St Richard's 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 people were protected from abuse and avoidable harm.

At our last inspection we rated this key question outstanding. At this inspection the rating has changed to good with a breach of regulation relating to safe care and treatment. This meant people were safe and protected from avoidable harm. We assessed all quality statements in this key question.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. There were sufficient staff who listened to people's safety and individual needs. Systems and processes were in place to review the safety of care provided. However, the service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

We have not awarded this service a score for Safe.

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

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

Staff were encouraged and confident about raising concerns. These were taken seriously, investigated and people received feedback. There were several ways in which people could raise concerns. These included, submitting an electronic incident, emailing the patient safety leads and in the safety huddle. Staff would also report directly to their line manager or member of the senior team. Most staff we spoke with felt that they could speak with their line manager and action would be taken. Staff told us about action taken by leaders following the last serious incident being raised. This included a review of all competencies and formalisation of an educational package for all nursing staff. For example, the competency for management of a Central Venous Access Device (CVAD line) was reviewed following an incident. Equipment had been purchased to effectively deliver this training.

Staff were aware of and confident to report incidents using the trust's electronic incident reporting system. Staff involved in an incident were involved in the investigation. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. The lessons learnt were shared with others to continually identify and embed good practice. Staff felt that there was a genuine no blame culture and learning was the primary outcome from the investigation. Feedback from learning responses was provided in daily safety briefings and through the practice educators who were responsible for the implementation of identified learning. The patient safety team had oversight of all incidents graded moderate and above. These were reviewed at the patient safety meetings which occurred at the hospital weekly and then through to the Patient Safety Incident Response Group. This group met monthly across the trust. There had been 10 incidents reported on Howard Ward in August 2025. The majority of these were around unplanned transfer of very sick children and young people to a specialist unit.

The trust had transitioned to the NHS England’s Patient Safety Incident Response Framework (PSIRF). This meant the trust focused on effective learning and compassionate, meaningful engagement with those affected when incidents occurred. Duty of candour was undertaken initially verbally where the patient safety lead apologised for what had occurred. This was then formalised in a letter asking if the parent, carer or young person had any questions to be answered by the investigation. The patient safety lead was the nominated contact with parents or carers and young people to keep them abreast of the findings of the investigation. We saw a completed investigation including the letters to parents or carers and the implementation of training packages for staff to reduce the risk of reoccurrence of the incident. The directorate governance report highlighted that within paediatrics the duty of candour had been carried out both initially informally and then by follow up letter. It also highlighted the number of conversations which were complete and those where investigations were continuing.

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

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services through a transition process. We saw good handovers of care from the emergency department through to multidisciplinary transition planning for young people entering adult services. There were around 19 clinical nurse specialists who assisted staff to care for children and young people and provided expert advice on the care required.

Whilst each specialty had a different transition process it was clear on speaking with staff that the patient was at the center of transition planning. The clinical director for the service was leading a piece of work to ensure that transition planning was equitable for every young person whilst being designed around the needs of the young person. We spoke with clinicians in the diabetic team about transition planning and heard that there were several joint meetings with the children and young people’s team and the adult services. The children and young people’s team often kept the lead for the young people until they were 19 to ensure that they felt supported within adult services. The team provided training to adult service staff to ensure that the technology used by young people was understood by adult services.

Handovers in the ward areas were robust and personalised to individual children. Safety huddles occurred throughout the day to share up to date information. Where other teams were in reaching into the service, such as the mental health team their participation in care was more limited at times due to capacity. The service had little influence on how this service was resourced or delivered. However, the service had recognised the need to support children and young people with mental ill health who were more frequently admitted to the ward. Staff in the ward were provided with enhanced training to assist them with the challenges caring for children and young people with acute mental ill health brought. Staff in all areas cared for children and young people with mental ill health as part of their core business. Multidisciplinary meetings occurred to ensure smooth handover between services.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’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.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Parents and carers were involved in the care planning for their child. We saw when children and young people with complex needs where admitted the parents and carers were involved as equal partners in care of their children. Staff were trained in adult and child safeguarding. Howard ward compliance against both these training was at 92% and the day surgery and outpatients’ areas were at 89% compliance. Staff knew how to make a safeguarding alert and did that when appropriate. Staff concentrated on improving people’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 could give examples of how to protect children and young people from harassment and discrimination, including those with protected characteristics under the Equality Act.

