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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.

Reports


Inspection carried out on 26 Mar to 04 Apr 2019

During a routine inspection

  • 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 .


CQC inspections of services

Service reports published 16 July 2019
Inspection carried out on 26 Mar to 04 Apr 2019 During an inspection of Specialist community mental health services for children and young people Download report PDF | 528.86 KB (opens in a new tab)Download report PDF | 2.07 MB (opens in a new tab)
Inspection carried out on 26 Mar to 04 Apr 2019 During an inspection of Child and adolescent mental health wards Download report PDF | 528.86 KB (opens in a new tab)Download report PDF | 2.07 MB (opens in a new tab)
Service reports published 23 October 2018
Inspection carried out on 14-15 August 2018 During an inspection of Child and adolescent mental health wards Download report PDF | 284.04 KB (opens in a new tab)
Inspection carried out on 14 to 15 August 2018 During an inspection of Specialist community mental health services for children and young people Download report PDF | 296.53 KB (opens in a new tab)
Service reports published 26 October 2016
Inspection carried out on 14 -17 June 2016 During an inspection of Community health services for children, young people and families Download report PDF | 347.93 KB (opens in a new tab)
Inspection carried out on 14 - 17 June 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 339.34 KB (opens in a new tab)
Inspection carried out on 14 - 17 June 2016 During an inspection of Child and adolescent mental health wards Download report PDF | 369.17 KB (opens in a new tab)
See more service reports published 26 October 2016
Inspection carried out on 14 to 17 and 30 June 2016

During an inspection to make sure that the improvements required had been made

Sheffield Children’s NHS Foundation Trust is one of four dedicated children’s hospital trusts in the UK. It provides integrated healthcare for children and young people from the local population in Sheffield and South Yorkshire, as well as specialised services to children and young people nationally.

We inspected the trust between 14 and 17 June 2016. We undertook an unannounced inspection at the Emergency department on 30 June. We previously inspected the Sheffield Children’s Hospital in May 2014 and rated it as good overall. The mental health services and community services were not inspected at that time. We have not inspected the Embrace service.

This inspection was to inspect the mental health and community services. We also undertook a focused inspection in areas within Sheffield Children’s Hospital that were identified as requiring improvement at the previous inspection. These were areas of emergency and urgent services, neonatal services, surgical services, medicine and critical care.

In the inspection in May 2014, we identified that the trust must ensure the hospital cover out of hours was sufficiently staffed by competent staff with the right skill mix, particularly in the Emergency department. We also identified the trust must ensure consultant cover in critical care was sufficient and that existing consultant staff were supported while there were vacancies in the department and that the process for ongoing patient review for general paediatric patients, following their initial consultant review, must be reviewed to ensure there were robust processes for ongoing consultant input into their care. We found that at this inspection, all these specific areas had been addressed.

At this inspection, we rated services that had not previously been rated and also the specific areas we inspected. However, we did not review the overall rating for the trust as the inspection was focused on specific areas only.

We rated children’s, young people and families services within the community services as good. Child and adolescent mental health wards, child and adolescent mental community services and transition services required improvement.

Our key findings were as follows:

  • The trust had taken action to address areas identified at the inspection in May 2014. However, the trust had made insufficient progress in developing transition services since our last inspection. The trust directors recognised there was further work to do.
  • There was an open culture within the organisation. Challenge was encouraged by executives and non-executive directors. However, the trust was not fully compliant with the Duty of Candour regulation.
  • There were some staff shortages; the Board had approved additional posts in principle and recruitment was underway.
  • Incidents were reported and investigated and lessons learned, although there were some concerns about the reporting of restraint in mental health services. The trust was planning to introduce an electronic incident reporting system which would improve capability to analyse themes.
  • Infection prevention and control policies were effective. There had been no cases of MRSA reported since 2008. All reported cases of Clostridium difficile between April 2015 and March 2016 were unavoidable.
  • Feedback from people who used the services we inspected and those who are close to them was mostly positive about the way staff treated people.
  • There was evidence of public engagement, however it was recognised by the trust, that there needed to be a more systematic approach; there was no patient and public involvement strategy in place.
  • There were no mortality outliers at the trust.
  • There was a lack of robust monitoring and governance in some areas, for example use of the Mental Health Act and equality and diversity.
  • Staff did not always take a proactive approach to safeguarding, particularly in the emergency department and within mental health services.
  • Within mental health services, staff used restrictive practices, some of which met the definition of seclusion. However, these were not recognised as such and were not dealt with in accordance with trust policy.
  • The trust was in the process of building work to provide new accommodation for some of the wards and outpatients. The aim was to provide an environment to better meet the needs of children, young people and their families.

