Basildon University 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

Maternity was part of the women’s and children’s services under care group 5. The leadership for maternity included a multi-disciplinary triumvirate consisting of a site based head of midwifery, clinical lead, and operations lead. They were supported by a managing director, director of midwifery, clinical director, medical director, and director of operations. Leaders had the experience, capability and integrity to ensure the services’ vision could be delivered. They were knowledgeable about issues and priorities for the quality of services and could access appropriate support and development in their role. Although leaders told us they visited clinical areas as often as possible, staff told us senior maternity staff and leaders were not always visible. There were clear governance, management and accountability arrangements, however, processes were not always effective. Staff understood their role and responsibilities. Managers accounted for the actions, behaviours and performance of staff. There were systems in place to manage current and future performance and risks to the quality of the service. There were arrangements for the availability, integrity and confidentiality of data, records and data management systems. Information was used effectively to monitor and improve the quality of care. Leaders implemented relevant quality frameworks, recognised standards and best practices to improve equity in experience and outcomes for people using services and tackle known inequalities. Staff and leaders had a good understanding of how to make improvement happen. There were processes in place to ensure that learning happens when things go wrong. The service had strong external relationships to support improvement and innovation. Staff and leaders engaged with external work, including research, to embed evidence-based practice.

This service scored 57 (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 Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Leaders of the service were able to describe the challenges that the service faced. They told us they had the experience and capability to ensure the service’s vision could be delivered, although some senior managers had only been in post for 2 years or less and some were new to their roles. Those senior leaders new to their roles were supported by another staff member who was able to provide guidance and support for the role. Staff told us they did not always feel respected, supported, or valued, particularly by senior leaders. They said senior maternity staff, such as the head of midwifery, the specialist midwives and matrons were not visible. Board safety champions did not complete walkabouts in the maternity unit, they had delegated this task to a specialist midwife who then fed back their findings to the safety champions. Senior managers told us they visited clinical areas as often as possible and completed walkabouts each week to engage with staff. This gave staff the opportunity to make suggestions about what would work better for them. Staff told us senior managers were approachable, but they did not feel they were listened to and senior staff did not support them in a hands-on way. They did not feel senior managers effectively managed the service and told us that staff were not told about a recent concern about nitrous oxide exposure that affected staff. All staff that we spoke with during the assessment felt confident to raise concerns and knew of the FTSUG but did not always get feedback on the concerns they raised.

Leaders worked with the local maternity and neonatal voices partnership (MNVP) to help make sure women’s and birthing people’s views were represented and maternity services were designed to meet local needs. They worked together to determine how accessible and inclusive information was, and what was needed to improve care and choice for all women and birthing people. The 2023 staff survey results showed that overall Mid & South Essex (MSE) Trust had improved in all areas when compared to their own results in 2022, However, the trust remained below the acute trust average score. Under the “we are compassionate and inclusive” element, maternity services scored 6.91 on a 10 point scale, where a higher score is more positive than a lower score. Both the average score for MSE and acute trusts for the same question was 7.24. Questions under this element specifically relating to compassionate leadership were responded to more negatively, compared to the trust. However, according to the survey, maternity staff did feel there was a compassionate culture within the organisation, as most scores were higher in comparison to the trust average. Maternity staff felt that equality and diversity was embraced with scores seen more positively or in line with the average score. Maternity staff experienced much less discrimination by managers and by patients/service users compared to the trust overall response. On the whole, scores for inclusion were in line with the organisation score.

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.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The chief nursing officer had overall accountability for governance at the trust, to whom the clinical director for women’s health, director of midwifery, and director of governance reported to. The service had a clearly defined governance structure that supported the flow of information from frontline staff to senior managers and the trust board. However, the governance processes were not always effective. Leaders monitored key safety and performance metrics. They identified and escalated relevant risks and issues and identified actions to reduce their impact. An audit programme was in place to provide assurance of the quality and safety of the service. Local audits, such as clinical and compliance audits were undertaken, however, we found these were not always undertaken on a regular basis. Weekly divisional triumvirate meeting’s agenda items included, but not limited to, risk and governance, incidents, training compliance, complaints, and guidelines. However, we noted poor attendance at these meetings and meetings did not always take place as planned. We requested minutes for the last 6 months from October 2023 – March 2024. Some meetings did not take place during October, December, January, and February. Monthly governance meetings were well attended by a multidisciplinary team. Discussion areas included performance data, audits and training, feedback, guidelines and research updates. The head of midwifery was responsible for leading on and reporting on this and other national outcomes to the trust board; they acted as an intermediary to keep staff and others updated. We reviewed the last 3 governance meeting minutes. Feedback on performance, workforce, incidents and audit showed discussions, but plans on how these would be addressed were not always clear. For example, IPC audit on Willow and delay in birthing reflections were identified but no actions on how this would be addressed.

