Executive summary

In May 2025, NHS England Workforce Training & Education (WT&E) Quality team engaged with Mid and South Essex NHS Foundation Trust (MSEFT) across their Basildon, Broomfield and Southend sites. There were four days of engagement meetings (6, 16, 19, 23 May) and two meetings to convey high-level feedback to senior trust representatives (2, 5 June).

The engagements identified areas that were working well, areas of improvement associated with the open improvement plan, as well as additional ongoing and emerging concerns.

NHS England WT&E Education Quality has an open improvement plan for Basildon anaesthetics, Southend medicine, and trust-wide obstetrics and gynaecology and midwifery; NHS England WT&E (formerly Health Education England) engaged with these groups in July 2022. There is also an open improvement plan for Broomfield Radiology and Southend Paediatrics, associated with education quality engagement meetings in September 2023 and March 2024 respectively. Nursing, Allied Health Professions (AHP) and midwifery learners were included further to the recommendation of the Regional Education Quality Improvement Panel.

The overall assessment for each area of engagement is as follows:

• Basildon anaesthetics: Multiple significant patient safety concerns and significant areas for improvement in education and training were identified. Due to NHS England WT&E’s quality assessment of extremely high levels of concern and the impact of significant issues on education and training, NHS England WT&E and the School of Anaesthetics have been collaborating and working with the trust on the next steps following the recommendation at Regional Education Quality Improvement Panel on 21st May 2025 for removal of anaesthetics residents from Basildon. The recommendation was approved through the quality governance processes and discussed with the General Medical Council (GMC).
• Southend medicine: Residents were generally positive about their training experience, trust colleagues and the learning environment and perceived a trajectory of improvement for medicine education and training at Southend. Key issues were staffing, especially post take, and ensuring protected time in the rota remained protected.
• Broomfield radiology: While major scope for improvement remains, there were improvements from the September 2023 NHS England WT&E quality engagement visit and improved mitigation of the impact of rapid placement expansion on education and However, there were concerns about the sustainability of improvements which residents perceived had been implemented previously but not embedded.
• Trust-wide paediatrics: Some key challenges identified at the March 2024 engagement continue including facilities, rotas, and multiprofessional working relationships. There were some improvements including the quality of consultant support for resident doctors (residents).
• Trust-wide obstetrics and gynaecology: Concerns remain for areas on the open improvement plan (rotas and support for exception reporting, although support for exception reporting has improved). There were positive elements to the teaching at Southend, however cultural challenges were identified, including perceived Basildon’s culture was more positive, but residents felt less positive about the quality of teaching. Broomfield residents were the most positive group in terms of their training experience and learning environment.
• Trust-wide midwifery: Some areas of improvement were identified from concerns raised in July 2022. Learners spoke highly of midwives and felt well integrated with the obstetric team. Learners felt that midwives worked incredibly hard and that some were burnt out. Key concerns were culture at Basildon Hospital, including the level of support from management in addressing escalated concerns regarding education and training. Additionally, there were gaps in learners’ awareness of escalation and exception reporting mechanisms, and the perceived effectiveness of these mechanisms across the trust. WT&E were aware of the challenges regarding substantive roles for midwives qualifying in summer 2025 and additional support was offered at the time of the engagement outside the quality meeting.
• Trust-wide nursing and allied health professionals: Feedback from nursing and AHP learners was mixed with some areas working well, however there were some key areas with scope for improvement, including support for escalating concerns and support to maintain supernumerary status.

Good practice and areas working well identified in the review are as follows:

Basildon anaesthetics

• Residents were positive about simulation

Southend medicine

• Residents were generally positive about education and training, including availability of consultant support, teaching quality, the teaching rota (when gaps not present), cohesive environment, and an improvement trajectory for education and training.
• Residents knew who the Guardian of Safe Working as and how to access
• Positive induction

Broomfield radiology

• Trainers were passionate about education and training and keen to drive
• Good learning environment, culture and
• Consultant led general (non-subspecialty)
• Very strong support for residents from a consultant in paediatric
• Residents felt they worked within their scope of competence and confidence (improvement from September 2023).
• Progress on general curriculum coverage (improvement from September 2023).
• Progress on plain film checking (improvement from September 2023).
• Progress with access and quality of US training (improvement from September 2023).

Trust-wide paediatrics

• Educator remuneration – 25 PA per resident and non-resident supported and job planning was felt to be appropriate.
• Wellbeing – trainers outlined wellbeing provisions in place for residents and
• Teaching – residents were very positive about teaching when it was

Consultant support for resident doctors – residents perceived consultants to be very supportive and attentive; this was an improvement from March 2024 when Southend residents and trainers felt that a portion of the trainer body was unsupportive of education and training.

