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Provider: Sheffield Children's NHS Foundation Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Good

Updated 16 July 2019

  • We rated effective, caring, responsive and well-led as good and safe as requires improvement.
  • Sheffield Children’s Hospital was rated as good overall. Safe, effective, caring, responsive and well-led were all rated as good. All ratings were the same as the previous inspection with the exception of safe, which had improved one rating.
  • At this inspection, we rated five out of the six services we inspected as good overall and one as requires improvement. In rating this trust, we took into account the current ratings of the five services not inspected this time.
  • Since our previous inspection in 2016, transition services and child and adolescent mental health wards had undertaken some significant work and improved one rating from requires improvement to good overall.
  • Our full inspection report summarising what we found and the supporting Evidence Appendix containing detailed evidence and data about the trust is available on our website .

Inspection areas

Safe

Requires improvement

Updated 16 July 2019

  • Safeguarding systems and processes did not always operate effectively and consistently to protect patients from the risk of harm and abuse, and the trust was not fully meeting the new or emerging mental health needs of patients at the acute site.
  • Since our previous inspections of specialist community mental health services for children and young people in 2016 and 2018, the trust had not demonstrated enough evidence of improvement and the pace of delivery was slow. For example, patient risk assessments and care plans were not completed or regularly reviewed, and crisis plans had not been considered, for all patients.
  • The environment in the emergency department did not fully meet the needs of patients. For example, there were no dedicated rooms to complete mental health assessments, some facilities were not child-friendly, and the unit easily became overcrowded during busy periods. This meant privacy and dignity could be compromised when the unit was operating at full capacity.
  • Children and young people receiving mental health inpatient care and treatment did not have free access to mobile phones and electronic devices. One lodge had a blanket restriction in place which was not in relation to managing procedural security or individual patient risk. Access to outdoor space was restricted and there was conflicting information in ligature risk assessments for the ward and for outdoor space.
  • Rates of compliance for completion for mandatory training was lower than the trust target in some services.

However:

  • Since our previous inspection of transition services in 2016, the rating of safe went up one rating from requires improvement to good. The trust had recruited more staff to improve and strengthen capacity within the team. All children were always cared for by a named consultant.
  • Services managed and controlled infection risk well and staff kept themselves, equipment and the premises clean.
  • Services managed patient safety incidents well. Staff recognised incidents and reported them appropriately.
  • Services had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

Effective

Good

Updated 16 July 2019

  • Services provided care and treatment based on national guidance and evidence of its effectiveness. New guidance was monitored through the trust’s clinical governance committee and managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health and assessed and monitored patients regularly to see if they were in pain.
  • Services monitored the effectiveness of care and treatment and used the findings to improve them.
  • Since our previous inspection of transition services in 2016, the rating of effective went up one rating from requires improvement to good. Staff worked collaboratively to ensure patients were cared for and supported appropriately and managers monitored the effectiveness of care and treatment.
  • Since our previous inspection of child and adolescent mental health wards in 2016, the rating of effective went up one rating from requires improvement to good. Physical health monitoring was embedded into patients’ care and treatment, the multi-disciplinary team provided a wide range of therapies and staff worked closely with external agencies and partners to review patients’ progress.

However:

  • Although staff from the services we inspected understood how and when to assess whether a patient had the capacity to make decisions about their care, Mental Health Act and Mental Capacity Act training only became mandatory in 2019 and the trust could not be assured of the competency of all staff.
  • Specialist community mental health services for children and young people had not improved since our previous inspections in 2016 and 2018. Care plans were not personalised and not completed for all patients, and staff did not regularly set or review goals with patients to ensure treatment was effective in meeting their individual needs.

Caring

Good

Updated 16 July 2019

  • Children, young people, families and carers were supported, treated with dignity and respect and were involved as partners in their care.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff provided emotional support to patients, families and carers to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.

However:

  • In specialist community mental health services for children and young people, the rating went down from good to requires improvement. Patients and carers did not always receive a plan of care or involved in decisions about care, experienced long waits to access the service, and did not always receive feedback when making suggestions about the service. Carers were not regularly offered any emotional or practical support for themselves.

