Mid and South Essex NHS Foundation Trust

On this page

• 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
• Environmental sustainability – sustainable development

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although the trust had implemented a new strategy, staff did not feel connected to it. Cultural challenges had continued since the 2020 merger, and many staff felt disconnected from leadership. This disconnect contributed to low morale and a lack of engagement across the organisation.

The trust had recently refreshed its strategy, publishing a new 10-year vision in April 2025. This strategy was underpinned by four strategic priorities: Our People Excel, Our Communities Thrive, Our Services Are High Performing and Sustainable, and Our Partnerships Deliver Benefits for Our Population. These priorities were supported by key enablers, including digital transformation, governance, financial sustainability, and research and innovation. The trust’s strategy was grounded in principles of equity, equality, diversity, and inclusion.

The strategy had been developed in alignment with the wider system strategy. Partners reported that the trust had a clear strategic direction, although they acknowledged that significant progress was still required to deliver it effectively.

While it was too early to determine the extent of staff awareness, there had been engagement with staff during its development. Oversight of the strategy sat with the trust board. The trust’s vision was articulated as One Team Working Together for Excellent Patient Care, and it had established three core values and behaviours: Excellent, Compassionate, and Respectful.

Quality was identified as one of the trust’s overarching priorities. The Clinical Quality Strategy was due for revision in 2025. Leaders recognised the need to focus on getting the basics of quality right. We looked at the nine quality priorities for 2024/25 and noted that 7 were partially achieved, and one priority, “Improving overall patient experience,” had not been achieved. Quality priorities for 2025/26 had been set and were aligned to the trust’s strategic priorities and the new 10-year strategy. The Chief Nursing Officer was the named executive lead for quality improvement, with each site’s Director of Nursing taking local ownership of quality improvement and delivery of the priorities.

The trust had a Nursing Strategy which was approved in November 2024. A Maternity Strategy was under development.

Culture was described by many executive leaders as the most significant challenge facing the trust.

Since the 2020 merger of the three NHS organisations cultural challenges remained. Leaders told us that some staff viewed the merger as an opportunity, others were less engaged and felt it should not have taken place. This was a theme we heard throughout our assessment, including the assessments we undertook in other parts of the trust, such as the maternity service.

Feedback indicated that not all staff felt positive or proud to work for the trust. The 2024 staff survey results showed that morale and staff engagement scores were among the lowest nationally. Some staff reported feeling that leaders were disconnected from frontline teams, and that there was a divide between the priorities of non-clinical management and patient-facing staff. This perception was consistent throughout the assessment. We found leaders were aware of the lack of cohesion and knew there was considerable progress needed to address the underlying causes.

We noted that many leadership interviews during our assessment were dominated by financial concerns, with limited attention given to patient outcomes. Despite receiving deficit support from NHS England, the trust remained in the National Recovery Support Programme, reflecting ongoing financial challenges—including a reported £84.6 million deficit in 2024/25 and a projected £85 million deficit in 2025/26. Staff expressed concerns that the organisation had become too financially driven, with insufficient focus on quality and safety.

Staff reported feeling undervalued and unsupported, with executive leaders acknowledging the need to “get the basics right.” This included simple but meaningful provisions such as access to cold drinking water, tea, and coffee—elements that contribute to a sense of care and respect in the workplace. The lack of these basic amenities was seen as symbolic of wider cultural and engagement issues, where staff felt disconnected from leadership and fatigued by repeated concerns that remained unaddressed.

We carried out focus groups with different staff and heard a similar narrative from all those we met with, in that they felt disconnected from the trust strategic leadership, and it was too focused on finance. Staff reported feeling let down, unsafe, and vulnerable, and expressed frustration at having to raise the same issues repeatedly.

We also heard a theme from staff and leaders that poor behaviours sometimes went unchallenged. Some leaders described a culture of non-compliance and a lack of accountability where not all staff and managers were held to account. The Chief People Officer reported the trust had a performance management framework via the appraisal system, but they were trying to embed it, so people were better held to account. Leaders recognised there was a need to strengthen accountability and reinforce professional standards to support cultural change.

We saw evidence that not all teams worked collaboratively or resolved conflict effectively. There had been limited investment in clinical leadership and organisational development, which contributed to inconsistent team dynamics and a lack of shared accountability. The absence of structured leadership development meant that clinical leaders were not always equipped to model expected behaviours, challenge poor conduct, or foster a culture of openness and improvement. Leaders acknowledged these gaps and recognised the need to strengthen clinical leadership capacity as part of wider cultural and performance improvement efforts.

Leaders aspired to embed a just culture across the trust; however, they acknowledged that this was not consistently realised in practice. The widespread perception that unacceptable behaviours had become normalised in some areas, and that staff were not always held to account, undermined efforts to foster psychological safety and trust across teams. While the ambition for a just and learning culture was there, it had not yet translated into consistent behaviours or experiences for staff.

The trust had a balanced board and a refreshed leadership team, but its new operating model caused confusion around roles and accountability. Staff engagement was low, with poor survey results highlighting concerns about inclusivity and leadership visibility. While leaders were committed and compassionate, they faced major challenges, including financial pressures and cultural issues, and showed signs of fatigue. There was no formal leadership strategy or reliable appraisal data, and staff continued to feel undervalued and disconnected.

The trust board consisted of six executive directors who held voting rights and nine voting non-executive directors (NEDs). This structure provided a balance of operational leadership and independent oversight. At the time of the assessment, the trust chair was nearing the end of his ten-year tenure, and the trust was actively recruiting a successor. Two new non-executive directors commenced their roles in April 2025, following the departure of two long-standing NEDs.

The executive leadership team had undergone several changes. The Chief Executive Officer (CEO) had been in post since 2023. In 2024, the trust appointed a new Chief Medical Officer and a Chief People Officer, further strengthening the leadership team. The Chief Operating Officer (COO) also joined the board in 2021. The longest-serving executives were the Chief Nursing and Quality Officer, who had been in post since 2017, and the Chief Finance Officer, who had been with the trust since 2020. These leaders brought continuity and institutional knowledge during a period of significant organisational change.

Interviews with senior leaders suggested they were inclusive and aware of the context in which they were delivering care. However, they also described the significant challenge of leading an organisation that needed to improve basic standards of quality and safety while operating under considerable financial pressure.

All executive and non-executive directors met the requirements of the Fit and Proper Persons Regulation (FPPR). FPPR is the regulation which requires NHS trusts to check that all executive and non-executive directors are suitable and fit to do their role. The trust had a process to ensure compliance and were proactive to avoid lapses in checks. A review of 4 executive files confirmed that individuals met the necessary standards of suitability and fitness for their roles.

To support cultural change, a leadership and management behaviours framework was introduced to embed standards of behaviour and clarify expectations for leaders and managers.

In November 2024, the trust implemented a revised operating model, introducing a new structure based on site-level leadership. This included four clinical divisions, three hospital divisions, and an overarching clinical strategy and academic board. The clinical strategy and academic board aimed to ensure consistency in clinical strategy. All clinical and hospital divisions reported to the trust Leadership Group and then to the board.

Some leaders expressed confusion about lines of accountability within the trust’s operating model. During interviews, different leaders provided varying interpretations of reporting structures, indicating that the model had not yet been fully embedded or clearly communicated. This inconsistency created uncertainty around roles and responsibilities, particularly in relation to site-based leadership and divisional oversight. While the model was still in its early stages, the CEO acknowledged the need for further clarification and refinement to ensure it supported effective governance and operational delivery.

The Chief Pharmacist reported professionally to the Chief Medical Officer to ensure executive oversight. They were lined managed by a divisional director. We were concerned about the level of oversight of the role of the Chief Pharmacist, especially given the legal responsibilities that came with that role.