Trust-wide obstetrics and gynaecology

• Southend – good quality of clinical learning, residents felt that good evidence-based practice was delivered according to guidelines.
• Southend – generally good access to learning opportunities; specialty trainees (STs) felt that handover was used as a teaching opportunity.
• Basildon – although we heard there was scope for improvement in some areas, residents perceived an improvement trajectory for education and training.
• Basildon – good support from on call
• Basildon – some residents felt the department was a very comfortable unit to work
• Broomfield – positive feedback from GP residents and the rota coordinator effectively communicates rota changes for the next day. Broomfield residents were generally positive about their experience and had a protected week for training.

Trust-wide midwifery

• Learners spoke highly of midwives and felt well integrated with the Obstetric team. Midwives were described as professional, compassionate, articulate, and future leaders of positive change.
• We heard good practice from Braintree Community Hospital where students were asked at the beginning of the shift what they needed/wanted to learn. Education lead would send emails to students letting them know about internal and external learning
• Very positive feedback about a Practice Education Facilitator at
• Learners have access to a Professional Midwifery Advocate (PMA).
• Some positive comments received pertaining to Cedar ward (when it was staffed appropriately).

Nursing and allied health professions

• Most would recommend training at the trust. Reporting mechanisms were described in
• Learners had access to interprofessional learning
• Mixed experiences of the culture but largely

Areas with scope for improvement

Basildon anaesthetics

• Six immediate mandatory requirements regarding patient safety and resident doctor safety were identified at the Basildon anaesthetics engagement. Action was taken to mitigate the concerns shared.
• Culture – residents reported incivility, rudeness, aggression, undermining, a culture of blame, and concerns about misogyny. Directors were felt to be kind and supportive when concerns were escalated, but residents did not see change.
• Teaching and learning – other than simulation, all other elements of training were perceived to be insufficient; we heard that face-to-face time with consultants was
• Escalating concerns – residents felt that escalations did not yield
• Sexually inappropriate comments – there were some reports of sexually inappropriate comments directed at residents and theatre staff by consultants.
• Acute Medical Unit – we heard that care, training, and culture had major scope for improvements based on a resident’s experience in August 2024.

Southend medicine

• Challenges with rota gaps (including the impact of gaps on clinic access) and attaining minimum staffing (rotas were also a concern at the July 2022 engagement). Residents felt that additional workforce at post take level was required to ensure patient safety.
• Exception reporting: residents were reluctant to exception report working additional hours as it was felt there would be no outcome or change.
• The Department used paper charts only, which could lead to patients who have already been seen overnight and put on the electronic system being re-prescribed medications / double dosed.
• Residents felt that emergency department colleagues insist on one-way referrals, often to the medical team, and this was resulting in some inappropriate referrals (this was also a concern at the July 2022 engagement).

Broomfield radiology

Although the following areas have improved, scope for improvement remains in subspecialty coverage, plain film checking sign off, and rota enabled access to ultrasound training.

• Escalating concerns – the College Tutor and Service Director held a split role, and a perceived conflict of interest makes residents reluctant to raise concerns; the individual holding these posts was aware and, at the appropriate time, will focus on one of these two
• Administrative support for education and training – trainers perceived that additional administrative resource would mitigate some challenges including subspecialty teaching rota clashes.
• Trainer job planning – although teaching was in the rota, there was scope for improvement in how this was formally reflected in job planning; the trust noted that the job plan policy recently changed and was hopeful for improvements.

Trust-wide paediatrics

• Skill mix – 2/15 residents were ST2s, and the remainder were Foundation or GP residents which caused challenges. Residents and trainers were very keen to receive more registrars but were aware there were no planned increases to national paediatrics training numbers following a conversation with the Paediatric School.
• Rotas – some resident doctors had limited ability to attend planned education sessions due to rota pressures entailing cancelations.

Multiprofessional culture:

• Higher residents indicated that relationships with surgery colleagues were usually very good, however some residents felt that clarity was required on where the professional responsibility lays in the trust for the under 5 years patient group who may require abdomen surgery. There was a perception that the surgery team were not following Addenbrookes’ guidance on further monitoring of patients under 5 (when the initial patient assessment was undertaken by Addenbrookes).
• GP/FY/ST1-ST3 residents – perceived incivility from senior nursing staff, g. pressuring residents into postponing breaks or finishing them early.
• Paediatric Assessment Unit (PAU) – heavy administrative

