All inspections: Southend University Hospital

Southend University Hospital is part of Mid and South Essex NHS Foundation Trust. Southend University Hospital is a district general hospital located in Westcliff-on-Sea, Essex. The hospital has approximately 730 beds, including medical, surgical, maternity, women’s, children’s, and critical care beds.

An assessment was conducted in March 2024 due to concerns about the safety and quality of services. The decision to assess was influenced by information received and a previous inspection, which took place between August and October 2022 at which the maternity service was rated as requires improvement.

The March 2024 assessment focused on the Maternity services, evaluating them based on five key criteria: Safe, Effective, Caring, Responsive, and Well-led. Following the assessment the Safe key criteria has resulted in a good rating however Responsive and Well-led remain as requires improvement.

Southend University Hospital is part of Mid and South Essex NHS Foundation Trust. Southend University Hospital is a district general hospital located in Westcliff-on-Sea, Essex. The hospital has approximately 730 beds, including medical, surgical, maternity, women’s, children’s, and critical care beds.

The March 2024 assessment focused on the Maternity services, evaluating them based on 5 key criteria: Safe, Effective, Caring, Responsive, and Well-led. Following the assessment the Safe and effective key criteria has remained at requires improvement. The rating for Caring and Responsive remained at Good and Well-led also remained at requires improvement.

Critical Care was rated Good overall in August 2016,

Services for children and young people was rated Good overall in April 2018,

End of life care was rated Good overall in April 2018,

Outpatients was rated Good overall in March 2020,

Surgery was rated Requires improvement overall in December 2021,

Urgent and emergency services was rated Requires improvement overall in December 2021,

Medical care including older people’s care was rated Requires Improvement overall in October 2023.

Southend 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 Southend. Medical wards provided by Southend Hospital include elderly care, acute medical assessment, general medicine, stroke, respiratory, gastroenterology, renal, endocrinology and cardiology.

Between January 2022 and December 2022 medical care had 45,835 admissions including 25,327 day cases.

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.

Southend 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 Southend. Medical wards provided by Southend Hospital include elderly care, acute medical assessment, general medicine, stroke, respiratory, gastroenterology, renal, endocrinology and cardiology.

Between January 2022 and December 2022 medical care had 45,835 admissions including 25,327 day cases.

We carried out this unannounced focused inspection because we received information giving us concerns about the safety and quality of the services 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. 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 team that inspected the service comprised of a CQC lead inspector, 2 CQC inspectors, and a CQC specialist advisor. The inspection team was overseen by Antoinette Smith, Interim Deputy Director of Operations.

During the inspection we spoke with 35 members of staff and carried out off site interviews with the senior leaders, the services falls team and the safeguarding lead. We spoke with 14 patients and 4 relatives. We observed care provided; attended site and staffing meetings, reviewed relevant policies and documents and reviewed 20 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.

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

The service did not always have enough staff to care for women and keep them safe. Actual staffing levels did not match planned staffing levels throughout the service.
The department lacked storage space and consumables and equipment were left in corridors. We were concerned this could delay the movement of staff or women in an emergency.
Staff had not completed their mandatory training in line with the trust target and service leaders did not have a robust plan to address the noncompliance.
The service had not completed records audits since October 2019 and did not have a robust plan to address this.
The service was not meeting its target for nursing staff appraisal and did not have a robust plan to address this.
Leaders did not run services using reliable information systems. Service leaders were unable to extract meaningful data from the new IT system and there were data gaps in performance dashboards.
Anaesthetists did not attend MDT handover. This was a concern at our previous inspection in 2021.
The service did not have a local strategy and vision.

However:

Staff had training in key skills, understood how to protect women from abuse, and managed safety well.
The service controlled infection risk well.

