Broomfield Hospital

On this page

• 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 maternity services formed part of the Care Group 5, Women’s and Children’s Services which included obstetrics, gynaecology, and paediatrics within the MSE trust. Care Group 5 was Care was led by a Managing Director, Medical Director, Clinical Director, Director of Midwifery, Deputy Director of Operations. The Broomfield senior leadership team known as ‘triumvirate’ was made up from the Head of Midwifery, Clinical Lead, and a General Manager. Significant concerns were identified during the assessment around safe systems, acting on identified risks and monitoring outcomes. A lack of robust governance meant that leaders had not identified all areas of risk and improvement. There were significant delays in completing outstanding incidents actions, dating back to 2020.The trusts senior leaders had acknowledged and recognised they were above the national figures for pre-term and neonatal deaths. However, leaders did not always have oversight of reasons for this increasing trend. Staff did not always feel supported within their roles and felt their work at times went unrecognised by the senior leadership teams. Staff told us that leaders did not always listen and act on their concerns. This was reflected in the 2023 trusts staff survey results. An absence of a standardised approach had led to a lack of cohesive multi-disciplinary team working (MDT). To address this, leaders had run a Maternity Culture and Leadership programme which included a monthly MDT meeting professional behaviours workshop to help improve culture.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some staff told us each maternity department across MSE were using different recording formats and found this lack of shared documentation processes impacted on the efficiency of the maternity services within MSE. For example, having to close incident investigations due to lost care records. Leaders told us they had worked with partners to develop a shared clinical observation recording system to align across all 3 MSE sites. This would enable accurate compliance monitoring and highlight any areas of improvement. Some staff told us it was difficult to get all MSE maternity services to work collaboratively leading to inequality of treatment and management dependent on which site women and birthing people attended. This lack of consistency meant often different clinical guidance were being used and staff told us they would welcome a more standardised approach. Some staff told us there appeared to be silo working and a lack of cohesive working between each of the wards within the maternity department. Leaders did not rotate staff to address this and there can often be a “them vs us” culture between the departments.

The trust in collaboration with system partners had developed a Women’s Health Strategy in 2023. This outlined their core objectives and strategies with 12 month and 3-year improvement plan targets. The strategy recognised the need for standardisation of clinical guidelines, strengthening integrated clinical governance around key reportable metrics, sharing of best practice. It also considered the need to ensure neonates and maternity services maintained a close working relationship with. The service planned to develop opportunities for staff e.g. rotations through specialist services. However, during the assessment, we saw limited progress had been made in relation to these plans and were not assured these actions were being addressed. This plan recognised and predicted the demand of MSE maternity services in the coming years based on current data trends. The plan highlighted the potential increase in ethic diverse women and birthing people and an increase in more high-risk pregnancies. However, it was unclear what actions the trust had taken to prepare for these predicted increases in women and birthing peoples care needs. The trust was part of a merger and appointed a Head of Midwifery (HOM) at each site that would report directly to the Director of Midwifery and the board. This role aimed to provide a clear directional leadership at each location. At time of the assessment there were gaps in Broomfield Governance team due to long term sickness, but additional resource had been allocated to support governance processes. It was not always clear how the governance responsibilities were being shared and managed amongst existing managerial staff and how safety was being monitored. As part of a previous CQC assessment in 2022, leaders had developed an action plan to address concerns raised. However, improvement actions had not been consistent across the whole of MSE and we did not see these improvements reflected at the Broomfield site.

