Southend University 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

Women, birthing people, and their families knew how to complain. Managers investigated complaints, identified themes, shared feedback with staff, and used the learning to improve the service. Risk assessments for women and birthing people were completed on arrival, and staff knew how to identify and report incidents and near misses according to trust policy. There was a reported lack of adequate medical cover for triage, leading to delays in women and birthing people being assessed by medical staff. This issue was on the risk register. Additionally, the service lacked a dedicated triage telephone line staffed by a midwife. However, there was a plan to implement this by the end of the year. Women and birthing people could access care, treatment, and support when needed in a way that worked for them. Staff reported a lack of hot water in the Cardigan wing, posing a risk to health, safety, and welfare regulations. However, women and birthing people spoke positively about the environment, describing it as safe, nice, and clean. The fetal medicine unit did not have adequate administrative staff. Staff told us that the absence of administrative staff put increased pressure on the midwifery staff. Staff told us they did not have support cover when any of the midwives was on sick or annual leave.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Women, birthing people, relatives, and carers knew how to complain. Those we interviewed felt safe and reported that staff supported them in managing risks. They received verbal and written information about their health and medical conditions, such as gestational diabetes and hypertension. Patient comments included: “I have access to all the information I need for support,” “I am happy with the care,” “I have been kept well informed about my plan of care,” and “I feel safe and supported”. Patient survey data for Southend University Hospital indicated that 88% of women and birthing people felt involved in decisions about their care and 92% felt their concerns were taken seriously.

Managers investigated complaints and incidents, identified themes, shared feedback with staff and used learning to improve the service. Staff acknowledged complaints and provided feedback. At the time of inspection, there was only one overdue complaint since February 2024, which had been investigated and was in the process of being closed. Staff knew how to report incidents and there was system in place to investigate incidents. Managers and the governance team shared learning about never events and serious incidents with staff through emails, newsletters, posters, governance boards, audit learning meetings and a closed staff social media page. Recent learning included accurately calculating postpartum haemorrhage and the importance of completing the maternity early warning score chart, which was shared cross-site. The service fostered an open culture where women, birthing people, their families, and staff could raise concerns without fear. Staff were encouraged and supported to raise concerns and most felt confident they would be treated with compassion and understanding, without fear of blame or negative treatment. However, some staff on the antenatal and postnatal wards did not feel comfortable raising concerns with certain managers and worried that their concerns would not be kept confidential. Staff we spoke to knew who their freedom to speak up guardian was.

Staff were able to identify and report incidents and near misses according to trust policy. Staff reported a good incident reporting culture in the service. Staff understood the duty of candour, maintaining openness and transparency with women, birthing people, and their families when things went wrong. The risk team conducted regular teaching sessions, requiring doctors to evoke duty of candour within 24 hours of an incident. Duty of candour compliance was checked during shift handovers and managers provided debriefs and support after serious incidents. Managers regularly reviewed reported incidents, identified necessary actions, and conducted thorough investigations involving women, birthing people, and their families. We saw evidence of learning, improvement and change in practice following feedback and reported incidents. For example, following a never event, whiteboards were introduced in delivery rooms to improve swab count documentation. In February 2024, space blankets were implemented to reduce hypothermia in babies and neonatal readmissions, and a breast milk sign-in/out folder was introduced.

Women and birthing people we spoke to reported that staff involved them in decision-making, birth planning, and treatment. They were also informed about their discharge and transfer arrangements. A patient survey for Southend University Hospital revealed that 71% of women and birthing individuals felt they received adequate advice on their physical recovery after birth. Additionally, 83% felt they received advice from a health professional about their baby's health and progress within 6 weeks after birth. Women and birthing individuals felt heard, with staff considering their views about their care and the service. This sentiment is reflected in the survey, where 92% felt that their midwives listened to them during antenatal check-ups.

Staff conducted risk assessments for women and birthing people upon arrival using a recognised, evidence-based tool, with regular reviews, including post-incident evaluations. From December 2023 to February 2024, an audit showed that midwives reviewed 79% of patients within 15 minutes of arrival and 98% within their allocated assessment time. However, only 61% were seen by doctors within their allocated time, indicating delays in doctor reviews. Key information was shared during handovers using the SBAR (Situation, Background, Assessment, Recommendation) tool. Consistent use of SBAR was confirmed by records, with an audit from January to March 2024 showing a 95% overall assurance rating. However, staff reported insufficient medical cover for triage. A registrar covered triage, planned appointments, and the antenatal ward, leading to potential delays in medical reviews, which was documented on the risk register. The service lacked a dedicated triage telephone line staffed by a midwife. Instead, ward clerks and midwives handled calls, causing delays during peak hours, especially in the evening. Although two midwives managed triage, busy periods often resulted in call-answering delays. Per trust policy, non-clinical staff should not answer the triage line. During the inspection, the service was working on implementing a dedicated maternity triage line, and we reviewed the draft Hospital Maternity Triage Standard Operating Procedure. Senior staff acknowledged gaps in triage and planned to address them, having secured funding for this initiative. Staff told us that approximately once a month, babies were born in triage; however, post-inspection review indicated only one unplanned delivery in triage happened in the past 12 months. Staff managed specific risk issues by reviewing antenatal care records and using the "fresh eyes" approach for safe fetal monitoring. Leaders audited the effectiveness of continuous cardiotocograph (CTG) monitoring during labour.