In the 2024 NHS Staff Survey, 35% of staff responded, which was lower than both the national average of 49% and the trust’s 2023 response rate of 39%. A total of 5,884 staff completed the survey. The trust received the lowest score nationally among similar trusts for the statement “We are compassionate and inclusive,” with a rating of 6.61. Three out of four areas under this theme were rated the worst in England. The score for equality, diversity, and inclusion was 7.63—below the national average of 8.08, though not the lowest among comparable trusts.

The trust produced a staff magazine, and the CEO held open staff sessions to engage directly with colleagues. Operational briefings were cascaded through a structured communication process. Despite this, we heard from many staff that they did not always feel valued by trust leaders. Executive leaders acknowledged the need to improve visibility and engagement with staff. For example, the Chief Nurse described having a large portfolio, which limited her ability to be as visible across sites as she would have liked.

At the time of the inspection, the trust did not have a formal leadership strategy or a talent management programme that included succession planning. However, there were opportunities for staff to access training and development. The Chief People Officer told us that developing a talent management framework was a future priority but there was no clear timescale at the time of the assessment.

The trust had recently introduced a new appraisal system called Elevate. Historically, the appraisal culture had been poor, but leaders reported that it was beginning to improve. However, challenges with the new system and operational pressures all had a negative impact on compliance rates.

There was no doubt that the leaders we spoke with demonstrated integrity and compassion. However, the scale of the challenge facing the trust required continued energy, enthusiasm, and tenacity. While leaders remained committed to the organisation and its values, the assessment team noted signs of fatigue and pressure, which may impact leaders’ ability to lead effectively during a period of significant organisational change.

Staff lacked confidence in raising concerns. Survey results showed low trust in the organisation’s response to issues. An independent guardian service helped some staff feel safer, and the number of concerns had increased. Guardians worked with HR and senior leaders to address issues, but poor communication and lack of transparency remained common complaints. Staff wanted clearer, more honest messaging from leadership.

Leaders were committed to improving culture, but building trust and psychological safety remained a major challenge.

Freedom to Speak Up (FTSU) was regularly promoted throughout the organisation. They supported the annual October Freedom to Speak up month as well as other campaigns to promote awareness throughout the year. Campaigns to promote FTSU included awareness-raising, policy promotion, and the introduction of training focused on listening well. Despite these efforts, staff survey results indicated that the trust continued to perform below the national average in key areas related to speaking up.

In the 2024 NHS Staff Survey,59.4%of staff agreed or strongly agreed that they would feel secure raising concerns about unsafe clinical practice, compared with anational average of 70%. Furthermore, only40.5%of staff felt confident that the organisation would address concerns raised, which was below thenational average of 55.1%.

The trust commissioned an independent provider to deliver its FTSU service. Some staff reported that the independent status of the guardian service helped them feel safer and more motivated to speak up. Between 1 April 2024 and 31 March 2025,325 new concernswere raised to the FTSU guardians—higher than comparable trusts. The majority of concerns were raised by nurses and midwives (98), admin and clerical staff (66), and additional clinical staff (57).

The most common themes raised included:

• Management issues(30%)
• System and process concerns(18%)
• Patient safety(11%)
• Bullying and harassment(11%)

There was regular reporting by the FTSU guardians, and a detailed annual report was presented to the board. Data showed a steady year-on-year increase in the number of staff speaking up. While this increase aligned with national trends, the volume of cases reported by the trust was higher than comparable organisations—though this was not necessarily a cause for concern.

The highest category of concern was management issues which often reflected perceptions that managers were not doing enough to relieve departmental pressures, such as staffing shortages and administrative burdens. Staff also reported feeling that their managers did not listen, respect their views, or take appropriate action when concerns were raised. Many preferred to speak with a guardian before addressing concerns directly, due to fear of being identified. Some cases were escalated, and the trust responded with targeted actions to gather further intelligence and develop plans to address the issues raised.

Concerns related to patient safety and quality showed an upward trend from 2021 to 2024. The guardian report also included data on discrimination and inequality, helping to identify patterns and inform targeted interventions.

Guardians undertook a range of activities to ensure learning and action followed concerns raised. They worked in partnership with the equality, diversity and inclusion (EDI) team, attended training sessions, and held monthly meetings with HR and multidisciplinary teams to review activity reports, emerging themes, and outcomes. Regular meetings were held with the Chief People Officer, and these were extended to include Directors of Nursing and the Chief Nursing Officer to ensure clinical oversight. Clinical cases were also reported through quality governance routes. A quarterly FTSU steering group was attended by the Chief People Officer and Chief Nursing Officer, and guardians also met quarterly with the Chief Executive Officer.

The trust was committed to improving people management capability and offered training for those in supervisory or leadership roles. This included aListening with Intentmasterclass, which was well received by attendees. However, leaders acknowledged the need to encourage wider participation and were considering making the training mandatory.

Staff told us they increasingly experienced concerns about their mental health and the impact of work-related stress.Several staff reported feeling isolated, unsupported, and anxious. A recurring theme across many accounts was poor communication—both in terms of frequency and quality. Staff consistently felt that major changes were not communicated clearly and that messaging lacked transparency.

Although staff acknowledged that there were opportunities to contribute, they described a pattern where decisions were made without recognising their input or explaining the rationale behind those decisions. This was particularly evident in cases where decisions were driven by financial pressures or national directives. Staff expressed a desire for leaders to be honest and open with them. One staff member told us,“We know we have to make savings, but tell us why you have had to make those decisions, and we can support you.”

The trust had begun work to raise awareness of the impact of civility and incivility on engagement, teamwork, patient safety, and staff wellbeing. Embedding civility training across development programmes was identified as a priority to help reinforce behavioural standards aligned with the trust’s values.

Although the FTSU guardians reported limited numbers of sexual harassment cases, the trust had signed up to the NHS Sexual Safety Charter and committed to further work in this area.

In 2023/24, the trust launched aValuing Peopleprogramme to address themes emerging from the national staff survey. Although the programme had run for more than a year, it was deprioritised due to financial pressures.

Interviews with executive leaders demonstrated a commitment to improving organisational culture and strengthening the speaking-up environment. Leaders were open about the scale of the challenge and identified FTSU as a key priority. While there was no doubt some progress had been made, there remained a significant journey ahead to build trust, psychological safety, and a culture where staff felt empowered to raise concerns without fear.

The trust’s review of race and disability workforce data showed some progress, but significant gaps remained in ensuring fair treatment for staff with protected characteristics. Ethnic minority staff continued to report less positive experiences than white colleagues, especially around career progression, bullying, and inclusion.

A review of the Workforce Race Equality Standard and Workforce Disability Equality Standard data showed some improvements; however, the trust still had work to do to ensure equitable treatment of staff, particularly those with protected characteristics. The data highlighted key areas for improvement, especially in relation to career progression, harassment, bullying, and abuse.

Within the race equality metrics, the data consistently indicated that White staff reported more positive experiences than staff from Black and minority ethnic backgrounds. This disparity suggested the presence of cultural issues within the trust that needed to be addressed to ensure a more inclusive and supportive working environment for all staff.

The trust noted the need to improve data collection across the organisation, particularly in relation to workforce demographics. As of the latest reporting period, 2.27% of employee records had no ethnic origin recorded within the Electronic Staff Record (ESR) system. The trust recognised that incomplete data may limit the accuracy of equality monitoring and hinder efforts to identify and address disparities. Improving data completeness was identified as a priority to support more effective analysis and targeted action.