During the assessment, we spoke to 10 staff from a range of staffing grades. Staff told us that there had been an increase in senior leadership visibility in recent months and the working relationship between midwifery staff and leadership teams had been improving. Concerns were raised around confidentiality when leaders dealt with employee relation cases, some staff were not confident processes and investigations were being dealt with in confidence. Staff told us they did not feel their role was always appreciated and their achievements had not been recognised by the senior leadership teams. Staff told us they were often given responsibilities but not given enough allocated time to complete them due to pressure within the department. Leadership was a consistent negative theme in the results of the staff survey 2023. Staff did not feel involved in decisions affecting them or their work, they felt unable to improve or make suggestions for improvements. Leaders we spoke to wanted to encourage staff to get involved in quality improvement projects, however they did not demonstrate how they would achieve this. Senior leaders told us they tried to make themselves visible to as many staff as possible, some leaders told us they used social media to connect with staff acorss all 3 sites.

In 2023, 278 maternity staff took part in the national NHS survey. Results showed staff did not always feel they had compassionate and inclusive leadership. Maternity results for these questions “my immediate manager works with me to understand problems” and “my immediate manager helps me with problems” scored 10% lower compared to the whole trust. It also showed maternity staff were dissatisfied with the level of reward and recognition they received from leaders when compared to the rest of the trust.

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.

Some student midwifes told us they felt they had been treated differently as learners. Concerns over bullying and negative behaviours had been raised with senior leaders at Broomfield and university leads. Leaders told us students had been supported to speak up and had worked with the existing staff to hold talking groups with the students to improve relationships. At times international midwives felt there was a lack of inclusion and did they did not always feel part of the maternity team. Leaders told us they had an open-door policy for the international midwives and they had arranged an away day for staff to help build stronger working relationships between midwifery teams.

As part of the trusts NHS People Promise commitment, they have implemented a 5-year Equality and Diversity Strategy. To aid this the trust commissioned and supported 6 diversity network groups within MSE. Staff can join the BAME, Disability, Faith and Belief, Armed Forces and Families, Gender Equality and LGBTQ+ networks. The trust staff network groups had seen a 10% increase of core membership over the last 2 years. Work had taken place under their recruitment processes as part of the Workforce Race Equality Strategy 2023, which had led to an 5.5 % increase from 2022 to 2023 in BAME candidate’s likelihood of being appointed following shortlisting. The trust also carried out a yearly gender pay gap analysis as part of the statutory requirements as a large employer. The trust 2023 Workforce Disability Equality Standard (WDES) statutory report showed an increase in those staff employed who had declared a disability, from 2.29% in 2022 to 2.78% in 2023. However, the number of disabled staff reporting they had suffered bullying and harassment by colleagues and managers had increased. The trust had produced an action plan to address several improvement areas within the report with completion of actions set for December 2024. As part of the Workforce Race Equality Standard (WRES) statutory report for 2023 the trust looked at the likelihood of staff being victims of bullying or harassment. The trust performed marginally worse against this metric with the number of staff from ethnic minority groups being bullied or harassed by their colleagues has increased from 27.80%in 2022 to 31.20% in 2023. The trust acknowledged the number of staff from ethnic minority groups experiencing bullying and harassment from their colleagues is regrettably higher than for white colleagues. The trust had plans to address these inequalities as part of their WRES 2023-2024 action plan.

Service leaders told us that although they had made good progress with governance processes, they recognised that there were still challenges present following the merger of 3 maternity services. Leaders acknowledged that there was still work to be done to ensure practice standards and policies were aligned. Delays in launching the EPR system was having impact on service progression and effective governance processes. Senior leaders told us they had improved the governance within maternity service and had established a maternity assurance committee and recruited maternity safety champions to all sites. Senior leaders told us they had been struggling with long term sickness in some leadership positions, but existing staff were sharing workloads in the interim. Leaders told us they had been set significant financial saving targets, and they made practical changes where possible, however they would not compromise patient safety. Staff raised concerns about Broomfield’s capacity and the units long term sustainability due to the lack of postnatal beds. Leaders had identified this as a risk and were looking to cap capacity and work with leaders across other MSE sites to relocate 700 women and birthing people to their own demographic area.