Summary findings

We carried out this announced inspection on 17 and 18 May 2022 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by two CQC inspectors and a specialist professional advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Background

At the time of the inspection, Mid and South Essex NHS Foundation Trust were commissioned to provide clinical examinations of children under the age of 13 who have suffered non-recent sexual assault or sexual abuse (non-recent means that it has been 72 hours or over since an alleged incident took place). This service was undertaken at a Sexual Assault Referral Centre (SARC) which was managed by another provider.

Clinical examinations were undertaken on Wednesday afternoons only and were carried out by a pediatrician. Between 1 April 2021 and 30 April 2022, 12 patients had been examined as part of this service.

Examinations were undertaken in a fully accessible building which is situated in the grounds of a community hospital with plenty of parking, including disabled spaces. The building is on one level and accessible for wheelchair users. There were two forensic examination suites, but one was used predominantly for children and was separate from the adult area. There was a child friendly non-forensic waiting room with lots of wipe clean toys and activities for a variety of ages. The forensic area had a separate waiting area with a working television and the examination room included a forensic shower room. The building also included a staff shower and changing area, an office with a kitchen area, storage rooms and interview rooms.

The service was undertaken by one paediatrician who is employed directly and another paediatrician who is substantively employed by another local NHS trust. All examinations had been undertaken alongside a crisis support worker who was employed by the provider which was responsible for managing the sexual assault referral centre.

On the day of inspection, we spoke with one paediatrician as well as other members of staff who were employed by a different provider, including a crisis support worker.

Throughout this report we have used the term ‘patients’ to describe people who use the service to reflect our inspection of the clinical aspects of the SARC.

We looked at policies and procedures and other records about how the service is managed. We reviewed five patient records

Our key findings were:

The staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
The service had thorough staff recruitment procedures.
Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
The clinical staff provided patients’ care and treatment in line with current guidelines.
Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
The appointment/referral system met patients’ needs.
Staff felt involved and supported and worked well as a team.

Following the inspection, the provider stopped providing the regulated activity at the sexual assault referral centre. If the provider was still carrying on the regulated activity, we would have issued a requirement notice, asking the provider to take action against the following points;

Ensure that effective governance systems are present to maintain oversight of the services provided. This includes, but is not limited to oversight of record completion as well as making sure that children have been safeguarded effectively.
Ensure that an effective risk management system is in place to identify and mitigate risk when needed and to be assured that important risk assessments have been completed by the provider of the sexual assault referral centre.
Ensure that effective joint working agreements are in place so that roles and responsibilities between providers who are involved in the delivery of the service are clear.

Full details of the regulation the provider is not meeting are at the end of this report.

There were areas where the provider could make improvements.

Following the inspection, the provider stopped providing the regulated activity at the sexual assault referral centre. If the provider was still carrying on the regulated activity, we would have issued a requirement notice, asking the provider to take action against the following points;

Ensure that the voice of patients, parents and carers are consistently captured within medical records, evidencing that they have been included in decisions about their care and that their wishes and preferences have been considered.
Ensure that health risk assessments are consistently completed, making sure that all the health needs of patients have been met.
Ensure that there is a system in place to seek feedback from patients, families and carers, providing an opportunity for further improvements to be made to the service when needed.
Ensure that patients have a choice of gender of the doctor they are examined by.

Southend University Hospital is part of the Mid and South Essex NHS Hospitals Foundation Trust which was formed in April 2020. The hospital is located in Southend at Prittlewell Chase site, and has outlying satellite clinics across Southend-on-Sea, Castle Point and Rochford, and Orsett Hospital. There are 737 inpatient beds.

As Southend University Hospital is the registered location for the Mid and South Essex Hospitals Trust, this report will contain information regarding the whole services, and trust wide initiatives. The Southend site is the only site that has previous ratings, due to this being the acquiring organisation in the merger.

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 site. We inspected Urgent and Emergency Care and Medical Care 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.

During this inspection, we visited a number of wards and departments, including the emergency department majors and minors cubicles, resuscitation bays, triage room, rapid assessment and treatment areas. We also inspected the paediatric emergency department, and clinical decisions unit.