The trust used the term BAME (Black, Asian and Minority Ethnic) in its reporting and communications, following a request from its staff network. However, national guidance indicated that the term was no longer recommended, as it grouped together diverse ethnic communities and risked masking disparities between them. The trust acknowledged that the continued use of this term was not in line with national guidance. We saw that terminology varied across reports and plans, which could lead to inconsistency in how ethnicity data was interpreted and acted upon.

In 2024, the trust reported that 37.27% of its workforce identified as being from different ethnic minorities, significantly higher than the national average of 26.4%. Recruitment of ethnic minority staff also improved markedly, rising from 6.03% in 2021 to 21.48% in 2024, outperforming the national average of 1.59%.

The trust had an established equality, diversity, and inclusion group chaired by the Chief People Officer, with director leads aligned to each of the six staff network groups. In 2024, the Chief Executive Officer signed the Equality Diversity and Inclusion Charter, reaffirming the trust’s commitment to inclusive practices.

Formal disciplinary rates had increased for all staff since 2021, though remained below national averages. In 2024, 0.46% of white staff and 0.70% of ethnic minority staff entered formal disciplinary processes, compared to a national average of 1.03% for ethnic minority staff and 0.44% for white staff nationally.

Perceptions of equal opportunities among ethnic minority staff improved by 3% since 2023, reaching 45.86% in 2024. This remained below the score for White staff (55.21%) and slightly below the national average of 46.40%.

Except for 2024, access to non-mandatory training was higher for ethnic minority staff compared to white staff, indicating there was not a disparity.

Discrimination experienced by ethnic minority staff decreased from 20% in 2021 to 16.94% in 2024, aligning with the national average of 16.9%. However, discrimination reported by white staff increased to 8.54%, up from 7.3% in 2021.

Senior leaders from minority ethnic backgrounds had access to a talent development programme designed to support their progression within the trust. The programme aimed to boost confidence, build leadership capability, and enhance the quality of patient care through inclusive leadership practices. This initiative formed part of the trust’s broader commitment to improving equity and representation at senior levels and was aligned with national priorities to address disparities in leadership opportunities for staff from underrepresented backgrounds.

The Workforce Disability Equality Standard (WDES) is a mandatory reporting framework introduced by NHS England to help NHS organisations better understand and improve the experiences of disabled staff.

In 2024/25, 3.24% of the trust’s workforce declared a disability, which was lower than the national average of 4.9%. The trust acknowledged that this figure appeared low and may have been affected by data collection or reporting limitations.

Disabled staff feeling valued remained below the national average. In 2024, 29.35% of disabled staff reported feeling valued, compared to 35.2% nationally. This was an improvement from 22.9% in 2023, but the trust recognised the need for continued focus in this area, as the score had remained below national levels since 2021.

Bullying and harassment scores were also worse than national benchmarks. In 2024, 19.27% of disabled staff reported bullying or harassment by managers, compared to 16.1% nationally. Bullying by colleagues was reported by 28.95% of disabled staff, compared to 24.8% nationally. These figures had remained relatively static since 2020.

However, the trust performed significantly better than the national average in terms of capability processes. In 2024, only 0.01% of disabled staff entered formal capability procedures, compared to 2.17% nationally. This marked a substantial reduction from 17.85% in 2022.

Perceptions of equal opportunities among disabled staff remained below the national average. In 2024, 46.97% of disabled staff felt there were equal opportunities for career progression, compared to 52.1% nationally. While this represented an improvement from 72.8% in 2020/21, progress had plateaued in recent years.

Recruitment of disabled applicants showed positive movement. In 2024, 4.41% of shortlisted applicants declared a disability, significantly above the national average of 0.99%. The trust recognised the contribution of their Diversity Partner initiative in supporting this improvement.

The trust’s gender pay gap had been reducing consistently each year since 2021. As of 31 March 2024, women’s average hourly pay was 24.2% lower than men’s, reflecting continued progress in narrowing the gap.

The gender composition of the workforce remained broadly aligned with national NHS trends, with 75.17% of staff identifying as female and 24.83% as male. This distribution was consistent with the demographic profile of the wider healthcare sector.

To support further improvement, the trust had implemented a gender pay gap action plan. The trust remained committed to fostering an inclusive workplace and ensuring that all staff, regardless of gender, had equal access to opportunities and reward.

In 2024/25, Mid and South Essex NHS Foundation Trust reviewed its ethnicity pay gap. Asian staff made up 9.67% of the workforce but held 30% of the highest-paying roles, showing strong representation in senior positions. In contrast, Black staff made up 6.39% of the workforce but only 7.58% were among the top earners. Most Black staff were in lower-paid roles, highlighting a need to improve fairness in career progression. White British staff made up 74.80% of the workforce and 45.04% of the highest earners, indicating a drop in senior-level representation compared to lower pay quartiles. Asian staff were more likely to earn higher salaries than white staff overall, while black staff were more likely to be found in the middle pay bands. Mixed ethnicity employees had the lowest representation across all quartiles.

The trust acknowledged the disparities in ethnic representation across pay quartiles and committed to further analysis and targeted action to address underrepresentation and promote equitable progression opportunities for all ethnic groups.

The trust had six staff networks representing specific groups, including disability, faith and belief, gender equality, and LGBTQ+, Armed Forces and their families, BAME. Each network was chaired by a member of staff, operated with structured agendas, and had defined objectives. Accountability for the networks sat with the Executive Chief People Officer.

Network chairs reported that while they felt well supported by the Executive Chief People Officer, members of the networks sometimes felt that senior leaders were disconnected from the frontline and wanted to see greater commitment to staff wellbeing. They recognised the financial challenges facing the trust and its wider strategic ambitions but acknowledged that further work was needed to improve the organisational culture and ensure that inclusion was embedded throughout the trust.

The trust had implemented a range of initiatives aimed at reducing bullying, harassment, and discrimination in the workplace. While any incidence of such behaviour was considered unacceptable, the trust had taken proactive steps to address concerns and embed a culture of civility and respect.

Key programmes included the civility and respect programme, respect and unconscious bias training, and the deployment of speak-up guardians and champions. In addition, targeted micro-aggression training had been delivered locally to address specific concerns. The trust had also refreshed its previous respect training by introducing respectful resolution training, which incorporated best practice and current thinking to support early and constructive resolution of issues.

All new and existing managers were required to complete managers essentials training, which clearly outlined the trust’s zero-tolerance approach to bullying and harassment. This was actively supported by the leadership team, who had demonstrated commitment to achieving a workplace free from such behaviours. The leadership and management behaviours framework, alongside the civility and respect campaigns, were seen as key enablers in achieving this aspirational aim.

To address discrimination, the trust had embedded training such as micro-aggression, unconscious bias, equality and diversity, and managers essentials training, which included a dedicated module on Equality, Diversity and Inclusion (EDI). These offerings were delivered across the trust and underpinned by the ongoing trust values project, which aimed to align values and behaviours across all teams. Training was delivered locally to line managers and staff to ensure accessibility and relevance.

The trust continued to deliver against its EDI 5-year action plan, recognising that the long-term success of these initiatives depended on their integration into everyday working practices. Sustained effort was being made to embed these programmes into the organisational culture, supported by the wider change programme.

Leaders were clear about their main challenges and were open and transparent about areas of failure and improvement. They were realistic about the trajectory for improvement, but the pace was slow. They acknowledged that the trust had historically been reactive rather than proactive. Despite this, there were numerous improvement programmes underway, and leaders were making concerted efforts to improve the quality and safety of care across the trust. However, persistent quality care failures had led to enforcement action by us in relation to maternity, children and young people, and urgent and emergency care services. Leaders also recognised that while improvements were sometimes made, they were not always sustained.