We saw several areas of outstanding practice including:

  • The CAMHS service had been successful in securing NHS England and local clinical commissioning group funding for a child and adolescent mental health service schools link pilot scheme. The aim of this was to improve joint working between child and adolescent mental health service and schools. The project arose from the ‘Future in Mind’ Department of Health document and the transformation plan to improve early access to mental health support for young people. The scheme consisted of a number of tier three child and adolescent mental health professionals working within 10 schools. The project had been positively received by the funders and organisations involved.
  • The trust had established paediatric palliative care simulation training.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure compliance with the Duty of Candour (regulation 20).

Child and adolescent mental health wards

  • The trust must ensure that practices used by staff to manage behaviour such as time out and seclusion are used and recognised correctly. Staff should follow applicable procedures for the use of these practices with clear rationale and evidence documented.
  • The trust must ensure that informal patients are aware of their rights, and any restrictions, and understand these when they consent to their admission and treatment. Staff should not use the threat of detention in order to prevent patients from leaving where this is not a justifiable and required intervention.
  • Staff must ensure that incidents involving abuse between patients are referred as safeguarding concerns where necessary. Evidence of safeguarding considerations must be documented accordingly.
  • The trust must ensure that there is consistency between staff about what incidents are reported and what the threshold is for reporting physical interventions.
  • The trust must ensure there are appropriate systems in place at service level in order to effectively assess and monitor the service and how it operates. This should include the ability to identify and monitor staff training requirements and that staff supervisions are undertaken in accordance with policy.
  • The trust must ensure there are effective systems and processes in place to monitor medicines management and infection control practices. These should be able to identify and highlight shortfalls in practice which must be addressed as necessary.
  • The trust must ensure that policies in place in relation to the Mental Health Act appropriately reflect current practice and legislation.
  • The trust must ensure that relevant staff receive appropriate training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
  • The trust must ensure that there is appropriate oversight of the application of the Mental Health Act and any breaches of this within the service.

Specialist community mental health services for children and young people

  • The trust must ensure that environments are assessed in order to identify and mitigate risks that may be present to people using the service.
  • The trust must ensure that lone working procedures are risk assessed as necessary and lone working processes are suitably robust to maintain safety.
  • The trust must ensure there are appropriate systems in place at service level in order to effectively assess and monitor the service and how it operates. This should include the ability to identify and monitor staff training requirements and that staff supervisions are undertaken in accordance with policy.
  • The trust must ensure that clinic room equipment is safe and suitable for use. There must be effective systems and processes to monitor infection control practices. These should be able to identify and highlight shortfalls in practice.
  • The trust must ensure staffing levels are sufficient to enable young people to access treatment within timescales set out in trust and NHS national targets.

Transition care

  • The trust must ensure that there are effective governance systems in place to capture, respond, and learn from transition related complaints and incidents.
  • The trust must ensure that sufficient numbers of staff have appropriate training in the Mental Capacity Act 2005.
  • The trust must ensure that there is an effective clinical audit system in place to monitor transitional care provision.

Urgent and emergency care

  • The trust must ensure all children are appropriately assessed for safeguarding risks.

Medical care

  • The trust must ensure that staff undertake and document appropriate risk assessments to promote safe care.
  • The trust must ensure all staff disciplines have safeguarding training.

