Broomfield Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Since our last assessment we found some improvements in the completion of risk assessments. We saw evidence staff were recognising risks factors and escalating appropriately in accordance with trust guidelines. We saw improvement in incident reporting by staff, which was overseen and supported my managers on duty. The service had made progress on the back log of open incidents and actions were in place to have the backlog cleared by end of August 2024. The service took steps to ensure staff were informed of prevention of baby abduction procedures and pool evacuation drills. Generally, records and documentation had improved. Leaders acknowledge there is still on-going work to be done and are on track with their digital improvement project for 2026. Since our last assessment the service had taken action to ensure that all medicines and milk products were stored correctly. Temperature monitoring continued and there were plans to install air conditioning units in treatment rooms. Improvements were made to equipment maintenance and servicing. We found most of the equipment throughout the department to be within service date, checked and clean. The service had improved the telephone triage system to ensure it was answered by the appropriately qualified midwife and that records were kept of every call. We continued to see how bed capacity for postnatal care, and the demand on the service was impacting on service delivery. Broomfield hospital had the highest birth rates of all the 3 Mid and South Essex Foundation Trust (MSE) hospitals but had the smallest postnatal bed capacity. This lack of available space was having a direct impact on people’s safety. Due to restrictions with the estate at Broomfield Hospital there had not been a sustainable solution for the space needed and we were advised other options were being explored.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Since our last assessment in March 2024, leaders had taken steps to improve the communication to staff regarding learning from incidents where there was an increased risk of harm to women and babies. Staff we spoke with at time of this assessment felt informed about incidents and received regular emails from risk leads highlighting any necessary learning. However, there was not a clear system to record which staff had read and acknowledge this learning. The new appointed head of midwifery at Broomfield Hospital had oversight of all maternity incidents and there was a platform for shared learning across all 3 MSE hospitals. Leaders told us there were still 164 overdue incidents to review and 11 identified risks on the Broomfield Hospital maternity risk register. Some staff told us the lack of digital patient care records could sometimes cause delays in carrying out investigations, but they were able to demonstrate how they escalated and record these delays accordingly.

Whilst the service had updated several maternity policies to reflect best practice and current guidance, there were still delays to safety investigations, shared learning for staff and across all MSE hospitals. The system did not demonstrate how leadership were assured actions and improvements were being implemented promptly to prevent future incidents. Impacting this process was the delay in accessing postnatal notes as they would be taken home post-delivery. This meant there could be a potential 3-to-4-week delay in reviewing those documents, delaying investigations and quality audits being completed. This delay further impacted on learning being shared with staff.

People told us during antenatal care they would not see the same midwife or consultant which meant explaining and repeating information at each care contact. They felt this led to poor communication between departments and information not being recorded correctly. Since our last assessment in March 2024 actions had been taken to improve this. Those waiting for elective caesarean section (ECS), had been provided with a new allocated waiting area. During this assessment, women, birthing people, and their families told us they felt comfortable and had privacy whilst waiting for their procedure. Some people still told us they felt communication about their caesarean section could have been better. Some told us they had experienced misinformation and delays when booking in for procedure and felt they had limited support from staff whilst waiting in the waiting room. Some told us due to high capacity in the department after delivery they had been moved to a room with a sofa bed as there was no beds available. They told us they felt this was not appropriate after just giving birth.

During this follow up assessment we saw evidence again that the bed capacity within the maternity department at Broomfield was impacting on the flow through the units. Leaders and staff told us again that due to the limited bed capacity in postnatal ward it meant managing patient flow through the department was a challenge. At time of our assessment, we saw women and birthing people having prolonged stays on labour ward post-delivery due to lack of space on the postnatal ward. This then impacted on the wait for delivery, whilst potentially awaiting an available bed on labour ward. Some staff told us that they felt under pressure to discharge women, birthing people, and their babies and that at times they were unable to give them all the care and support needed prior to discharge. Other staff told us they saw a direct link between pressures to discharge and the readmission of babies, women, birthing people back into the unit. At the time of our assessment staff on Day Assessment Unit told us they manage induction of labour (IOL) well and felt they were safe in their processes. However, at times IOL could be delayed due to lack of capacity within DAU. It was unclear how these women, birthing people were monitored, and risk assessed whilst waiting to attend the unit.

