University Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The service planned and provided care in a way that met the needs of local people and the communities it served. However, the service did not always ensure care for children in crisis was delivered in a person-centred way. Children and young people were not always able to get care when it was needed in a timely way due to lengthy waiting lists after the pandemic.

We have not awarded this service a score for Responsive.

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

People’s experience

Children, young people, and their families gave mixed responses about whether they felt involved in their care and treatment or that of their child. Some feedback reflected families did not always understand the care or treatment being provided. However, some people told us they felt they were able to ask questions which staff answered in a way they could understand. Other families told us they had not been given details of their child’s care and treatment plan and had to seek information from staff.

Data submitted by the service showed families whose babies were supported by neonates felt they were involved in their babies care and treatment.

Feedback from staff and leaders

The service had systems and process to ensure most care plans were up to date and fully reflected children and young people’s needs. Compliance was regularly monitored, and audit data was shared directly with staff. Where shortfalls were identified they were addressed quickly.

However, during the inspection we identified one child who had far too much of the relevant documentation not fully completed. Staff did not have the detailed information on how best to care for this child and minimise the risks of providing inappropriate and inconsistent care and support during their hospital admission.

There was a range of documentation and protocols to support children and young people who had a learning disability or autism. These included paediatric hospital passports, learning disability hospital communication book, and a reasonable adjustments assessment. However, we found this documentation was not always completed.

Staff told us there was a multi-faith chaplaincy service available on site, which offered pastoral, spiritual, and religious care to patients, visitors, and staff and who were also able to provide specific bereavement support to families.

The service employed a bed manager, who had oversight of where the children and young people were placed in the department. The service monitored young people who were placed on adult wards and would visit them to ensure they were safe and ensured safeguarding processes and risk assessments were recorded for these young people.

There were operating procedures and policies to support staff with decision making which included the ward 14 adolescent admissions, bed management policy, paediatric critical care/HDU operating procedures, procedures for paediatric internal and external transfers.

The service held patient participation groups and used feedback in collaboration with colleagues to improve the service. As part of improvement efforts, the service involves one member of staff from the chaplaincy team with every unexpected child death. They provide bereavement support and pastoral care. They attend all joint agency response meetings and can act as a single point of contact for bereaved families guiding them through the child death review process.

The service worked within the local community to provide care and treatment to children/young people who did not need to stay in the hospital.

The service had a paediatric practice educator, which could offer additional and individual educational support to staff.

Observation

Most of the time, staff interacted with children, young people and their families in a way that was person centred and met their needs. They ensured there was sufficient time to ask questions and actively listened to parents’ concerns. Conversations and interactions were respectful, and their communication style adapted appropriately depending on who staff were interacting with.

Patient care plans were mostly contemporaneous and updated regularly to reflect changes in treatment plans or included preferences.

We reviewed 18 care records, and 16 records had been fully completed and were person-centred. However, on ward 14, we found for 2 young people with complex needs, records were incomplete. Missing or incomplete documentation included a psychosocial assessment, a care plan, behaviour support plan, and a communication plan. There were no plans for restrictive practices, including therapeutic interventions. There were no records made to reflect the multiple episodes of restrictive practice used by staff and security guards.

Records also lacked a schedule of the day to ensure structure for 1 young person. There was no process to help them understand what was happening each day. This had a significant impact for the young person as it led to increased anxiety which resulted in poor behaviours and the use of restraint at times. It also led to poor communication between staff and meant it was difficult for staff to provide consistent, safe, and effective care.

We identified another young person who presented with eating disorder. We found a lack of an eating disorder care plan, and the mandatory admission protocol was not completed. There was no person-centred information recorded in the care plan. There was no information about any known behaviours or concerns added to the care plan. Staff did not have access to the information they needed from the local eating disorder service provider to understand the young person’s individual care needs.

Feedback from staff and leaders

The service understood the diverse needs of the patients and the community, so care was joined up and flexible where possible. For example, staff told us they were able to book appointments directly for cancer services and for the fracture clinic.

The service monitored the most unwell children and identified when they needed to be transferred to specialist services for ongoing care. The service had a level 2 critical care unit in the paediatric department. This supported children who were on long term ventilation and non-invasive ventilation, liaising closely with 2 other local NHS trusts with level 3 units.

Processes

Processes were established to ensure care was as joined up as possible and included those who had protected characteristics and their families. However, the process for joined-up care for children in crisis was not working effectively with not all community partners being sufficiently involved.

The service operated a fast-track pathway for children and young people with complex health needs. This meant children were facilitated with immediate assessment bypassing the normal triage procedure in the emergency department.

People’s experience

We had a mixed response in relation to staff providing information to people in a way they understood. Some children, young people, and their families did not always receive the information in a format they could understand, although most found they did get answers when speaking more directly with staff.

Feedback from staff and leaders

Staff provided information to children and, young people and their families in a way they could understand. They adapted their approach to communication to ensure it was individualised and information was conveyed in a way that maximised understanding. The trust also provided access to a translation service to support individuals whose first language was not English.

The wards had information boards which helped children/young people and their families to make healthier choices, and they shared information which included, internet safety, smoking awareness, and obesity. These boards had a child friendly design and used bright colours, simple language, icons, and pictures.

Staff met daily in safety huddles to discuss patients’ care and treatment. Information related to the child/young person was handed over to the next team coming on duty.

The service had access to printed information leaflets designed for children, young people, and their families. These were also available for those whose first or chosen language was not English.

