Good Hope 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 people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people's liberty was protected where this was in their best interests and in line with legislation.

There was a good culture around learning and safety was a priority. There were safe systems, pathways and transitions. Children and young people were safeguarded and their rights protected. Staff managed risk safely and the environment, although ageing, was safe and met the needs of the children and families.

Some risks to children and young people were not being managed well enough. There were not always safe levels of staffing, and this was the highest worry for staff, although they were at times supplemented by bank staff. Some medicines management needed to be improved. Some annual reviews for staff needed to be completed. Sepsis audits were not completed and managers lacked oversight of how sepsis risk was being managed. Paediatric Early Warning Score (PEWS) audits scores for observation lowered showing these targets had not been met. However, the trust had established a working group to review all elements of sepsis management with oversight from one of the senior consultants and experienced staff team.

This is the first assessment for this service since the trust was formed in 2018. Safe is rated as requires improvement. This meant children and young people were mostly safe and protected from avoidable harm but some improvements were required.

This service scored 66 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff had a good understanding of how to report incidents. They stated they received feedback from managers of any outcomes or learning identified.

Incidents were reviewed for seriousness and themes in order to make improvements if needed or learn when things went wrong. Incidents reported were mostly for no harm or low harm events and predominantly for staffing issues. Between September and December 2024 neonates had 21 incidents and children's ward had 50 incidents. These had been identified into levels of harm to babies and were categorised as either no harm or low harm. The service identified themes for which the highest number of incidents for both neonates and children's ward had been due to staffing issues.

Staff understood their responsibilities to explain and apologise if something was to go wrong. All staff were able to explain and give examples of the duty of candour, which showed they had a good understanding of when this duty needed to be applied. They knew this involved an apology to those affected as well as an investigation into certain adverse events.

There was sharing of learning. The service held perinatal mortality review group and child death review panels to identify and share learning associated with neonates, children, and young people. The service completed a child death review analysis form for every child death. Reviews identified which professionals attended the meeting, the personal information relating to the child, and any learning or outcomes which had been identified. We saw evidence of meeting minutes and actions. These also identified any learning or improvement the service needed to address.

The service held daily safety huddles and handovers where incidents were discussed. During our assessment we attended the daily meetings, and they were well attended by staff.

The service worked with children and young people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when children moved between different services.

There were good systems to support patient pathways. The service had good links with external agencies and teams. Staff would visit the ward to see the child or young person and complete, for example, a mental health needs assessment, which also identified future care and support. The service was working on a new care bundle to support young people with mental health needs, and this document was in the review process at the time of our assessment. The service held meetings between the different children's services at the hospital including the emergency department and the children's wards to ensure the child's pathway through the hospital was safe and worked effectively.

There was joint working to support joined-up care. The service was working well with other departments in the hospital and with other trusts, with children, young people and their families. This was to ensure plans and support were ready for them attending the ward or being transitioned over to another NHS trust.

The service worked with children and young people to understand what being safe meant to them and the best way to achieve this. Staff concentrated on improving children'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.

Staff we spoke with demonstrated a good understanding of safeguarding and different forms of abuse. They knew who the safeguarding lead was and how to report and get support for making a safeguarding referral. We saw nursing and medical staff dealing with a safeguarding concern for a child. The needs of the child were kept at the centre of these discussions, and there was evidence of actions in the meeting minutes. Actions were taken around safety of the child while the investigations took place. Parents were kept informed, and staff explained the process and next actions clearly. Staff spoke to parents in a supportive and non-judgemental manner.

There were alert flags for staff. The patient record system clearly identified and flagged any safeguarding involvement within the records. These were easily identifiable to staff so they would not be missed. The service monitored all safeguarding referrals and supported the staff when they had any questions or queries, or if they were not sure about the next steps. There was evidence in records of multiagency meetings taking place, bringing the correct professionals together agreeing the concerns, actions and outcome.

The service recorded any missed safeguarding opportunities through screening of records and incidents. These were discussed at the hospital board meetings every month and the team would take any learning from this to support the staff to help minimise missed safeguarding, although these were infrequent.

Staff were kept up to date with the latest guidance and information. Each week the service held `hot topics' meetings. These were 7-minute briefings which had recently covered, domestic violence, vulnerabilities and working within the community. The service also had the support from the hospital's experienced vulnerabilities and safeguarding teams to give staff support or advice. Staff were accessing this help and support when needed.

