The Care Quality Commission
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Broomfield Hospital

Overall: Requires improvement read more about inspection ratings

Court Road, Broomfield, Chelmsford, CM1 7ET (01245) 362000

Provided and run by:
Mid and South Essex NHS Foundation Trust

All Inspections

12/07/2023

During an inspection looking at part of the service

Broomfield Hospital is operated by Mid and South Essex NHS Foundation Trust. The hospital provides local elective and emergency services to people living in and around the districts of Chelmsford, Maldon and Braintree. Medical wards provided by Broomfield Hospital include acute monitored and renal, elderly care, acute medical assessment, general medicine, stroke, respiratory, gastroenterology and hepatology, active home unit for patients medically fit for discharge and frailty assessment day unit.

Between January 2022 and December 2022 medical care had 32,663 admissions including 16,912 emergency admissions. The specialties with the highest number of admissions during the same period were general medicine (9,323), geriatric medicine (7,873) and medical oncology (5,783)

We carried out this short notice announced focused inspection of medical care on 12 July 2023.

The service was rated as inadequate following our previous inspection, in January and February 2023. Following our last inspection, we issued a warning notice under Section 29A of the Health and Social care Act 2008 because of concerns relating to poor governance, incomplete risk assessments, incomplete patient records, equipment not being maintained, patients’ nutrition and hydration needs not being met and medication not being managed in line with the service’s medicines policy.

As this inspection was a focused follow up inspection, we only looked at the key questions of safe, effective and well led. We carried out this inspection to determine whether improvements had been made against the requirements of the warning notice we issued at our previous inspection. Although the service had made improvements against the section 29A warning notice, this inspection did not look at the requirement notices that were issued at the previous inspection. As these requirement notices remain, this meant the ratings were limited to requires improvement.

Our rating of this service improved. We rated the service from inadequate to requires improvement. During this focused inspection, not all breaches identified at the last inspection were reassessed to include all potential improvements.

We found:

  • The design, maintenance and use of facilities, premises and equipment kept people safe.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to obtain consent from patients.
  • Leaders operated effective governance processes, throughout the service. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

However:

  • The service needed to continue to embed processes and evidence this improvement through continued audit.

24-25 January and 7 February 2023

During an inspection looking at part of the service

Broomfield Hospital is operated by Mid and South Essex NHS Foundation Trust. The hospital provides local elective and emergency services to people living in and around the districts of Chelmsford, Maldon and Braintree. Medical wards provided by Broomfield Hospital include acute monitored and renal, elderly care, acute medical assessment, general medicine, stroke, respiratory, gastroenterology and liver, active home unit for patients medically fit for discharge and frailty assessment day unit.

Between January 2022 and December 2022 medical care had 32,663 admissions including 16,912 emergency admissions. The specialties with the highest number of admissions during the same period were general medicine (9,323), geriatric medicine (7,873) and medical oncology (5,783).

We carried out this unannounced focused inspection because we received information giving us concerns about the safety and quality of medical care and older people’s services. The information of concern related to the quality of care provided including patient nutrition, hydration, pressure care and the management of risks.

As this was a focused inspection, we only inspected parts of our five key questions. We inspected parts of safe, effective, caring, responsive, and well-led.

We did not inspect all the core services provided by the service as this was a risk-based inspection. Broomfield Hospital has been rated inadequate overall. As a result of the acquisition, Mid Essex Hospitals location and Basildon and Thurrock Hospitals locations did not retain their location level ratings. When one core service is rated inadequate out of three, this aggregates to an overall rating of inadequate. We continue to monitor all services as part of our ongoing engagement and will re-inspect them as appropriate.

How we carried out the inspection

The inspection team comprised of a lead CQC inspector, an inspection manager, 2 other CQC inspectors and a CQC specialist advisor.

