The Care Quality Commission (CQC) has told leaders at Mid and South Essex NHS Foundation Trust that improvements are needed following an inspection of its maternity, surgical, medical and urgent and emergency services.
CQC carried out an inspection in July, August and September at Basildon University Hospital, Southend University Hospital and Broomfield Hospital to follow-up on concerns about the quality of care people were receiving. An inspection of the well-led domain of the trust overall was also carried out.
As a result of the inspection, the trust was rated as requires improvement overall. The trust was rated as good for being effective and caring and requires improvement for being safe and responsive. This is the first time inspectors have rated trust leadership which resulted in a rating of requires improvement. The overall rating for maternity services at Basildon University Hospital went up from inadequate to requires improvement.
The overall rating for maternity services at Southend University Hospital went down from good to requires improvement. Surgery, urgent and emergency and medical services were rated requires improvement.
Philippa Styles, CQC’s head of hospital inspection, said:
“Our inspection of Mid and South Essex NHS Foundation Trust found a mixed picture with areas where positive improvements had been made, but also areas where concerns were found. Following the trust’s formation in 2020, leaders should now be able to work together effectively to ensure care is consistent across all services.
“I recognise the enormous pressure NHS services are under across the country and that usual expectations cannot always be maintained, especially in the urgent and emergency department, but it is important they do all they can to mitigate risks to patient safety while facing these pressures.
“We did find however, that women and babies were having a better experience at Basildon University Hospital’s maternity department due to improvements. There has been historic issues and enforcement action in this department over a number of years, so it is very encouraging they are now making progress to ensure women have a positive birth experience.
“There was a decline in the quality of care being provided at Southend University Hospital’s maternity service. The service was continually short-staffed which affected midwives’ ability to work effectively. Leaders must ensure these issues are addressed so staff feel supported to do their jobs safely. Despite this challenge, staff and managers worked well with local organisations to ensure women received timely and appropriate care.
“The pandemic has been extremely challenging for urgent and emergency department staff, with many having low morale and being fearful to raise concerns. The leadership team were aware of this issue and had commissioned an external review of culture within the department.
“We continue to monitor the trust closely to focus its’ attention on the areas where it must improve, and to help it sustain areas where progress has already been made. We will return to check on their progress.”
Throughout all services visited and despite the unprecedented challenges the trust faced throughout the COVID-19 pandemic, the workforce remained unwavering in its focus on the needs of patients.
Staff generally worked well together to benefit patients and inspectors saw a kind workforce that supported patients, families and carers to understand their condition and make decisions about their care and treatment.
At Basildon University Hospital, inspectors found:
- The maternity service managed patient safety incidents well. Staff recognised and reported incidents and near misses
- Leaders in the maternity service understood and managed the priorities and issues the service faced. Local leaders were visible and approachable and supported staff to develop their skills and take on more senior roles
- Understaffing in surgery was often an issue but managers regularly reviewed and adjusted staffing levels and skill mix to keep patients safe.
At Southend University Hospital, inspectors found:
- Staff in the emergency department did not feel respected, supported or valued. The service did not have an open culture where staff could raise concerns without fear
- The surgery service didn’t always have enough medical staff with the right qualifications, skills and experience
- There was no robust process in place for prioritising women in the maternity service once they had been triaged.
At Broomfield Hospital, inspectors found:
- The maternity department was often understaffed which impacted on staff morale and workload
- Managers investigated incidents and shared lessons learned with the whole team and wider service
- Surgery staff identified and quickly acted upon patients at risk of deterioration. However, safety checklists and assessments were inconsistently completed.
Inspectors also found the following outstanding practice at Basildon University Hospital:
- The same day emergency care (SDEC) service had developed an admission avoidance pathway for COVID-19 patients to allow them to be monitored safely at home. This pathway could be adapted for other respiratory conditions.
Full details of the inspection are given in the report published on our website.
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Read the report published 1st December 2021: