The Care Quality Commission (CQC) has rated Mid and South Essex NHS Foundation Trust requires improvement, following an inspection undertaken between August and October.
Inspectors visited diagnostic imaging at Southend University Hospital as well as maternity services at Basildon University Hospital, Broomfield Hospital and Southend University Hospital.
The inspection was undertaken to assess concerns about the safety and quality of the services.
CQC also inspected trust’s leadership arrangements, due to the link between leadership and the quality of care people receive.
In addition to rating the trust requires improvement overall, CQC rated it requires improvement for being safe, responsive to people’s needs and well-led. CQC rated it good for being effective and caring.
Zoe Robinson, CQC head of hospital inspection, said:
“Although we found instances of good practice, despite the pressure NHS services and the wider healthcare sector face, there are improvements Mid and South Essex NHS Foundation Trust must make.
“These include ensuring care is not undermined in its maternity services by staffing shortages. While this is a national problem affecting many hospitals, leaders must develop ways of minimising the risk to patients this causes.
“The trust must also ensure its staff complete all relevant training to support them to meet patient need, and that it engages with patients and families in line with its legal obligations when something has gone wrong in a patient’s care.
“However, staff collaborated well in the interests of patients.
“We also found the trust worked well with other local healthcare providers to support patients, and it captured people’s feedback to help it improve.
“Following the inspection, we reported out findings to the trust’s leaders – so they know where they have work to do. We continue to monitor the trust to ensure people receive safe and effective care and treatment.”
The inspection found:
- In addition to rating the trust requires improvement overall following the inspection, CQC rated its three major hospitals – Basildon University Hospital, Broomfield Hospital and Southend University Hospital – requires improvement
- The following core services were inspected. Each was rated requires improvement:
- Maternity at Southend University Hospital
- Maternity at Basildon University Hospital
- Maternity at Broomfield Hospital
- Diagnostic imaging at Southend University Hospital.
- Across the trust, inspectors found not all staff had completed mandatory training
- Maternity services did not have enough staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm, and to consistently provide the right care and treatment
- The trust did not always share learning from incidents, or ensure mitigating actions were appropriately embedded
- The duty of candour, a legal obligation requiring healthcare providers to be open and honest with patients and their families after something has gone wrong in their care, was not discharged as soon as reasonably practicable after a notifiable safety incident had occurred
- Nurses and midwives did not always receive an appraisal in line with the trust's target
- Women using the trust’s maternity services were not always triaged within target times, neither could they always access the service when they needed it. This meant they did not receive the right care promptly or within national target times.
However:
- Staff provided care and treatment based on national guidance and evidence-based practice.
- Doctors, nurses and other healthcare professionals in maternity collaborated to benefit women and babies
- People could easily give feedback and raise concerns, and complaints were taken seriously
- Leaders operated effective governance processes throughout the trust and with partner organisations.
Following the inspection, CQC told the trust that it must take some actions to meet legal requirements. These include:
Trust wide:
- Discharging the duty of candour appropriately
- Sharing learning from incidents and ensuring mitigating actions are embedded.
In maternity services across the trust:
- Ensuring there are enough staff to meet demand
- Meeting targets for all mandatory and safeguarding training
- Appraising nursing and midwifery staff in line with trust targets
- Auditing care records
- Recording all necessary data appropriately
- Ensuring all handovers are managed appropriately.
In the maternity service at Broomfield Hospital:
- Implementing a process for the safe storage and distribution of breast milk
- Triaging women in line with target times
- Ensuring there are processes to record cleaning and equipment checks, reviewing these and escalating non-compliance.
In the maternity service at Basildon University Hospital:
- Ensuring processes are in place for the safe storage of all medicines
- Checking equipment in line with policy to ensure its suitability.
In diagnostic imaging at Southend University Hospital
- Implementing policies to support staff to provide safe care and treatment for children
- Ensuring patients receive treatment within agreed timeframes and national targets
- Continuing to recruit radiography staff to fill vacancies to meet the required staffing levels
- Ensuring learning from all incidents is escalated, shared and clearly recorded
- Ensuring CCTV in the CT and plain film waiting area is operational to give staff oversight of waiting patients, and to keep patients and staff safe – particularly out of hours.