The trust had introduced a new operating model based on three site-based leadership structures, each led by a triumvirate team.While assurance systems were in place, our review of documentation and interviews with leaders, staff, and system partners indicated that assurance processes were not always effective. Leaders were not consistently able to demonstrate how learning had been captured or how actions had been taken to minimise the recurrence of quality and safety issues.

Concerns were raised by leaders about a culture of non-compliance and weak shared learning across the trust. In response, a rapid integrated improvement plan was developed to address the underlying drivers of underperformance. The plan focused on four key areas: better care, through a relentless focus on basic standards of patient safety and quality; better staff experience, by creating conditions that enable staff to excel; better performance, by improving waiting times; and better finances, by achieving financial sustainability through improved value.

Non-executive director roles were clearly defined, and leaders reported positive working relationships. There was evidence of challenge from both non-executive directors and governors, but responses and follow up were sometimes lacking. Some leaders felt it took too long for concerns to reach the board and there was not enough time for the appropriate amount of scrutiny.

Processes and systems were applied to manage current and future performance. A monthly integrated performance report, using statistical process control (SPC), was presented to the board and included narrative to support interpretation of the data.

Although staff expressed concerns that the trust was overly focused on financial matters, observations of committee and board agendas confirmed that quality, safety, and patient outcomes remained central to discussions and decision-making.

The trust used the seven levels of assurance model, which was embedded into the Board Assurance Framework (BAF) risk process and was consistently referenced in meeting papers to provide the appropriate level of assurance. ABAF is a strategic tool used by NHS trusts and other healthcare organisations to help boards identify, assess, and manage risks that could impact the achievement of their key objectives.

The board discussed its risk appetite in May 2025, ensuring alignment with the trust’s strategic objectives and embedding this into its decision-making and oversight processes. Risk appetiterefers to the amount and type of risk that an organisation is willing to accept in pursuit of its objectives. It helps guide decision-making, especially when balancing innovation, service delivery, financial sustainability, and safety.

The trust’s Board Assurance Framework (BAF) was presented clearly, with appropriate controls in place. The BAF was consistently referenced throughout the board papers we reviewed, supporting effective oversight and assurance.

InApril 2025, the trust added a new risk to itsBoard Assurance Framework (BAF):
“Failure to deliver a high-quality, safe service against agreed trajectory.”
This risk was rated at20, reflecting ahigh likelihoodandhigh impact, and was categorised asalmost certainto result in failure to meet required clinical standards. The trust acknowledged that this failure was already contributing topatient harm,poor outcomes, and anegative patient experience.

The trust undertook a review of the associatedcontrols and gaps in actionsto understand the underlying causes and identify areas for improvement. While this demonstrated awareness and a willingness to address the issue, the rating of 20 indicated that the risk wasnot yet effectively mitigatedand required urgent attention.

This assessment aligned with other findings across the trust, including concerns about clinical supervision, staffing pressures, and inconsistent learning from incidents. It further reinforced the need for a more proactive and integrated approach to quality improvement and risk management.

The trust was improving its risk management processes by ensuring that all risk leads and risk owners received the appropriate level of training. This was aimed at enhancing the quality of risks recorded on the register and strengthening overall governance. As of June 2025, 72% of relevant staff had completed the training. Additionally, 91% of risks were reviewed within their due date.

The trust had processes in place to complete Equality Impact Assessments (EIAs) and Quality Impact Assessments (QIAs)for all Cost Improvement Schemes (CIPs). However, while these assessments were completed, there was no evidence that they were routinely reviewed to evaluate whether the cost improvements had negatively affected patient outcomes or service quality.

TheChief Nursing Officerhad raised concerns about theconsequences of some cost improvement measures, specifically highlighting thepotential adverse effects on quality, safety, and staff morale. These concerns were raised to the board in January 2025. There were subsequent conversations at the Quality Governance Commission from the Chief Medical Officer and Chief Nursing Officer where escalations of concern were discussed. We were told this was reviewed in conjunction with the BAF and corporate risk register. Actions were added to review the discretionary spend process to ensure that essential orders were not delayed and the action was completed in August. This demonstrated that senior leaders were aware of the risks and had taken action to mitigate.

The lack of post-implementation review limited the trust’s ability to identifyunintended consequencesand takecorrective action, representing a gap ingovernance and assurancearound the delivery of safe and effective care.

A review of committee and board papers demonstrated that the trust had maintained an appropriate level of detail to enable effective review and challenge of its financial position, providing assurance on financial governance. Non-executive directors (NEDs) consistently reflected positively on the Chief Financial Officer (CFO), describing her as experienced, competent, and well regarded. Staff survey results from the finance team had shown year-on-year improvement, and the team had achieved Level 2 accreditation through a peer review process as part of the One NHS Finance Towards Excellence Programme, evidencing a strong culture of finance skills development.

There had been a notable shift in the past year, with broader engagement in financial matters across the organisation. Finance was more frequently discussed outside of the CFO’s team, supported by improved corporate communications and enhanced board engagement.

NED’s confirmed they had been able to challenge executives on financial and performance matters, with good levels of transparency and scrutiny. Committee reports had remained consistent over time, with new areas such as productivity added to reflect evolving priorities. The Council of Governors contributed to oversight through observing committee meetings, providing independent feedback on the quality of challenge and assurance.

Committees were well structured and promoted a joined-up approach to assurance. Internal audit reports were reviewed by the Audit and Risk Committee, with relevant findings also considered by other committees such as Finance and Performance for follow-up and management. During the inspection, we observed the People and Organisational Committee and noted that it was well attended, included robust and thought-provoking discussions, and resulted in clearly defined action points.

In 2024/25, the trust had been placed under Level 4 of the National Oversight Framework (NOF) and became part of a system-wide NHS England investigation and intervention process to support delivery of the financial plan. In response, the trust established the Financial Intervention Programme Board (FIPB) in November 2024, chaired by the chief executive and supported by the Turnaround Programme Director and Turnaround Portfolio Office. The FIPB provided leadership and governance for financial recovery efforts.

The trust continued to focus on grip and control, monitoring 40 key performance indicators. While controls were in place, compliance remained an area requiring further improvement to ensure sustainability.

The 2023/24 Annual Report and Accounts included a Head of Internal Audit opinion that the trust had an adequate and effective framework for risk management, governance, and internal control, receiving an amber/green rating. However, internal audit noted that enhancements were needed, and action plans had been signed off by management. External audit identified one significant weakness in the trust’s arrangements for securing economy, efficiency, and effectiveness—specifically concerning financial sustainability and the need to agree a financial plan that delivered recurrent break-even over the medium term.

The trust had systems and processes in place to prevent and control infections. IPC data was presented to the board through the integrated performance report.

Benchmarking data indicated that the trust was in the bottom 25% (worse) nationally for MRSA rates between October 2023 and October 2024. Similarly, it was in the bottom quartile for Klebsiella and Clostridioides difficile (C. difficile) infection rates during the same period.

Flu vaccination data had not been submitted to the UK Health Security Agency. Internal reporting showed that the trust had a low (24%) uptake rate for healthcare workers in 2024. The most recent figures, covering the period from September 2024 to February 2025, showed that 41.3% of healthcare workers with direct patient care had been vaccinated against seasonal influenza. This increase in the uptake of flu vaccination was very positive and reflected the work that had been done to encourage staff to take up the vaccine. It was above the national average for front line NHS staff of 37.5%.

PLACE (Patient-Led Assessments of the Care Environment) results showed that the trust performed below the national average in several key areas, including dementia, disability, and privacy, dignity, and well-being. However, all sites performed slightly better than the national average in cleanliness.

