

Processes

We reviewed a total of 18 care plans during our inspection. We found evidence in 16 records care was being delivered effectively. We also saw written evidence multidisciplinary care was being provided. This meant the care delivered was holistic, person centred and had the expertise of different disciplines and professionals promoting better clinical outcomes.

However, we did find 2 care plans on the ward which were incomplete and did not evidence the same standard in approach seen elsewhere in the service.

The service used nationally recognised tools to monitor the care provided to children and young people. Care was provided in line with national clinical guidelines and quality standards set by Royal Colleges and the National Institute for Health and Care Excellence.

The trust’s systems ensured staff were kept up to date with national legislation, evidence-based good practice and required standards. Staff could easily access these on the staff intranet.

We saw a number of new and improved clinical pathways and care bundles to improve clinical outcomes. Examples of these included the implementation of a preterm respiratory care bundle in the neonatal unit, a perinatal optimisation pathway, and ‘midline matters’: a project to improve positioning for preterm babies.

Real time clinical dashboards were also used to monitor the quality of care delivered. Staff could easily identify shortfalls and address them quickly.

The service promoted the use of specialist area leads. These included but were not restricted to diabetes, sepsis, learning disabilities, and play specialists. Staff with this specialist knowledge could offer additional up to date advice or support to other staff working with a patient with additional or complex needs.

Children’s nutrition and hydration needs were assessed using a screening tool. When a risk was identified appropriate action was taken by staff. Staff and leaders were encouraged to learn about new and innovative approaches where evidence showed they could improve the way their service delivered care.

The service completed children and young people’s asthma audits for 2023. There were 5 audit indicators checked, and records showed the trust were above the national target for 3 out of the 5 checks.

The National Neonatal Audit Programme (NNAP) reports on aspects of care given to babies on neonatal units. Between January and December 2022, the service compared well with the overall (England, Scotland, and Wales) performance. Six out of 12 scores were above the overall target.

The service received a letter of recognition on 8 July 2024 in relation to their audit of measuring normal temperature on admission for NNAP. The service performance was 89.3%, higher than the national average of 80.4%.

People’s experience

Children, young people, and their families told us they were supported by a range of staff from different disciplines acting as a multidisciplinary team. This included nurses, doctors, and allied health professionals.

Feedback from staff and leaders

Staff told us they worked well as a multidisciplinary team. They ensured they followed guidance and maintained good record-keeping of the multidisciplinary care provided. Records we viewed and the feedback from families also support this.

Staff said there was good communication and teamwork both inside the service and with outside partners. They gave examples of working well with social workers, and other hospital teams to plan care for children and young people. Staff explained when tasks were shared, clear instructions were always given and written down in the medical records.

Leaders helped make sure new staff or those coming back from leave were updated through handovers, team briefings and meetings, and shared care plans.

Some staff said there were times when information was missed, but the team worked together to improve this by using better handover notes and checking in with each other more often.

Processes

There were processes to support multidisciplinary team working.

The trust had operational procedures to support staff working together. For example, there was an operational policy for the paediatric oncology services which clearly defined the leadership arrangements, responsibilities of core members and the referral pathways.

Examples of multidisciplinary teams included paediatric orthopaedics, paediatric oncology, paediatric allergy service, paediatric cystic fibrosis service, paediatric rheumatology, paediatric diabetes, neonatal teams and mental health team specialist clinical input.

There was a number of well-established multidisciplinary care pathways for example, the Cerebral Palsy Integrated Pathway (CPIP), gait analysis laboratory multidisciplinary meetings, allergy service, cystic fibrosis, rheumatology outreach and diabetes.

People’s experience

Children, young people, and their families told us staff supported them to lead healthier lives by providing them with a wide range of health promotion materials, as well as signposting to various services and community support groups.

Feedback from staff and leaders

Staff told us we mostly have the time and tools to support to help young people be as independent as possible. Where appropriate staff encouraged them to manage parts of their own care and make healthy choices. Staff involved children and young people in talks about their health and helped them learn how to stay well, like choosing better foods or getting more exercise. Staff generally understood the health needs of the children and young people they cared for and knew how to prevent problems or respond quickly if someone became unwell.

Leaders made sure health and wellbeing were closely watched by checking care plans, holding regular team meetings, and reviewing any changes in condition.