Within surgery, we inspected Trauma and orthopaedics, Ophthalmology, Oral and maxillofacial surgery (OMFS), Ear, nose and throat (ENT), Urology, Breast surgery, Vascular surgery and Colorectal surgery.

Within Maternity services we visited the antenatal and postnatal wards (Margaret Broom 1 and Margaret Broom 2), the consultant led central delivery suite (CDS), and the midwifery-led birthing unit for women.

At this inspection, we rated Urgent and Emergency Care (UEC) as, requires improvement for safe and well led. We did not rate effective or responsive and did not inspect caring as this inspection followed our focused methodology.

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:

UEC:

Mandatory training compliance was not in line with trust targets.
Not all staff had completed safeguarding training.
Staff did not always use equipment and control measures to protect patients, themselves and others from infection.
Staff did not always complete risk assessments for each patient swiftly to remove or minimise risk to patients. Staff did not always identify and act quickly upon patients at risk of deterioration.
The trust did not always maintain critical equipment within the premises infrastructure well to keep people safe.
Staff did not keep detailed records of patients’ care and treatment. Records were not clear or up-to-date, or stored securely and easily available to all staff providing care.
The service was not always managing medicines safely.
Staff did not always assess and monitor patients regularly to see if they were in pain.
Managers did not always appraise staff’s work performance and did not hold supervision meetings with them to provide support and development.
Waiting times were not always in line with National standards.
Leaders did not demonstrate that they understood or managed the priorities and issues the service faced. They were not always visible and approachable in the service for staff. Staff did not feel supported.
Staff did not feel respected, supported or valued. The service did not have an open culture where staff could raise concerns without fear.
Staff did not always have regular opportunities to meet, discuss and learn from the performance of the service.
The service did not identify or escalate relevant risks and issues or identify actions to reduce their impact. Leaders and teams did not use systems to manage performance effectively.
The service collected data and analysed it. Staff could find the data they needed, to make decisions. The information systems were integrated and secure.
Leaders did not always engage with staff actively and openly

Surgery:

Staff did not always keep equipment and the premises visibly clean.
The design, maintenance and use of facilities did not keep patients safe, we had concerns about the environment in the newly opened surgical assessment unit. Equipment was not always maintained in all areas we visited.
The service did not 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, training and experience.
Records were not always clear, up to date, or stored securely.
Waiting times from referral to treatment and arrangements to admit, treat and discharge patients varied.
Governance processes were not embedded.
Staff felt that there was a lack in consistency between electronic and paper records.

Maternity:

Mandatory training compliance was not in line with the trust target.
There were gaps in cleaning records.
Annual equipment checks were not always completed.
There was not a robust process in place for prioritising women in triage.
The service did not always have enough maternity staff with the right qualifications, skills, training, and experience.
Anaesthetic representation at handovers was not consistent.
Women’s records were not always held securely.
Not all staff had an appraisal within the last year.
The leadership structure was undergoing significant change and was not fully embedded.
There was a mixed culture amongst staff with an apparent disconnect between midwives and matrons. Staff did not always feel respected, supported or valued.
Trust wide governance structure was under review and not embedded.
Processes for monitoring risk were under review, were not fully embedded and some data was either not collected or was not sufficiently robust to enable informed decisions or oversight.

However:

The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
Surgical and maternity service staff completed and updated risk assessments for each patient and remove or minimise risks. Staff identified and quickly acted upon patients at risk of deterioration.
The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
The service provided care and treatment based on national guidance and evidence-based practice.
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.
The service made sure staff were competent for their roles.
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 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 or were experiencing mental ill health. They used agreed personalised measures that limit patients' liberty.
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. It also worked with others in the wider system and local organisations to plan care.
The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services.
Local leaders were visible and approachable in the service for patients and staff.
Local leaders and staff engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

At this inspection we inspected urgent and emergency services, medical care including older people’s care, surgery, maternity and outpatients. We did not inspect critical care, services for children and young people or end of life care but we combined the last inspection ratings to give the overall rating for the hospital.