Most staff, depending on their role, had the level of safeguarding training required. This included safeguarding adults and children, PREVENT (in relation to recognising the threat of terrorism and extremism), and safeguarding adults and children enhanced training. Each had met the trust's compliance level of 90%. Mental Capacity Act and deprivation of liberty safeguards training was included with the safeguarding training. However, safeguarding adults and children level for specialty resident doctors was not meeting compliance at 66.6% against the 90% trust target and needed to be improved.

The service did not always work well in some difficult cases with children and young people to understand and manage risks. There were occasions when staff did not always provide care to meet children’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

There was a notable issue with the evidence of risks from the use of rapid tranquilisation not being recorded, so action taken around critical safety factors was not known. We reviewed the records of a young person on the children’s ward. There had been good mental health support, safeguarding records were completed, and there was evidence of psychiatric support (which staff and patients spoke highly of) and good multidisciplinary team working. However, during our onsite assessment we shared with senior managers how we found a young person had been prescribed controlled drugs to be administered as required, with concerns over how this was managed. The medicine was intended to be used for rapid tranquilisation in specific circumstances. The records were unclear as to whether the 15-minutes observations post rapid tranquilisation had been followed. There was no clear explanation for the regular use of this controlled drug. The Children’s, Young People and Adult Chemical Restraint Clinical guidelines were up to date and appropriate. It detailed and included the use of chemical restraint which would only be used when all attempts to defuse a situation had failed. This policy was not being followed in the documentation of how the medicine was used. Following the assessment the service re-shared the policy to ensure all staff were aware and knew to complete records.

The ward was free from ligature risks. Although the ligature risk assessment was coming up for a 3-yearly review having last been updated in May 2022. Following our assessment, the trust arranged for the health and safety team to review the ward with the senior nurse to ensure all ligature risk assessments had been reviewed in accordance with trust policy.

Sepsis audits were not completed and managers lacked oversight of how sepsis risk was being managed. We found data for sepsis indicators for children and young people had not been developed and were in the discussion phase. The hospital trust had recently introduced mandatory training around sepsis care and treatment. Staff were making progress on undertaking this new training. Medical staff were so far 68% compliant and nursing staff 75% compliant. However, the trust had established a working group to review all elements of sepsis management with oversight from one of the senior consultants and experienced staff team.

Records showed observations for monitoring patients’ vital signs and assessing the risk of deteriorating patients were safely undertaken in a timely way. However, the data for Paediatric Early Warning Score (PEWS) records from September 2024 to February 2025, showed that in November 2024, the category of ‘15 minutes observations until review’ had dropped to 67%, and for February 2025, ‘15 minutes observations until review’ had dropped to 33%. ‘General observations’ had dropped to 67%. All other scores were 100% for the remaining months, so this needed to be more consistent.

In children’s clinical records we reviewed, falls risks were not assessed on paperwork designed in a specific way for children and young people. Paperwork for assessing falls risks in children covered adult parameters and it was a challenge to use this for assessing fall risks for young children. However, we reviewed 10 patient records and falls risk assessments were all complete. The trust reported to us after the inspection how the falls team had worked with the senior paediatric nursing team to develop a specific children’s falls assessment which was being brought into use.

Children, young people, and their families told us they were given information to help them make decisions about the care and treatment and what risks needed to be understood.

Staff had a good understanding of Martha’s Rule which was being piloted at the trust. Martha's Rule is a patient safety initiative to enable patients, families, carers, and staff to request a rapid review from a critical care outreach team when they have concerns about a patient's deteriorating condition.

The service had suitable facilities to meet the needs of children and young people. The windows on both wards were safely secured to prevent the risk of falls. All electrical equipment had been tested and labelled to show it was safe to use. Both wards had weighing scales, baby baths and baby changing units. These were in good condition, had been serviced, and the servicing date was visible on the equipment. Both wards used cots, which were in good condition. The ward had access to sensory toys, ear defenders and a weighted blanket to support any children and young people who had additional sensory or other needs. There was a hoist to help move children and young people safely who were not able to weight bear.

Resuscitation trolleys were in good condition and in date and daily checks had taken place on both wards. Sharp boxes were stored correctly and were not over full. Oxygen tanks were stored securely, clearly labelled with an expiry date, and were in date. Spill kits were located on the ward and neonatal unit within the sluice room.

The service monitored equipment safety alerts. When there were concerns about equipment this information would be shared with staff by email, and within safety huddles.

Entrances were secure and children kept safe. Both ward/unit entrances were locked, and visitors needed to use the intercom to enter after they verified who they were and who they were visiting. There was a security camera at the staff workstations, so staff could check who was at the door. There was additional security for babies in line with required guidance. In the neonatal unit, all babies were tagged in line with the service abduction policy and protocol.

