St James's University Hospital

On this page

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

Caring – this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At this inspection we rated caring as requires improvement. This meant babies and families were not always supported and treated with dignity and respect; or involved as partners in their care.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. Staff did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

We reviewed friends and family feedback and saw that families felt they had been treat with kindness, compassion and dignity throughout their involvement. People we spoke to during inspection told us that they had been listened to and staff had communicated in a way that they could understand. We heard that staff on the transitional care unit had been able to respond to needs efficiently and took the time to understand individual's personal preferences.

We saw that a monthly compassion audit was carried out for the neonatal unit and transitional care unit. This comprised of five questions including pain control, infant feeding choices, hygiene support, environmental suitability, worries and fears and timeliness of help when needed. Over a five-month period reviewed there was only one area that scored less than 100%. However, it was not clear from the questions reported on how parents were supported to answer the questions on behalf of their babies, for example, ‘have staff done everything they can to control your pain?’ This audit did not appear to be specifically adapted to the needs of babies and parents on the neonatal unit. It was understood to be a generic trust wide audit.

Staff did not always take everybody's needs into account, for example, we saw individual care being given to neonates without privacy from curtains being pulled around. This meant that there was limited privacy at cot spaces where care was given and visitors to other cot spaces were not protected from observing care provision that could impact on their own wellbeing. We reviewed the most recent parent and staff feedback survey that identified space could be made more private and there was limited space for visitors around the cot area due to necessary equipment.

There was no designated private space for mothers to express breast milk.

There was no designated space for private consultations. Staff told us that one of the bedroom areas or playroom could be used.

The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. Staff took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Families and staff told us that individual needs were taken into account when care planning. This included being aware of cultural backgrounds and protected characteristics.

Staff had access to an interpreting tool which was available in many differing languages. Staff could also access face to face interpreters if and when required.

There were educational materials and posters available to meet a range of individual support needs, for example, including dad's mental wellbeing.

The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

There was a family integrated care team dedicated to supporting families accessing the neonatal service. This team worked across St James Hospital and Leeds General Infirmary site. This team told us about a clear vision aimed at ‘supporting families to become partners in care and not just visitors to the service’. The team offered educational sessions for families to learn about areas of interest to them. We saw a weekly timetable of educational sessions that parents and carers could sign up to. However, we also saw a family care monthly update notice board that shared details of sessions dated for November 2024. We weren’t assured the families always had enough information to be as fully involved as possible.

We spoke to allied health professionals (AHP’s) who aspired to support babies and families to have independence, choice and control over their treatment. Family integrated care and AHP staff recognised a short fall in staffing of AHP’s and therefore an impact on ability to provide consistent daily support for babies and families. The shortfall also meant there was limited MDT support and sharing of good practice to consistently ensure that families and babies had support to build independence with a range of choices available to them.

The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

We did not see effective systems and processes in place to consistently support babies voices being heard in a timely way, for example, we heard about a baby who had become more unsettled when there was a change from oral to nasogastric feeding. There was no clear plan identified for emotional support during the MDT discussion. We heard from allied health professionals and observed conversations that evidenced their focus was on trying to give families and babies a voice. For example, by trying to focus on positioning to support self-soothing and advice on positive touch for parents. We understood that this was difficult to provide in a timely way because of shortages within the AHP staff team and high turnover of nursing staff. Therefore, it was difficult to support nursing staff to maintain positive practices and there was a lack of a consistent clinical lead AHP on the unit to influence change.

There was limited breast pump availability for parents and staff did not always have the training on use of breast pumps to support mothers. The parent and staff feedback survey identified that there could be a delay of up to 24 hours before mothers received support with expressing breast milk. Some mothers and staff felt that this was too long to wait.

Access to the unit was via a buzzer entry to the ward, followed by a walk down a lengthy corridor. During inspection we encountered numerous lengthy waits to access the unit following pressing the buzzer. We saw from family feedback that this lengthy wait had been experienced by families and caused additional stress and worry when families were anxious to get in to see their babies. Some families received swipe card access following risk assessments that lessened this anxiety provoking time.

The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Staff sickness rates were just above 9% for the six months prior to inspection. The rates had fallen slightly from the previous six months. The leadership team recognised the pressures and emotional demands of working within the neonatal environment. We saw that the staff survey results for wellbeing had been used to further develop appropriate support options for staff. For example, informal safe space sessions had been created which allowed staff to connect with others and easily access other support services within the organisation such as chaplaincy services.

There was an established psychological support service for staff with dedicated psychology time. There was a clear understanding around the kind of support that might be required by neonatal staff in supporting their wellbeing at work.

There were processes in place to ensure support for staff was available from the beginning of their journey within the service. For example, a preceptor and buddy system.