Ward staff used the least restrictive practice for children and young people with mental ill health. Whilst there were systems and processes in place to ensure the safety of the child or young person and others the ward team worked with others to diffuse situations that had the potential to escalate. The hospital provided a youth support worker who was able to provide several examples where they had been able to de-escalate situations through good communication and understanding of children and young people with significant mental ill health. The youth support worker was not seen by young people as a member of the clinical team but as someone who was provided to support them in a neutral way. This encouraged openness with them and enabled them to resolve several situations.

The service always worked well with people to fully understand and manage risks by thinking holistically. They provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

The service worked with children and young people to understand and manage risks by thinking holistically. Staff spent time with children and young people to understand their individual needs and during board rounds this was evident that children and young people were at the centre of their care. The views of the child, young person, their family and staff caring for the patient were included in the discussion which resulted in a plan of care that everyone agreed. Staff communicated with children and young people so that they understood their care and treatment, including finding effective ways to communicate with children and young people with communication difficulties. The service shared concerns quickly and appropriately. Some speciality services provided clinics in schools so that children or young people attended outpatient clinics and received timely reviews of their care. This made it easier for the child or young people to access their appointments. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff undertook a holistic risk assessment of the patient on admission. This included using national assessment scoring systems such as the Peadiatric Early Warning Scores (PEWS), nutritional assessments and assessments of the child or young person’s condition of their skin. Where necessary risk assessments such as their mental health status, need for restraint and how this would be carried out and general ligature assessments were completed for appropriate children and young people. These risk assessments were used to plan individualised care and to regular evaluate the care against the plan.

Children, young people and families were encouraged to give feedback on their care. This was through formalised processes such as the national system for collection of feedback and through informal feedback mechanisms on the ward. In the national children’s and young people’s survey 2024, the trust scored much better than the national average for overall experience of care (7/10 or above) at 94% against 88% nationally. The trust was in line with national averages, or above, for all questions in the survey. We saw that the parents and carers of children or young people who had complex needs were involved in care planning to ensure some consistency with care received in the home environment. We spoke with the youth support worker for the service who told us that they were involved in making sure that young people who were patients on the ward were able to continue to do the things that mattered to them. The diabetic team facilitated residential weekend for children with diabetes to maintain their safety whilst supporting them to do the things that mattered to them and to try new adventures in a safe and supported environment.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff had access to the equipment and disposable items that they needed. However, the storage of equipment and consumables, such as syringes and needles was not ideal due to lack of space. Howard ward and the children’s assessment unit appeared cluttered, equipment was stored in corridors. The ward was accessible via a buzzer which linked to the nursing station. A door lock was controlled at this point. Hospital staff had access via their hospital pass. The children had access to a playroom in which there were play specialists available during the working day. The playroom contained many toys which were educational and directed at different ages. For young people there was a separate room in which there was a pool table and a sofa area where young people could play electronic games or watch films.

Planned preventive maintenance and electrical appliance tests were completed yearly and recorded. We checked 25 pieces of equipment and all but one piece of equipment had undergone electrical safety checks within the last 12 months. The department’s fire safety equipment and emergency systems such as call bells, were tested and maintained appropriately. There were systems to ensure emergency equipment in children’s areas was checked daily. When a piece of equipment was found not to have been checked daily the staff immediately addressed this issue. Chemicals that were hazardous to health were securely stored and could not be accessed by children or young people. Similarly, the kitchen areas were secure, and staff let mothers in to access the breast milk fridge. Staff had access to high sided enclosed beds for children and young people who required specialist bedding.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs. Staffing was planned and managed according to national guidance. Leaders used recognised staffing tools to ensure that there was enough staff to deliver care and treatment. Staffing was discussed in regular site management meetings at trust level so that staff could be redeployed if needed. Staffing was monitored through governance meetings and by the director of nursing to ensure that there were sufficient staff to provide care. We saw that there were sufficient staff on the children areas. Staff had time to deliver care in a person-centred way and to fully understand the individualities of their patients. The department did not use agency doctors but 8% of shifts in the preceding year were filled by doctors undertaking additional shifts. This meant that doctors knew the service and patients.

Staff had extended competencies to safely care for children and young people in specific areas of the service such as the neonatal and the day surgery units. Vacancy rates for unregistered nursing staff were 5%. However, whilst the service was over budget in respect of registered nursing staff it was under budget for nursery nursing staff. We saw that there were sufficient staff on duty to care for children on the ward.

There were opportunities for development and staff received appraisals. 97.8% of nursing and administrative staff and 100% of medical staff received appraisals. We spoke with ward managers and practice educators who told us that there were ample opportunities for development.

