St Richard's Hospital

On this page

• 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 that 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. When the hospital was busy, leaders reviewed staffing levels to meet the needs of their children and young people.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. We assessed all quality statements in this key question.

Staff delivered good care and treatment following evidence-based practice and people had good outcomes. The service monitored care outcomes and sought to improve, even when meeting national benchmarks.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. We reviewed 6 sets of patient records and saw that a comprehensive health assessment of the child or young person had been completed in a timely manner. Parents and carers were involved in the completion of the care record. Care plans reflected the individual needs of children and young people on the ward. Care plans had age-appropriate age pain assessment and management plans. These were also matched to the ability of the child so that they could understand.

Children and young people could choose from either the adult menu or a children’s menu offered a variety of options for different ages and needs. Snacks were available on the ward. Baby formula was available to parents and carers who were not breastfeeding. A milk fridge which was appropriately controlled was in place for mothers who were breast feeding and expressing milk. Where children were nil by mouth this was in line with national guidance and intravenous fluids were prescribed and administered in line with hospital guidelines. On a Friday evening the menu choice was supplemented by a takeaway for children and their parents and carers supplied by a charity affiliated with the ward. This service extended to maternity and antenatal wards and was warmly received by parents and carers and teenagers particularly.

Children and young people admitted with mental ill health were placed in designated spaces. The ward had seen an increase in the number of children and young people admitted with mental ill health in recent years. They had taken steps to ensure that the environment was suitable to meet their needs. Care was planned with the local psychiatric liaison team who supported staff between the hours of 8am to 6pm. Monday to Friday. Extending hours has been raised with the local mental health trust. Additional staff training had been given to general nursing staff to ensure that they could meet the needs of the child or young person with mental health concerns on a day-to-day basis. The service employed a youth support worker who provided support to all children and young people but especially those who were worried or had ill health. The youth support worker was not part of the medical team and was there only to support the young person. They were able to spend time with young people to enable them to speak with them confidentially about any concerns they had. The youth support worker met with young people with long-term conditions assisting them to come to terms with their disease and the effects that this had on their life. The extra strand of the team facilitated an open and supportive conversation with the young person and assisted with compliance with treatments.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff gave children and young people and their parents and carers clear information about care and treatment needed to support both their physical and mental health. Staff met people’s nutrition and hydration needs. We saw that ward staff ensured that children and young people had access to fluids. They used effective tools for screening malnutrition and dehydration and acted on any indicators of concern.

Staff used the trust’s systems to follow the latest guidance and evidence-based practice. Speciality teams provided an in-reach service to Howard ward and the special care baby unit to identify children and young people who require their input. The trust kept its database of guidance up to date. Staff used information given regularly in safety briefings and newsletters to implement new guidance or changes to existing procedures. The trust’s intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected best practice. It had guidance for staff around collaboration with multi-agency teams and for delegation of clinical tasks to ensure the right people delivered evidence-based care and treatment.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Educational practitioners were in place to ensure staff were up to date with evidence-based guidance and legislation. Staff had access to a variety of training to ensure that they were competent to deliver care. Staff were assessed against competency frameworks to ensure that they were delivering best practice. Where incidents were reported the practice educators were part of the action planning to prevent recurrence. Clinical records we saw demonstrated care was provided in line with current guidance.

The trust has an audit cycle connected to the Fundamental Standards of Care (FSOC) programme. The cycle of audits includes weekly and monthly monitoring. The audit contained questions on patient experience, safety of medicines, safety measures for children and young people, as well as infection prevention and control measures. All measures had taken a slight dip in the month of August (97-98%) apart from the weekly minimum safety standards audit which had remained at 100%. However, all scores were above the organisational average.

The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

The service worked well across teams and services to support people. Staff worked effectively across different disciplines to ensure all staff involved in assessing children and young peoples' needs to maintain the continuity of care. We observed effective working within different disciplines to review the care children and young people received. We observed good compassionate multidisciplinary working to ensure that the patient received appropriate care and discharge. This in some cases meant working with external organisations to secure the appropriate ongoing care for children and young people. Effective team working between external organisations, physiotherapists, occupational therapists, nursing and medical staff at an on-site level enabled children and young people to maintain their health needs at home or in school.