Trust-wide obstetrics and gynaecology

• Southend – residents we met with perceived misogyny – the Foundation/GP/Core group felt that midwives took male residents’ patient plans more seriously than female residents’ patient plans. Higher residents indicated that Southend was a good unit from a work point of view but felt there was “sexism”.
• Southend – feedback may not be given in an appropriate manner (e.g. feedback given in a large forum rather than in private conversation). We also heard reports of incivility, bullying, and undermining.
• Southend – ongoing issues with supervision in clinics which was escalated
• Basildon – residents were more positive about the culture but less positive about the quality of teaching.
• Culture and pastoral care quality was variable depending on the
• Rotas – issues included access to sign off, teaching time for ST1-3, and short notice weekly changes to the 4-month rolling The Southend rota was split into AM or PM sessions, which residents felt resulted in no continuity for patients.
• Escalating concerns – many residents felt they were able to raise concerns, but we heard some concerns that were not escalated internally by residents.
• Facilities – lack of rooms for

Trust-wide midwifery

• Escalation mechanisms – fear of escalation and lack of closure of feedback loops in the event of The majority were not aware of Freedom to Speak Up Guardian. Midwifery learners were also unaware how to submit a Datix report.
• Midwives were commended but felt to be stretched, stressed and under a lot of Reports on an unhappy workforce and this was impacting service users.
• Learners with limited employment prospects at the trust with noted student attrition high in year 1 due to reports of the lack of jobs for newly qualified midwives.
• Concerns about minimum staffing levels and support for staff when this was
• Clinical supervision – multiple reports of learners working outside their scope of competence and confidence.
• No centralised Cardiotocography (CTG) monitoring, increased risk as learners reported being left on their own on the antenatal ward, or patient to staff ratio being high, meaning patients were being left on the telemetry CTG without being monitored.
• Supernumerary status was not maintained, and learners felt they were being counted as part of the workforce.
• Breaches in BSOTS (Birmingham Symptom-specific Triage system) – with patients often not being seen within the timeframes required by the system.
• The breaches included women attending with reduced foetal
• Reports of a toxic culture at Basildon between maternity staff and maternity managers. Accusations of bullying and staff being unable to speak Managers were perceived to be dismissive of staff’s escalated concerns.
• Equipment availability and accessibility – no bedpans on labour Foetal Scalp Electrode, CTG belts and neonatal stethoscopes are difficult to locate.
• Prompt training & MD training – student midwives were not included in these learning

Trust-wide nursing and allied health professions

• Supernumerary status was sometimes not maintained with reports of learners being used as Health Care Assistants (HCAs) when staffing was poor.
• Escalation reporting – some reports of learners fearing being targeted if concerns were escalated or whistle blown.
• Electronic Practice Assessment Document (ePAD) – some students described that it was difficult to get sign off and some students felt that the practice assessor would sign off ePADS without review due to workload pressures. Some students felt their practice assessors’ understanding of the ePAD could be improved.
• Student nursing associates felt there was no clear understanding around their role by multiprofessional colleagues and lacked an understanding of a clear career pathway within the Trust.
• Continuing Professional Development – only essential training being supported, with Continuing Professional Development courses full.

Next steps

Due to Basildon anaesthetics resident doctors being removed from and relocated to other MSEFT sites, since the quality engagement the GMC have put conditions on MSEFT Basildon anaesthetics department which WT&E quality will be monitoring as part of WT&E processes to support improvement.  NHS England WT&E quality have sought assurance of the immediate mandatory requirements  for the patient/resident safety concerns and have requested a further response from the trust for the four remaining areas where additional immediate action is required.  NHS England WT&E Education Quality are working closely with the NHS England Patient Safety Team, the CQC and the GMC to ensure alignment and confirm arrangements for ongoing monitoring of these concerns where appropriate and anticipate concerns remaining regarding patient safety and care to be taken forward by the patient safety team, CQC, or the GMC where appropriate.

For all other areas listed, these areas need to be actioned and monitored against improvement plan requirements and outcomes to ensure that education quality improvements are embedded and sustained. NHS England WT&E will continue to work collaboratively with MSEFTto agree milestones and actions against the educational requirements within the improvement plan.

Review overview

Background to the review

NHS England WT&E has an open improvement plan for Basildon Anaesthetics, Southend medicine, and trust-wide obstetrics and gynaecology and midwifery following WT&E (formerly Health Education England) engagement meetings in July 2022. There are also open improvement plans for Broomfield Radiology and Southend Paediatrics, associated with education quality engagement meetings in September 2023 and March 2024 respectively. Following a review of evidence, including outcomes from the Broomfield Paediatrics Quality Improvement Group, this engagement report encompasses feedback from trust-wide Paediatrics. Nursing and AHP learners were included in this engagement further to the recommendation of the February 2025 Regional Education Quality Improvement Panel, following multiple Nursing and Midwifery Council exception reports submitted in 2025, with AHP learners included on the recommendation of NHS England WT&E’s regional AHP lead.

