Southend University Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation. This assessment did not cover all parts of our assessment framework; therefore, we did not rate the service and we have only given scores for those areas which we have assessed. We will carry out future assessments to cover other parts of the Framework and will update our website with our findings. At our last inspection we rated this key question requires improvement. At this inspection the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of the legal regulation in relation to people’s safe care and treatment.

This service scored 47 (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 Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service did not work well with people and health system partners to establish and maintain safe systems of care. Staff did not always manage or monitor people’s safety. They did not make sure there was continuity of care, including when people moved between different services

Some families told us the PED was busy and they could experience long waiting times to be seen. Staff and leaders told us that children and young people experienced significant delays when being transferred from the PED to the paediatric assessment unit (PAU) or to the ward, partly due to the physical distance between these areas. Staff provided examples of times where this had meant that children and young people had experienced delays in being reviewed or beginning treatment. Staff and leaders said that this was an ongoing issue which had been escalated to senior leaders, but had not yet been addressed by the time of our assessment.

Staff told us that they experienced challenges in getting support from other specialties to review patients. We observed an example of this during our on-site visit. Leaders had not implemented interprofessional standards within children and young people's services. The creation of these standards would have allowed leaders to monitor staff compliance and take action to address any areas of concern.

There was no standard operating procedure in place which described the action that staff should take when a child or young person had multiple attendances to the PED. This meant that there was a risk that a child or young person re-attending the department would be discharged without a review by a consultant or equivalent, in line with national guidance.

When children and young people were transferred from the PED to another area of the hospital, staff completed an SBAR (Situation, Background, Assessment, and Recommendation) transfer form, to ensure that all relevant information was communicated and that any risks had been assessed and mitigated. Leaders carried out an audit in December 2024 to review compliance with the SBAR transfer form and this had highlighted some areas of poor compliance. It was not clear what action had been taken to address the areas of concern.

Children and young people had to book in via the main ED reception as the paediatric ED did not have allocated administrative staff. A separate paediatric reception within an emergency department would have provided a more child-friendly environment and facilitated efficient triage and care for children and young people.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff told us that the high level of demand within the department and staffing shortages impacted on their ability to maintain oversight of the patients in the department and to manage risk effectively. There were only 2 nurses allocated to the PED at all times. The unit had no administrative support, which impacted the workload for nursing staff. Leaders had recognised, based on increased activity within the department, that a 3rd nurse needed to be allocated to the PED on an ongoing basis. As a result, an increase of 3 whole time equivalent nursing staff was required in PED.

Staff and leaders told us that triage and the completion of observations could be delayed at times of high demand. This was confirmed through a review of patient records during our assessment. Data provided by the trust showed that children and young people were usually receiving a timely initial assessment (triage) in the 12 months prior to our assessment. The average time to triage in the 12 months prior to our assessment was 16 minutes. Data provided by the trust showed that children and young people were experiencing longer waiting times to be seen by a clinician within the emergency department. The average time from arrival to being seen by a clinician was 87 minutes in the 12 months prior to our assessment. This compared to 81 minutes at Broomfield Hospital and 105 minutes at Basildon Hospital.

Leaders told us that the nursing staff allocated to the department were not always paediatric trained nurses. This could impact on their ability to identify and respond to risk. Leaders also told us that paediatricians were not always easily accessible to staff in the PED. Paediatricians were located on the paediatric assessment unit (PAU), which was located a significant distance away from the PED. This meant there was a risk of a delay when responding to a child who was requiring medical input.

Leaders told us they monitored capacity and acuity daily across paediatrics ED and worked across all departments to manage risk levels. However, staff felt some senior leaders did not understand the real time risks. As part of our assessment, we requested evidence of the escalation of staffing shortages and capacity issues, with actions taken in response. The information provided did not give assurance that the escalation of staffing shortages and capacity issues was always acted on appropriately.

Staff used a track and trigger system to identify and respond to deteriorating children and young people. The patient records reviewed during our assessment showed that physiological observations had mostly been recorded appropriately. However, it was not always clear that escalation had taken place when required or that a medical review had taken place following escalation. We were not assured that leaders monitored or had oversight of the track and trigger system within the PED. We were not provided with evidence to show that regular audits were completed. This meant that leaders could not be assured that deteriorating patients were escalated appropriately.

The service had processes in place to support staff to identify and respond to patients with sepsis. The patient records reviewed during our assessment showed that sepsis had mostly been appropriately considered where applicable and the sepsis screening tool was in use. However, there were gaps in the completion of documentation which meant that staff could not demonstrate that all relevant actions had been taken. Sepsis audits carried out in the 3 months prior to our assessment showed mixed levels of compliance. There was evidence that learning from the audit had been shared with staff. Nursing staff had high levels of compliance with sepsis training. All medical staff had completed face to face sepsis training. However, only 5% of medical staff had completed a sepsis in paediatrics course, which had a compliance target of 90%.

We were not assured that leaders monitored or had oversight of the completion of patient risk assessments within PED. As part of our assessment, we requested evidence of any audits which monitored the completion of patient risk assessments. We were not provided with evidence to show that regular audits were completed. This meant that leaders could not be assured that patient risk was being appropriately assessed and managed.

Staff had access to appropriate equipment to respond to patient deterioration. However, we were not assured that the completion of resuscitation trolley checks was regularly monitored by leaders. We requested the last 3 resuscitation trolley audits as part of our assessment; only 1 audit was provided. The audit had identified concerns and had been marked as a ‘fail’, but no re-audit had been carried out at the time of our assessment.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service did not always assess or manage the risk of infection. Staff did not always detect and control the risk of it spreading.

Families provided positive feedback about the cleanliness of the service during our on-site assessment.

Staff did not always follow infection control principles. Cubical curtains had not always been changed at the frequency set out in the provider policy. Chairs in the waiting area were ripped and this posed an infection prevention and control risk. Some mattresses were torn and covered in tape, which posed an infection prevention and control risk.

The service mostly performed well for cleanliness. Internal audits showed mostly high levels of compliance. However, audits were not always being completed at the monthly frequency set out in the provider policy. This impacted on leader’s ability to identify and respond to any areas of concern. It was not always clear what actions had been taken in response to areas of concern identified during the completion of audits.

Staff compliance levels for mandatory infection prevention control training (IPC) were above the trust target.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Clinical pharmacy services, medicines advice and supply were available from the pharmacy team. An on-call pharmacist was available outside of core working hours. Staff told us that there was more limited pharmacy support out of hours due to staffing levels

Staff told us that they had received competency assessed medicines management training, including sepsis management training.

Staff told us that they were encouraged to report incidents and learning from incidents were shared widely.

Medicines management audits showed high levels of compliance and were carried out on a regular basis.

Medicines were stored safely and securely, including controlled drugs (CDs) and CD stationaries. Ambient room and fridge temperatures were monitored regularly.

Controlled drugs were stored in line with legislation and records of administration were mostly completed in line with guidance.

The service had a process for obtaining relevant patient history. However, staff we spoke with did not have access to nationally held patient summary care records (SCR) via the electronic patient record system widely used within the trust. This meant staff may not be able to access all relevant information from GP medical records relating to current medication and allergies.

The service used paper prescriptions throughout the trust, and different prescription charts were used in the three hospitals.