Trust Headquarters

We carried out this announced inspection on 31 May 2022 and 16 June 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 conducted by two CQC inspectors.

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

This sexual assault referral centre (SARC) is located at Cobham Community Hospital. The SARC comprises a suite of rooms on the first floor of the hospital site and is occupied by this provider, Surrey and Borders Partnership NHS Foundation Trust (SABP) and another provider.

The other provider is responsible for the SARC service for adults, for children aged 13 and over and for children under 13 who have recently experienced sexual assault (the under 13 ‘acute’ pathway). The other provider is also responsible for the premises, the environment and the equipment used in the centre. We have previously inspected and reported on the service provided by the other provider.

SABP is responsible for the SARC service for children aged under 13 whose experience of sexual assault is regarded as ‘non-recent’; that is where the type of assessment would not need to include a forensic examination due to the amount of time elapsed following the assault and usually described as being over 72 hours. This inspection was solely of that service. This report focuses just on the pathway and the clinical assessment of children in this group. All other aspects of the centre that relate to the sexual assault pathway for adults, children aged 13 and over, the under 13 acute pathway and for the premises and environment can be found in our report of the other provider.

Assessments of this small number of children are carried out in a ‘non-forensic’ examination room; the room is not used for collecting forensic samples. Children visiting this this service also used other, non-forensic waiting and reception rooms located in the centre.

Each examination and assessment is carried out by two consultant paediatricians who are more usually employed in other paediatric medicine services provided by SABP. The service operates during the daytime every Thursday, with paediatricians selected from a rota for that day. This rota runs alongside the daily paediatric rota for child protection / non-accidental injury medicals.

The other provider supports SABP paediatricians with some administrative and record keeping functions. All children requiring this service are seen by virtue of an appointment scheduled for this clinic and so there is no out-of-hours or emergency function associated with the service.

As the service is provided by SABP, the trust is responsible for meeting the requirements of the Health and Social Care Act 2008, and the associated regulations about how the service is run.

Prior to our inspection we reviewed a range of policies, procedures, data and other records that the provider had sent to us in advance. On the day of our visit we spoke with two paediatricians and with two members of a therapeutic and advocacy service to whom children are referred following their visit to the centre. Whilst visiting the centre we reviewed the records of six of the 22 children whom had used the service provided by SABP in the last year. Subsequent to our visit we held a meeting with two members of the trust’s senior leadership team.

Our key findings were:

• Staff carried out safe, effective and comprehensive assessments of children.
• The service had good systems to help them manage risk.
• The staff used safeguarding processes effectively and knew their responsibilities for safeguarding children.
• The service had effective recruitment and staff training and development procedures.
• Doctors provided children’s care and treatment in line with current guidelines.
• Staff treated children with dignity and respect and took care to protect their privacy and personal information.
• The appointment / referral system met children and families’ needs.
• The service had effective leadership and a culture of continuous improvement through peer review.
• Staff felt valued and supported and worked well as a team.
• The staff had suitable information governance arrangements.

There was an area where the provider could make improvements. They should:

• Develop ways to obtain feedback from children and families in order to better understand their experience and make improvements as necessary.
• Ensure that all children are offered a choice of the gender of clinician prior to the examination.