The condition, appearance, and maintenance of Southend and Basildon hospitals were rated slightly worse than the national average, while Broomfield Hospital performed slightly better in this domain. Food quality was assessed as slightly worse than the national average at Southend and Broomfield hospitals, but slightly better at Basildon Hospital.

The estate at Mid and South Essex NHS Foundation Trust varied significantly in age and condition, with many buildings and infrastructure elements presenting challenges to safe and effective service delivery. The trust faced substantial levels of critical backlog maintenance, which created risks to patient safety and impacted both functionality and continuity of services.

The trust had seen an improved picture in relation to its internal processes for managing the Central Alert System (CAS). Since May 2024, the trust had managed alerts within set timescales. CAS alerts are official safety communications issued to healthcare providers across the NHS in England. They are designed to quickly inform staff about urgent safety issues that could affect patient care, staff safety, or the use of medical equipment and medicines.

Workforce instability was identified as a principal risk for the trust. Although the risk rating had reduced since 2016, reflecting improvements in workforce stability, it remained a key area of concern. There was no dedicated safer staffing annual report available at the time of review, but one was scheduled to be presented to the board in June 2025.

In the 12 months leading up to November 2024, the trust reported a sickness absence rate of 4.5%, which was better than expected. The overall staff turnover rate was also favourable, suggesting that turnover was not significantly impacting staffing capacity.

However, during the assessment of other services and in focus groups, a recurring theme emerged from staff who felt they did not always have sufficient staffing levels to provide safe and effective care for patients. While leaders recognised this concern, they noted that although staffing numbers may have aligned with establishment the skill mix requirements may not always have been appropriate to meet service needs.

Shortly before our assessment, the Deanery raised concerns about the anaesthetics department at Basildon Hospital, including unsafe clinical practice, failure to report incidents, and issues related to sexual safety. Adeaneryis a regional body responsible for overseeing the education and training of medical and dental trainees. These concerns had previously been raised around ten years ago but were not properly addressed. In response, all anaesthetic trainees were removed and relocated to other hospitals, and an investigation was commenced

All consultants and specialty and specialist (SAS) doctors should have a transparent, current, signed off, job plan with agreed objectives that is reviewed at least annually. Job planning should be prospective and agreed no later than 31 March for the following financial year. Consultant job planning is a structured process used to define how consultants allocate their time across various responsibilities, including direct clinical care, teaching, research, and leadership. It aims to ensure that consultant capacity is used effectively to meet service demands, support fair workload distribution, and improve patient outcomes. However, completion performance (when a job plan has been signed off) achieved only 69.4% at the end of December 2024, which was worse than the 90% target. Job planning was discussed at the fortnightly medical workforce and pay meeting chaired by the Chief Medical Officer. Heads of medical workforce continued to provide support and training on the process.

Benchmarking data showed that the trust performed better than the national average in relation to patient flow and discharge planning. Specifically, it had a lower percentage of beds occupied by patients who were clinically ready for discharge and a smaller proportion of patients with a length of stay of 21 days or more, compared to other trusts nationally. These metrics suggested that the trust had effective systems in place to support timely discharge and reduce unnecessary hospital stays. However, despite these positive indicators, staff raised concerns about bed capacity, highlighting issues such as “boarding” and overcrowding in urgent care areas. Staff expressed significant frustration, noting that these pressures sometimes prevented them from delivering the standard of care they believed patients deserved.

Operationally, the trust performedbetter than peer organisations in theatre utilisation, indicating efficient use of surgical capacity and scheduling. However, the trust consistently demonstrated worse performance than both regional and national averages for cancer waiting time standards. For the 31-day standard, the trust not only failed to meet the 96% performance threshold but also showed a declining trend. As of May 2025, performance against the 31-day standard had fallen to 79%, and the trust was consistently the lowest performing trust in the East of England region.

Performance against the 62-day standard also fell short of the 85% threshold, except for April 2024. However, from October 2024 onwards, there was evidence of a gradual improvement. Despite this, the persistent underperformance suggested that the trust did not have effective oversight of its cancer care pathways.

In addition, the proportion of patients waiting over 13 weeks for an endoscopy steadily increased throughout 2024, further indicating challenges in diagnostic capacity and patient flow.

The trust was due to open a new Community Diagnostic Centre (CDC) which would offer diagnostic services, including CT, MRI, ultrasound, heart scans, lung checks, blood tests and X-rays. The new centre will be open seven days a week and was expected to speed up access to diagnostic tests and helping to reduce waiting lists.

During the winter period of 2024, the trust showed deterioration across several urgent and emergency care metrics, particularly in AE waiting times. While this decline should be considered in the context of national winter pressures, it was positive to note that readmissions within seven days remained consistently lower than both the England and regional averages.

As of spring 2025, ambulance handover times at the trust had shown some improvement at specific sites but remained a significant challenge overall. At Southend Hospital, targeted interventions—such as the introduction of Ambulance Handover Units and increased emergency department capacity—had reduced average handover times from over 60 minutes in late 2024 to approximately 15 minutes by March 2025. However, across the trust, including Basildon and Broomfield hospitals, delays persisted. The trust continued to be among the worst-performing nationally for ambulance handover breaches, with a high proportion of patients waiting over an hour to be transferred from ambulance crews to hospital staff. Collaborative efforts with the ambulance service were ongoing to address these delays and improve patient flow.

Between December 2024 and January 2025, the trust performed worse than the England and regional averages for admitting, transferring, or discharging patients within four hours of arrival. Prior to this period, performance had generally been in line with national benchmarks, although the trust consistently missed the aspirational 76% standard.

A notable rise was observed in the number of patients waiting over 12 hours from the decision to admit to actual admission. In November 2024, 66 patients experienced such delays, increasing significantly to 451 patients by January 2025.

Since August 2023, the trust’s median time to initial assessment had consistently been longer than the England average. Similarly, the median time to treatment and total time spent in AE were also consistently worse than national benchmarks, indicating ongoing challenges in patient flow and timely care delivery.

The overall care hours per patient day had increased slightly over the 11 months leading up to August 2024. The rate rose from 8.3 in October 2023 to 8.9 in August 2024, indicating a modest improvement in staffing levels and care provision across the trust.

The Audit Committee had expressed concerns regarding the trust’s current level of preparedness for cyber incidents. the committee was not assured that sufficient mitigations are in place to respond effectively to potential cyber threats. The trust had identified Cyber Security as a risk, and it was recorded on the BAF reflecting the increasing complexity and frequency of cyber-attacks across the health sector. The trust recognised the need to take ongoing action to mitigate the risks of a successful cyber-attack.

There were no reportable breaches to the Information Commissioner’s Office (ICO) during the reporting period 2024-2025.

The trust continued to demonstrate strong performance in data quality, with an index score of92.1%, exceeding or matching the national average across all four evaluated datasets. Furthermore, the trust reported a lower National Clinical Coding Improvement (NCCI) rate than all its peers, further reinforcing the quality of its clinical documentation and coding practices. This reflects a high level of accuracy and completeness in clinical coding and reporting, supporting of effective decision-making and service planning.

The trust had not developed a clear strategy for patient engagement. Complaints and PALS services were under pressure due to rising demand. Despite an improvement plan, response rates to PALS concerns stayed below target.

Safeguarding referrals had increased, raising concerns about care quality. There was limited evidence of board-level assurance or an annual safeguarding report.

The trust had not yet taken a strategic approach to patient engagement. At the time of the inspection, a patient experience strategy had not been developed. While the trust had engaged with a range of community groups and stakeholders, leaders acknowledged that further work was needed to embed meaningful patient and public involvement across all levels of the organisation.

