Trust Head Office, CEME

Summary findings

We carried out this announced inspection on 18 and 19 May 2022 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 in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by two CQC inspectors and a specialist professional advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Background

North East London NHS Foundation Trust is commissioned to provide clinical examinations of children under the age of 13 who have suffered non-recent sexual assault or sexual abuse (non-recent means that it has been 72 hours or over since an alleged incident took place). This service is undertaken at a Sexual Assault Referral Centre (SARC) which is managed by another provider.

The trust employs one paediatrician who undertakes all clinical examinations of children requiring an examination on a Monday. All examinations are undertaken alongside a paediatric crisis support worker who is employed by the provider which manages the SARC. The paediatrician does not see children alone as there is always a member of staff from the provider which runs the SARC present to assist in the examinations. Between 1 April 2021 and 30 April 2022, six patients were referred for non-recent examinations as part of this service on a Monday, of which five were seen by the service, and one child did not attend for the arranged appointment and returned another day when examinations were undertaken by a different provider.

Examinations are undertaken in a fully accessible building which is situated in the grounds of a community hospital with plenty of parking, including disabled spaces. The building is on one level and accessible for wheelchair users. There are two forensic examination suites, but one is used predominantly for children and is separate from the adult area. There is a child friendly non-forensic waiting room with lots of wipe clean toys and activities for a variety of ages. The forensic area has a separate waiting area with a working television and the examination room includes a forensic shower room. The building also includes a staff shower and changing area, an office with a kitchen area, storage rooms and interview rooms.

During the inspection we spoke with the paediatrician, the paediatrician’s line manager, the contract manager, as well as other members of staff who were employed by a different provider, including two paediatric crisis support workers. We also spoke with the commissioners of the service from NHS England.

We looked at policies and procedures and other records about how the service is managed. We reviewed all six patient records. We left comment cards at the location two weeks before our visit, but we did not receive any completed feedback cards.

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.

Our key findings were:

• The staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• Staff knew how to deal with emergencies with support from staff based within the SARC. 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 patients’ needs.
• Staff felt involved and supported and worked well as a team.
• Following our inspection, the provider initiated governance systems to maintain oversight of the services provided, including ensuring all risk assessments are consistently completed.

There were areas where the provider could make improvements. They should:

• Ensure that the voice of patients, parents and carers are consistently captured within medical records, evidencing that they have been included in decisions about their care and that their wishes and preferences have been considered.
• Implement a system with the provider who manages the SARC to ensure feedback from patients, families and carers, is obtained to provide an opportunity for improvements to be made to the service when needed.
• Ensure they have mechanisms in place to obtain ongoing assurance (from the provider who manages the SARC) that the environment and equipment is fit for purpose and that appropriate risk assessments have been completed and shared.
• Ensure that patients have a choice of gender of the doctor they are examined by.