Our rating of services went down. We rated them as requires improvement because:

Our rating for safe remained the same, requires improvement. Not all staff had completed mandatory training, infection prevention control processes were not always followed. Risk assessments were not always completed and documented in full. Not all safety results and performance met the expected standards.
Our rating for responsive remained requires improvement. Patients could not always access the service when they needed it. Waiting times from referral to treatment and arrangements to admit treat and discharge patients were generally not in line with good practice. Complaints were not always responded to within the time lines of the trust’s complaints policy.

However,

Our rating for effective remained good. The service provided care and treatment based on national guidance and evidence of its effectiveness. The trust provided care and treatment based on national guidance and evidence of its effectiveness, staff assessed and monitored patients regularly to see if they were in pain, staff were competent for their roles, staff understood their roles and responsibilities in relation to consent and under the Mental Health Act (MHA)1983, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Nutrition and hydration needs were identified.
Our rating for caring remained good. Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff provided emotional support to patients to minimise patients’ distress. Patients and those close to them were able to receive support to help them cope emotionally with their care and treatment.
Our rating for well led remained good. There was generally a positive culture that staff felt supported and valued. The services generally had managers at all levels with the right skills and abilities to run services providing sustainable care. The trust generally collected, analysed, managed, and used information well to support all its activities. Services had a vision for what they wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. Staff understood and demonstrated the trust’s vision and values.

All the information for this location appears in the overall summary above.

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Southend University Hospital NHS FT is part of the Essex Success Regime. This includes Southend, Basildon and Mid Essex trusts working together to influence system change across the health economy. This process is key to improved care in the NHS.

We undertook a short announced focused inspection at Southend Hospital on 9 and 10 February 2017 in response to concerns raised to CQC. We found that the trust is under significant capacity pressures and all the risks we saw were known to the senior management team. Actions were in place to deal with most of these issues. We have not rated this inspection in line with our current guidance. However, we will return to Southend Hospital to review actions taken in line with the current improvement plan and the issues raised within the report.

We found:

There were shortages of medical and nursing staff but that the trust was managing the risks associated with these shortages. However, continued focus needs to be kept on ensuring that the service has sufficient staff to ensure patient safety.
Mandatory and safeguarding training was not always undertaken in line with the trusts target.
Staff had a good understanding of incident reporting procedures and received feedback on incidents reported.
Staff worked together to meet patients’ individual needs. Staff gave us examples of coordinating care to meet the needs of patients with learning disabilities and told us about actions they took to improve the experience of patients living with dementia.
Leaders were visible and approachable. There were opportunities for leaders to engage with staff at ward level and listen to their concerns.
Some wards reported issues with outliers being seen by the correct team. I am aware that there is a buddying system being discussed and this will assist this issue.
There were no named pharmacists for surgery. Reconciliation of medicines was not done in a timely manner. An example was found that in February only 10% of admissions had had their medication reconciled within 24 hours.
The stroke unit staff were unclear if they still operated as a HASU. They told inspectors that they did at times. Senior staff told us that there was no HASU.
At times in the stroke ward nurse to patient ratios was 13:1 and in Benfleet the ratio was 3 to 4: 25 patients.
There was conflicting information about the BAMS unit medical staffing. We were told by staff that they had put forward a plan for changes but that these had been dismissed. However the medical director appeared unaware of this plan during his interview.
There are challenges within the consultant body which impact upon the patient experience and capacity of the hospital. There was little evidence of a plan in place to address these. However impacts were seen through the lack of specialist nurse and capacity issues within outpatients.
There were concerns around the extension to SAU which was behind doors so sight of these patients was limited. We also found that there were approximately 12 patients to one toilet in this area.
There was a disconnect between the senior management team and the workforce and a lack of appetite to change. Staff felt that they were not always supported to change and that change took a long time.
There were several established systems to ensure good clinical governance and monitor performance, clinical governance, mortality, and morbidity and infection control.
Patient record keeping was of a very good standard, allergies, national early warning scores (NEWS) and paediatric early warning scores (PEWS) were all clearly documented within the Emergency Department.