The local Maternity and Neonatal Voices Partnership (MNVP) held quarterly meetings with the service to convey feedback from women and birthing people to maternity leaders. A significant focus was on supporting the diverse communities using the service. The MNVP collaborated with ethnic community leaders to enhance maternity services across Mid and South Essex. They assessed the accessibility of information and identified areas for improving care and options for all women and birthing people. They reported having a good working relationship with the Heads of Midwifery and the Director of Midwifery and believed this collaboration positively impacted the pregnancy experiences of women and birthing people, ensuring the views of women and birthing people were represented and that the maternity services were tailored to local needs.

Staff used a nationally recognised tool, such as the Maternity Early Warning Score (MEWS), to identify and appropriately escalate women and birthing people at risk of deterioration. In our review of five MEWS records, staff had correctly completed them and escalated concerns to senior staff as needed. A quarterly audit of 120 records from October 2023 to March 2024 showed 94.2% compliance against a target of 90%, indicating timely documentation and escalation of concerns. The November 2023 to February 2024 World Health Organisation (WHO) surgical checklist audit showed 99% overall compliance. However, the Venous thromboembolism (VTE) assessment audit revealed only 56% compliance against the trust's 90% target. At the time of inspection, the service was implementing a dedicated maternity triage line and provided a draft of the Hospital Maternity Triage Standard Operating Procedure. Senior staff acknowledged gaps in the triage process and had plans to address them, having secured funding for these improvements. However, the service currently does not audit call wait times, the time it takes for women and birthing people to speak with a midwife, or the frequency of dropped calls. As a result, women might need to call repeatedly without follow-up, potentially putting them at risk.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Women and birthing people we spoke to during the assessment said, “I’m kept informed about my care and know the next steps for my plan of care,” “There is good communication and I’m involved with my care” and “Since transferring hospitals due to moving at 26 weeks pregnant. I have been under Southend Hospital. I have found in comparison that this hospital is very thorough, making sure you and baby are ok.” People also said that staff were knowedgable and they knew where to get support when they needed it. The patient survey data for Southend University Hospital also showed that 93% of women and birthing people were asked by their midwives about their mental health during check-ups and 88% were given the help they needed if they contacted the midwifery team.

Women and birthing people we spoke to felt safe and supported in understanding and managing any risks. They knew who to contact with concerns or if their health condition worsened. They felt well-informed and advised prenatally and postnatally about their health, care, and support needs by multidisciplinary staff and through the hospital's maternity website. The service used feedback and other evidence to improve access for women and birthing individuals who might face barriers or delays in their care. This included providing translation services for those whose first language was not English. However, staff sometimes struggled to access these translation services and had to rely on partners or Google Translate during care or clinical appointments. Most staff could identify at least 1 of the top 3 risks for the maternity service, and senior staff were able to explain all 3 risks.

Staff handovers at shift changes included all essential information to ensure the safety of women, birthing people, and babies. During the assessment, we attended staff handovers and confirmed that all critical information was shared. The handovers were attended by a multi-disciplinary team, including anaesthetists. The service provided transitional care for babies needing additional attention. Staff completed risk assessments before discharging women and birthing people into the community, ensuring that third-party organisations were informed of the discharge. An audit from March to April 2024 showed 79.5% overall compliance, with "fresh eyes" assessments conducted hourly in 75% of cases. However, the service did not clearly interpret the CTG audits or the related management plans. This meant that there was limited oversight potentially putting women and birthing people at risk.

Women and birthing people spoke positively about the environment; one woman told us “Staff have been lovely and caring and very informative. Environment has always felt nice and clean”

Staff reported having enough suitable equipment to safely care for women, birthing people, and babies. For example, the birth centre had pool evacuation nets, and the maternity assessment unit had a portable ultrasound scanner, cardiotocograph machines, and observation monitoring equipment.