Responsive

Good

Updated 16 July 2019

  • Services were planned and delivered in a way to meet the individual’s needs and the local population, taking into account people with complex needs, and there was access to specialist support and expertise.
  • Since our previous inspection of transition services in 2016, the rating of responsive went up one rating from requires improvement to good. The trust had established a robust process to discuss and review complex cases, co-ordinated by the transition team, and had developed a centrally-based electronic database to monitor all children and young people with a transition plan.
  • A specialist team was available for children and young people who presented in the emergency department with symptoms of deliberate self-harm, although more work was required to meet other specific needs of children with mental health needs and learning disabilities throughout the organisation.
  • The emergency department consistently met the 95% national standard for patients who were admitted, transferred or discharged within four hours of arrival in the unit, and the trust performed better than the England average.
  • The child and adolescent mental health inpatient wards were discharge oriented and the service worked collaboratively with community teams to plan discharge from admission. The ward facilities promoted recovery, comfort, dignity and privacy, and children and young people had access to outdoor space and sports facilities at Becton Centre.

However:

  • Waiting lists for assessment and treatment remained long for children and young people receiving care and treatment from specialist community mental health services, and some patient appointments were not rearranged in a timely manner
  • In outpatients, although referral to treatment times were better than the England average, the service had overdue follow up and new appointments and the ‘did not attend’ rate was consistently higher than the national average.
  • Although services treated concerns and complaints seriously, complaints were not always resolved within the timescales as set out in the trust policy.

Well-led

Good

Updated 16 July 2019

  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
  • There was a cohesive executive team. There was more work to do about capacity of executive leaders, however the trust had recognised this and already had existing plans in place.
  • There was leadership development at board level and the board planned to roll leadership development training out across different levels in the organisation.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The trust engaged well with children, young people and families, and there was an established youth forum where patients over 12 years of age could contribute their thoughts and ideas to improve services. The trust also engaged well with staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.
  • The trust was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.
  • The trust had a strong focus on quality and safety balanced against financial stability.

However:

  • Although the trust used a systematic approach to continually improve the quality of its services and promote high standards of care by creating an environment in which excellence in clinical care would flourish, more development was required to ensure consistency throughout the organisation, and to provide assurance from ward to board.
  • Although the trust had systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected, further work was required within the community child and adolescent mental health service to improve and strengthen the escalation of risks and develop a robust culture for seeing actions through to delivery.
  • There was more work to do in relation to caring for children with mental health needs and learning disabilities. The trust was not fully meeting the new or emerging mental health needs of patients at the acute site.
  • Safeguarding systems and processes did not always operate effectively and consistently to protect patients from the risk of harm and abuse.

Checks on specific services

Child and adolescent mental health wards

Good

Updated 16 July 2019

  • The service had undertaken significant work to improve since our last inspection. They had reduced the amount of fixed ligature anchor points, improved staff knowledge and practice on safeguarding, ensured that medicines were managed safely and properly and increased the reporting of incidents and feedback to staff following incidents. Remaining improvements were in progress and managed through the service’s action plan and risk register. This included the installation of the nurse call alarm system.
  • Leaders were visible and approachable and engaged with staff. Staff who raised concerns reported positive experiences of the support they received and the action taken to address their concerns. The trust was engaging with staff for their views in the development of the new child and adolescent mental health services vision and strategy. Staff could be involved in developing and delivering the strategy through quality improvement methods in use.
  • The service managed the beds available well and the wards were discharge focussed. The only patients placed out of area required specialist services to meet their needs, staff planed discharge from admission and there was only one delayed discharge in a 12-month period.
  • The teams comprised of a range of multi-disciplinary professionals that provided a range of therapies and worked together and with external agencies to review patients’ progress through care and treatment and to plan discharge.
  • Staff understood and carried out their responsibilities in relation to Mental Health Act and its code of practice, Mental Capacity Act and the five statutory principles and Gillick competency.
  • Staff knew patients and their needs well. They involved patients as partners in their care and valued parents and carers’ involvement. They demonstrated supportive and non-judgemental approaches.
  • The care environments and facilities promoted recovery, comfort privacy and dignity. The Patient Led Assessment of Care Environments for ward food and disabilities were higher than the trust and England Averages.
  • The wards received nominations in the recent trust staff awards and a member of staff from Sapphire Lodge won the award for direct patient care.

