Royal Preston 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 assessed 2 quality statements under the effective key question. Patients’ needs were systematically assessed, and their care and treatment were delivered according to standards and evidence-based practice. Staff understood the importance of seeking informed consent and always explained to patients what their rights around consent were.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

During the core working day administrative staff took initial referrals and out of hours SOEs undertook this role. This helped identify clinical risks that needed to take priority over the forensic examination, consideration of safeguarding risks and vulnerabilities and any additional patient requirements to inform the planning and timing of their visit to the SARC.

Patients aged 0 to 15 years were examined by a doctor, supported by a crisis worker. Patients aged 16 years and over were examined by either a doctor, nurse or midwife, also supported by a crisis worker. The service worked hard to maintain paediatric medical cover across 7 days; however, this was challenging as only 2 suitably trained doctors were available at the time of inspection. As a result, on some occasions children were required to attend an out-of-area SARC for their examination. Managers worked hard to try and ensure paediatric cover was spread equally over 7 days.

All patients received a comprehensive assessment of their health and wellbeing needs. Assessments included a review of their medical history, sexual health, mental health and safeguarding concerns. Staff identified and documented any vulnerabilities and considered specific risk factors, including non-fatal strangulation and female genital mutilation to ensure that appropriate interventions and support could be provided. Assessments took a holistic approach and considered wider factors affecting the patient, including family and social history, and household composition.

Health risks associated with unprotected sexual activity were assessed and managed in accordance with national guidance. This included consideration of the need for HIV PEP and emergency contraception in line with guidance from the British Association for Sexual Health and HIV (BASHH) and the Faculty of Sexual and Reproductive Healthcare (FSRH). The service was also able to provide on-site sexually transmitted infection testing for children under 13 years of age when clinically indicated.

Staff used standardised templates in assessing and examining patients. We reviewed a sample of patient records and found them to be detailed and described the care and treatment offered and provided to patients, as well as any follow up actions.

The service had established referral pathways to support patients’ wider health, safeguarding and emotional wellbeing needs. Records demonstrated that referrals were made appropriately to partner agencies and services, including independent sexual violence adviser (ISVA) and children’s independent sexual violence advisers (CHISVAs), general practitioners and mental health services. As part of the SARC post examination process, staff completed case reviews to ensure referrals had been made. However, there was no check to confirm that these had been received or actioned by the receiving service, which could increase the risk of patients being lost to follow-up.

The judgement for Delivering evidence-based care and treatment is based on the latest evidence we assessed for the Effective key question.

The judgement for How staff, teams and services work together is based on the latest evidence we assessed for the Effective key question.

The judgement for Supporting people to live healthier lives is based on the latest evidence we assessed for the Effective key question.

The judgement for Monitoring and improving outcomes is based on the latest evidence we assessed for the Effective key question.

Staff received training in the Mental Capacity Act. Staff understood the importance of gaining consent from all patients prior to carrying out any examinations. Staff consistently reviewed patients’ consent throughout their time at the SARC. Children, young people and adults were supported to communicate and make decisions to enable the service to deliver person-centred care and treatment in line with their best interests.

Patient records we viewed documented consent, capacity, and choice in relation to physical examination, management of intimate images, information sharing, and onward referrals. Staff consistently told us how they explained in detail forensic procedures to ensure patients fully understood what would happen during their examination. Staff stated they always made patients aware that they could withdraw consent at any time. Patients signed clinical records to evidence their consent to care and treatment.

Staff described consent as an ongoing process rather than a single event. During forensic examinations, clinicians checked regularly with patients to confirm their continuing willingness to proceed and to ensure they remained comfortable with each stage of the examination.

Staff understood the importance of gaining consent from younger children, even when their understanding meant they could give consent, this was obtained from their advocates or carers. However, some trust policies and procedures did not reflect Gillick competence guidelines. Following our inspection, the trust agreed to review these.