During the inspection we spoke with 31 members of staff and carried out off site interviews with the senior leaders, the services falls team, safeguarding lead, tissue viability nurse and end of life care team. We spoke with 13 patients and 4 relatives. We observed care provided; attended site and staffing meetings, reviewed relevant policies and documents, and reviewed 27 patient records.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

20-21 September 2022

During a routine inspection

Our rating of this service stayed the same. We rated it as requires improvement because:

  • The service did not have enough staff to care for women and keep them safe. Staff had not completed their mandatory training in line with the trust target. The service was not meeting its target for nursing staff appraisal.
  • The service did not maintain robust cleaning and equipment check records to provide oversite that all checks were completed in line with trust policy.
  • Triage was not always staffed appropriately, and this led to delays in women being seen within the required timeframe. The service was regularly breaching the target to triage women within 15 minutes.
  • The service had not managed safety incidents well and learned lessons from them.
  • There were 450 incidents outside of their 20-day target. There was an action plan in place and all incidents had been harm reviewed.
  • People could not always access the service when they needed it and sometimes had to wait for treatment. Capacity in the post-natal ward impacted flow through the unit.
  • Not all staff felt respected, supported and valued.

However:

  • Staff had training in key skills, understood how to protect women from abuse, and managed safety well.
  • Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available 7 days a week.
  • The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback.
  • Staff were focused on the needs of women receiving care.
  • The recently established substantive leadership team demonstrated an understanding of the service and had plans in place to deliver improvements.

29 July to 5 August

During a routine inspection

Broomfield Hospital is part of the Mid and South Essex NHS Hospitals Foundation Trust which was formed in April 2020. The hospital is in Broomfield and provides a variety of services for the local population of Essex. There are 566 inpatient beds at the main hospital site.

Although we rated Broomfield Hospital on 6 March 2020 the ratings did not carry over as the hospital was acquired into Mid and South Essex Trust. This was the hospitals first inspection as part of the trust.

This inspection was completed as part of our routine regulatory action and to follow up on the safety of maternity services following regulatory action being taken at the Basildon University Hospital site. We inspected Surgery due to concerns around the management of risks and patient safety.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activities.

At this inspection, we rated Surgery as requires improvement for safe, responsive and well led and good for effective and caring. This inspection followed our comprehensive methodology.

We rated Maternity services as requires improvement for safe, effective and well led. We rated responsive as good and did not inspect caring as we followed our focused methodology.

The overall rating was Requires Improvement because:

Surgery:

  • The service provided mandatory training in key skills to all staff but could not evidence that everyone had completed it.
  • Not all staff completed safeguarding training on how to recognise and report abuse.
  • Infection prevention and control audits were not routinely completed.
  • Safety checklists and assessments were inconsistently completed.
  • The service did not always have enough nursing and support staff with the right qualifications, skills, training and experience.
  • The service did not have enough medical staff with the right qualifications, skills and training.
  • Paper records were not always clear, and not stored securely.
  • The service did not always ensure the safe use of medicines.
  • Not all staff received an appraisal in the last 12 months.
  • Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards.
  • Patients did not always have new appointments for procedures booked within 28 days of being cancelled.
  • Not all leaders were visible and approachable in the service for patients and staff.
  • Not all staff were aware of the trust vision.
  • The governance processes were not embedded, and the surgical team were not always represented at all governance meetings.
  • Staff felt that there was a lack in consistency between electronic and paper records.

Maternity:

  • Mandatory training compliance was not in line with trust target.
  • The handover between teams was not always structured.
  • Triage times and processes were not always recorded or robust.
  • The service did not always have enough maternity staff with the right qualifications, skills, training and experience.
  • Compliance with some specialist training and appraisals was not always in line with trust target.
  • The leadership structure was not fully embedded.
  • Staff did not always feel respected, supported and valued.
  • Governance processes were not embedded.
  • Processes for monitoring risk were under review and not fully embedded.
  • Staff could not always find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.

However:

  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. Staff followed national guidelines to make sure patients fasting before surgery were not without food for long periods.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Key services were available seven days a week to support timely patient care.
  • Staff gave patients practical support and advice to lead healthier lives.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients' personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service planned and provided care in a way that met the needs of local people and the communities served.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services.
  • Leaders and teams used systems to manage performance. They identified and escalated relevant risks and issues and identified actions to reduce their impact.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.