Archived: Broomfield Hospital

Updated 6 March 2020

Mid Essex Hospital Services NHS Trust was established in 1992 and continues to provide local elective and emergency acute medical services for adults and children for over 380,000 people living in and around Chelmsford, Maldon, Braintree and Witham. The trust also includes Braintree Community Hospital which covers the whole of Mid Essex and includes a variety of services including x-rays, MRI scans, CT scans, ultrasound, day surgery, endoscopies, physiotherapy, nursing and rehabilitation services. 

In addition, the trust provides county wide plastics, head and neck, and upper gastrointestinal (GI) surgical services to a population of 3.4 million and a supra regional burns service to a population of 9.8 million.

The trust employs over 5,000 staff and had a total turnover of £317m in 2018/19.  

The trust continues to focus on performance and financial improvements, supported by NHS Intelligence, NHS England and the CCG, to deliver their vision of becoming a financially stable, modern health system that delivers integration and excellence in local and specialist services. 

Updated 6 March 2020

We did not inspect all services at this inspection but we combined previous inspection ratings for those not inspected to give an overall rating for the hospital. We inspected urgent and emergency care, medical care, surgery, children and young people’s services, outpatients and diagnostic imaging.

Our rating of services went down. We rated it them as requires improvement because:

• We rated safe, effective, responsive and well-led as requires improvement and caring was rated as good.
• Our rating for safe remained the same. Staffing remained a challenge for the trust and the processes to ensure that temporary staff were competent for roles was not consistently applied. There were inconsistent practices in medicines management and record keeping.
• Our rating for effective went down to requires improvement. Local and national audits were not being utilised to drive improvements and improve patient outcomes, there was a lack of training for staff in the Mental Capacity Act, 2005.
• Our rating for caring remained the same. However, we found in some areas of medical care services, that staffing challenges limited staff’s capacity to always deliver compassionate care.
• Our rating for responsive went down to requires improvement. There were significant issues with access and flow throughout the hospital. Patients could not always access care and treatment in a timely manner.
• Our rating for well-led went down to requires improvement. There were no clear strategies for individual services. Staff were unclear of how they could contribute to the development and delivery of long-term objectives. The trust was going through a period of transition and infrastructures were being developed and were yet to be implemented.

However

• The trust had developed plans with external stakeholders for future provision of services in line with national objectives to achieve sustainable quality care.

Updated 6 March 2020

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However,

• The ward areas lacked space for family rooms or break out rooms to support patient activities.
• We were not assured that people could access the service when they needed it or that they received the right care promptly.
• The staff handovers lacked consistency and impacted on the patients’ experience, privacy and confidentiality.

Updated 16 April 2015

There were arrangements in place to implement good practice, learning from any untoward incidents, and an open culture to encourage a focus on patient safety and risk management practices. There were effective arrangements to identify and manage risk, and keep patients safe. We saw good examples of care being provided, with a compassionate and dignified approach.

National guidance was being implemented, and monitoring systems to measure performance were in place. The number of staff receiving mandatory training and appraisals was high. The children and young people’s service understood the different needs of the communities it serves, and acted on these to plan and design services. The paediatric department encouraged children, their relatives, and those close to them, to provide feedback about their care, and were keen to learn from experience, concerns and complaints.

Updated 16 April 2015

We found that the critical care service was safe, effective, caring and responsive to meet the needs of patients and relatives, and the service was well-led, with strong local leadership of the units. Medical staffing levels were in line with national guidance, Core Standards for Intensive Care Units 2013, with factors such as case mix, patient turnover and ratios of trainees considered. Nursing staffing establishment levels and skill mix were adequate across both units. The management at service level were clear about their roles and vision for the service. Staff morale was high, and a supportive environment was in place, with robust competency and training packages, small team allocations, and close working with the wider multidisciplinary team (MDT).

Updated 30 January 2019

We previously inspected diagnostic imaging jointly with outpatients so we cannot compare our new ratings directly with previous ratings.

We rated this service as requires improvement because:

• The service did not always have systems in place to ensure that staff were able to identify and respond appropriately to changing risks to people who used services.
• There were staff shortages and low mandatory training and appraisal rates.
• The service had not always ensured that checks on the environment and equipment were regularly carried out, or that cleaning was regularly carried out or documented.
• The service was not carrying out discrepancy audits to review the quality of reports and audit activity in 2017 had been limited.
• Patients were not always able to access diagnostic imaging services or receive imaging reports in a timely manner.
• The management of risk and performance was not always robust.

However,

• Storage of contrast media had improved since our last inspection
• Staff understood their roles and responsibilities in safeguarding and under the Mental Capacity Act.
• Patients gave consistently positive feedback about the care provided by staff.
• Staff described cooperative, supportive and appreciative relationships with colleagues.

Updated 6 March 2020

We rated this service as good because:

• Nursing staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records and stored them securely. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However,

• Not all national time to treatment targets were published so we were unable to assess if the trust met these targets. Complaints were not closed within the timeframes set out in the trust’s policy.

Updated 1 December 2016

We rated the service as good overall. The safety, effective, caring and well-led domains have all been rated as good, and the responsive domain has all been rated as requires improvement.

End of life care to patients was good overall. The specialist palliative care team (SPCT) and the ward staff involved in end of life care were passionate, caring and maintained patients’ dignity throughout their care.

Since our last inspection visit in 2014 the completion of do not attempt cardiopulmonary resuscitation (DNACPR) forms had improved significantly.