We saw several areas of outstanding practice including:

There was a stroke emergency phone, which provided direct contact between the emergency department and the stroke ward.
Surgeons are undertaking innovative surgery for stroke patients during which they remove the blood clot to ease pressure on the brain. This reduces the symptoms that stoke patients’ experience.
Ambulatory wound unit on Balmoral ward taking referrals from community, podiatry, GP’s as well as wound care for discharged patients. Focused on early intervention and admission avoidance.
The musculoskeletal team had created a Trauma Assessment Centre (TAC) within the ED as an extension of the fracture clinic, where patients were streamed directly to be seen for treatment.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust should:

The hospital should ensure there are sufficient numbers of suitably qualified, competent, skilled and experienced consultant medical staff to meet the needs of patients in the medical service.

The hospital should ensure there are sufficient numbers of suitably qualified, competent, skilled and experienced junior medical staff available on BAMS to meet the needs of patients.

The hospital should ensure there are sufficient numbers of suitably qualified competent, skilled and experienced nursing staff available in the medical and surgical services to meet the needs of patients.

The hospital should ensure that there are processes in place to make sure that medical outliers are reviewed by their speciality team in a timely way.

The hospital should ensure that staff complete mandatory and safeguarding adults and children training in line with trust targets.

The hospital should ensure staff are trained in the recognition and management of sepsis to the appropriate level in line with trust targets.

The hospital should ensure all fridge temperatures for the storage of medication are recorded and acted upon in line with trust guidance.

The hospital should ensure that male and female patients are not accommodated in the same bay on the stroke unit.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We undertook this inspection 12-14 January and returned unannounced 24 January 2016. The main part of the inspection was a comprehensive announced inspection. We inspected Southend Hospital and the outpatient’s service for children and young people at the Lighthouse Child Development Unit.

This service was not triggering as high risk from national data sets or as an outlier.

Southend University Hospital NHS FT is part of the Success Regime. This includes Southend, Basildon and Mid Essex trusts working together to influence system change across the health economy. This process is key to improved care in the NHS.

During the first day of the inspection the junior doctor’s strike was in progress. The trust was offered the option to cancel the inspection but declined. We noted that the trust had a clear plan for patient care during this period of industrial action.

During our inspection the trust was on a high state of escalation due to the increased number of patients coming in to the hospital. This had existed for some time before our inspection.

We rated the services offered by Southend University Hospital NHS Foundation Trust as ‘requires improvement’.

Our key findings were as follows:

The increase in the number of beds at the trust had put additional strain on the services, but in particular a strain on the staff.
Staff nurse to patient ratios were too high particularly in medicine and musculoskeletal surgery.
High numbers of elective surgery cancellations were seen in addition to clinic cancellations all relating to the alert status, capacity and congestion within the hospital.
Good patient outcomes were evidenced in particular the stroke service.
Staff went the extra mile for patients and demonstrated caring and compassionate attitudes.
The trust scored above the England average for Patient-led assessments of the Care Environment (PLACE) consistently for all categories assessed. (2013-2015)
Cleaning undertaken by nurses and technicians for November and December 2015 of high risk equipment was 95% and 97% compliance rates. There were no MRSA cases reported and lower than the England average rates of C.Diff.
Mortality and morbidity meetings took place but they did not follow a consistent format, and actions to support learning lacked timescales.

