We carried out a routine scheduled inspection of this service. We visited the hospital and spoke with managers and key individuals about aspects of the organisation and running of the hospital. In addition, we visited two wards and spoke with some patients and their parents about the care and treatment they (or their child) were receiving. We spoke with some nursing staff about working at Sheffield Children’s Hospital. We observed interactions between patients, their parents and nursing staff.

Staff spoken with said that assessments of needs were always undertaken so that important information was available to them. They told us that they received good support and training so that they could do their jobs well.

All of the parents spoken with confirmed that they had been involved in discussions about their child’s care and treatment. They told us that nursing staff and doctors kept them informed and they felt included in any decision making. Children and young people spoken with said that staff always spoke to them and asked them their opinion. Children, young people and parents felt that privacy and dignity was respected by staff, and staff explained things in a way they could understand. Young people told us they felt safe in the hospital. Similarly, parents of children told us that staff were attentive and that there was always enough staff to assure them that their child was safe. All of the children, young people and their parents spoken with said that they had no worries or concerns, but they felt able to talk to staff if they had.

Without exception, people spoke very positively about the support, care and treatment they (or their child) received. They said that nurses and doctors were always polite and respectful. People’s comments included; “The nurses are wonderful. I know that (my child) is safe and I can have a break knowing that they are in good hands.” “The staff are very helpful and always there if I need to ask anything.” “All the staff are friendly. I can talk to them about anything. Even if they are really busy they take time to talk to me.” “They (staff) give good care and attention. They are very supportive and respectful.” “The nurses explain things to me as well as my mum and dad. They make sure I understand.”

All children, young people and parents who we spoke to, told us they were very satisfied with the quality of service provided. They were complimentary about the care and treatment they had received from all staff and described staff as: “approachable and friendly and they could ask for anything”, “very good and very helpful”, and “they always come to check I am okay and are always around if I need them”.

Children, young people and parents felt that privacy and dignity was respected by staff, and staff explained things in a way they could understand. They told us that staff were “very good and respectful” and “very good at explaining things”. Young people were particularly pleased that staff talked to them as well as their parents.

Young people told us they felt safe in the hospital. Similarly, parents of children told us that staff were attentive and that there was always enough staff to assure them that their children were safe.

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.

At this inspection we followed-up areas identified as requiring improvement or not rated at the previous inspection. We have rated the individual areas we inspected. We did not review the overall rating for the hospital as the inspection was focused on specific areas only.

We inspected the following core services:

• Urgent and Emergency Services
• Medical Care
• Surgery
• Critical Care
• Neonatal Services
• Transitional Care

We did not inspect outpatients and diagnostic services or end of life care at this inspection.

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 areas had been addressed.

At this inspection, our key findings were as follows:

• The trust had taken action to address most 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 meeting all the requirements under the duty of candour.
• There were some staff shortages, however additional posts had been approved in principle by the Board and recruitment was underway.
• Incidents were reported and investigated and lessons learned. 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 service 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.
• Services were planned and delivered to meet the needs of people.
• There were no mortality outliers at the trust.
• Staff did not always take a proactive approach to safeguarding, particularly in the emergency department.
• The trust was in the process of building work to provide new accommodation for some of the wards, accident and emergency and outpatients. The aim was to provide an environment to better meet the needs of children, young people and their families.

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

Importantly, the trust must:

• Ensure there are effective governance systems in place to capture, respond, and learn from transition related complaints and incidents
• Ensure that sufficient numbers of staff have appropriate training in the Mental Capacity Act.
• Ensure there is an effective clinical audit system in place to monitor transitional care provision.
• Ensure all children are appropriately assessed for safeguarding risks.
• Ensure that staff undertake and document appropriate risk assessments to promote safe care.

In addition the trust should:

• The trust should implement sepsis tool documentation to enable early intervention for febrile patients.
• The trust should implement the use of the paediatric early warning system for all children who attend the department to enable early intervention for deteriorating patients.
• The trust must ensure that staff undertake and document appropriate risk assessments to promote safe care.
• The trust should ensure that there is a consistent and robust approach to the assessment and planning of transitional care.
• The trust should ensure that a consistent approach is adopted to the completion and storage of transition medical records.
• The trust should ensure that steps are taken to create and maintain a transition database to allow patients in transition to be identified.
• The trust should ensure that staff dealing with transitional patients have appropriate knowledge and training around transition care.
• The trust should ensure that its transition pathway is considered in conjunction with community and mental health services.
• The trust should ensure that an appropriate gap analysis is conducted to identify any gaps in its transition service provision against the applicable guidance from the national institute of health and care excellence.

Professor Sir Mike Richards

Chief Inspector of Hospitals