Southend University Hospital

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• 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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked those leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities. This was the first assessment for this service. This key question has been rated Requires Improvement.

This meant there were some shortfalls in service leadership. Following our assessment concerns demonstrated a Regulation 17 breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was in breach of legal regulation in relation to the governance of the service. A Section 29A Warning Notice for Regulation 17 breaches was served to the Trust following our assessment

Leaders and the culture they created mostly assured the delivery of high-quality care. Leaders and staff had a shared vision and culture based on listening, learning and trust. Senior leaders were not always visible, knowledgeable, supportive, helping staff develop in their roles. Staff told us they were supported by local leaders to give feedback and were valued. Young people and their families with protected characteristics were supported. Staff understood their roles and responsibilities but would struggle to manage risk when short staffed. Nursing managers did not always have the time to work with the local community groups. There was a positive culture of continuous improvement when staff were supported and given time to develop and train.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Staff in did not always feel part of the wider trust. Engagement between all children and young people services needed to improve and staff felt senior trust leaders did not always have the same aims and focus. Staff told us they had taken steps to improve their culture and safe care, but this was not always recognised by the senior trust leadership.

Staff we spoke with at all levels were concerned senior leaders did not fully understand the demand and pressure and recognise the changes that were needed. Visibility of senior trust leaders was inconsistent but local leaders where always available to help. Comments included “support was amazing”. They were able to share concerns with their local leaders over safety and sustainability of the service. Local leaders raised concerns around staff’s wellbeing and told us staff were “burnt out” and worried current pressures on the service were not sustainable.

Trust leaders acknowledged there had been challenges with the culture within children and young people services across the trust. Action taken to address this involved commissioning independent reviews into root causes and identify recommendations. However, progress on implementation of improvement plans had been slow and staff were frustrated.

The workforce had a clear shared local vision, strategy and culture. However, we requested evidence the trust had a specific children and young people’s clinical and cooperate strategy to support the diverse community they serviced. This was not provided There was limited assurance the trust had a clear shared vision, strategy and culture across all children and young people services

We scored the service as 2. The evidence showed some shortfalls. Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Children and Young People services is part of the Women and Children's division across the trust. Executive structures consisted of a Chief Executive Officer, Chief Medical Officer, Managing Director and Chief Nurse and Quality Officer. The service had a divisional Medical Director, Director of Operations, Deputy Director of Nursing for Paediatric and Neonate and a Director of Midwifery. Southend had an allocated Associated Director of Nursing

We requested evidence of how leaders engaged with staff and what opportunities staff were given to speak to divisional and executive leaders. Evidence provided showed local leaders carried out some virtual ward meetings, neonatal meetings being the best attended. Meeting agendas were detailed, and staff were given opportunities to raise concerns.

Nursing managers did their best to complete appraisals and one to ones, but these would often be cancelled due to demand on the service. Local leaders ensured staff received debriefs after incidents and that wellbeing was always being considered. Staff also told us they had positive experiences being involved with debrief processes.

Some staff told us senior trust leader were not always visible, and they did not always understand the day-to-day challenges staff faced. They voiced concerns around how the trust board was informed of their concerns and if they understood the long-standing issues within paediatrics. Some staff said there was not a clear line of communication from ward to board which impacted on their confidence in improvements being made.

Not all senior trust leaders had an awareness or recognition of what was impacting all levels of staff. They were aware of pockets of concerns but could not demonstrate how current communication strategies with staff were working. For example, staff did not always understand rationales for change or if leaders had considered the impact on staff, service delivery and care outcomes.

We scored the service as 1. The evidence showed significant shortfalls. People did not feel they could speak up and that their voice would be heard.

Medical staff were very protective and passionate about their nursing and support staff’s wellbeing and would advocate for them. However, staff told us they were not aware of the Freedom To Speak Up (FTSU) provision available to them and there was limited uptake from staff to become a FTSU champion as staff champion had to carry out these duties in their own. Some staff told us they had spoken up before and were scared they would be identified and were concerned it would have a negative impact on their work life.

We requested information around the numbers of FTSU champions available within service. The trust had 37 champions that had completed training with a further 3 awaiting course completion. There was 1 champion within children and young people services at Southend. The Trust did not demonstrate how FTSU was shaping the culture within the service and alerting them to opportunities for responding to emerging concerns or ineffective systems

Evidence provided showed there was inconsistent empathises placed on the FTSU provision. However, Neonatal leads took a proactive approach and sent email reminder to staff of the it’s availability following staff meetings and incidents

We were not assured trust leaders recognised the need for an embedded freedom to speak up provision within children and young people services. The presence of ongoing cultural issues did not flag the need for a strong FTSU presence in children and young people services.