The trust worked with three community and mental health providers, 149 GP practices, 27 Primary Care Networks (PCNs), and the regional ambulance trust. It was an active partner in the Integrated Care System (ICS) and contributed to the Joint Forward Plan, which outlined shared system priorities.

The trust was part of the Mid and South Essex Anchor Programme, alongside other system partners. The Mid and South Essex Anchor Charter 2024–2027 aimed to improve the health and wellbeing of the local population and reduce inequalities. Leaders cited the programme as a success, highlighting an intensive employment initiative for young people with autism and learning disabilities, delivered in partnership with the County Council and a local college. Progress against the Anchor Programme was reported to the board.

As part of its 10-year strategy, the trust aimed to place community involvement at the centre of its work and increase the role of patient voice in decision-making. However, leaders acknowledged they had a long way to go to make this a reality.

Healthwatch worked collaboratively with the trust and used patient feedback to support learning and improvement. Healthwatch had conducted “Enter and View visits,” which were welcomed by the organisation. Healthwatch had offered more support to work with the trust and told us further opportunities had not yet been explored with them.

The trust had over 700 volunteers supporting a wide range of roles, including dementia befriending, car driving and gardening.

The trust encouraged the use of hospital passports for patients with learning disabilities or autism and had specialist teams in place to support people. Contact details for these teams were available on the trust’s website. However, we found during our inspection of the children’s service, these passports were not consistently being used.

As a foundation trust, the organisation had a Council of Governors comprising of elected and appointed members from partner organisations. The Council met publicly four times a year, providing a structured platform for oversight, challenge, and engagement.

Governors demonstrated an understanding of strategic priorities and actively engaged in discussions around performance, for example outpatient services and waiting times.

The governors operated within a defined governance structure, with regular meetings and access to key performance information. Governors consistently asked probing questions and challenged the non-executive directors, evidencing a healthy scrutiny culture. However, feedback indicated that attendance by both executives and NEDs could have been improved to strengthen accountability and visibility.

While governors were able to raise concerns, some reported that assurance was not always fully provided. There were instances where issues were perceived to have been prematurely closed or deferred with future-focused responses. This highlighted a need to enhance assurance pathways and ensure that concerns were tracked and resolved effectively.

The trust had a process in place for managing complaints and concerns. However, we found a mixed picture in relation to the Patient Advice and Liaison Service (PALS). There was no face-to-face or walk-in PALS service at any of the trust’s sites, although telephone contact was available. The number of PALS enquiries had increased significantly, from approximately 1,000 per month in 2021/22 to 1,700 per month at the time of the inspection. This increase placed pressure on the service, which was staffed by 5.6 fulltime equivalent PALS officers.

In March 2025, the trust implemented an improvement plan to address declining PALS performance, including weekly reporting and divisional oversight. Despite this, responsiveness remained below target, with only 52% of enquiries responded to in June 2025, well below the trust’s 85% target.

The number of formal complaints remained stable month to month, but response times varied, and the trust did not meet its 2024/25 target of 85% to be responded to within agreed timescales. Complaints were signed off by site-based directors, but there was no sampling or oversight by the Chief Executive or other corporate executive directors.

The most common subjects of complaints in 2024/25 were outpatient waiting times, unanswered telephones, lack of information, and delays in admission dates. The trust had taken steps to understand the increase in complaints about telephone access, and this had been reported to the board.

The trust had an established relationship with Staff Side representatives and met with them regularly. Staff Side reported that they did not feel leaders always communicated effectively and described the trust’s approach as reactive rather than proactive. They identified missed opportunities to involve Staff Side more meaningfully in the journey towards improvement.

Concerns were raised about staff wellbeing and morale, which Staff Side felt were deteriorating. They noted an increase in managers approaching them for support, often expressing fear about raising concerns themselves. This suggested a lack of psychological safety and confidence in internal escalation processes.

Staff Side also highlighted that wellbeing hubs were not consistently available across the trust, despite being viewed as essential resources. Their absence was seen as a gap in the trust’s support infrastructure, particularly during periods of operational pressure. Nevertheless, Staff Side reported they had a good relationship with the Chief People Officer and met with them regulatory.

Concerns were raised during the inspection by other agencies about the trust’s safeguarding arrangements, particularly in relation to adult safeguarding and its relationship with the lead agency. There had been an increase in safeguarding referrals, including those related to pressure damage and potential omissions in care. The lead agency for safeguarding noted the numbers of referrals relating to the trust were increasing and had concerns about the quality of patient care.

The trust produced a quarterly public newsletter and a range of topic-specific newsletters, including those focused on health and wellbeing, children’s services, and pain management. While these were positive steps, leaders recognised that both staff and public engagement required further development. As noted elsewhere in this report, staff engagement and organisational culture remained significant challenged.

The trust had significant shortfalls by not focusing on continuous learning and improvement across the organisation and local system.

There was a lack of consistent focus on continuous learning, innovation and improvement across much of the organisation. While there were pockets of good practice, leaders acknowledged that significant action was required to address the shortfall and embed a culture of improvement more widely.

Feedback from staff and external partners described the trust as being reactive rather than proactive in recognising where improvements were needed and in implementing sustained change. This was reflected in several areas of the trust’s performance, including the dissemination of learning from incidents, learning from deaths, and safeguarding concerns.

In the 2024 NHS Staff Survey, the theme “We are always learning” received a score of 6.6 which was lower than the national score of 6.84.

Although some improvement programmes were in place, there was limited evidence of a strategic approach to quality improvement or innovation. The trust had not consistently demonstrated that learning was driving change or that improvement was embedded in everyday practice. A recurring theme across this and other service assessments was the inability to evidence improved outcomes. While information was provided on new systems and training compliance, it was not linked to demonstrable impacts on quality, safety, or outcomes for people. In many cases, responses lacked any reference to the experiences or needs of patients.

The trust’s Summary Hospital-level Mortality Indicator (SHMI) was within the expected range. SHMI is the ratio between the actual number of patients who died following hospitalisation at the trust and the number that would be expected to die, based on average figures across England.

The most recent SHMI data covered the period from November 2023 to October 2024. During this period, the trust’s SHMI was 1.091, which was categorised as “as expected.” This represented a slight increase from the previous reporting period (October 2023 to September 2024), when the SHMI was 1.08. There was no consistent trend in the trust’s SHMI over time.

The trust’s Hospital Standardised Mortality Ratio (HSMR) for the 12-month period from February 2024 to January 2025 was 121.08, which represented a deterioration from the previous period’s HSMR of 119.14. An HSMR above 100 indicates that more deaths occurred than would be expected based on national averages, and the upward trend raised concerns about clinical outcomes and the effectiveness of care. In addition, the crude mortality rate for the trust in March 2025 was reported at 2.55%.

The trust had a medical examiner function in place which scrutinised all deaths occurring within the trust. This process ensured that deaths were accurately certified and referred to the coroner where appropriate. The medical examiner service provided an additional layer of oversight and contributed to the trust’s governance of mortality.

Structured Judgement Reviews (SJRs) are a nationally recognised method used in the NHS to review the care provided to patients who have died. They are part of the Learning from Deaths framework and aim to identify areas of good practice, opportunities for learning, and potential improvements in care.

Completion rates for structured judgement reviews (SJRs) were poor. For the period January -March 2025, there were 459 SJR’s due for completion, with a target to complete these within four months. As of February 2025, 65% of the SJR’s had been completed. The trust had identified contributing factors to the delay, including capacity constraints and difficulties accessing case records.

While the trust had mechanisms in place to review deaths and identify learning, the low completion rate of SJR’s limited the effectiveness of this process. There was insufficient assurance that learning from deaths was being consistently captured, analysed, and used to inform improvement. This represented a missed opportunity to strengthen clinical governance and improve patient safety.

