Broomfield Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected, that they understood that their care experience and how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them. This was our first assessment we rated this key question Requires Improvement.

This meant young people and their families did not always feel well-supported, cared for or treated with dignity and respect. Young people and their families were treated with kindness and compassion. They treated them as individuals and mostly supported their preferences. Staff did not always respond to young people in a timely way. The service did not always support staff’s wellbeing.

This service scored 50 (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 3. The evidence showed a good standard. The staff always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Young people and their families told us staff were kind and showed compassion. When the wards were busy, a parent told us they sometimes felt they were “a nuisance” when asking for help, but overall, the nursing and medical staff were helpful. During our assessment staff were observed to be kind and friendly with children, young people and their families. We also saw respectful and professional conversations, between nursing and medical staff working together

Staff told us they did their best to provide the highest standard of care. However, they often left shifts feeling frustrated at not being able to give children and families the time and attention they needed due to the ongoing demand on the service.

Partners also shared concerns around staffing levels and the lack of clear communication to parents / carers around waiting times which often caused families' distress.

The service did carry out the national friends and family test survey and results were published quarterly. The Friends and Family Test (FFT) is an important feedback tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. Recent results showed 85.7% of 3602 family’s surveyed had a positive experience of children and young people services within the trust. Some families commented that “staff were fantastic, really supportive and helpful” and “all staff were kind helpful and polite”.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat children and young people as individuals or make sure care, support and treatment met their needs and preferences. They did not always take account of family’s culture and unique backgrounds and protected characteristics.

Young people and their families told us they did not always feel staff were able to treat them as individuals due to demands on the service, this concern was also shared with us by staff.

Staff told us they would often become overwhelmed with workloads and were not always able to spend sufficient time with children and their families. During our assessment we observed staff supporting children individually and good communication with parents and carers. Nursing leaders acknowledged high demand on staff’s workloads and told us they would seek support from all staff, for example the play leads when available to give individualised support to children where needed.

On assessment there was a lack of resources and information available for parents and carers of children with additional needs. For example, there was limited accessible, information tailored to the needs of the children and information displayed was not always child focused. The inpatient wards did not have a dedicated quiet space to facilitate children and young people with any additional sensory or neurodiverse need.

The service did not utilise the trusts ‘paediatric hospital passport’ resource that was available. This resource was a tool to discuss and record children’s individual needs and requirements with families and carers. This lack of consistent processes meant care delivery was not always equitable across services.

We scored the service as 2. The evidence showed some shortfalls. The service did not always promote children and young people’s independence. People did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Most parents and families told us they were able to express opinions about their child’s or baby’s care. Some parents shared they were concerned that assumptions had been made about their ability to make decisions, and they had not been listened to during parental decision-making discussions.

The service did not have effective guidance for staff on how to support and promote children and young people’s independence and choice whilst they were in hospital, for example Gillick competency. Gillick competency is applied where a child under 16 can consent to their own treatment. We reviewed the consent policy which did not outline how staff would follow Gillick competency or access advocacy services. Although requested, there was limited evidence to demonstrate how the service monitored care in relation to child and young people’s independence, choice and control.

We scored the service as 2. The evidence showed a some shortfalls. Staff did not always responded to children and young people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Some parents and families on the inpatient ward and the neonatal unit told us staff were prompt at responding to call bells. However, at times of high demand, they may have to wait to be assisted but said there was no impact on their wellbeing.

During our on-site assessment we saw staff were doing their best to respond to children and young people’s needs promptly. However, staff told to ensure children and young people were observed they would often have no breaks and would stay late when the service was busy. They found it difficult to maintain regular clinical observations and checks during periods of high demand. Leaders were aware of departments being busy and were monitoring the responsiveness of teams through audits and safety incident reviews. Ward leaders told us they would prioritise children’s safety and always assist nursing staff with any escalations or concerns

We scored the service as 1. The evidence showed significant shortfalls. The service did not care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care.

Staff told us there was limited formal support they could access during work time. They took part in informal peer support between colleagues, but did not always feel comfortable approaching all senior leaders if they were struggling. Concerns were raised over confidentiality and level of support they would receive. Staff told us there was limited opportunities for career development and training was at a minimum due to financial restraints on the service.

There was limited evidence of opportunities for staff to provide feedback, raise concerns and suggest ways to improve the service. Staff shared they did not always feel listened to or have confidence their concerns would be acted on. Monthly drop-in sessions were arranged by senior nursing leaders, but there was evidence that the sessions were put on hold due to operational pressures.

Senior Trust leaders acknowledged staff would often not get breaks, but this was monitored daily by rota coordinators. There was no short-term plan to address this but financial support was needed to increase recruitment. Leaders acknowledged staff morale was low and nursing sickness rates were 5.76% sitting above the trust target of 4%. Leaders told us staff’s wellbeing and enablement was identified as a priority, but this was not reflected by staff’s experience or senior leadership actions.

We requested evidence on how the service supported staff’s wellbeing an enablement. Information reviewed showed there was a Professional Nurse Advocates on each neonatal unit in the trust. The service had in house occupational health teams and had collaborated with local stakeholders to provide staff with a 24-hour wellbeing support phone line. Previously there had been a permanent Well-being hub for staff, however this provision had been downsized. The hub did not have a permanent location as was now staffed with volunteers. Staff had limited knowledge of all services available to them and improved communication on well-being provisions was needed.