Norwich Community Hospital

We carried out this announced inspection on 25th January 2022 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a second inspector.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

Background

The Harbour Centre is a sexual assault referral centre (SARC), jointly commissioned by NHS England (NHSE) and Norfolk Police and Crime Commissioner. The SARC is available 24 hours a day, seven days a week (including public holidays) for patients over 13 years of age.

The children’s service (under 13 years of age) is available Monday to Friday (9-5 pm inclusive). Access to this service is by police or social worker referral only and following a strategy discussion. The service offer is to provide advice to police and patients, deliver acute forensic examination, provide support following recent and non-recent sexual assault and violence, and onward referrals to Independent Sexual Violence Advisors (ISVA).

The Harbour Centre has two health providers: Norwich Community Health and Care Trust (NCHCT) providing Forensic Medical Examiners (FMEs) for children and Mountain Healthcare providing Forensic Nurse Examiners (FNEs) for those over the age of 13 years, including adults. The Police provide crisis workers and Independent Sexual Violence Advisors (ISVA's) and are responsible for the overall running of the SARC building including the forensic cleaning and maintenance.

This report will focus solely on the health provision for the children’s service provided by NCHCT.

The Harbour Centre is a fully accessible building, and provides comfortable supportive surroundings, forensic areas and interview facilities. There is parking for patients outside the SARC. The building is on one level and accessible to wheelchair users. There are two forensic medical rooms which have adjacent (not en-suite) shower and toilet facilities for use by patients. At the time of inspection, the forensic room examined was used specifically by NCHCT for paediatric forensic examination, the two providers used separate facilities within the same building. The building also has a pre- examination waiting room, a staff toilet, a kitchen area, staff offices, storeroom/staff changing room, and a medical room utilised by the FME.

There have been approximately 25-50 children seen per annum, but this number had fallen significantly to around 20 since the start of the COVID-19 pandemic.

Forensic medical examinations are undertaken by FMEs, who are paediatricians working in other roles within the trust. At the time of inspection there were seven FMEs providing forensic medical examinations at the SARC.

During the inspection we spoke with three of the seven FMEs, the head of service for safeguarding, the clinical lead, the interim head of service for children and young people’s services, and the named doctor for safeguarding. We examined policies and procedures, reports, and seven patient records to gain understanding of how the service was managed.

Throughout this report we have used the term ‘patients’ to describe the children who use the service to reflect our inspection of the clinical aspects of the SARC.

Our key findings were:

• The FMEs provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The FME service had a culture of learning and continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The service asked staff and clients for feedback about the services they provided.
• Staff had a complaints policy.
• The staff had suitable information governance arrangements.
• The building appeared clean and well maintained.
• Infection, prevention and control procedures which reflected published guidance were followed by staff at the SARC.
• The service had thorough staff recruitment procedures, and we saw that these were adhered to.
• Staff received safeguarding training in line with national guidance and knew their responsibilities for safeguarding adults and children.
• The service had systems to help them manage risk.

We identified regulations the provider was not meeting:

• An automated external defibrillator with paediatric pads was available in the SARC at time of inspection. However additional equipment and medicines were not available for use with children. The provider rectified this immediately following inspection and appropriate training was delivered to staff.

The Provider must make improvements to:

• Undertake a review to guarantee the assessment templates meet the requirements set by the Faculty of Forensic and Legal Medicine (FFLM).
• Undertake a record keeping audit to demonstrate that documentation is complete, including discharge planning and onward referrals.
• Ensure there is a competency framework in place, particularly for practitioners new to post, which demonstrate the practitioner’s abilities, progress and training needs.

Full details of the regulations the provider was not meeting are at the end of this report.

Further areas where the provider could make improvements. They should:

• Ensure all staff should have access to appropriate facilities, at present there are showers and changing rooms for the NCHCT staff working in the SARC to use in the adjacent police buildings but at present they do not access them.
• Be assured that the frequency of the disclosure and barring (DBS) checks is proportionate to the work that SARC staff deliver.
• The provider should consider an age appropriate leaflet for children and young people attending the SARC.
• Review lone working risk assessments for staff working in the SARC.