Since our last assessment the service had implemented an induction of labour (IOL) and elective caesarean section (ECS) risk assessment proforma that were due to be completed daily and discussed at their morning safety huddle. However, evidence reviewed showed risk assessment meetings did not always happen. During the assessment, concerns were raised over delayed induction of labour (IOL). There was limited monitoring of those women and birthing people being asked to remain at home till they had capacity within the unit to start their IOL process. On the day assessment unit (DAU) we continued to see delays to IOL processes due to capacity issues within the department, these delays were not always risk assessed and prioritised. There had been an increase in post-partum haemorrhages (PPH) and 3rd and 4th degree tears, where IOL is identified a risk factor. The service did not always follow national guidance and their own policies when commencing IOL processes. Reviewing data post assessment, we continued to see evidence that fetal growth scans were not being carried out within policy timeframes due to constraints within the scanning departments. The failure to carry out the scans in a timely way impacted on the early recognition of small for gestational age babies and put babies at risk of poor outcomes. Smoking risk factors were not always identified and monitored in line with national guidance.

People told us they felt supported by staff and felt able to seek support. Women, birthing people and their families told us they have received the appropriate referrals for assistance and were always asked by midwifery staff if they had any concerns.

Staff told us they received safeguarding training as part of their mandatory training sessions. Staff and leaders understood their roles and responsibilities relating to safeguarding and had systems to follow to make referrals and record actions taken. Staff were aware of the maternity safeguard lead role and felt able to seek support and advise if needed. Staff told us any safeguarding concerns would be discussed at shift handovers and all relevant staff would be made aware of any safety alerts.

The service had policies and processes to recognise and report safeguarding concerns for women, birthing people, and their babies. The service provided evidence during assessment that demonstrated when safeguarding referrals were correctly made there had been a multiagency approach to this process and women, birthing people and families received tailored support with welfare for all involved. However, this was not always applied and activated appropriately which led to some safeguarding concerns being missed in some cases.

People feedback on their pathway through maternity services was mixed. Women and birthing people told us that sometimes during antenatal care they received conflicting information and advice given lacked consistency. They felt improvements needed to be made with communications about their care. Women, birthing people and their families we spoke to on postnatal ward felt there was a need for clearer conversations about care options as they felt at times plans were not shared. This had led to feelings of anxiety and uncertainty about what was happening. People on DAU told us midwifery staff had been very supportive and explained processes well. They had shared information around risk and gave options to manage symptoms.

Since our last assessment staff told us processes had changed around risk assessment of induction of labour (IOL) and elective caesarean section (ECS) pathways. Up to date posters with risk information were displayed in all areas of the department. Leaders told us morning risk meetings had been introduced to better manage risk and capacity within the unit but not all staff were informed of these meetings outcomes. Staff told us ‘Hot Topics’ were shared with staff via email, and they would talk about learning from incidents and any safety alerts during shift handovers and there was an improved multi-disciplinary approach to risk management. Staff told us they felt there was shared learning across all the 3 MSE hospitals. Some staff told us they were concerned and did not have confidence that prompt actions would be taken or escalated as some reporting leaders did not have the right clinical experience.

Since our last assessment the service had taken steps to improve its maternity triage processes. There was a system established to monitor incoming phone calls and identify repeated and drop calls. Maternity risk factors throughout the care pathway were not always being identified and not always escalated promptly. Daily risk meetings did not always happen, and risk assessments were not always carried out or documented. Since our last assessment there had been a decline in several safety compliance elements relating to Saving Babies Lives Care Bundle v3. Obstetricians were not always involving women and birthing people in conversations regarding pre-term delivery and the care options available to them. There had been limited progress with obtaining additional ultrasound facilities which continued to impact the identification of small for gestational age babies putting them at risk of poor outcomes.

Improvements had been made to the IOL waiting area, people told us they were made to feel comfortable by staff, but they were not sure how to call for help if needed. Some women, birthing people and their families told us they had concerns over the security on postnatal ward. They felt at times it was not safe as people were able to tailgate staff and other people into the ward without being challenged by staff. People told us they were worried about the safety of their loved ones whilst on postnatal ward as it was a very busy unit with many visitors, staff and contractors on the hospital site.

Staff told us that due to triage appointment phone lines being moved out of DAU there was now more space to carry out assessments. Staff felt this change had a positive impact on the flow within the unit and enabled greater oversight of care during busier times. Staff told us there had been a recent security incident on postnatal ward where a family member became verbally abusive and would not leave. Staff told us there was limited measures to stop this person coming back onto the unit and were not assured security teams could identify them if they returned. Staff told us there was limited space in the unit for staff to take rest breaks. Staff rooms were shared between wards and at times these were crowded and had no available seats for all the staff taking breaks. Leaders told us they were aware of the staff room issues and had struggled to accommodate additional space due to available space. Shift handovers on DAU were still being carried out in the wating room, which meant those women and birthing people present would have to leave and wait in the corridor. This remained an issue for maintaining confidentiality as seen at our last assessment. Staff told us they had limited storage space for theatre equipment, and they would often run out before new stock had arrived which at times would leave them without some equipment. We were not made aware of anyone coming to any harm due to lack of equipment being readily available however it was not part of the risk assessment for the area.

