We carried out this announced inspection of East Midlands Children and Young People’s Sexual Assault Service (EMCYPSAS) over two days on 26 and 27 November 2019. We conducted this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements of the Health and Social Care Act 2008 and associated regulations. Two CQC inspectors, supported by a specialist professional adviser, carried out this inspection.
To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions about a service:
• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?
Background
The East Midlands Children’s and Young People’s Sexual Assault Service (EMCYPSAS) was provided from two regional hubs. The Serenity Suite in Northampton (inspected in 2018) and The Children and Young People’s Suite at the Queen's Medical Centre, Nottingham. This inspection looked at the paediatric sexual assault referral centre (SARC) services provided from The Children and Young People’s Suite at Queen's Medical Centre (QMC), Nottingham University Hospitals NHS Trust (NUHT).
The service had been delivered by NUHT since April 2018 when there was a change in provision of paediatric and adult SARC services in the East Midlands. The regional model allowed better support for staff and sharing of knowledge and skills to benefit the patient experience. The children and young people’s suite at the Queen's Medical Centre accepted referrals from children and young people who had been a victim of rape or serious sexual assault and reside in Derbyshire (including Derby City), Lincolnshire and Nottinghamshire (including Nottingham City) or if the assault had been committed in that area. In cases that were close to the regional border, care of the patient and patient preference is paramount. If a patient chose to access a different service, staff told us that they were happy to manage the onward referrals and ensure the patient could access local aftercare services if they want to.
The SARC saw children and young people up to 18years and 18-24year olds with additional needs. There was an on-call out of hours rota for telephone advice and strategy discussions.
The centre was within a wing of the Queen's Medical Centre. Families and the police had dedicated parking so that they could access the centre via the most direct route. Access to the SARC was via a video intercom. A staff member from the SARC had to attend the entry door to allow access.
The suite was designed and refurbished to deliver paediatric SARC services with a dedicated forensic waiting and examination room. There was also a non-forensic waiting room. The areas had been made as child and young person friendly as possible. They were bright and secure. There was ongoing work and refurbishment to add a police suite and non-recent clinical space.
Nottinghamshire Sexual Violence Support Services (NSVSS) delivered a single point of access (SPA) for the regional service and provided crisis workers 24 hours a day to the Nottingham Hub.
Self referrals were not accepted for children and young people aged 13yrs and under. With appropriate assessment young people aged 14-17yrs could self refer. All forensic examinations were completed by doctors. The suite was staffed by doctors, specialist nurses and crisis support workers.
The hub had a rota of medical staff who completed the forensic examinations. This included Forensic Physicians and Paediatric Consultants. There was a Clinical Lead who was a member of The Royal College of Paediatrics and Child Health (RCPCH) who represents The RCPCH on the academic committee of The Faculty of Forensic and Legal Medicine (FFLM). In addition to being on the rota, the clinical lead provided staff support and had been instrumental in the setting up of the SARC. There were three specialist nurses who supported in examinations, referrals and day to day running of the SARC Monday to Friday. One nurse has a dual role providing clinical support and managing the SARC processes. In total the nursing establishment was 1.2 whole time equivalents. There were seven crisis support workers, a lead crisis support worker and a crisis support worker service manager.
On the day of inspection we spoke with 10 members of staff. We reviewed eight patients' records and seven safeguarding referrals. We left comment cards at the SARC in the two weeks prior to our visit and received 3 responses from patients who had used the service.
Throughout this report we have used the term ‘patients’ to describe people who use the service to reflect our inspection of the clinical aspects of the SARC’.
We looked at policies and procedures and other records about how the service was managed.
Our key findings were:
- The service used systems to help them report risk.
- The service had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
- The service had thorough staff recruitment procedures.
- Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The appointment/referral system met clients’ needs.
- The service had effective clinical leadership and a culture of continuous improvement.
- Staff felt involved and supported and worked well as a team.
- The service asked staff and clients for feedback about the services they provided. The feedback was overwhelmingly positive.
- The staff had suitable information governance arrangements.
- The service appeared clean and well maintained.
- The staff had infection control procedures which reflected published guidance.
We identified regulations the provider was not meeting. They must:
- Ensure that local leadership capacity means that all risks are identified.
- Ensure that governance and management systems support local leaders to identify, address and manage risks.
- Ensure a clear line of accountability through NUHT governance structures from the local SARC leaders to the trust board. This includes the use of locally agreed performance measures.
- Ensure there is a clear system in place so that the service is continually improving in relation to staff learning plans and job role priorities.
Full details of the regulation/s the provider was/is not meeting are at the end of this report.
There were areas where the provider could make improvements. They should:
- Identify competency frameworks for all staff groups.
- Ensure ligature assessments are updated when there are changes to the physical environment.
- Offer examination information for patients, families and carers to take away with them or have prior to the examination.