However, milk storage facilities had not been checked for safe temperatures. The staff documented and monitored the medications fridge temperatures, but the milk fridge on the children's ward had no documentation or evidence this had been monitored. We raised this with the ward manager at the time, and it was confirmed it had been missed, and the matter was resolved while we were on site.

The service did not always have enough qualified, skilled, and experienced staff to safely care for patients. Sickness levels were above the trust target. Managers did not always make sure staff received effective support, supervision, and development. However, staff worked together well to provide safe care which met people's individual needs. We saw good working relationships between nursing and medical staff and staff felt supported by managers.

There were staffing shortfalls and rota evidence showed the actual numbers did not always meet the planned numbers of nurses, although bank staff supplemented vacant shifts. Staff told us there were often times when they were short of nursing or healthcare assistant colleagues and the service had sometimes included student nurses into the staff numbers. The service used bank staff to cover nursing and healthcare assistants' shortfalls on the children's ward. Between August 2024 and January 2025 bank usage had increased. The service did not use any agency staff in this time period.

However, the children's ward at Good Hope Hospital was run as a student-led learner-ward initiative which the trust told us was the first of its kind in services for children and young people. The trust also told us its evaluation of the initiative through the student form had shown it to be a success.

The staff we spoke with said nursing staffing levels were not always increased when patient acuity increased on the ward. However, action was taken to keep the ward safe when there were gaps in the numbers. This included daily monitoring; redirection of patients to other local services; redeployment of staff from other areas when this was possible; study leave being postponed; and bank staff offered shifts. The trust advised that since our inspection, all staff vacancies had been recruited.

There was 1 high dependency bed on the children's ward used to stabilise an unwell child or young person before them being transferred to another hospital such as Birmingham Heartlands Hospital for more specialised care. Staff told us they were not always allocated to these beds and if a child or young person was admitted, staffing levels did not always increase to cover staff moved to the high dependency beds. However, the trust advised that its staffing model included one of the nursing team being trained for high dependency patients on each shift. If the number of staff on shift did not meet the required numbers, the number of patients was reduced to ensure the service was safe. This was continually reassessed. There were arrangements to bring nurses from other areas or from the other hospital with the right skills or to divert new patients to other agreed hospitals such as the trust's Birmingham Heartlands Hospital.

There were not always safe levels of medical staff available, particularly overnight. There was 1 doctor who covered 4 children's services overnight and often had multiple pressures to prioritise with limited alternative options. There was a consultant on call when not on site who would be asked to attend the hospital when medical support was needed. Since our inspection, the medical workforce cover had been increased. The service was adequately staffed for medical cover in the day. Locum doctors were used to fill staffing gaps for paediatric consultants and resident doctors. Between August 2024 and January 2025, 10.7% of shifts were covered by locum doctors which was relatively similar to typical levels in NHS trusts. The neonatal unit also used bank nursing staff, but this was usually at lower levels than the children's ward. We discussed the staff's concerns about safe staffing levels with the trust and managers told us they were undertaking a capacity and demand review which included a staffing review.

Some staff were not up to date with their annual performance review. Staff received appraisals and the service compliance rate overall was 90%, which met the trust target, but there were individual areas not meeting the target. The appraisal rate for clerical staff, medical secretaries and officers was 100%. However, the consultants were at 70.6%, neonatal and staff nurses at 87.5%, and sister or nurse in charge at 50%.

Staff sickness was rising and above trust target levels of 4%. Staff sickness had increased from 4.9% in August 2024 to 7.8% in January 2025. The data identified the staff taking sick leave absence was on the children's ward. The neonate's ward reported no sickness absence during this time.

However, when there were high levels of sickness, the ward managers (trained nursing staff) often worked clinically to increase levels of staffing. Education and training were monitored at the monthly workforce meetings alongside staff turnover and recruitment.

At times of staff shortage, the wellbeing team also came to the department to offer support. Also, the children's practice education team offered support and supervision development for nursing staff.

The service had mandatory training to be updated at different intervals. It was suitable to meet the needs of the children and young people using the service and was mostly compliant with the trust target of 90%. However, a small number of staff on the neonatal nursing team had yet to update their training on learning disability and autism (compliance 86%) but compliance for the children's nurses overall was 96%. Staff were given time to update their mandatory training. The service gave staff 7.5 hours of study leave each year to support them to complete training. Staff received an email from the service education team 3 months before any training was due to expire, with the expectation of staff to book onto training. If training had not been completed a reminder email would be sent to staff requesting completion within 3 weeks. Managers monitored completion rates for training.