The service shared their paediatric monthly campaign diary for 2024. This was a yearly planner listing events took place to encourage and support children and young people and their families to live healthier lives. For example, around skin care, breast feeding, epilepsy awareness, eating disorders and sexual health.

Staff told us children and young people, and parents of babies were asked about healthy lifestyle behaviours as part of routine history taking. Issues such as smoking, vaping, alcohol, and drug misuse were identified and raised with families. Parents were offered referrals to smoking cessation services. Young people could also be referred to a service for support regarding drugs and alcohol.

Obesity, health, and exercise was discussed with families in clinics and on the wards. Families could be referred or directed to the local “One Body One Life” service. This service addressed exercise, diet, lifestyle issues with families as a group rather than as individuals.

There were posters located within the wards which helped promote healthy lifestyles to children, young people, and their families. These included internet safety, smoking cessation, eating healthily and vaccinations.

Processes

Staff mostly used clear care plans to help them understand each person’s healthcare needs, including how much support they wanted and how independent they could be. These plans included advice from health professionals and supported people to make healthy choices. Care records were kept up to date and showed staff followed health guidance. Teams used the records to spot early signs when someone’s health might be changing. Staff contacted doctors, dentists, and other services quickly when there were any concerns.

Children and young people were supported to live healthier lives. There were also programmes within the local community children and young people could be referred to for support.

Feedback from staff and leaders

Staff were aware of the audit activity in their clinical areas and knew what the audit outcomes were. This information was shared with them on their communication boards, in emails, at staff meetings and safety huddles and at governance meetings.

Processes

There were systems and process to ensure the care delivered was safe, delivered in line with national guidance and delivered good outcomes for children and young people.

The department participated in a wide range of national and local audits for the period 2023 to 2024. We saw summaries of how findings had been appropriately responded to. Audit outcomes and associated learning was shared from this through the mortality and morbidity meetings and governance meetings.

The service was compliant with data submission reporting to the MBRRACE-UK perinatal mortality surveillance. MBRRACE-UK stands for Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK and it is a national programme set to collect and analyse data on maternal and perinatal deaths.

The Avoiding Term Admissions to the Neonatal Unit (ATAIN) audit, is for all babies over 37 weeks' gestation who were admitted to the neonatal unit and remained on the unit for 4 hours or more.

There were 19 term admissions during May 2024, 4 of which were not suitable for ATAIN. Following the ATAIN reviews, the panel agreed of the remaining 15 admissions, 14 were unavoidable and 1 was avoidable. For the avoidable harm, the service identified what action was taken and what learning came from this and shared it with the staff team. The service monitored the type of delivery, reason for admission, ethnicity, if the mother smoked or if they had diabetes.

The service completed children and young people’s asthma audits for 2023. There were 5 audit indicators checked, and records showed the trust were above the national target for 3 out of the 5 checks.

Monitoring the sepsis standards showed the service were consistently delivering antibiotics within 60 minutes from the decision to treat.

Data was also routinely shared with national surveillance programmes, this included but was not restricted to, cancer registration and analysis service, peer review/quality surveillance program, diabetes, epilepsy, and asthma audits.

People’s experience

We observed staff speaking with children and young people and seeking consent before delivering care and treatment.

Patients told us staff asked for their consent before any intervention. Care and treatment options were clearly explained, ensuring children, young people, and their families had the information they needed to give informed consent.

Feedback from staff and leaders

The service were able to tell us where all 16 and 17 years old were placed on adult wards. We confirmed during the assessment that there were no young people placed on adult wards. However, during discussions with the bed manager, it was identified where this had happened previously each child consented to being placed on an adult ward, and documentation was completed to keep the young person safe.

Children and young people’s records clearly documented consent had been discussed, and consent had been given, where relevant.

The service told us Mental Capacity Act training formed part of the mandatory training requirement. The Mental Capacity Act related to only children aged over 16 years of age. Otherwise, staff followed trust policy around consent for children under 16.

Processes

There were policies and procedures to ensure staff could support children and young people to make informed decisions about their care and treatment, with the support of their parents if needed. These policies reflected Royal College guidance, Gillick competencies and Fraser guidelines.

Fraser guidelines can be defined as the legal guidance in the UK helps determine whether a child under 16 can consent to medical treatment without parental permission, especially in relation to contraceptive advice and treatment.

A child is considered Gillick competent if they have enough maturity, understanding, and intelligence to fully understand the medical treatment being offered, can weigh up the risks and benefits and make an informed decision about their own care.