Basildon University Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Managers monitored patient care, treatment, and outcomes in line with legislation, standards and evidence-based clinical guidance. However, audits were not always carried out regularly which meant learning was not identified in a timely manner to support effective care for women.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Women and birthing people said they had extremely good communication from staff, they felt their care was coordinated and staff kept them informed throughout their care journey. For example, staff enabled women and birthing people to continue to breast feed, even when their babies were in another part of the service, and midwives prioritised women and birthing people’s wishes.

Staff told us that daily huddles and multi-disciplinary handovers were held to support safe transition of care between teams during shift changes. Potential and planned discharges were also supported through daily meetings with referrals made prior to discharge. Staff told us how they could access specialist teams, such as alcohol liaison and mental health, to support women they cared for and improve outcomes. Working groups and senior leaders reviewed performance and audit results which were shared with staff so that they were aware of performance. However, not all staff were aware of performance on their ward, for example, some staff we spoke with were not aware of performance against the BSOTS triage tool. Staff told us they collected and analysed data, such as fridge and freezer temperatures, birthing pool temperatures and infection prevention and control. Actions were identified for areas of poor compliance. Improvements were made following incidents. For example, an Entonox Antenatal Training Pathway Policy was developed in response to a recent Entonox high exposure incident. Entonox is used for the relief of acute pain and discomfort. An ongoing programme of quarterly monitoring to measure exposure levels of Entonox in the maternity unit was in place.

The service planned audits to improve care, performance and provide assurance. Audits were prioritised and leads were identified for accountability. However, we were not assured that clinical effectiveness audits were carried out regularly and that learning was identified in a timely manner to support effective care for women. For example, the delay in care audit showed low staffing contributed to delays in admission and induction in June 2023, but this continued to remain high through July and August 2023. A range of clinical effectiveness audits were reviewed such as delayed care, pain relief and fresh eyes with compliance ranging from 60 to 100%. Red flags audit data was only reflective of 1:1 care when indicated, however, the pain relief audit carried out in April 2024 post assessment found 65% effectiveness in delivering pain relief against the recommended RCOA guidance. The trust had identified actions to improve compliance. The service completed perinatal mortality reviews for maternal and baby deaths, with the aim to learn from and prevent future deaths. However, following the assessment, we were told that 46% of reviews had been completed and published for 2023-2024. This meant the trust were not identifying causes of deaths within the recommended timeframe, thereby increasing the risk of reoccurrence. A process was in place to learn from incidents and improve outcomes for women and their babies. The service received 5 serious incident reviews from the Healthcare Safety Investigation Branch (HSIB, now MNSI) in the 12 months prior to this assessment. HSIB undertook independent investigations into incidents within maternity services which fall under a defined criteria that includes maternal deaths, stillbirths and babies that require treatment for a lack of oxygen to the brain caused during birth. All investigations accepted by HSIB were reported as a serious incident.

Outcomes for women were monitored and benchmarked against national and local standards. Outcomes monitored included, but were not limited to, maternal deaths and morbidity, and stillbirths. A live dashboard of performance was in place which was accessible to senior managers. Key performance indicators were displayed for review and managers could see other locations for internal benchmarking and comparison. Key information from the dashboard, score cards, audits and performance data were available for staff, women, birthing people and public to access. Managers monitored outcomes on the maternity scorecard, which provided statistical information monthly. When these statistical figures were outside national standards, these were discussed at risk meetings to ensure actions were taken to improve. Maternity services participated in both national and local audits, including the National Maternity and Perinatal Audit. This looked at statistical information about birth, such as the number of caesarean sections performed, whether an episiotomy (deliberate cut to avoid a tear during birth) was performed or the number of women and birthing people who had given up smoking while pregnant.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.