Community health services for children, young people and families

  • The trust must ensure that electronic record systems enable staff to identify and assess risks to the health, safety and welfare of people who use the service.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 7-9 & 22 May 2014

During a routine inspection

Sheffield Children’s NHS Foundation Trust is one of four dedicated children’s hospital trusts in the UK. It provides integrated healthcare for children and young people from the local population in Sheffield and South Yorkshire, as well as specialised services to children and young people nationally.

Sheffield Children’s Hospital has been a foundation trust since 1 August 2006. They employ around 3,000 staff. They treat around 30,000 children and young people admitted to hospital as inpatients or day cases and more than 164,000 attending outpatient clinics or being treated in emergency department.

The trust has three locations registered with the Care Quality Commission. These include Sheffield Children's Hospital, Becton Centre for Children and Young People, and Ryegate Children's Centre. The trust also runs the EMBRACE retrieval service for the region.

The trust was in the process of a new hospital build, due to be complete in 2016. This aims to improve privacy and dignity of patient with increased number of single rooms and larger bed space areas. It also aims to increase the recreational and support facilities for children and young people and their families.

We carried out this comprehensive inspection as part of the pilot phase for the methodology adapted for dedicated children’s hospitals. Sheffield Children’s Hospital NHS Foundation Trust was rated as medium risk in the CQC’s intelligent monitoring system. The inspection took place between 7 and 9 May 2014 and an unannounced inspection took place on 22 May 2014. We did not inspect the Children’s and Adolescent Mental Health Services (CAMHS) provided by Sheffield Children’s Hospital.

Overall, this trust was rated as good. We rated it good for being caring, effective and responsive to patients’ needs and being well led, but improvement was required in providing safe care.

Our key findings were as follows:

  • All staff working at the hospital were extremely proud to work for the hospital and dedicated to their work.
  • The culture was found to be open and transparent with an evident commitment to continually improve the quality of care provided.
  • The executive team were well known throughout the hospital and some members of the team did regular walkabout, and the medical director still worked clinically in the A&E department.
  • The care provided throughout the Hospital was consistently found to be compassionate and demonstrated dignity and respect with good examples of providing emotional support to children, young people and their families or carers.
  • Staffing out of hours (OOH), particularly within the A&E department was not always sufficient. The trust was in the process of presenting a paper on OOH cover to increase the number of consultants available and strengthen the OOH cover at the hospital.
  • The nurse staffing tool used by the hospital was developed specifically by the Chief Nurse to take into account national standards and other factors specific to the needs of each ward and agreed levels for each shift were agreed with the ward manager as a basis for recruitment and ongoing staffing.
  • The end of life care service demonstrated a clear commitment to always meet the preferences of patients on an end of life care pathway.
  • The accuracy of statutory and mandatory training data was not consistent between the central database and those records held locally at the wards. Staff reported this was due to them reluctance to rely on the central database at it was often inaccurate.
  • The hospital was clean and infection prevention and control measures were found to be good in the majority of areas, although a few staff were found to not comply with being bare below the elbows.
  • The flow throughout the hospital was in the majority good and they had a high rate of day case activity to prevent children and young people having to stay in hospital. They were also starting to work with other providers to develop pathways to keep care closer to home.

We saw several areas of good and outstanding practice including:

  • Outstanding practice was found to be evident in end of life care, in particular their leadership and responsiveness to patients wishes and preferences on an end of life care pathway.
  • The commitment and dedication of all staff and the transparent and open culture.
  • The tool used for nurse staffing was developed by the chief nurse and agreed staffing levels were decided in a collaborative manner with ward managers to ensure all aspects of specialism and acuity were taken into account.
  • The care and commitment provided in the A&E department was found to be excellent and the trust had consistently met the A&E 4 hour target for the previous twelve months.
  • There was a drive to deliver care closer to home and reduce unnecessary admissions.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure the hospital cover out of hours is sufficiently staffed by competent staff with the right skill mix, particularly in A&E.
  • Ensure consultant cover in critical care is sufficient and that existing consultant staff are supported while there are vacancies in the department.
  • Review the process for ongoing patient review for general paediatric patients following their initial consultant review to ensure there are robust processes for ongoing consultant input into their care.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.