Good Hope Hospital

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• 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 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.

The service made sure children's care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them. The service planned and delivered children's care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based practice and standards. The service worked well across teams and services to support children and young people. Staff made sure children only needed to tell their story once by sharing their assessment of needs when they moved between different services. The service monitored care and treatment to continuously improve it. Staff ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

This is the first assessment for this service since the trust was formed in 2018. Effective is rated as good. This meant children and young people's outcomes were consistently good, and people's feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service planned and delivered people's care and treatment with them, including what was important and mattered to them. Staff mostly did this in line with legislation and current evidence-based good practice and standards. However, data provided by the service following our assessment showed limited oversight of deteriorating children and young people.

There was evidence the service were not following best practice in relation to NICE guidance when delivering evidence-based care for deteriorating patients, this included the oversight, monitoring and learning from the services own internal audits.

There was evidence-based care and treatment including pain management and specialised feeding techniques. Children, young people and their families told us pain had been well managed and pain relief was given promptly when required. The staff provided nasogastric feeding training to parents. They supported them to ensure they felt confident using the nasogastric tube when the child or young person went home. The service also provided support for new mothers who were struggling to breastfeed their babies. This support could take place at home, so the mother and baby were able to be discharged. Food and fluid balance charts were regularly updated where required.

Trained nurses supported new mothers who had been with the neonatal service with psychological support in the community once they had been discharged. They arranged to visit them at home and helped them with adapting to becoming a new mother and feeling safe at home without the nurses there for support.

Staff had access to up-to-date policies and procedures which enabled them to follow national guidelines and evidence-based practice.

The service worked well across teams and services to support children and young people. There were excellent relationships between nursing staff and doctors, and all healthcare professionals working with them. Staff made sure children only needed to tell their story once by sharing their assessment of needs when they moved between different services.

Staff worked well together. There was good communication between doctors and the nursing team to meet the needs of the children and young people. Student nurses told us they felt supported by nursing and medical staff; they also told us they felt like they were learning and developing well. There was good mentoring observed for student nurses within the neonatal unit. Nurses took time to explain care and treatment. Senior nurses observed student nurses during procedures and provided encouragement and support. Staff sought support from managers who they said were supportive and approachable.

The play team were an integral part of the multidisciplinary team. All staff working with children recognised the anxiety for them of attending hospital and were practised in delivering distraction techniques for children for medical procedures such as cannulation and administration of medication.

Effective multiagency working was clearly documented in patient records. The service had a mixture of staff, which included doctors, nurses, healthcare assistants, but also a play therapist, staff leading on mental health and for children and young people with learning disabilities and autism.

The service worked well with outside agencies. This included the local authority, local safeguarding teams, social workers, and mental health teams who attended the service to support an individual child or young person if they required additional support.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service monitored people's care and treatment to continuously improve it. Staff worked to provide outcomes that were positive and consistent, and they met both clinical expectations and the expectations of children and young people themselves. The service completed audits to determine outcomes and improve practice where needed.

The service was providing good care for children and young people with diabetes. The service had approximately 170 children and young people attend to receive treatment for their diabetic check-ups. The service was recognised by the National Paediatric Diabetes Audit where they were in the top 5% in England and Wales for diabetic check-ups being delivered.

The service completed the perinatal care bundle to reduce injury in premature birth. This was designed to improve outcomes for preterm babies. There was a clear plan of the key performance indicators to be actioned. These were all scored amber using the red, amber and green risk tool, so in the middle. The document identified key risks, areas for escalation, the progress from the last report, and what the service were doing well. The service had a clear picture of what needed to be done to meet these outcomes and when they had been completed.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service knew when any 16- and 17-year-old young people were placed on adult wards, as legally they were still classed as children. The service monitored this daily to provide support if needed to the children and the ward staff. Staff were in contact with the adult ward staff to ensure consent had been sought from the young person, and they felt happy and safe to receive care and treatment on an adult ward.

Consent was obtained effectively. Staff spoke with the children and young people before any care and treatment was started. They obtained verbal or implied consent and checked children, young people and their families understood what was to happen next. We saw consent was clearly documented in records. They showed consent had been discussed and given where relevant.

Staff were obtaining consent in line with legislation and trust policy. Staff understood how some children were able to give their own valid consent, regardless of their age, should staff assess them as mature enough to fully understand what they were being asked. Staff understood `Gillick competencies' which covered the legislation relating to the consent for children.

Where consent could not be obtained, staff delivered care in the patient's best interests. The service would also ensure other professionals and family or carers were involved in the decisions of the child's or young person's care and treatment.