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Broomfield Hospital

Grading:  - Requires Improvement

Broomfield Hospital is part of the Mid Essex Hospital Services NHS Trust (MEHT). Broomfield Hospital is an acute district general hospital and it is the only hospital location within Mid Essex Hospital Services NHS Trust to provide accident and emergency (A&E) services. Broomfield Hospital also provides a county-wide plastics, head and neck and upper gastrointestinal (GI) surgical centre to a population of 3.4 million, and an internationally-recognised burns service in the St Andrew's Centre within Broomfield Hospital that serves a population of 9.8 million.

Broomfield Hospital is an acute hospital providing accident and emergency (A&E), medical care, surgery, critical care, maternity and gynaecology, children and young peoples services, end of life care, and outpatient and diagnostic services, which are the eight core services always inspected by the Care Quality Commission (CQC) as part of its new approach to hospital inspection. In addition to these eight core services, the hospital provides a regional centre for burns and plastic surgery. We have therefore included these as an additional core service on this scheduled inspection.

We carried out this inspection as part of our commitment to inspect all NHS trusts in England. Our rationale for choosing this service was based upon its aspirations to become a foundation trust, but also due to risks that had arisen around the non achievement of the four hour target in A&E, and also an increased number of whistleblowing and safeguarding concerns received by the Commission.

This was a scheduled and announced inspection, which took place between 26 and 28 November 2014 and on 6 December 2014 we conducted an unannounced inspection of the service. In addition, on 05 February 2015 we returned and carried out a focused unannounced inspection of the Emergency and Assessment Unit (EAU) and took enforcement action, on 26 March 2015 we returned to ensure that systems were in place to protect people from avoidable harm.

Overall, we have found that the ratings and provision of care in each core service varied greatly. The trust was a caring organisation throughout, and staff we observed in the majority were passionate about their work and caring towards patients. We found that the burns service was providing excellent care, with some of the best outcomes for patients with severe burns in the country, and the results were competitive with burns centres worldwide. Generally, we found the critical care and services for children and young people good, with improvements needed in medical care, surgery, end of life care and outpatient and diagnostic services. We found examples of poor care and practice in urgent and emergency services which we have rated as inadequate, and also in maternity and gynaecology and specialist burns and plastic services which required improvement. During our inspection of Broomfield Hospital EAU on 5 February 2015 we found that the safety of the emergency assessment unit (EAU) was inadequate but this did not impact on the rating for urgent and emergency services which was already rated as inadequate. However the rating for leadership within urgent and emergency services changed from requires improvement in November 2014 to inadequate. This is because the leadership of the unit did not act to ensure that appropriate and registered staff were responsible for the direct care of patients on the EAU. The leadership of the service failed to act on concerns raised by staff and the senior management team failed to have effective governance and assurances processes in place to monitor the work and roles of the staff working in adaptation posts whilst they were awaiting registration. Overall, we have rated Broomfield Hospital as a requires improvement service as whilst there are two inadequate ratings for the safe domain this only relates to one core service. We have identified areas where improvements are required.

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