There were systems in place to manage current and future performance and risks to the quality of the service. Information was used to monitor and improve the quality of care. However, audit processes were not always effective, which meant senior leaders were not always sighted on concerns. Leaders implemented relevant quality frameworks, recognised standards and best practices to improve equity in experience and outcomes for people using services and tackle known inequalities. However, a perinatal and mortality review tool report in December 2023 showed that although the service’s actions were appropriate, they were rated as weak. A risk management strategy, as well as a risk management policy and procedure was in place. The strategy recognised an integrated approach to the management of risk across the trust. The policy provided guidance on the processes and procedures for risk management. The service had a risk register which reflected current risks within the service. All risks had dedicated owners, risk and effect, risk ratings from red to green, and control measures. The risk register was reviewed and updated at regular intervals. The service worked with external agencies to ensure compliance with national reports and incentives, such as the NHS Resolution Maternity Incentive Scheme (MIS). The maternity service was on track with most measures outlined within the year 5 MIS and held regular meetings to discuss progress. There were arrangements for the availability, integrity and confidentiality of data, records and data management systems. An information governance (IG) and management policy, as well a staff handbook was in place which described the trust’s IG Framework for managing its responsibilities and obligations. An Information Technology Cyber Security Policy was in place which set out the provision of IT security in regard to hardware, software and information/data system. Various policies and procedures were in place to cope with unexpected events.

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 and leaders had a good understanding of how to make improvement happen. They were committed to continually learning and improving services. There was an understanding of quality improvement methods and the skills to use them. We saw evidence of the services’ external/peer reviews which identified areas for improvement. Examples included a Quality Assurance report of the delivery unit and recommendations to improve staff feeling valued; and the use of the East of England sixty steps review. Mock CQC inspections were undertaken to identify areas for improvement. There was evidence of quality improvement workstreams through the Maternity Improvement Programme board, such as culture, and maternal medicine. The trust board were made aware of patient safety issues as required by the national document “implementing a revised perinatal quality surveillance model, NHSEI (2020)”. A comprehensive action plan was in place following response to the Ockenden report and of audit to comply with the Saving Babies Lives Care Bundle v3. The maternity safety champion had a dual role and supported with learning to improve safety through both formal and informal teaching, for example staff had a lack of knowledge in setting up an epidural trolley and this was actioned on the ward with staff. The role was site specific, however, not all staff knew of the named lead or their role. There was a plan to address this and promote the role. Staff told us they were not always encouraged by leaders to drive improvement. There was recognition of this and a proposal to introduce an anonymous ‘board of improvement’ to encourage generation of ideas from all staff groups and roles audit/quality improvement leads were to be defined.

The service was committed to improving services by learning when things went well or not so well and promoted training and change. However, there was sometimes a delay in learning from incidents. Staff contributed to programmes, such as the patient safety incident response framework (PSIRF) and multidisciplinary review meetings, that provided reflection and learning. Staff and leaders engaged with external work, including research, to embed evidence-based practice. The service collaborated with regional organisations, such as the Integrated Care Board and Local Maternity & Neonatal System, where these organisations supported research ideas. The service collaborated with regional universities and charities to support research studies. For example, Basildon Hospital were involved in an observational multicentre cohort study in collaboration with a university looking at early versus late monitoring among women and birthing people with a history of gestational diabetes. The aim of the study was to study two groups of women/birthing people: early blood glucose monitoring and later glucose monitoring and determine, if there is a difference in short- and long-term outcomes. The service had strong external relationships to support improvement and innovation. We saw evidence of regular engagement of leaders with service users to review and improve the service such as the Maternity and Neonatal Voices Partnership (MNVP) steering group which met every quarter. There was a newly established system to review risk to enable better oversight. This had led to a reduction in the backlog of overdue serious incident investigations and having more timely oversight of incidents at daily trust level risk meetings to share immediate concerns promptly. Senior leaders had embedded numerous strategies to ensure practice was embedded following incidents such as stepping up Tuesday, and sharing of learning through emails, where staff could read about incidents and the lessons learnt.