The ‘Last Days of Life Care Plan’, a holistic document which was in line with the five priorities of care has been rolled out in all the adult wards. This document not only guides staff to consider the clinical needs of the patient but also prompts to consider and discuss the patient’s physical, emotional, spiritual, psychological and social needs.

The SPCT delivered end of life care education for medical, nursing and allied health care professionals as part of the mandatory trust induction, Preceptorship programme, Health Care Assistant and Healthcare Professionals study days, and also on the medical training programme.

The trust had put in place an end of life care facilitator which worked across the trust and each ward had a palliative/end of life care champion to support staff with any end of life training needs.

However:

Patients who had requested to be cared for in their own homes had experienced delayed discharges. There was no rapid discharge process in place.

There was no formal audit process of peoples preferred place of care/death or discharge times

Updated 6 March 2020

We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings. We rated it as good because:

• The service controlled infection risk well. Staff assessed risks to women and babies, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave women enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to women, families and carers.
• The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of women receiving care. Staff were clear about their roles and accountabilities. The service engaged well with women and the community to plan and manage services and all staff were committed to improving services continually.

However,

• The service did not always have enough medical staff to care for women and keep women and babies safe and did not always make sure staff completed mandatory and safeguarding training. Staff did not always manage medicines well.

Updated 6 March 2020

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week. Not all nursing staff received an annual appraisal.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders ran services well and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However,

• The design, maintenance and use of facilities, premises and equipment did not always keep people safe. Not all nursing staff that treated children were trained to safeguarding level three in line with the intercollegiate document ‘Safeguarding children – roles and competencies for healthcare staff’ 2014.
• We were not assured that people could always access the service when they needed it. Waiting times for treatment and arrangements to admit, treat and discharge patients did not meet the England average for all specialities. Complaints were not closed within the timeframes set out in the trust’s policy.

Updated 1 December 2016

We rated the Specialist burns and plastics service as outstanding overall. The Safety and Responsive domain has been rated as good, and the effective, caring and well-led domains have all been rated as outstanding.

Safety performance since our last visit in 2014 had improved significantly in the plastic’s trauma service, and performance remained outstanding in the burns service.

Compliance with mandatory training for all staff was was well above the trust average, and there was always a sufficient number of staff on duty to meet the needs of people who used the service.Lessons were learnt following incidents and appropriate action taken to improve safety beyond the affected team.

There was an abundance of service specific policies and procedures available developed by the directorate, which reflected evidence based practice, national guidance and relevant legislation. There was dedicated research team for the directorate, and audit results showed that outcomes for people using the burns service were good.

All nursing and support staff had either completed or were working through service specific competencies.

Pain management was effective and delivered through a multidisciplinary team approach.

The Friends and Family Test (FFT) results for the directorate were consistently high and the best in the trust, and feedback from people who used the service was consistently and overwhelmingly positive.

The service was innovative in ensuring patients understood and were involved in their care.Emotional support available was extensive and tailored to individual need. Services were planned and delivered to meet the needs of people using the service, and they were constantly evolving to improve continuity, flexibility and choice of care. Formal complaints were low and managed effectively.

Access and flow throughout the burns service was seamless, and in the plastic surgery service significant improvement and action had been taken to enhance seamlessness. Leaders were quick to respond to concerns, were visible and approachable, and staff could not speak more highly of them.

We found an extensive amount of examples which demonstrated the directorate was innovative, made improvements where needed and ensured sustainability of service provision. Throughout services staff were extremely positive, energised, passionate about their role and felt involved in service development.

However :

MRSA screening for elective and emergency patients was below trust expectation, and the service was not monitoring trauma surgery cancellations.

Staff appraisal rates on some wards was below trust expectation, however we found that appropriate action was being taken to improve compliance.

The Friends and Family Test was not carried out on Mayflower ward.

Updated 6 March 2020

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service did not have enough staff to care for patients. Not all medical staff had completed training in key skills to understand how to protect patients from abuse. The service did not always control infection risk well. Staff did not always assess the risks to patients or keep good care records. They did not manage all medicine processes well.
• The service did not always make sure that staff were competent for their roles. Not all staff had received an appraisal within required timeframes.
• We were not assured that people could access the service when they needed it and that they received the right care promptly. Complaints were not closed within the timeframes set out in the trust’s policy.
• We could not gain assurance that leaders always operated effective governance processes throughout the service. Performance did not always show steady and sustainable signs of improvement. Not all risks were identified and escalated with documented actions to reduce their impact.

However,

• The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• Staff understood the service’s vision and values, and how to apply them in their work. Staff were focused on the needs of patients receiving care. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 6 March 2020

Our rating of this service stayed the same. We rated it as requires improvement because:

• Although we found the service largely performed well, it did not meet legal requirements relating to Regulation 12, Safe care and treatment, meaning we could not give it a rating higher than requires improvement.
• The service did not always have enough staff to care for patients and keep them safe. Staff did not always assess risks to patients or act on them. Staff did not always keep good care records. Equipment was not always visibly clean.
• Managers did not always monitor the effectiveness of the service or make sure staff were competent. Although they generally provided good care and treatment they did not always meet national clinical audits, calculate fluid balance charts or complete staff appraisals.
• People could not always access the service when they needed it and did not always receive care promptly. Complaints were not always dealt with in a timely manner.

However,

• Staff had training in key skills and understood how to protect patients from abuse. Staff managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff generally provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders ran services well, using mostly reliable information systems, and supported staff to develop their skills. Staff understood the service’s vision and values and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.