As part of the trusts staffing sustainability plan, new employees joining MSE did not have a site-specific employment contract, this enabled more flexibility for maternity staff to be reallocated to respond to demand. There was a cultural improvement pathway underway with 25 international midwives being supported through the programme. The trust had invested in staff development, with 5 staff on the Apprenticeship Midwifery programme all of which are existing Maternity Support Workers within MSE. The trust had been working with a local University to implement a system to demonstrate learning from incidents and to develop assessable learning for all. On reviewing existing governance and management processes we were not assured the service kept women, birthing people and babies safe. Leaders did not operate an effective governance process throughout the maternity service. We found leaders did not always monitor key safety and performance metrics and there was a lack of evidence of lessons learnt and subsequent improvements to practice. We found that governance systems were not operating effectively to ensure risk and performance issues were identified, escalated appropriately, and addressed with timely action to keep women, birthing people, and babies safe. Leaders did not provide regular opportunities for staff to meet, discuss and learn from the performance of the service or incidents. Leaders were not always able to provide audit programme details or audit results. The leadership team did not always take timely action to make change where risks were identified. The services risk register showed leaders were aware of identified risks and had failed to prevent repeated incidents occurring. We were not assured that leadership governance structures enabled full oversight of risk and prompt action to ensure women, birthing people and their babies were safe.

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.

Leaders told us they had regular reviews and updates around the progress being made on their trusts Maternity Improvement Plan. As part of the plan, senior leaders and workstream leads would meet to report on progress which was then fed up the board monthly. Current workstreams included, clinical effectiveness, culture, cervical screening, fetal medicine, maternal medicine and patient experience. Additional workstreams were being proposed and awaiting approval these were, demand and capacity of the postnatal pathway, antenatal pathway, maternity triage, digital implementation and preterm babies. Leaders told us all workstreams had been making progress, however, due to the patient experience maternity lead role being vacant, this work had to be shared across the team. Leaders told us they were an outlier for patient experience scores on the recent NHS survey result 2023. In response to this they were actively recruiting into the Patient Experience Lead Role and were hopeful they would have someone in post by June 2024. Staff told us they felt there was a lack of maternity specific knowledge amongst some senior leaders, and staff were concerned they did not fully understand what improvements needed to be made. Staff at Broomfield had been recognised at a regional awards event, a member of staff at Broomfield had won the Midwife of The Year award. The staff member who won said “it was huge honour. This award would not have been possible without the entire maternity team at Broomfield Hospital. We are all committed to providing compassionate and high-quality care to women and birthing people and their newborns.” Leaders told us they had a continuity of care team at Broomfield whose role was to focus on the birthing experience of ethnic minority women, birthing people, and their families. This is a team they wish to establish on all MSE sites.

MSE had developed a Membership Strategy to enable the local communities to listen to feedback, ideas, and suggestions to improve the delivery of care. Individuals could register and become a public member. Members attended meetings with governors, attended events and communicated directly with trust leaders. Members could also stand for elected positions on the board of governors. This scheme was trust wide and not maternity specific and we did not see evidence how maternity services had improved through this partnership working. The trust held monthly meetings with leaders to monitor progress and review actions relating to their improvement journey, this was then fed into the trust board of directors. It was not clear how these workstreams were accessible to staff and if staff were encouraged to get involved in quality improvement projects. Effective processes were not embedded within the service to ensure learning and improvement to care was consistently made. We were not assured senior leaders had full understanding the urgency that improvements that needed to be implemented. For example, there had been limited progress in implementing recommended changes to practice, policy and guidance updates and capacity issues. The service had linked in with The East of England NHS quality improvement network to benchmark their improvement journey against other NHS maternity services. An action identified by the membership was for them to join up with other internal teams to promote areas of the Trust such as volunteering opportunities, charity events, vacancies, and apprenticeships. The trust held “Shine Awards” for staff and volunteers to nominate their colleagues for their outstanding contribution. Categories included, Leadership, Patient Champion, rising star and team awards.