Broomfield Hospital

On this page

• 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

The trust provided a 7 day a week maternity service with a 24-hour triage line. The service made use of an external digital application to sign post women, birthing people and their families to additional support and local maternity community groups. The staff took part in handover meetings between shifts and leaders took part in safety huddles twice a day. However, during handovers staff did not always identify safeguarding risks and escalate them appropriately. Staff used nationally recognised observation charts for women, birthing people, and their babies. Broomfield was taking part in a national pilot which had commenced in early March 2024. However, on reviewing previous observation charts were unsure how these were being monitored for compliance and the service did not have an effective system in place to manage performance and improve standards. The trust did not always provide care and treatment based on national guidance and evidence-based practice. For example, monitoring small gestational age babies in relation to women and birthing people who smoked as well as a lack of individualised growth scans where indicated. Leaders did not always monitor if care was being delivered in line with service guidance. Policies and procedures were not always reviewed and updated to support staff to deliver good care. The service did not have an effective electronic patient record (EPR) system, which had been identified as a risk by the service on its risk register in August 2023. We received feedback and reviewed data that’s supported there had been an increase in poor outcomes for women, birthing people, and babies. Staff did not always monitor and identify risk factors associated with poor outcomes, therefore putting women, birthing people, at risk.

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.

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.

People told us they had received regular observation checks whilst awaiting clinical decisions. Women and birthing people and families were included in discussions about birthing plans, treatment options and care decisions. People had antenatal, labour, and postnatal information within their maternity packs. They also made use of the QR codes and additional information available online. Women and birthing people felt the midwifery teams worked well together and there had been good communication between community midwifes and hospital teams. People awaiting elective c-section felt their birthing experience was less coordinated than they had previously experienced at Broomfield.

Staff told us they were able to signpost women, birthing 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. Staff had concerns that women and birthing people’s weight and body mass index’s (BMI’s) was not being rechecked throughout their antenatal care. Staff felt that potentially increased risk factors were being missed which they felt could lead to poor outcomes. However, recalculating women and birthing people’s BMI is not routine unless profound weight gain is noted. Staff told us that leaders were not proactive at preventing incidents before they had occurred. They told us senior leadership teams did not always have oversight of learning from poor outcomes. This lack of monitoring meant opportunities were being missed to improve care. Midwifery staff felt their opinions and concerns were not always listened to by consultants and at times a lack of teamwork within the department. Staff told us they could not access all relevant information easily due to multiple care booklets; loose document sheets and additional forms being stapled in care records. Leaders told us the maternity services were forming part of the design groups involved in developing the new EPR system. There was limited scope to make changes in maternity documentations and the EPR system would not be launched until 2026. Staff said this lack of progress to move to an EPR system continued to put women, birthing people, and babies at risk, and impacted on the effectiveness of documentation and ability to effectively monitor outcomes.

On reviewing investigation reports from PMRTS, HSIB, Child Death Overview Panels (CDOP) staff were not always following proformas designed to identify smoking risk factors in early pregnancy. Not recognising this risk can have a direct impact on poor outcomes for women, birthing people and their babies. It was not clear from the services own guidelines if smoking or passive smoking during pregnancy constituted a high or low risk factor, therefore monitoring outcomes in these women, birthing people would be challenging. The trust has since updated their guidance to reflect the recommendations from Saving Babies Lives v3 to increase monitoring and scanning for mothers who smoke more than 10 cigarettes a day. However, we did not see evidence that women and birthing people were being ask these questions at time of assessment. Therefore, we were not assured the trust were monitoring this risk. As part of the assessment we reviewed 15 patient care notes, 8 HSIB reports and 3 serious incident reports. From reviewing care outcomes, it was clear staff were not always following national guidelines when treatment was given to women and birthing person or babies. We saw no evidence that the recommendations from these findings had been actioned. To monitor effectiveness in treatment and improve outcomes the trust had adopted a “fresh eyes” approach to reviewing care. Royal College of Midwifery (RCM) and the RCOG recommends midwife or obstetrician regularly reviews the fetal heart rate trace with a colleague to reinforce good practice and help with decision making. Audits reviewed from Jan 2024 to Feb 2024 showed a 50% compliance rate with this monitoring. We were not assured the trust had appropriate monitoring in place to promote good outcomes.

Incident reports that identified lessons learnt with recommendations for improvements to care, were not always implemented in line with trust policy. The service was not always proactive in monitoring the care outcomes of women, birthing people and babies. Opportunity for learning, improvement and change in practice had been impacted by delays in leaders completing outstanding actions plans. This slow progress was putting women, birthing people and babies at risk of poor outcomes. Outcomes for women and birthing people were monitored and benchmarked against national and local standards using performance dashboards The Broomfield site had the highest neonatal readmission for 2023/2024 in the trust, with 260 babies returning to hospital for additional care. Between May 2023 and September 2023 there had been several neonatal deaths. Broomfield neonatal deaths rates were higher in comparison to the other two MSE sites. Concerns had been raised by staff with leaders as to the possible impact perinatal and postnatal care had on these babies returning to the unit and what may have contributed to their need for additional care. However, leaders told us that the neonatal death review that was done did not find any cases where postnatal care and returning to the unit was implicated. As part of the assessment, we reviewed incident and investigation reports, we raised concerns that at times there had been a lack of awareness to risk factors which may have impacted on the outcomes for those babies.

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.