Broomfield Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Broomfield Hospital maternity services formed part of the care group which included obstetrics, gynaecology, and paediatrics within the MSE trust. On this follow up assessment there were still shortfalls in the management and safety of the services care pathways, risks identification, escalation, and outcomes. Some measure had been taken by the services leadership to address the lack of oversight of risk, but these processes had not been fully embedded in practice. Concerns remained over how staff were being listened too and supported. Learning from incidents was still slow. Leadership considered pressure in the department and poor outcomes/incidents were normal for the size of service and accepted as everyday occurrences. Alternative approaches and proactive actions were not always understood or recognised. Where changes were being made, they were not happening fast enough to benefit people as soon as possible.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they had seen changes since our last assessment and felt leaders had now listened to some of the concerns and views from staff. Staff told us there was still work to be done to standardise practices across all the MSE hospitals but felt the new head of midwifery (HOM) having come from another MSE location was bringing fresh eyes to the Broomfield Hospital maternity services. Within the department staff told us there was a much-improved relationship between midwifery and obstetric staff. However, it was not yet possible to demonstrate if this had improved outcomes for people using the service.

During this assessment we continued to see variations in procedures which meant women, birthing people and their families could receive different maternity care experiences depending on what MSE hospital they attended. Following on from our assessment the service did review and update several maternity policies that were out of date and not standardised across MSE. Since our last assessment leaders had implemented several actions however not all staff were included in this change management processes.

Staff told us that they felt supported by their immediate clinical leads. Staff felt able to speak to the shift managers about concerns or personal issues. Staff spoke with colleagues and shift managers when involved in incidents but told us there was no process for official support offered. Midwifery staff told us that shift leads tried their best to make sure all staff had breaks but sometimes due to the unit being busy this would not happen. Leaders told us that since our last inspection they had carried out several staff engagement ‘walk arounds’ in the unit as a listening experience. Leaders told us they had monitored staff welfare during the journey of improvement, and staff told us they welcomed the opportunity to make lasting changes to improve care delivery and outcomes.

Evidence we reviewed showed since our last inspection leaders had carried out ‘walk arounds’ in the unit to engage with staff. However, we did not see what issues or concerns were discussed or what actions the trust had taken to address staff comments. Opportunities for staff to develop and influence change was limited. We saw no evidence where midwifery and support staff were being included in quality improvement projects. At the time of assessment Broomfield Hospital maternity services was not meeting its staff’s yearly appraisal target of 90%.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Since our last assessment some student midwives told us they felt well supported and part of the team. They said there had been previous issues with negative behaviour towards students, but this had been dealt with by leaders and they now felt it was a great place to work. They told us that maternity coordinators were great advocates for students on the unit and felt confident in raising concerns and speaking up. They were aware of all the services policies and procedures and knew where to find learning from incident information.

The service offered equality and diversity and inclusion (EDI) online training as part of their mandatory package. This brief online course explored the Humans Rights Act 1998, and the responsibility employees must uphold the acts principles. We asked leaders but were not provided any data on how many maternity staff had completed this training.

Some staff told us there had been an instability within the midwifery senior management structure for many months. Because of this they felt leadership teams at times lacked clear objectives as there had been a constant fluctuation in priorities. Since our last assessment the trust had relocated an interim head of midwifery to assist in the changes needed to improve the service. Leaders told us they reviewed daily the capacity and safety of the unit. They said they used a national recognised tool Operating Pressures Escalation Levels (OPEL) to grade what pressure the unit was under and what assistance they might be able to offer other maternity services. However, staff told us they would often be bed blocked but declare a “green” OPEL status which meant they would be able to help other maternity services when in fact they did not have such capacity to offer out. Staff felt this was unsafe. Since our last assessment the service had relocated one elective caesarean section list to another MSE hospital, however this action had not improved the overall capacity or flow issues on the unit.

During our last assessment we raised concerns around the capacity management of the unit and the service’s daily OPEL status. Since then, the service’s daily OPEL status had been reviewed, shared, and agreed amongst leaders. However not all capacity and flow associated risks had been identified, escalated, and addressed. There was a lack of effective governance processes to address the management and sustainability of the maternity service. We continued to see a back log with investigating incidents. This meant that any recommendations and lessons learnt were not being shared with staff promptly. Instability within the senior leadership and governance structures had impacted the need for consistent improvement.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff still felt there was a lack of leaders with maternity specific knowledge and background which had been impacting the service’s maternity improvement plans. Some staff felt there had been little visible improvements to the unit since our last assessment. However, some staff felt the new triage system and processes had made a positive impact on women and birthing peoples care journeys. It meant triage calls could be answered in a quiet space with no distractions and the new phoneline system gave more of a safety net for missed and abandoned calls.

Since our last assessment in March 2024, there were still significant shortfalls around the processes of learning from incidents and actions were not taken in a timely way. The service leaders stated they found the lack of digital records was causing a delay. Staffs feedback to leaders around safety recommendations was taking many months for actions to be initiated and delays in information being shared amongst staff. For example, staff had identified that monitoring equipment on labour ward was not fit for purpose, however new equipment was not ordered for 5 months. There was also no process for checking and monitoring which staff had received and acknowledged that learning. Evidence we reviewed showed staff groups had made suggestions around improvements to care pathways and patient safety.