The trust recognised the need for better alignment between learning from deaths, serious incidents, and the outcomes of inquests. While mechanisms were in place to review each of these areas individually, there was limited evidence that learning was being consistently shared or acted upon across the organisation.

The trust had self-assessed its assurance level as Level 1, indicating that initial actions had been identified, but outcome measures were still in development and there was no increasing evidence of impact. This self-assessed rating reflected a lack of assurance that learning was being embedded into practice.

However, the board papers did not include specific steps taken to address the gaps in assurance. There was limited visibility of a structured plan or timeline to improve integration and dissemination of learning across the trust.

This finding was consistent with our assessment of other areas within the trust, where similar gaps in assurance and follow-through were observed. While the trust had identified the issue, further work was required to ensure that learning from deaths, incidents and inquests was systematically captured, shared, and used to drive improvement.

The trust had re-established its sepsis steering group and progressed work through its deteriorating patient group to improve the recognition and response to clinical deterioration. This included actions focused on treatment escalation planning and the use of deteriorating patient scores. However, in January and March 2025, enforcement action was taken due to concerns regarding the identification and management of deteriorating patients, including children. These concerns highlighted that such a critical area of care did not appear to have the necessary level of oversight. The lack of robust governance and assurance mechanisms meant that risks to patient safety were not being adequately identified or addressed, and the trust had not demonstrated sufficient leadership grip in this area.

Analysis of incidents logged in STEIS and LFPSE reports revealed recurring themes of siloed working and missed opportunities to learn. STEIS stands for the Strategic Executive Information System. It was a national system used by NHS organisations in England to report Serious Incidents (SIs) to NHS England. STEIS has now been replaced by the Learn from Patient Safety Events (LFPSE) service, which is a more modern and integrated system for reporting and learning from patient safety events across the NHS. A prevalent issue across multiple services and all three sites was the failure to recognise and escalate clinical deterioration. Incidents reviews had highlighted systemic issues in how deterioration was managed and how learning from serious incidents was shared across the trust. While the trust had taken steps to strengthen oversight through the deteriorating patient group, further work was required to ensure that learning was embedded and that escalation processes were consistently applied.

We analysed 11 Prevention of Future Death (PFD) reports issued between 30 May 2021 and February 2024. These reports highlighted recurring concerns that aligned with wider findings across the trust.

A common theme identified during the assessment was the inconsistent completion of medical documentation, which frequently lacked key clinical information. This posed risks to continuity of care and clinical decision-making. In several instances, staffing levels were reported as low, and the skill mix was affected, with only junior or inexperienced staff available at critical times. Additionally, poor communication and strained relationships between medical teams were noted in some areas, further impacting the quality of clinical decisions and patient care. In addition, the clinical knowledge of staff did not always align with national standards. In some instances, this was attributed to trust guidance being insufficient to support decision-making in complex or unusual circumstances.

The trust participated in the Learn from Patient Safety Events (LFPSE) national reporting system. Analysis of the trust’s incident data showed that the proportion of incidents recorded as “very concerned” or “fairly concerned” ranged between 5.55% and 6.7%. This was slightly higher than the national average for all trusts, which ranged between 5.3% and 5.9%. This suggested that staff at the trust were appropriately identifying and reporting concerns. The trust had systems in place to capture and review patient safety events, but as noted elsewhere in this report, there were gaps in how learning from incidents was disseminated and acted upon. Strengthening the feedback loop from incident reporting to improvement actions would support a more proactive safety culture.

The trust had implemented the Patient Safety Incident Response Framework (PSIRF), in line with national requirements. PSIRF is designed to support a more compassionate, systems-based approach to learning from patient safety incidents.

However, at the time of our review, there were a significant number of overdue PSIRF incidents and action plans. This raised concerns about the trust’s capacity to manage its incident response workload and to ensure timely learning and improvement following safety events.

While the framework was in place, the backlog of overdue actions meant the trust had not yet embedded the processes required to fully realise the benefits of PSIRF. Further assurance was needed to confirm that incidents were being reviewed within expected timeframes and that learning was being translated into meaningful change.

The trust had implemented the Patient Safety Incident Response Framework (PSIRF) in November 2023 and had commissioned 44 Patient Safety Incident Investigations (PSIIs) since its introduction.

In March 2025, seven new PSIIs were commissioned, all within the women’s and children’s division. These cases were being reviewed under PSIRF, with collaborative meetings scheduled where multiple organisations were involved.

In the period 2023/24, there were 14 PSIIs commissioned, five remained open, all within the women’s and children’s division, and had exceeded the six-month completion threshold. Eight investigations had been closed, with findings reported to the Quality Governance Group (QGG) and the PSIRF Oversight Group to support organisational and system-wide learning.

During the period 2024/25, 30 PSIIs had been commissioned, all of which remained in progress. 14 cases were overdue, including:

• 10 in the women’s and children’s division

• 1 in the surgery division

• 1 in the Essex Cancer Centre

• 2 in the Basildon Hospital division

A trajectory for resolving overdue PSIIs was implemented on 3 March 2025, with review meetings scheduled to approve completed investigations. All relevant stakeholders, including patients and relatives, were actively engaged in the revised timelines.

The Patient Safety Incident Oversight Group (PSIOG) had convened to review the first cohort of completed PSIIs, with further meetings planned to conclude the next cohort.

Between April 2024 and March 2025, the trust reported two Never Events, representing an improved position compared to 2023/24, when six Never Events were reported.

Never Events are serious, largely preventable patient safety incidents that should not occur if national guidance and preventative measures are properly implemented. The reduction in reported events indicated some progress in the trust’s approach to patient safety and adherence to protocols.

The trust had consistently reported a higher number of safeguarding cases raised against it when compared with other trusts, including those serving similar populations and with comparable workforce sizes. This raised concerns about the effectiveness of safeguarding practices and oversight across the organisation.

A significant proportion of safeguarding cases related to hospital-acquired pressure ulcers. Specific issues included:

• Lack of access to pressure-relieving equipment

• Inconsistent referrals to tissue viability nurses

• Inaccurate or incomplete Waterlow scoring (a tool used to assess pressure ulcer risk)

In addition, poor discharge planning was frequently investigated by the local authority. Discharge documentation often lacked essential information, and referrals for onward care were not consistently made, posing risks to continuity of care and patient safety.

There had also been two substantiated safeguarding cases at Basildon Hospital involving inappropriate restraint. These incidents highlighted serious concerns regarding the use of restraint, staff training, and clinical decision-making. They also reflected broader issues around staffing, skill mix, and adherence to national standards, as identified in coroner reports and incident reviews.

Pressure ulcers had flagged as an area of concern for the trust in 2024. During the first quarter of 2025, the trust demonstrated a positive trajectory in the reduction of hospital-acquired pressure ulcers. Category 2 pressure ulcers decreased from 95 cases in January to 67 cases in March, remaining within the expected range. Category 3 pressure ulcers also showed improvement, with only three cases reported in March—two at Broomfield Hospital and one at Basildon Hospital. No category 4 pressure ulcers were reported during this period.

Several common themes were identified in relation to pressure ulcer development, including inconsistent care rounding, (care rounding is a structured and proactive process where staff regularly check on patients using a standard protocol to ensure consistent, high-quality, and patient-centred care), repositioning practices, and risk assessment tool compliance. Additionally, gaps in pressure-relieving care were noted within the Emergency Department (ED) and Acute Medical Unit (AMU).

