Broomfield Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This was our first assessment we rated this key question Requires Improvement.

Young people and their families were not always involved in assessments of their needs. Staff reviewed assessments but did not always take into account of young people’s communication, personal and health needs. Staff did not always have time to work with other agencies involved in young people’s care. Staff involved parents and carers in decisions about their child’s care and treatment.

This service scored 42 (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 always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Young people and their families told us their individual needs were not always fully assessed. Children with additional, complex and mental health needs were not always reviewed to identify the need for additional support and/or reasonable adjustments. For example, children with special dietary and/or sensory requirements were not able to be fully supported due to lack of available resources and facilities.

Staff told us they would do their best to assess individual needs during assessments, however facilities available lacked sufficient space for children with sensory and additional needs. The playroom had limited access out of hours and staff told us the service would benefit from additional play specialists to improve the care experiences for children.

A ‘direct access’ system to the paediatric assessment unit was in place for children with complex medical and additional needs. However, there was limited oversight of this process to monitor its effectiveness and benefit through measuring outcomes. The service had regular audits in place to monitor staff compliance with pain assessment and management processes. The audits for th hospital showed high levels of compliance in the 3 months prior to our assessment.

A passport and reasonable adjustment card system was used to inform staff about children and young people’s additional needs was in place across the Trust. However, the use of this was low with only 4 passports logged at the hospital. On review of care records during assessment children and young people’s physical and emotional needs were not always documented or considered.

We asked for evidence how the trust monitored care for children with additional needs and any associated action plans. The service provided an overview of actions to be taken in relation to national recommendations, but did not provide evidence of any current monitoring processes. Therefore, we were not assured the service had good oversight of assessing needs and care outcomes.

We scored the service as 1. The evidence showed significant shortfalls. The service did not always plan and deliver children and young people’s care and treatment with them and their families.

Parents and carers told us staff were knowledgeable about care and treatment delivery. However, some parents and carers who had children with additional needs told us they had to explain multiple times, to different staff, their child’s diagnosis and requirements for their care.

Staff told us they were trained and used nationally recognised paediatric observations systems to record children’s vital signs. The paediatric early warning score and paediatric sepsis screening tool were used by staff across all areas of paediatrics. Monthly audits carried out to monitor these tools showed consistent compliance. However, records reviewed during assessment showed inconsistent documentation and escalation of high paediatric warning scores. Particularly when children moved between paediatric departments.

There was recognition of good practice within the neonatal department with a gold standard accreditation award from a premature baby charity.

During assessment we observed staff taking clinical observations. However, staff in paediatric wards raised concerns that at times of high demand they found it difficult to complete and record regular and timely observations to meet patient’s clinical needs in line with trust policy and national guidance. The trust had also completed and shared incident reviews which highlighted delays in observations not being completed in line with national guidance. Furthermore, there had been a delay in updating some guidance and policies against national guidance with no clear timeframes or completion date for this work. This meant staff would not always have access to the most up to date guidance and methodology around paediatric care.

Staff also raised concerns over the lack of staff in speciality areas, such as the diabetic and sickle cell services. They shared the challenges of recruitment and filling vacancies. This issue was included on the trust’s risk register. Staff were looking at online technology to assist them with effectively managing increasing caseloads. They were also working with system partners on improving services, but funding availability was limited

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support children and young people.

Parents and carers told us, at times information sharing between departments was not always consistent. They said there could be disconnected communication between teams which caused delays in care and treatment for their child.

Staff also told us they were concerned the relationship between medical staff and the senior leadership within the trust. There had been a breakdown in communication and disagreements about how risks were being addressed and managed within paediatrics. Nursing teams often felt “stuck in the middle” with a lack of progress made by senior leaders to make lasting effective cultural changes. Medical staff also shared their concern about the wellbeing of nursing teams, their working conditions and the impact of increasing demand.

Leaders had not implemented interprofessional standards within children and young people's services. Interprofessional standards are a clear description of the expected values and behaviours within a service, when healthcare professionals from different disciplines are working together. The creation of these standards allows leaders to monitor how teams are working together and take action to address any areas of concern. This was not in place at the hospital.

Staff commented they found it difficult to engage with community teams due to ongoing demand on the acute paediatric services which hampered their ability for wider collaborative working. Some community partners also told us there could be improvements made in communication and team working between services.

Community mental health services often held a coordination role to progress care for children and young people and worked closely with the safeguarding leads at the hospital. Capacity pressures on wider community services meant children would present to the hospital in mental health crisis, which often was not the most appropriate location for their care.

We scored the service as 2. The evidence showed some shortfalls. The service did not always support children and young people to manage their health and wellbeing.

Parents and carers in the neonatal unit told us they were provided with fresh fruit and healthy snack options for breast feeding mothers and family members. On the wards and paediatric assessment unit, young people and their families told us they had been given emotional support by nursing staff during their care.

Staff told us they did their best to support all young children using their service. However, this could be challenging during times of high demands and acuity with limited resources and staff. Children had access to a large outside play area for exercise, but this had limited use during winter months.

Information collated by the service regarding children and young people’s physical and mental health was sporadic and inconsistent throughout departments. There was no clear focus or workstream dedicated to this aspect of paediatric care.

We scored the service as 1. The evidence showed significant shortfalls. The service did not routinely monitor children and people’s care and treatment to continuously improve standards. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of young people and their families.

Parents and carers on the in-patient wards told us it was not always clear what treatment outcome to expect. They told us at times diagnosis explanations were not always communicated. However, parents and carers in the out-patient department told us they were informed about outcome goals and care plans.

Local nursing leaders told us they had processes in place to audit care records to identify themes to monitor care delivery standards. There had been a particular focus on the management of sepsis and escalation processes. Staff told us there had been refresher training around sepsis and said this was being closely monitored. They told us senior leaders did not always see the link between service demand and acuity, with poor outcomes for children and young people. They told us leaders did not always fully communicate with them and provide assurance/plans for improvement in outcomes.

We requested current evidence of any national benchmarking data collected in relation to children and young people services. Reports provided were not current and associated action plans had not all been completed. There was a low compliance rates with national audits and data were not always submitted to monitor outcomes and support learning. Leaders told us there had been a lack of admin support and ongoing data issues that had caused this delay.

National audits, particularly in healthcare, offers several benefits, including improving patient care, identifying areas for improvement, and benchmarking performance against national standards. These audits can also influence funding decisions and demonstrate commitment to quality improvement.

Limited progress had been made by the service to improve low compliance, and we were not assured they had effective systems in place to monitor and benchmark care outcomes to drive improvements.

We scored the service as 2. The evidence showed some shortfalls. The service did not always tell people about their rights around consent and the service did not always provide staff with the right tools to support consent decisions.

Young people and their families told us that staff discussed and explained procedures and treatments prior to starting their care.

Staff were aware of the need for informed consent when discussing assessments and treatment plans with families and carers. However, staff did not always have available guidance and training around paediatric care and Gillick competence. Gillick competency is applied where a child under 16 can consent to their own treatment. The service had a generic consent policy which lacked information relating to children and young people. The policy did not give staff guidance on what to do if treatment was being refused by young people with capacity.

Oversight of consent processes was lacking because the Trust did not carry out any audits on mental capacity and consent assessments. Therefore, there was limited evidence to show current processes were effective and robust.