Security staff were trained in order to use physical restraint and were able to support a child or young person who may be displaying verbal and physical aggressive behaviours.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of spreading infections and shared concerns with appropriate agencies promptly.

There was a good standard of cleaning. All areas and equipment were visibly clean, and equipment was clearly labelled with an `I am clean' sticker, with a date to show when it had last been cleaned. Cleaning schedules clearly identified when rooms and equipment were due to be cleaned and were up to date. However, there were no domestic staff to clean the neonatal ward at the weekends. The service completed environmental infection prevention audits for both children's wards and the neonatal unit. Between September 2024 and January 2025 compliance ranged from 90% to 100%.

There was good identification of possible risks from infection and staff took safety precautions. The ward clearly identified rooms where children or young people were isolating if, for example, if they had been diagnosed with influenza. Staff washed their hands before contact with a child or young person, and also once the treatment had finished. The service completed hand hygiene audits for both the children's ward and the neonatal unit. Between August 2024 and January 2025, the service was 100% compliant every month.

Staff used personal protective equipment and stored waste safely. This included wearing aprons, gloves, and masks and using these when appropriate. There was antibacterial hand gel for visitors and staff to use. Visitors and people using the service also had access to handwashing facilities. The wards had an appropriate storage space for clinical waste, which had a locked door, and containers were emptied on a regular basis.

Some medicines were not always stored and managed safely. Ward staff did not know who their ward pharmacist was and felt processes to order and supply medicines did not always work. However, the service made sure medicines and treatments were safe and met children's needs, capacities, and preferences. They involved parents in discussions and decisions about medicines, including when changes happened.

Medicines were not always stored safely. For example, in the medicine trolley on the children's ward we found loose strips of medicines. These were not stored within their original container despite a notice on the medicine trolley stating, "Please do not store loose strips of medicines." In a medicines cupboard were loose ampoules and patient packs of medicines had been opened and part used. This increased the risk of a potential medicine error. However, medicines were locked away and secure with access only to authorised staff.

There were some issues with effective working with pharmacists. Staff said they did not know who the ward pharmacist was and processes to order and supply medicines did not always work effectively. However, staff told us they knew how to contact pharmacy for advice. Staff on the neonatal unit and the children's ward told us although a pharmacist did visit most days there was no dedicated named pharmacist to contact. Staff felt this made it more difficult to obtain pharmacy support to manage medicine processes and ensure availability of medicines.

Children and young people were supported to receive their prescribed medicines in a way which met their individual needs. Parents, carers, and patients told us they were included in discussions about medicines, and they felt informed about what they were taking. One parent told us, "They have been awesome and really supportive. Their depth and empathy and explaining everything is great."

Medicines requiring more scrutiny or oversight were well managed. Controlled drugs were stored safely and securely with access restricted to authorised staff. Checks were undertaken and recorded by 2 staff twice a day which showed they were within date and stock balances were accurate. Resuscitation medicines required in an emergency followed Resuscitation Council (UK) guidance. Staff recorded safety checks daily on emergency medicines and equipment to ensure they were safe to use.

Medicine room storage and refrigerator temperatures were monitored to ensure the medicines were stored safely. Staff were informed by pharmacy if there were any issues needing action. Pharmacists conducted medicines management and medicines optimisation audits. These included controlled drugs and safe and secure handling of medicines. Any issues were dealt with by the ward team and discussed at ward safety huddles.

Staff followed systems and processes to prescribe and administer medicines safely. We reviewed 5 medicine administration records, and they were all complete. Patients' weight and allergy status were recorded on all these records. Records contained the route and time of administration, including recording a reason if a medicine was not given. It was easy to track a patient's medicine administration timeline which helped to ensure medicines were being given as prescribed. There were processes for reviewing antibiotic prescribing which included documenting a reason for the antibiotic choice. A review date after initiation of treatment was highlighted on medicine charts.

There was a clear process for managing and reporting any errors or incidents involving medicines and guidance was available. Staff were able to talk through the process that would be followed if errors or incidents occurred. Staff told us they had access to relevant medicine policies, procedures, and guidelines.

Records of monitoring children and young people's physical and emotional impact when chemical restraint was used did not always detail or demonstrate continuous monitoring was being undertaken. However, otherwise, the service ensured children and young people's behaviour was not controlled by excessive and inappropriate use of medicines.