We scored the service as 1. The evidence showed significant shortfalls. The service did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Medical staff were very protective and passionate about their nursing and support staff’s wellbeing. They were concerned many senior experienced nurses were leaving and other less experienced nurses, with potential to reduced senior support, were in post.

Senior trust leaders acknowledged there were some cultural issues, and there were actions being taken. However, action plans did not incorporate workforce equality and did not utilise any staff networks input in the cultural transformation work needed in paediatrics. There was a lack of processes to ensure staff were included in change management and could influence improvements. Decisions made were leadership led and did not always incorporate opinions of all staff groups.

National Health Service (NHS) survey results published March 2024, there was 190 staff from children and young people services that participated. When asked “Disability: organisation made reasonable adjustment to enable me to carry out” response 66.7%. This was below the trust s overall score of 70.2%. From all the questions within the NHS staff survey, children and young services, 67% of responses scored worst that the trust average.

Evidence reviewed in relation to trust Workforce Race and Equality Standard (WRES) reports and associated action plans, showed poor progress year on year. With objectives still outstanding from December 2023. This was similar in the trust Workforce Disability Equality Standard (WDES) action plans where deadlines had not been met and then just extended.

We scored the service as 1. The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Children and young people services had a governance structure that reported to the Deputy Director of Nursing Paediatrics and Neonates. Some staff told us they were unsure of senior leaderships structures and who held accountability for good governance. Evidence showed that governance meetings were well attended and had associated action logs. However, it was unclear how concerns raised, or outstanding unresolved actions were escalated to the executive board.

We requested information on how they monitored all children and young people services polices, guidance and standing operating procedures. And how they were assured they were up to date, contain current national guidance or need review. The service provided a trust overview of policy compliance showing there was only 4 polices that were not compliant. However, on review of submitted data 16 polices relating to children and young people services were running on 12-month extension for compliance. Each policy extension had been risk assessed but we were not provided with this evidence.

Staff expressed concerns over the sustainability of the service as staff retention continued to be an issue. Staff said senior trust leaders were not always proactive in addressing shortfalls in staff numbers. Data requested for service leavers showed 86 full time equivalent staff left children and young people services across the whole trust between December 2023 and October 2024. However, it was not clear which departments / wards had been affected the most. We also requested evidence of feedback collected from staff’s exit interview and how this shaped their long-term retention plan and workforce sustainability. This was not provided as the service did not collect this information.

Staff told us they did not feel included in all stages of current change management processes happening within children and young people services. Some staff said changes were being made to service provision without adequate consultation with staff. They told us this lack of collaborative working had further impacted on the poor culture within paediatrics.

A significant amount of information requested as part of our assessment was not provided or available. We therefore did not have assurance that the service collected, analysed and managed information appropriately. Evidence that was provided did not demonstrate a clear and accurate escalation of risk from ward to board. It was not clear how the board interrogated the information it was presented with to assure them of the accuracy or how they ensured staff and patient voices were heard.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Staff told us they had strong links with community groups and charities to help provide and fund the children and young people’s provision at Southend. This collaboration enabled additional toys and information technology equipment to be available for children, and they worked with local therapy services and arranged animals to visit children on the wards. Site leaders praised the play team for their innovation and continued commitment to deliver this provision.

Community health watch partners told us they would produce monthly reports but did not receive any assurance the information was being used effectively by the service. They said it would be beneficial to have named contact from the service to enable prompt and effective communication and sharing of information. The service understands their duty to collaborate and work in partnership, so services work seamlessly for children, young people and their families.

We scored the service as 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Staff told us there were some opportunities to make suggests and actively contribute to safe, effective practice and research. They told us local leaders encouraged staff to drive improvements and move the service forward. However, some staff told us there were limited career development opportunities and funding for nursing apprenticeships had just been reduced. Some staff were actively seeking employment elsewhere due lack of opportunities within the service.

We requested evidence of any quality improvement projects, participation in research projects and examples of any innovation. Information shared showed there had been 2 completed, 2 in progress with a further 4 quality improvement projects to been launched. However, it was unclear from the information provided what impact these projects had on quality across all services There was limited data to show what lessons had been learnt and what improvement measures had been put in place because of the project.
Due to demand on the service there was not always a focus on learning, innovation and improvement.