During this assessment we reviewed equipment in all areas of the unit. Equipment had been serviced, well maintained and clean. On the postnatal ward we found some medical consumables out of date and an unsecured resuscitation trolley which was escalated to staff and rectified. Entry doors to units had locked entry and exit systems with Close Circuit Television Video (CCTV) monitoring in use. However, during our assessment we observed a very busy postnatal ward, with visitors, maintenance contractors and staff walking through the department. We observed people tailgating others into the unit. Staff could not be assured all people entering the unit had their identification checked before entry. The midwife’s station on the postnatal ward had a white board with women and birthing people’s surnames visible for all to see. This accompanied with the lack of challenge to visitors by staff posed an additional safety risk.

Since our last assessment, processes around equipment maintenance and monitoring had improved. New cardiotachygraph (CTG) machines had been distributed throughout the department and staff had received the relevant training. The service had up to date maintenance records and maternity leads were working closely with the medical equipment team to maintain good compliance with servicing. Despite having processes and guidance regarding the security of entrances to the department, this had not been fully embedded in staff’s practice.

Capacity and staffing concerns remained from our previous assessment. Staff told us they continued to be stretched and did their best under the pressure. Staff said they would often be short staffed at night or weekends and that leaders were slow to escalate and manage the situation. Staff told us staffing levels were a challenge particularly in DAU, explained that midwives were often pulled into labour ward leaving DAU understaffed by a midwife. However, staff overall felt they kept the department safe and the care they delivered was good. Staff told us that due to demand on service the recent cardiac arrest training and baby abduction drills had been cancelled. However, training leads told us they carried out regular simulation training under their competency framework and new staff completed a 3-week induction and mandatory training package. Following this new staff completed supernumerary hours under supervision until deemed competent to work autonomously.

As part of this assessment, we again visited the day assessment unit, triage, theatres, labour, and postnatal wards to carry out observations. Staff overall were responsive and caring to those in their care. Staff answered call bells in a timely way and introduced themselves on first contact. The department was busy throughout our assessment, midwifery and support staff were continually caring for women, birthing people and their babies delivering good care. In DAU staff had benefited now the triage line had been moved and we observed a more structured assessment unit. Interaction between staff was overall positive and productive.

The service has policies and procedures to support and develop its midwifery workforce. However, there remained breaks in training schedules with sessions often cancelled due to the unit’s activity. Department staffing levels were monitored daily and minimum staffing levels were not always met. Staff were often moved around during night and weekend shifts to relieve pressure on the unit however the impact of this approach was not clearly escalated to trust leaders. Ward clerks were also only working 8am to 4pm on postnatal ward which put extra pressure on midwifery staff outside of these hours when the visiting level was also at its highest

Staff told us transitional care (TC) space was still being utilised for postnatal capacity when the unit was busy. Babies coming back into the unit were also next to newborn babies in this area. This risk of community acquired infection being brought into the TC bays was increased with the limited isolation spaces available on the ward. Staff discussed their concerns with the lack of clear readmission pathways and that other MSE hospitals had more effective processes to reduce risks. Staff told us due to limited spaces for staff facilities they often used the family kitchen to make drinks and heat food.

The service had procedures regarding cleaning and infection control within the unit. Cleaning schedules were completed by the domestic staff, equipment was labelled as clean and deemed ready to use. The service used digital audits tools to help monitor its compliance with hand hygiene, equipment, and environmental infection prevention control measures. However, the policies or audits did not show that windows, doors, and administrative areas were being cleaned and monitored. The trust had an isolation policy that addressed the risk of spreading infectious diseases, however this document did not give guidance on the readmission of neonatal babies back into the postnatal ward and potential risk associated with infection transmission.

Staff were trained to administer medicines safely. Staff demonstrated good understanding of how to monitor for and manage medical emergencies that can occur in pregnancy, including post-partum haemorrhages and sepsis. Where people had a history which put them at increased risk of certain conditions developing, these were recorded throughout their medical records so that staff understood risks to people. There were processes followed by staff to mitigate risk through safe and effective use of medicines. Staff ensured they followed peoples cultural and religious beliefs when supporting them through their pregnancy with medicines.

The trust used a paper-based system to prescribe and record administration of medicines. There were policies and procedures to support the safe and effective use of medicines. People were supported to manage and administer their own medicines where appropriate. There were processes to ensure people entering services received the medicines they needed. People with more complex needs were cared for in areas where staff were able to monitor them more effectively. Medicines were usually stored safely and securely. Staff took appropriate actions to ensure that medicines were still safe to use if stored at higher than recommended temperatures. Prescribers sometimes did not follow best practice guidance when writing prescriptions. We saw some examples where shorthand was used that could be mis-interpreted or where doses had not been written for common analgesia medicines.