We saw several areas of outstanding practice including:

We rated well led for the emergency department as outstanding.The local leadership and team worked well to deliver the service.There governance practices ensured risks were identified and managed. They engaged staff to ensure they remained motivated.
Stroke service patient outcomes receiving the highest rating by Sentinel Stroke National Audit Programme.CT head scanning were delivering a 20 minute door to treatment time which was a significant achievement.
The trust had implemented an Early Rehabilitation and Nursing team (ERAN). The ERAN Team supported the early discharge of primary hip surgery and knee surgery patients.
The ‘Calls for Concern’ service, allowing patients and relatives direct access to the CCORT (critical care outreach team) following discharge home.
The learning tool in place within Radiology allowing learning from discrepancy in a no blame environment.
The Mystery Shopper scheme that actively encouraged people to regularly give their feedback on clinical care and services.
Safe at Southend was a new initiative to allow staff to share day to day clinical and operational issues with executive Directors for rapid action.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Ensure staffing ratios comply with NICE guidelines, to ensure both patients and staff are not at increased risk.
Ensure duty of candour regulations are fully implemented, the trust was not able to demonstrate that they had met all parts of the requirements.
Ensure that clinical review is part of the process for cancelling elective surgical patients.

To see the full list of actions the trust must and should take please see the areas for improvement section toward the end of this report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Southend University Hospital is an established 700 bed general hospital and provides a range of services to a local population of some 338,800 in and around Southend and nearby towns. The trust provides a range of acute services including acute medical and surgical specialties, general medicine, general surgery, orthopaedics, ear, nose and throat, ophthalmology, cancer treatments, renal dialysis, obstetrics and gynaecology and children's services. Southend University Hospital is the South Essex surgical centre for uro-oncology and gynae-oncology surgery. The trust achieved Foundation Trust status in 2006.

We inspected this hospital on 7 August 2014 in response to concerns of stakeholders and information of concern received into the CQC. Southend University Hospital NHS Foundation Trust was found to be in significant breach of its terms of Monitor authorisation since 2011-2012 due to their failure to demonstrate that there were appropriate arrangements in place to provide effective leadership and governance. There were also concerns around the trust’s failure to meet cancer and C. Difficile targets.

This was a responsive review undertaken by six inspectors from CQC and two specialist advisors in A&E and governance practices. Only the services within the A&E department and the governance structures at Southend Hospital location were inspected. We have identified that the service was not compliant with some regulations following this inspection. We have not rated the service as this was a focused inspection however a further comprehensive inspection will be undertaken in the future to determine ratings of all services within the trust.

Prior to the CQC on-site inspection, the CQC considered a range of quality indicators captured through our intelligent monitoring processes. In addition, we sought the views of a range of partners and stakeholders.

The inspection team make an evidenced judgment on five domains to ascertain if services are:

Safe
Effective
Caring
Responsive
Well-led.

Whilst we noted some good practice there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Improve its cleaning schedule within the A&E department.
Improve the security and storage of medicines within the A&E department.
Increase the number of permanent trained nurses, paediatric nurses and consultants within the A&E department.

In addition the trust should:

Take prompt action to ensure that the children’s A&E department is in line with national guidance.
Review working with the psychiatric liaison services to improve the care provided to patients within the department.
Ensure that there are robust systems in place for checking stock to ensure it is in date and safe to use within the A&E department.
Review the management and directorate structure which supports A&E to improve clinical excellence.
Improve on the overall achievement rate of doctors attending mandatory training.
Ensure that all doctors within the A&E department have received children’s safeguarding level 3 training.
Review the process for equipment reported as faulty within the service, ensuring it is repaired or replaced in a timely manner.

During this inspection we found that the essential standards of quality and safety were not being met in some areas. As a result of our findings we have issued the trust with compliance actions. We have asked the provider to send CQC a report that says what action they are going to take to meet these essential standards.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We carried out this visit to check on improvements made to the service following concerns identified when we last visited the service in May 2013. Overall we found that the required improvements had been achieved in the areas where we visited.

We found that improvements had been made to the arrangements for ensuring that people were treated with respect and involved in making decisions about their treatment. People we spoke with told us that they were treated well, and that they received the care and treatments that they expected. People said that staff treated them with respect, involved them in making decisions about their care and treatment and they received information and explanations in a way that they could understand.

