Basildon 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 Inadequate.

This meant there were widespread and significant 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 staff did not always have a shared vision and culture based on listening, learning and trust. Senior leaders were not always visible, knowledgeable and supportive, helping staff develop in their roles. Staff did not always feel supported to give feedback and were worried they would not be treated equally and be free from bullying or harassment. Young people and their families with protected characteristics did not always feel supported. Staff understood their roles and responsibilities but often were understaffed and under pressure. Nursing managers did not always have the time to work with the local community groups. There was not always a culture of continuous improvement and staff were not always given time and develop and train.

This service scored 25 (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 1. The evidence showed significant shortfalls. The service did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of children, young people and their communities.

Staff were concerned senior leaders within the trust did not fully understand the demand and pressure on staff and that moral was low. Staff said senior trust leaders were not acknowledging how bad the situation was. They said leaders focused on finances and cutting costs rather than addressing the risks. Some staff also told us there was no psychological safety to voice concerns and would often leave shifts worried about children and young people’s outcomes.

Staff told us prolonged recruitment processes had meant they had lost external candidates and roles remained unfilled for long periods of time putting additional strain on existing staff. They said senior trust leaders did not communicate their understanding of pressures on the service and future planning lacked real time staffing solutions and risk management.

Senior trust leaders acknowledged the staff were under pressure and moral was low. They recognised the need for an uplift in nursing and medical staff, and they had continued to review the structures within paediatrics but had financial restraints on any proposed staffing increase.

Leaders also 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.

We requested current children and young people clinical and cooperate strategy. This was not provided. There was limited assurance the service had a clear shared vision, strategy and culture.

We scored the service as 1. The evidence showed significant shortfalls. The service did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

Children and Young People services are part of the Women and Children 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. Basildon 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 with the ward and PAU meetings being the best attended. Meeting agendas were detailed, and staff were given opportunities to raise concerns.

However, staff told us senior trust leader were not always visible, and had concerns they did not understand the day-to-day challenges staff faced. Although there were debriefs after incident they were not always documented, and staff said the impact on their wellbeing was not always considered. Nursing managers did their best to complete appraisals and one to ones, but these would often be cancelled due to demand on the service. There was low appraisal compliance rates and no identified actions to improve. Staff told us there was limited opportunity to make suggests direct to senior trust leaders for change and were frustrated with the lack of improvement.

Local leaders acknowledged and understood that demand on the service and how the lack of staff was putting continued pressure on existing services. They were concerned the service continued to be run on the good will of staff and this could not be maintained. A long-term sustainable solution was required.

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. Staff did not feel they could speak up and that their voice would be heard.

Staff told us they were unsure of the freedom to speak up (FTSU) provision but had access to the trust’s intranet for information. They were not aware of their local freedom to speak up champions. The trust had 37 champions that had received full training with a further 3 awaiting course completion. The was no FTSU champions within children and young people services. Therefore, this staff group did not have representation at board level meetings to feedback.

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.

Workforce equality, diversity and inclusion was inconsistent across the service. Staff raised concerns over the perceived limited support available for international nurses. During post assessment staff focus groups, concerns were raised that not everyone employed was treated the same. For example, poor shift allocation for staff who might feel unable raise concerns or say no. The trust did not have a system in place to monitor equitable workforce planning to demonstrate there was fairness in shift/work allocation.

Medical staff were very supportive of their nursing staff colleagues. They were concerned many senior experienced nurses were leaving and other less experienced nurses were joining, with the potential to reduce senior support. Staff did not feel they were not being treated equitability, and said their knowledge and experience was not always valued.

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 trusts 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 paediatric assessment unit and long-term staffing issues across the service. They told us they were continually losing staff and sickness levels were high. 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. We also requested evidence of feedback collected from staff’s exit interview and how this shaped their long-term staff retention plan and workforce sustainability. This was not provided as the service did not collect this information.

Staff did not always act on the best information about risk, performance and outcomes, or could share this securely with others when appropriate. Audit requirements and schedules were not consistent across all trust sites, making it difficult for leaders to spot emerging trends and risks across the whole trust.

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 1. The evidence showed significant shortfalls. The service did not understand their duty to collaborate and work in partnership, so services work seamlessly for children and young people. They did not share information and learning with partners or collaborate for improvement.

Leaders told us they worked with community partners but could often be inconsistent due to funding and demographic restraints. However, the service did not have any parent or community forums to facilitate shared communication and engagement with their community. This was a missed opportunity to seek further support from the wider community to positively impact care delivery. Leaders told us the need for community engagement had been identified but were at times there was conflicting priorities across the paediatric services. Further work needed to be undertaken to align processes to meet the populations needs.

We requested evidence how the service engaged and worked in partnership with local communities and external organisations. We were provided with posters advertising community events that had not been organised by the service. There was no evidence submitted to demonstrate the service proactively planned and participated in community and partnership projects. There had been missed opportunities to engage with external partners and community groups.

Community Healthwatch 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 did not always understand their duty to collaborate and work in partnership, so services work seamlessly for children, young people and their families.

We scored the service as 1. The evidence showed significant shortfalls. The service did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Learning and improvement were not always consistent due to continued pressures on departments. Some staff us there was limited opportunity to make suggestions and actively contribute to safe, effective practice and research. They were disempowered to drive improvements within children and young people services. They would escalate concerns and suggestions for improvements to senior managers, but they said their hands were tied due to financial restraints and cultural issues within the service. Staff told us there was limited opportunities for career development. For example, funding for nursing apprenticeships had just been reduced. Due to this some staff were actively seeking employment elsewhere for career development.

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.
The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. Evidence reviewed showed there had been repeated themes from incidents and identified lessons to be learnt. The recommendations for improvement in care were not fully embedded and children and young people remained at risk.