To address these issues, a series of interventions were implemented. Pressure Ulcer Prevention and Management Training was scheduled to recommence in April 2025 following a pause on non-mandatory training. The trust continued to apply the Patient Safety Incident Response Framework (PSIRF) to investigate hospital-acquired pressure ulcers, supported by weekly reporting and local site rapid reviews. Training compliance was reviewed across all three sites and streamlined to encourage attendance. As of the reporting period, 13.4% of registered nurses across MSEFT were compliant with pressure ulcer prevention and management training. An ED-specific improvement plan was introduced at Broomfield Hospital to target the reduction of hospital-acquired pressure ulcers.

We saw evidence that some serious incidents had prompted external clinical reviews, demonstrating that the trust was willing to seek independent scrutiny in response to concerns. One such review was commissioned by the Royal College of Surgeons, which examined 99 wedge resections. The review identified 19 cases as a cause for concern, including five cases where cancer had recurred. This raised questions about the quality of surgical technique, case selection, or follow-up processes.

Another external review was initiated following a cluster of incidents involving deaths after postoperative care for abdominal aortic aneurysm (AAA). These cases highlighted potential issues in the management of patients during the postoperative period, including escalation of care and monitoring. An action plan was developed and reported to the board.

The 2024 GMC National Training Survey indicated that Mid and South Essex NHS Foundation Trust was performing below the interquartile range for overall trainee satisfaction and three key indicators:

• Clinical supervision

• Supportive environment

• Adequate experience

The adequate experience indicator had consistently remained in the lowest quartile (Q1) since 2021, although it had not fallen below the national lower threshold. Similarly, clinical supervision had remained below the interquartile range since 2022, though the 2024 results showed some improvement compared to the previous year.

Two indicators—induction and clinical supervision—had shown notable improvement from 2023, bringing the trust within the interquartile range for those areas. Despite this progress, the overall results suggested that trainees were not satisfied with their training experience, particularly in relation to the quality of clinical supervision, the supportiveness of the working environment, and the opportunities to gain adequate clinical experience.

These findings aligned with broader concerns identified during our assessment, including staffing pressures, skill mix challenges, and inconsistent access to senior clinical support.

The trust had taken steps to standardise medical staff bank rates across its sites to ensure consistency and financial control. However, this change had contributed to gaps in medical rotas, as some staff chose not to work under the revised rates.

Although the trust had recruited additional bank staff, this was not sufficient to cover all rota gaps, and staffing shortfalls persisted. These gaps had the potential to impact service delivery, clinical supervision, and patient safety, particularly in areas already under pressure.

The trust was aware of the challenges and had taken steps to mitigate them, but further action was required to ensure that medical rotas were reliably staffed and that continuity of care was maintained.

Mandatory training compliance for medical and dental staff was reported as below target in the trust’s May 2025 Integrated Performance Report, with a completion rate of 73.4% against a trust target of 85%.

The trust cited operational pressures and limited capacity to complete training as the primary reasons for the shortfall. This was particularly evident in clinical areas experiencing staffing challenges and high service demand.

While the trust had acknowledged the issue, there was limited evidence of a clear recovery plan or targeted support to improve compliance rates. Ensuring that all staff are up to date with mandatory training is essential for maintaining safe and effective care, and further action may be required to address this gap.

The trust participated in several recognised external accreditation schemes and had achieved several awards across different services, demonstrating a commitment to meeting national standards in specific areas of care.

This included participation in the Joint Advisory Group (JAG) on Gastrointestinal Endoscopy. At the time of our review:

• Broomfield Hospital had achieved JAG accreditation

• Southend Hospital was responding to an ongoing assessment

• Basildon Hospital had been deferred

The trust was also a Veteran Aware accredited organisation, recognising its commitment to improving care for members of the armed forces community.

In cardiology, the echocardiography department at Basildon Hospital had been accredited by the British Society of Echocardiography, reflecting good practice in diagnostic imaging.

All three hospital sites were working through UNICEF’s Baby Friendly Initiative accreditation, supporting best practice in infant feeding and parent-infant relationships.

These accreditations reflected areas of strength within the trust, although further work was needed to ensure consistency across all sites and services.

The trust had implemented nationally recognised training in learning disability and autism, with a target of 95% compliance for all eligible staff. As of June 2024, the trust had achieved a compliance rate of 88%, demonstrating progress towards the target.

However, it was not clear how the trust was monitoring ongoing uptake or addressing any barriers to completion. Given the importance of this training in improving care for people with learning disabilities and autism, further assurance was needed to confirm that the trust was on track to meet its target and that completion rates were being actively monitored and supported.

There was a focus on research and development across the trust. The trust worked in partnership with local universities and academic institutions to support research activity and promote evidence-based practice.

The trust ran the Mid and South Essex Innovation Fellowship, which aimed to support staff in developing and implementing innovative ideas to improve patient care and service delivery. One notable area of innovation was the development of virtual reality therapy for patients living with a learning disability and/or autism, reflecting a commitment to personalised and inclusive care.

In addition, the trust had developed a digital application called MyStaffApp, which had been shortlisted for three national awards, highlighting its contribution to workforce engagement and digital transformation.

The trust had a Quality Improvement (QI) methodology in place and was aligned with national frameworks. The trust used the Quality, Service Improvement and Redesign (QSIR) methodology as its core approach to quality improvement. This included both a one-day introductory course and a more intensive five-week programme offered four times a year. The training programmes were designed to build internal capacity and capability for improvement, bringing together clinicians from across the trust to work on specific improvement projects while undergoing training. QI training had been paused during 2024 but had recommenced early 2025. Over 700 staff members had been trained in QI. 69 project ideas had been submitted, 45 projects had been completed, with 99 more in progress. The trust had noted that some improvements were being seen because of the projects. For example, there had been a reduced patient length of stay, and improved staff morale

In addition to QSIR, the trusts quality strategy was built on the National Quality Board’s Shared Commitment to Quality, which included seven steps for delivering quality.

The estate at Mid and South Essex NHS Foundation Trust varied significantly in age and condition, with many buildings and infrastructure elements presenting challenges for environmental sustainability. For example, many engineering systems were aged or at end-of-life, requiring urgent attention.

Patients, visitors, and staff frequently experienced long waits for parking, which disrupted service flow and was exacerbated by a lack of sustainable transport options. Furthermore, energy performance across the estate required improvement, and the trust’s constrained sites and capacity limitations added to operational pressures.

There was a board level lead for environmental sustainability, and the trust recognised its responsibilities to reduce its carbon footprint and deliver sustainable healthcare. The trust had a green plan 2025 to 2028 in place and aimed to reduce their carbon footprint by 80% by 2030 and be net zero by 2045. The trust encouraged staff and visitors to get involved in achieving their aims and recognised it was another way of engaging with people.

The trust was working on several public transport options to try to reduce the number of cars attending the sites. This included a park and ride scheme subsidised bus fares for employees and free bike schemes for staff on bands 2-4. All these initiatives supported the delivery of the Green Plan and reducing the number of cars being used by patients and staff. The trust had agreed to work towards electrifying its fleet of vehicles by the end of 2026.

The trust was in the process of moving onto combined heat and power (CHP) which would improve its energy efficiency. CHP is a highly efficient process that captures and uses the heat that is a by-product of the electricity generation process. In addition, they were also delivering numerous LED and solar projects which were reducing costs and increasing efficiency.

The trust had a unified approach to working towards a net zero with other partners in the Mid and South Essex system.

The trust had around 270 green champions who came from a wide range of backgrounds. They supported the greener agenda by creating ideas for projects, supporting existing projects, and research and events. There were governance arrangements for monitoring progress against the green plan. Leaders acknowledged there was much to do to implement the plan. The Anchor programme charter set out the trust responsibility to reduce its carbon footprint and was working to protect the environment biodiversity in the local communities they served.