The Care Quality Commission (CQC) has published a report on maternity services at Broomfield Hospital, run by Mid and South Essex NHS Foundation Trust following an inspection in March last year. The inspection in March saw the maternity service’s overall rating decline from requires improvement to inadequate. A follow up inspection in July showed that some improvements have been implemented since then, and the results of that inspection will be published shortly.
During the inspection in March, CQC raised immediate concerns about triage times and capacity to support women, people using the service and their babies, and issued the trust with a Section 31 letter of intent under the Health and Social Care Act 2008 to ensure rapid improvement. CQC placed conditions on them as part of that, requiring them to demonstrate how they were managing people’s safety and mitigating risk in line with national guidance. The trust submitted an action plan setting out the immediate action they would take. Since the inspection CQC has seen some improvements in these areas at the July inspection, which will be reflected in the subsequent report.
As a result of the March inspection, the overall rating for maternity services at Broomfield Hospital dropped from requires improvement to inadequate, as have the ratings for how safe and well-led the service was. The service has again been rated requires improvement for effective. It has been rated as good for responsive. How caring the service was has not been rated.
The ratings of the hospital and the trust overall remain unchanged as requires improvement.
Rob Assall, CQC’s director of operations in the East of England, said:
“When we inspected in March, we raised immediate concerns with the trust and demanded they took action to keep mothers and babies safe. In response, they set out a clear action plan and we inspected again in July to check these improvements had been made. We saw evidence of steps taken to improve safety, including a telephone triage line and caesarean section waiting room area. We’ll be publishing the findings from our July inspection - which details improvements alongside the work that still needs to be done – shortly.
“We’ve worked with the trust in the months since our initial inspection and will continue to monitor closely to ensure that improvements are being embedded. If we do not find that these improvements are sustained, we will take action to ensure that mothers and babies are getting the high-quality care they deserve.
Inspectors found:
- Staff didn't always have time to complete incident reports, and these were often completed retrospectively by leaders
- Staff told inspectors that leaders weren't proactive at preventing incidents before they had occurred. They told inspectors senior leadership teams didn't always learn from poor outcomes after incidents had been reported
- Inspectors observed incorrect storage of medication and milk products that weren’t in line with trust policy or manufacturers' guidance. There was no effective audit process in place to ensure medicine records were completed as required
- Staff told inspectors they weren't sure what constituted a maternity red flag. A midwifery red flag is a warning sign that something maybe wrong with staffing.
However:
- People told CQC that staff were working hard to meet everyone’s needs
- People told inspectors that they felt able to raise concerns to maternity staff and felt they were dealt with promptly
- Staff told CQC they were able to signpost women, people and their families to the trusts complaints procedure and that they felt able to escalate any immediate concerns to the heads of the department
- Call bells were accessible, and staff encouraged them to be used to call for assistance if needed.
Due to a large-scale transformation programme at CQC, this report has not published as soon after the inspection as it should have done. The programme involved changes to the technology CQC uses but resulted in problems with the systems and processes rather than the intended benefits. The amount of time taken to publish this report falls far short of what people using services and the trust should be able to expect and CQC apologises for this. While publication of some reports has been delayed, any immediate action that CQC needed to take to protect people using services will not have been affected and acted on appropriately. CQC is taking urgent steps to ensure that inspection reports are published in a much more timely manner.