The environment design adhered to national guidance, with the maternity unit being fully secure and equipped with a monitored entry and exit system. Staff told us that regular risk assessments, including those for ligature and self-harm were conducted. The service had suitable facilities to meet the needs of women, birthing people, and their families, with support for birth partners. This included 2 maternity theatres for elective and emergency caesarean section and triage areas. A dedicated bereavement suite was available, furnished in line with best practice guidelines to care for bereaved mothers and their families. Call bells were accessible to women and birthing people, and staff responded promptly. Staff disposed of clinical waste safely. Sharps bins were correctly labelled and not overfilled. Clinical waste was properly separated and placed in appropriate bins. Waste was securely stored in locked bins awaiting removal. There was no Postpartum Haemorrhage (PPH) box in triage, and women and birthing people who were readmitted to the maternity unit, accessed the service through triage, posing a safety risk. Additionally, we observed some worn and torn chairs in the postnatal ward, which posed an infection control risk. Staff informed us of the lack of hot water in the Cardigan wing prevented water births and showers, posing a risk to health and safety and welfare regulations. This issue has been escalated, added to the risk register, and was expected to be resolved by April 2024.

Staff were expected to conduct daily safety checks of specialist and emergency equipment, including emergency trolleys. A review of equipment checks records indicated these checks were performed regularly and signed by staff however out-of-date consumables were found on a neonatal resuscitation trolley on the labour ward. In the delivery suite, items from a broken postpartum haemorrhage trolley were stored in another drawer, and a blister pack was improperly stored, posing a risk during emergencies. However, staff were knowledgeable about the consumables and their locations. Staff regularly checked the cleanliness of birthing pools on the labour ward and midwifery-led unit, and the service had a contract for legionella testing of the water supply.

Women and birthing people told us they felt safe and supported and knew who to contact if needed. They were satisfied with the staff, their skills, and the information provided, 1 woman mentioned that staff were understanding, flexible and gave good quality of care.

Staff understood how to protect women and birthing people from abuse and collaborated effectively with other agencies. They were trained to recognise and report abuse and knew how to apply this knowledge. Most staff were up to date with their mandatory and maternity specific trainings, and safeguarding training. As of March 2023, 80% of midwifery staff and 79% of medical staff had completed the safeguarding level 3 training against the 85% trust target. This was an improvement from the last inspection, where compliance was at 59%. The service had low vacancy rates, turnover and sickness rates. As of February 2024, the turnover rate was 9.9% for midwifery staff and 8.6% for obstetric staff, both below the 12% target. The sickness rate was 2.8% for midwifery staff and 2.1% for obstetric staff, against a trust target of 3.5%. The vacancy rate was 5.8% for obstetric and gynaecological medical staff. At the time of the assessment, there were 26 midwifery vacancies (12.5%), slightly above the trust target of 11.5%, mainly in specialist roles. Senior staff reported improvements in staffing figures and retention. The service had recently recruited 15 preceptor midwives. The fetal medicine unit was understaffed due to staff sickness and lack of administrative support, which placed additional pressure on midwifery staff. Staff reported a lack of cover during times of high sickness sick or annual leave.

Staffing levels did not always match the planned numbers needed to ensure the safety of women, birthing people, and babies. Managers regularly reviewed and adjusted staffing levels and skill mix, providing temporary staff with full induction and training. Managers moved staff between areas according to the number of women and birthing people in clinical areas and acuity. A supernumerary labour ward shift coordinator and a maternity service coordinator were on duty around the clock, overseeing staffing, acuity, and capacity. A recent Birthrate Plus report identified a deficiency of 12 midwives. Due to the suspension of continuity of care, senior managers agreed to use the funding to recruit more specialist midwives.

Staff received and maintained up-to-date mandatory and maternity-specific training, which was comprehensive and met the needs of women, birthing people, and staff. Training included cardiotocography (CTG) competency, manual handling, human factors, skills and drills, and neonatal life support. The service held regular emergency skills and drills for staff. By March 2024, 90% of midwifery and obstetric staff had completed all their mandatory training. By April 2024, 97% of midwifery staff had completed maternity training, and 97% of multidisciplinary staff (MDT) had completed simulated obstetric emergency training (PROMPT). The service ensured staff competence in their roles. Managers regularly appraised staff performance, with data showing that 90.2% of staff had completed their annual appraisal by March 2024, meeting the trust target of 90%.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff adhered to established systems and processes for the safe prescription and administration of medicines. We reviewed 5 prescription charts, the charts were fully completed by the staff. Medicines records were maintained, up-to-date, and clearly documented. All medicines and prescribing documents were stored securely, with access restricted to authorised personnel only. The clinical room was locked, ensuring controlled access. Medicines were stored at the appropriate temperature, and staff monitored and recorded fridge temperatures.