The diabetic team had in reached into six schools to provide ongoing support to young people with diabetes. These clinics were held in schools, which parents and carers could attend, so young people did not miss any available educational time. This also improved the attendance at follow up clinics whilst providing schools with some education and advice on the support young people required. This team and others ensured effective transition for young people to adult services. Speciality teams for children with long term conditions worked with speciality adult teams to ensure that the transfer of care was as smooth as possible. The age of transfer to adult services varied but a good transfer was seen by all consultants and speciality teams that we spoke with as a very important part of the care. There was an action plan being developed to ensure that all young people transitioned well into adult services. This was despite the support of young people being different in adult services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. Records of care were recorded on paper-based notes and babies in the special care baby unit’s observations were also recorded on the IT system used for new mums. Daily safety huddles occurred where the team shared any issues, events or learning too all.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Children and families were empowered and supported to manage their own health, care and wellbeing needs by staff who understand their needs and preferences. The diabetic multidisciplinary team included a dedicated dietician for children and young people. As a team they worked together to ensure that young people with diabetes understood the need to remain compliant with their treatment plan but had options which suited their needs.

Children and families were involved in regularly reviewing their health and wellbeing needs where appropriate and necessary. Whilst longer stay children and young people are rare the nursing staff told us that teachers, parents and carers brough work into the hospital if this was necessary. Provision to take exams whilst in hospital could be arranged. The youth support worker held difficult conversations with young people around smoking, drug and alcohol use as they were seen as an independent source of support.

Children, young people and families are encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. Children, young people and parents or carers were offered healthy culturally appropriate food to meet their needs. Young people were supported to choose healthy options from the menu. Activities were available Monday to Friday for children and a playroom with a variety of toys for different ages was available 24hrs a day. The ward had an allocated outside space for older children with space to play games in. This area was on the ground floor so children and young people had to be accompanied to use this facility. However, this was overgrown through lack of use. Staff were aware of this and planned to seek support to maintain this in the spring.

Children, young people and families were involved in regularly monitoring their health, including health assessments and checks where appropriate and necessary with health and care professionals.  The diabetic team held clinics in secondary schools to maintain regular assessment and support for young people. Activities such as forest schools and residential weekends were organised for young people with long term conditions. These encouraged young people to get active whilst managing their conditions with support.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance. The service had access to seven days a week diagnostic and support services. Staff we spoke with said that there was good access to services to support patient treatment and care.

Staff had access to and followed a wide range of policies and treatment guidelines which were stored electronically. Policies and procedures were based on best practice from National Institute Clinical Excellence (NICE).

Outcomes for children and young people were monitored and action plans developed to improve the services. We reviewed national diabetic audits which showed there had been an improving picture with monitoring of children and young people’s key health check completion since 2014 (59%) to 2023 (89%).

The hospital was performing at or above many national indicators. The number of missed outpatient appointment was well below their peer group (9.5%) at 6.2%.

Staff used recognised tools to improve the detection and response to clinical deterioration in children and young people as a key element of patient safety and improving patient outcomes. This included the use of standardised assessment scoring tools such as NPEWS and the Paediatric Safeguarding and Managing Risk Tool (PSMART). This ensured that physically and mentally deteriorating children or young people were identified and received the appropriate care as soon as possible.

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

Children, young people and families understand their rights around consent to the care and treatment they are offered. Children, young people and families’ views and wishes are considered when their care is planned. We observed staff dealing with a child who has soiled themselves. The child had refused help to clean them up and had locked the lavatory door. Staff gently persuaded the child to accept help following a discussion as to how this could be provided in a private and dignified way. Staff listened to the child’s distress and sought to find the most amenable solution to help the child.

There were systems and practices to ensure that children, young people and families understood the care and treatment being offered or recommended. This helped them make an informed decision. Children, young people and families received information about care and treatment in a way they could understand and had appropriate support and time to make decisions. Staff understood the importance of ensuring that children, young people and families fully understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment. We saw that staff obtained verbal consent from a child prior to carrying out a procedure.

Staff demonstrated a good understanding of the requirements of the Mental Capacity Act 2005, including the duty to consult others such as families, where appropriate. Staff also were able to describe taking a child’s capacity and ability to consent into account, and how they, or a person lawfully acting on their behalf, are involved in planning, managing and reviewing their care and treatment.