However:

  • The services implemented restrictions that included a blanket restriction on Emerald Lodge for mobile phones and electronic devices and areas of the wards were locked and only accessible with staff supervision including outdoor space and kitchenettes. The environmental risk assessments for outdoor space contained conflicting information about the level of supervision required.
  • The health-based place of safety had been used on two occasions both of which were not in line with the trust policy and not in relation to risk of the patients who were cared for there.
  • There were some lapses in record keeping. When staff added incidents to patient risk assessments, it was not clear whether they had reviewed these, on Sapphire Lodge, three patients’ expired section 17 leave forms had not been cancelled or removed and the template for patient observation recording was pre-populated with times.
  • Not all staff were up to date with all the mandatory training requirements.
  • Although patients were involved in their care and treatment, staff had not always ensured that care plans reflected patient views and the patients voice. We also identified issues with one patient’s care and treatment records which had not always reflected their wishes about their identity. Although easy read information was available, this was not used for relevant patients.
  • Activities mostly took place between Monday and Friday during the day times.

Specialist community mental health services for children and young people

Requires improvement

Updated 16 July 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Patient risk assessments and care plans were not completed for all patients and were not regularly reviewed. Description of risks were brief, and only basic risk management plans were in place. Crisis plans had not been considered for all patients and implemented where required in line with best practice guidance. Care plans were brief and did not evidence involvement of patients or carers or of regular goal setting and review. Information was not readily available in accessible forms and staff were unsure how to access these if required.
  • The Sheffield Treatment and Recovery (STAR) team were unable to take referrals for community intensive treatment due to low staffing levels, and staff within a variety of teams told us that in some cases high caseloads prevented them from seeing patients as often as they would like.
  • Waiting lists for assessment and treatment continued to be long, and mandatory training compliance continued to be low in a number of courses, including Mental Health Act and Mental Capacity Act. This was despite some action plans in place to drive improvement in these areas.
  • Staff did not regularly receive feedback from complaints, audits and incidents, and patients and carers did not consistently receive feedback when making suggestions for the service.

  • Governance systems and processes in place to assess, monitor and improve quality and practice within the service at the time of inspection were not effective. Some staff members were being managed and supervised by staff external to the service rather than internal managers. Policies were not consistently reviewed and updated in line with set timescales.

However:

  • Staff reported incidents and made safeguarding alerts where appropriate. Staff understood the duty of candour and were open and transparent with patients. Staff knew how to contact the trust Freedom to Speak Up Guardian and could access the trust whistleblowing policy.
  • Staff attitudes when interacting with patients were respectful and responsive and most patients and carers were positive about their interactions with staff.
  • Staff provided a range of care and treatment interventions and the staff team included a full range of specialists required to meet the needs of patients. Staff used recognised rating scales to assess and monitor outcomes of care and treatment.

Community health services for children, young people and families

Good

Updated 26 October 2016

We rated effective, caring, responsive and well led as good. Safe was rated as requires improvement. We rated this service as good overall because:

  • Staff were aware of their responsibility to report incidents, they knew how to report incidents, near misses and accidents and were encouraged to do so. Learning from incidents was shared between teams. However, it was hard for service leads to identify trends with regards to incidents as reporting was paper based.
  • Safeguarding processes were in place and there was a dedicated safeguarding team in place. Practitioners received safeguarding training. However, we were not assured that the computer system kept children safe but relied on practitioner’s knowledge of the system.
  • Care and treatment was evidence based with policies, procedures and pathways available to staff. There was good evidence of multi-disciplinary working. Staff were aware of their responsibilities with regards to obtaining consent.
  • We observed staff treating people with compassion, kindness, dignity and respect. Feedback from children, young people and their families was positive.
  • Services were planned to meet people’s needs and the needs of different people were taken in to account. Practitioners were aware of the needs of the local population.
  • Leaders were approachable, supportive and encouraged staff engagement. However, some staff felt that there was not enough information given to them at an unsettling time, due to service redesign.
  • Staff knew the trust vision and values. Governance systems were in place to ensure delivery of good quality care.

However:

  • Health visitor caseloads exceeded recommendations and not all areas were offering a face to face antenatal contact to all mothers as part of the core offer.
  • There was no consistency across the trust with regards to records. There was a risk that practitioners did not have access to information in a timely manner.