We found improvements in how risks to the health and safety of people were managed. Appropriate safety checks, assessments and observations were carried out and recorded. These practices and procedures were regularly monitored to ensure that the improvements made were sustained.

Staff we spoke with reported that there had been improvements and that they had support from senior colleagues and opportunities for learning and development. Staffing levels and skill mix were regularly monitored and there was an on-going recruitment plan to address staff shortages.

Improvements were on-going to address the issues with premises and to ensure that the quality and safety of the service was monitored and improved.

We carried out this inspection to assess how the hospital was delivering its services to patients to ensure their safety and promote their health and wellbeing.

People we spoke with gave us very mixed views about their experience of care at the hospital. Some people felt they were treated with kindness and told us that they were happy with the care and treatment they received. Others experienced less positive outcomes and told us that staff could be abrupt and uncaring and that they sometimes felt 'forgotten.'

We observed some staff caring and supporting people in a positive way. However, we also witnessed examples of poor engagement of staff and a lack of respect for promoting people's privacy and dignity.

The arrangements for staff training and support varied across the hospital. Some staff reported that they felt well supported and that they had opportunities for training and development. Others told us that they felt less supported and some told us that they felt bullied and harassed at work.

While there were systems in place for monitoring and improving people's safety and experience of care they received at the hospital, these were not always effective as not all staff were fully engaged in the hospital's objectives and core values. Overall we found that a number of improvements were needed to ensure that effective systems were in place to provide safe, effective, caring and responsive services.

During our visit we spoke with patients in Accident and Emergency and outpatients departments, paediatric, medical and surgical wards and the maternity unit.

Patients told us that they were happy with how staff explained their care and treatment. They told us that everything was explained in a way which they could understand so that they could give their consent to the care and treatment they received.

People told us that they were very satisfied with the care and treatment they received at Southend University Hospital. One patient told us: 'Staff are so nice to me they have explained everything, they treat me with respect.'

Patients we spoke with told us that they were involved in planning their discharge from hospital. Patients said that they were given appropriate information and an estimated discharge date to assist them in making arrangements for leaving hospital. One patient and their relative who told us that staff had discussed discharge arrangements with them on the first day the patient was admitted into hospital. The patient required support in a care home. We were told that nursing staff and the hospital based social worker had dealt with this sensitively.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Patients we spoke with confirmed they were happy with the care, support and treatment provided. Patients told us that since their admission to hospital they had been treated with respect and dignity and had no areas of concern. Comments included 'I am very happy with the care', 'everything has been fine' and 'staff have been very respectful'.

Patients who came in for planned routine treatment told us they had received written information regarding their stay in hospital and felt well informed. However those patients who had been admitted as an emergency were not aware of any written information being available, which included how to raise complaints or concerns about service provision.

Although patients were not always provided with information about the ward, they confirmed that staff were able to answer any questions they may have had. They told us that on their admission, the ward had been expecting them but they didn't remember being given any information about the ward and the services available to them.

Patients told us that they were happy with the care and treatment they received during their stay in hospital. We were told 'The care is great' and 'Medical treatment and attention is superb.' Patients also confirmed that nursing and medical staff explained procedures and treatments and were available to answer any questions or queries they had.

One person said that they 'Could not fault the care and treatment or the dedication of most staff.'

We spoke with patients in five of the six wards we visited and received positive and complimentary comments from everyone.

People described the standard of cleanliness as 'quite reasonable', 'good', 'always very clean', 'the cleanest ward I've been on' and 'spotlessly clean'. They also told us that cleaning and bed changing was carried out everyday or 'more if necessary'.

People consistently told us that nursing staff were very conscientious about washing their hands, using gel hand rub and putting on gloves and aprons before they provided any care.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

All Inspections

Professor Sir Mike Richards

Professor Sir Mike Richards

Professor Sir Mike Richards