Broomfield 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 is the first assessment for this service. 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. We found that 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 19 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

We received mostly positive feedback from families regarding their experiences of admission, discharge, and moving between services. However, some families told us that they had experienced long waiting times to be seen. This was confirmed through some of the patient records reviewed during our assessment, which showed that some patients had experienced delays in triage or to be seen by a clinician within PED. 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 in PED. The average time from arrival to being seen by a clinician was 81 minutes in the 12 months prior to our assessment. This compared to 87 minutes at Southend Hospital and 105 minutes at Basildon Hospital.

Some families described attending the service on multiple occasions for the same concern. This was also identified in some of the patient records reviewed during our on-site visit. 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.

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. There was also a risk of a delay in staff becoming aware of safeguarding and child protection information. Departmental guidance stated that staff should only access electronic systems for safeguarding information after triage had taken place in the PED.

Staff said that the paediatric assessment unit (PAU) was used as an overflow area from the PED, to avoid breaching the four-hour waiting time target. Staff said that they did not have the staff or facilities to safely cope with the numbers and acuity of patients in PAU. This was supported by the workforce plan reviewed during our assessment which stated that for PAU “10-12 trolley spaces are utilised daily rather than the funded 6 trolleys”. Leaders had recognised, based on increased activity, that an increase of 10 whole time equivalent nursing staff was required across PAU and PED.

Staff told us that the paediatric resuscitation area was often used by adults when the emergency department was busy. This meant that there was a risk that a child or young person could experience a delay in treatment in the resuscitation area. Staff recognised that the arrangements were not ideal but confirmed that no patient safety incidents had been reported as a result.

Staff did not always feel that there was a collaborative, joined-up approach to safety that involved other partners in children and young people’s care. Staff described challenges in accessing staff in partner organisations to discuss patient care. Staff said that an increased number of children and young people were attending the PED, in part because services were not available in the community.

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. The form was used to ensure that all relevant information was communicated between staff and that any risks had been assessed and mitigated. An audit was carried out in December 2024 to review compliance with the SBAR transfer form and this showed high levels of compliance.

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. Leaders had recognised, based on increased activity, that an increase of 10 whole time equivalent nursing staff was required across PAU and PED.

Leaders told us they monitored capacity and acuity daily across paediatrics ED and worked across all departments to manage risk levels. However, a review of capacity trackers during our assessment demonstrated that capacity escalations at times of high demand were not always acted on effectively by leaders

Staff used a track and trigger system to identify and respond to deteriorating children and young people. The patient records reviewed during our on-site assessment showed that physiological observations had mostly been recorded appropriately. However, it was not always clear when escalation had taken place or when 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.

Some staff told us that they were hesitant to escalate concerns regarding patients to consultants, partly because they did not want to “bother” them and partly because of the negative response that they received when they did escalate. However, staff said that the escalation of concerns had increased and consultant’s response to escalation had improved following recent patient safety incidents. 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.

The service had processes in place to support staff to identify and respond to patients with sepsis. The patient records reviewed during our on-site visit showed that sepsis had mostly been appropriately considered where applicable. Sepsis audits carried out in the 3 months prior to our assessment showed mostly high levels of compliance. Nursing staff had high levels of compliance with sepsis training. However, we were not provided with evidence that medical staff had completed sepsis training. We therefore could not be assured that this had been completed.

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.

There was no paediatric outreach service available to support staff to manage patient clinical risk. Senior paediatric nursing staff would provide support to staff when they were on duty, but they recognised that this was not sustainable or ideal. This meant that staff may not always have support available to manage and respond to patient clinical risk.

Staff had access to appropriate equipment to respond to patient deterioration. Resuscitation trollies had been regularly checked in line with the provider’s policy. However, we were not assured that the completion of resuscitation trolley checks was regularly monitored by leaders. We requested evidence of resuscitation trolley audits as part of our assessment but this was not provided.

The service did not always assess or manage the risk of infection.

The service had gathered feedback from families which raised concerns regarding infection prevention and control. As a result, staff had been sent a reminder to ensure that mattresses were checked and cleaned in line with infection prevention and control protocols.

Clinical areas and toilet facilities were mostly visibly clean during our on-site assessment. However, the floor in the paster room was not visibly clean. Chairs in the waiting area were cracked and posed an infection prevention and control risk.

The service performed well for cleanliness. Internal audits for hand hygiene and infection prevention and control showed high levels of compliance. However, audits were not always being completed at the monthly frequency set out in the provider policy. This meant that there may be a delay in leaders identifying and responding to any areas of non-compliance.

Staff compliance levels for mandatory infection prevention control training (IPC) were above the trust target overall. However, medical staff compliance was only 78% and this was below the trust target of 85%.

The service did not always make sure that medicines and treatments were safe.

Staff told us the pharmacist team fully supported them. Staff told us that that the in-hours and out-of-hours pharmacy support varied due to staffing levels. Staff told us that they had received medicines management training, including for patient group directives (PGD) used in the paediatric department. Staff told us that they were encouraged to report incidents, and learning from incidents was shared widely.

Medicines were stored safely and securely. Controlled drugs were stored in line with legislation and records of administration were mostly completed in line with guidance. However, staff told us that unused controlled drugs (CD) were wasted in the sharps bin, which does not have absorbable material. This was not in line with national guidance.

The service did not always perform well for medicines management. Audits carried out in September and October 2024 had identified a number of areas of non-compliance with provider policy. Overall compliance levels ranged between 77% and 83% during this period. It was not clear what action had been taken in response to the concerns identified.

The service had a process for obtaining relevant patient history for people presenting to the PED. However, staff did not have access to nationally held patient summary care records (SCR). This meant staff may not be able to access all relevant information from GP medical records relating to current medication and allergies. Staff told us that there were sometimes delays in accessing relevant information as access was limited to senior members of staff. The service used paper prescriptions throughout the trust, and different prescription charts were used in the three hospitals