Staff had completed mandatory training including training to manage risk and incidents. The 93% completion rate for mandatory training was above the trusts target of 90%. However, there were some areas where completion rates were below this target, including training in resuscitation and back (manual handling) training where completion rates ranged between 56% and 87%. This was particularly in the day surgery and outpatient staff. There was a plan in place to ensure that the areas met the key performance indicator set by the trust in respect of training. The ward area team had received extra training and support to care for children and young people with a mental ill health. This included: Children and Adolescent Mental Health training, eating disorders training and a five-day mental health training programme had commenced in March 2024. The service had used the reflections of young people and their families through the lens of our incident investigations, complaints and informal feedback from their stays in the acute hospital to inform the content of this training. The ward had a system by which children and young people needing a greater level of observation were assessed and the appropriate staff allocated.

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

The service assessed and mostly managed the risk of infection. The service detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff followed infection prevention and control (IPC) guidance, washed hands between patient contacts and wore appropriate personal protective equipment (PPE) correctly. All staff were bare below their elbows and items of equipment had labels that informed staff and others that they had been cleaned. Children and young people who required to be cared for in isolation were able to have single rooms and staff managed effective barrier nursing. Barrier nursing is when personal protective equipment such as aprons, gloves and mask are used to minimise the risk of any spread of an infection.

The trust monitored the number and type of infections seen in the hospital. For example, repatriated children and young people, and the risks of multi-resistant organisms. Children or young people who had been treated overseas were admitted to cubicles under barrier nursing procedures until the presence of multi-resistant organisms had been ruled out.

The service audited and monitored infection control processes including hand washing. The service had moved from simple handwashing audits to a ‘Safe Hands’ initiative where the audits focussed on staff knowledge and understanding of the five moments of hand hygiene. This promotes staff good hand hygiene practice. Regular audits were undertaken by the teams in the clinical areas and by the infection prevention and control team. The infection prevention and control team visited the ward regularly to undertake spot checks. Hand hygiene and environmental audits including equipment audits were carried out. The results of these audits were discussed with the relevant departments and an action plan to identify areas of deficit agreed. Monthly hand hygiene audits in the children’s and young person’s service showed improvement from 66.7% in July to 100% in August 2025. Winter preparedness included roving vaccinators, offering staff vaccinations as they work, to increase uptake across the hospital. Staff could also book into clinics and peer vaccinations were also available.

Cleaning schedules detailed who was responsible for what items and how frequently they should be cleaned. Checklists were in place for cleaning staff to monitor the level of cleanliness. Most areas we inspected appeared visibly clean. However, the resuscitaires in the Special Care Baby Unit were dusty, which was a recurring issue noted on audits, and the ceiling vent in the children’s outpatient department was very dusty. Resuscitaires are the responsibility of the nursing team to keep them clean and dust free. The contract cleaners are responsible for cleaning the vents. Furnishings in the ward area were clean.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

Processes were in place for the secure storage of medicines including controlled drugs and medical gases. However, across the services for children and young people where medicines manufacturers recommended a revised "in use expiry date", we identified variation in the use of revised expiry dates when a medicine was opened. This resulted in some medicines having an ‘opened’ date and others ‘expiry date’. This meant that there was not a standard procedure in place.

Room and fridge temperature records indicated medicines were kept within their recommended temperature ranges. Emergency medicines boxes prepared centrally across the trust were available, tamper evident and in date. The content and presentation of locally produced emergency "psychotic episode" boxes varied between the children's wards on the St Richards and Worthing sites. The lack of standardisation of these boxes meant that staff may not be familiar with the contents. This concern had been previously identified during the inspection of a different service at the trust.

Over labelled medicines were available for staff to supply against emergency department and discharge prescriptions. However, the quality of the over labelling of the medicines in the TTO (To Take Out) cupboards were variable, including appropriate over labelling or incomplete labelling. Therefore, there was a risk that children and young people on discharge may receive medicines with incomplete labelling and directions. This concern had been previously identified during the inspection of a different service at the trust. Staff provided an update on steps they were introducing to improve the labelling of TTO packs.

Trust guidance was available to support the record keeping of controlled drugs and controlled stationary. The controlled drugs registers we reviewed showed staff were following trust guidance. However, when we reviewed the controlled stationary records whilst guidance and processes had been produced, these were not consistently followed.

Guidelines to support the prescribing and administration of medicines were available via the trust intranet. If access to the internet was lost paper copies were also available. However, a few of these documents lacked version details, without evidence to demonstrate they were the current version. Therefore, we were not assured that staff would always access the current version. When we raised this with the trust, they started a review of their policies and processes to manage these risks. Staff explained the clinical pharmacy service provided to the Children's Ward and SCBU.