Processes

The trust had systems and process to ensure information was accessible and made readily available in verbal and written form in multiple languages. For example, the trust website was available in multiple languages and provided a large library of patient information and health promotion material.

Policies and procedures were written to ensure information collected about people met data protection legislation requirements. Staff showed an awareness of what information could be shared and with whom, such as other healthcare and social care professionals, and schools.

People’s experience

Parents told us they knew how to raise concerns and give feedback. They told us they were given information to support them make a formal complaint or give feedback on care.

Feedback from staff and leaders

Staff were aware of how to support people using the service to provide feedback or make a formal complaint. When a patient or family member raised a concern, staff made efforts to resolve the issue through informal conversations wherever possible, aiming to address concerns before they escalated to a formal complaint. Staff also received compliments, which were shared within the team to recognise positive practice.

Staff told us they saw complaints as an opportunity to improve practice and learn.

Processes

There were appropriate mechanisms to gather feedback and used it to improve the service. The service asked children, young people, and their families to share their thoughts about the care and treatment they received using the NHS Friends and Family Test.

The service had a complaints policy and procedure to support children and young people and their families to make a formal complaint or raise concerns. Between 1 July and 1 October 2024 there had been 7 formal complaints. These resulted in 1 being partially upheld, 3 not upheld, and 3 remained open and did not yet have an outcome.

People’s experience

Children and young people were able to access the service when they needed it. Care and treatment received was timely and made reasonable adjustments for people. However, the NHS Friends and Family Test data showed there was feedback to the service about appointment waiting times, as children and young people sometimes waited over their allocated time slot. Other feedback received was that out of hours contact numbers could be more available to support families when services were closed.

Feedback from staff and leaders

Staff told us children and young people were admitted to the service though a number of routes, which included the emergency department, pre-arranged appointments, and referrals from GPs.

The service had a bed manager who had oversight of where there were empty beds, and which wards accommodated any young people over the age of 16 years. The service gave older children the choice if they would like to stay on the children’s wards or be placed on an adult ward.

Senior staff had a daily meeting to discuss plans for patients who were going home. They spoke then with parents/carers to identify a suitable time for the child or young person to go home and how this would be arranged, if there were additional needs.

Processes

The service was taking longer than national and local averages to see children and young people. As with much of the NHS and all groups of patients, there were a growing number of children and young people waiting for appointments. The trust was worse than the local and national average for waiting times. In September 2024, the service had 153 paediatric patients who were waiting over 52 weeks for an appointment, but none waiting in the longer time-categories. This was the highest number since after the COVID-19 pandemic and higher than the England average. The 153 children and young people represented 9.7% of the total paediatric waiting list against the England average for paediatrics of 2.8%, and the local average of 5.8%. The NHS standard for waiting times was for 92% of children and young people to be seen within 18 weeks of referral to treatment. At this trust, 48.4% of children and young people had been seen within 18 weeks against the NHS average for September 2024 of 58.1% and 56.9% for the region.

The service had a paediatric did not attend/was not brought guideline, which had been agreed at the service quality improvement and patient safety meeting on 22 December 2022, with a review date of 22 December 2025. There was data for children who did not attend their appointments or were not brought. However, all data provided was from 1 May and 31 October 2023 and not current to this assessment. The recommendations from this audit included to inform paediatric teams highlighting positive improvements and to re-audit in 12 months, which was to be completed in 2024.

A significant number of children did not attend for their planned appointments. These were subject to review or safeguarding if needed. The trust provided data of a ‘paediatric did not attend/was not brought guideline’ safeguarding audit. This was undertaken to ensure there was follow-up around patients who did not attend for an outpatient appointment.

In a 6-month period, although not recent (May to October 2023) an average of 530 patients a month under the age of 18 were not brought or did not attend their appointments. Over the 6-month timeframe, this amounted to 12% of patients under the age of 18 (3,191 patients).

There were 1,729 missed follow up appointments and 1,462 missed new appointments. There were 43% of children who were not brought or did not attend were under 6 years of age. The largest cohort of children not being brought to their appointments were aged 0 to 2 years.

Most but not all children were followed up. In the event of a failure to attend, the staff had 2 standards to follow. Standard 1 being a letter sent to the GP for no attendance, for which this had been met for 84% of these events. For standard 2, if a child or young person were known to children’s social services or was a ‘looked after child’ or subject to a child protection plan, the staff would inform the social worker involved. This had been met for 67% of these failed attendances.

Feedback from staff and leaders

Senior staff told us they reviewed patients feedback relating to care and treatment to support the wider community and those with inequality in experience. Staff said they worked with patients and families to be able to improve experiences for those who were likely to experience health inequalities.

Processes

The service had policies and procedures to comply with equality and human rights legal requirements.

There were processes for staff to follow to meet the needs of children and young people if they needed reasonable adjustments. However, the rights of children in crisis to ensure their human rights were protected were not meeting trust’s values and objectives.

People’s experience

We did not obtain any evidence for this category.

Feedback from staff and leaders

Staff worked with other agencies to help get support for patients who needed to plan important life changes. This included other health and social care professionals such as GPs and social workers. Staff asked children and families what mattered to them about their independence and treatment to help them plan for the future.

When staff were breaking bad news or having end of life discussions, they did this in a professional, caring, and supportive way. They gave their full attention and displayed compassionate body language throughout.

Processes

The service had policies and procedures for staff to follow which guided them on how best to support end of life discussions.

Staff were provided with communication training which included breaking bad news. Bereavement training was also provided to ensure staff had the necessary skills to support bereaved families.