Southend University Hospital

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

Staff understood their roles, took responsibility, and knew how to escalate issues when needed. Local leaders generally ran the service effectively, and staff reported feeling well-supported by their line managers, ward managers, and matrons. However, junior staff informed us that the divisional maternity leadership team was not always visible. Staff development was encouraged, with service leaders offering opportunities for skill enhancement. The service conducted various governance meetings regularly, including discussions on items on the risk register, which were reported to the trust board. During and following the assessment, outdated policies were found. Some policies did not reflect current clinical practices or adhere to the ratification process. Specifically, the maternity safeguarding policy did not include topics such as domestic violence and sexual exploitation and did not reference the safeguarding team or broader trust-wide policies. This was an issue as staff, particularly newer staff, might not know who to contact.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Local leaders had the skills and abilities to run the service effectively. They were well-respected, approachable, and supportive, ensuring that staff felt well-supported by their line managers, ward managers, and matrons. Junior staff told us that the cross-site divisional maternity leadership team was not always visible, however, senior and specialist staff reported good access to and support from the divisional and trust leadership team. The head of midwifery was reported to be regularly visible, attending handovers, participating in training, and being accessible for support. Service leaders encouraged staff development by offering opportunities for skill enhancement and participation in leadership and development programs. Some leaders attended aspiring leadership courses, perinatal leadership training, and master’s programs. Maternity service level leaders felt well-supported by their managers and trust executives, with good support and direct access to the trust board. Regular appraisals and meetings with their staff further reinforced this support. The service is supported by maternity safety champions and non-executive directors. However, staff were unaware of their maternity safety champions and non-executive directors, although they were familiar with their service-level maternity safety champions. Posters displaying the board maternity and neonatal safety champions, complete with pictures and role information, were observed across the maternity units during the assessment.

The management and leadership structure was clearly defined. The hospital maternity leadership team included a head of midwifery and gynaecology, an obstetric clinical lead, and a consultant midwife, supported by three maternity matrons, specialist midwives, and band 7 midwives. The hospital maternity lead reported to the trust-wide director of midwifery, medical director, clinical director for obstetrics and gynaecology, director of operations, and interim managing director. In the 2023 staff survey, overall improvements were noted across all areas within the Mid & South Essex (MSE) Trust compared to their 2022 results. However, the trust's scores remained below the average for acute trusts. Specifically, under the "we are compassionate and inclusive" category, maternity services received a score of 6.9 on a 10-point scale, where higher scores indicate a more positive response. The trust as a whole and all acute trusts averaged 7.2 for the same question. Responses related to compassionate leadership within this category were somewhat less positive compared to the trust average. Despite this, maternity staff indicated a perception of a compassionate culture within the organisation, with most scores higher than the trust average. Maternity staff also felt that equality and diversity was embraced, with scores generally positive or in line with the average.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service maintained a well-defined governance structure designed to facilitate the flow of information from frontline staff to senior managers and the trust board. However, there were instances where the governance processes were found to be ineffective. The Chief Nursing Officer held ultimate accountability for governance within the trust, overseeing the Clinical Director for Women’s Health, Director of Midwifery, and Director of Governance. Governance meeting agendas covered performance data, audits, training, serious incidents, and feedback, with some meetings featuring full multidisciplinary participation. However, the minutes from divisional triumvirate meetings between September 2023 and March 2024 indicated that not all scheduled weekly meetings occurred, and attendance was poor. Outcomes and service dashboards were disseminated via the Friday Governance newsletter, emails, posters, and governance boards. Staff understood their roles and took responsibility for their actions, knowing how to escalate issues to clinical governance meetings and the divisional management team. Information was shared back to sub-committees and all staff, ensuring effective communication throughout the service.

Three outdated policies were found on the intranet: these were the maternity escalation policy (overdue since June 2022), the DNA policy (overdue since August 2022), and the PEWS guideline (overdue since December 2023). The trust also had a Maternity and Medical Staffing and Escalation Policy, which was ratified 17 August 2021 and 16 August 2024. Some policies did not reflect current clinical practice or adhere to the ratification process. For example, the maternity and medical staffing escalation policy required three midwives and one support worker per shift, but we noted that planned staffing levels during our assessment were only two midwives per shift. Additionally, the Baby Abduction Policy, professionally approved in 2019, was ratified by the trust only two years later, without recent multi-professional consultation. Staff had access to a trust-wide child safeguarding policy and a maternity-specific safeguarding policy. However, the maternity safeguarding policy did not include topics such as sexual exploitation, a flow chart on actions to take if a safeguarding concern arose and contact details for safeguarding midwives or the safeguarding team. This omission raised concerns that staff, particularly new staff, might not know who the safeguarding midwives or teams were or how to contact them, especially during out-of-hours periods and weekends.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff had a good understanding of Quality Improvement (QI) methods and the skills to implement these improvements. The service was committed to improving services by learning from both successes and setbacks, promoting training and innovation. They had a QI training program and a QI champion who coordinated the development of quality improvement initiatives.

QI initiatives were regularly reviewed and discussed during QI and governance meetings. Examples of completed or ongoing QI projects included enhancements to epidural connections, strategies for managing high pre-birth rates, improvements in communication with women and birthing individuals, the introduction of space blankets, a project focusing on areas of deprivation based on postcodes, and the implementation of weighing scales to measure blood loss. These initiatives were driven by incidents, feedback from staff, and input from women and birthing individuals. However, there were occasions where the process of learning from incidents experienced delays.