Who we met with

Southend medicine

Resident doctors

• resident

Trainers

• trainers including college tutor, Foundation Training Programme Director and Foundation

Trust-wide paediatrics

Resident Doctors

• GP/Foundation/Core/ST1-ST3 resident doctors from Southend, Basildon, and
• higher resident doctors from Southend, Basildon, and Trainers
• Southend trainers, Basildon trainers including Clinical Director, Broomfield trainers including College Tutor.

Basildon anaesthetics

Resident Doctors

• resident doctors Trainers
• trainers including College

Trust-wide obstetrics and gynaecology 

Resident Doctors

• Basildon residents, and residents from Southend and from Trainers
• trainers from Basildon, Broomfield, and

Broomfield radiology

Resident Doctors

• resident

Trainers

• trainers

Trust-wide midwifery

Learners

• midwifery students from Basildon, and midwifery students from Broomfield and

Educators

• midwife educators and consultant

Trust-wide nursing and AHP

Learners

• >100 nursing and AHP learner Educators
• Basildon nursing and AHP educators including Practice Education Facilitators, ARU Education Champion, and Trust Professional Commissioned Education Facilitators.
• Broomfield and Southend

High-level findings were communicated to the following senior level trust representatives following the engagement meetings:

• Chief Executive Officer
• Chief Nursing and Quality Officer
• Group Director of Medical Education
• Head of Professional and Commissioned Education – Basildon & Mid Essex
• Clinical Director Division of Children
• Director of Medical Education – Broomfield Hospital
• Group Medical Education Manager

Evidence used

• NHS England WT&E internal governance documentation
• GMC NTS 2024 and NETS 2024 survey outcomes
• Outcomes from Broomfield Paediatric Quality Improvement Group
• School of Anaesthetics “evidence package” for Basildon training (May 2024-February 2025)
• CQC overall trust inspection report published 23rd December 2022, and maternity report for Basildon University Hospital published 16th January 2025.

Review panel

6 May, Southend Medicine and trust-wide Paediatrics

• Chair: Regional Lead for Education
• Notes: Education Quality Intelligence Analyst, and Education Quality Coordinator.
• Specialty experts: Head of School of Medicine, GP Associate Postgraduate Dean for Quality, TPD for Quality – School of Paediatrics, Deputy Postgraduate Dean.

16 May, Basildon Anaesthetics and trust-wide obstetrics and gynaecology 

• Chair: Regional Lead for Education
• Notes: Education Quality Coordinator, Education Quality Intelligence Analyst.
• Specialty Experts: TPD Quality Lead – School of Anaesthetics, TPD Anaesthetics Education Lead and Deputy Foundation School Director, Head of School of O&G.

19 May 2025, Broomfield Radiology

• Education Quality Intelligence
• Notes: Education Quality
• Specialty experts: Head of School of Radiology, Deputy Postgraduate

23 May, trust-wide Nursing, Midwifery, and Allied Health Professionals (AHP)

• Chair: Regional Lead for Education
• Notes: Education Quality Coordinator, Education Quality Intelligence Analyst.
• Specialty experts: Assistant Director of Nursing and Midwifery, Senior Clinical Manager – Nursing and Midwifery, Senior Nursing and Midwifery Clinical Lead, Regional AHP Programme Lead.

Review findings

All learner and resident doctor groups that we met with identified colleagues within their teams who were supportive and well meaning. Most learner and resident doctor groups we met with (except paediatrics) had concerns about escalation or exception reporting. These concerns were  primarily driven by a reluctance to escalate exception reports due to a belief that raising issues would not lead to change and/or a perception of insufficient support for residents when doing so.. Limited trust facilities to enable the delivery of education and training was also a theme across many areas of engagement.

Basildon anaesthetics

Residents stated that their clinical lead was approachable and helpful, and felt that simulation training was good, but all other elements of education and training had scope for improvement. There were multiple concerns about achieving curriculum requirements and trainers’ understanding of curriculum requirements, and a feeling that face-to-face teaching time was incredibly limited. The culture was also reported to be very challenging, with resident doctors discussing numerous examples of observing unprofessional behaviours by consultants. The discussions identified several immediate mandatory requirements.

It was positive that trainers sought resident feedback and were giving consideration to specific support for International Medical Graduates, but trainers’ perceptions of the learning environment overall did not align with resident feedback and their experiences. For example, both groups had different perceptions of competency sign off timeliness, the extent to which teaching was structured, and access to training opportunities. Both resident doctors and trainers wanted to improve the timeliness of rota circulations.

Concerns directly impacting resident and patient safety

Resident doctors felt pressured by consultants to push patients towards specific treatment options during consent discussions. If a patient refused the consultant would encourage another patient discussion, which was felt to adversely affect patient wellbeing and choice. This was primarily a concern for adult patients but also occurred with paediatric patients. In the residents’ view, when they escalated their concerns, it was completely dismissed by the consultant(s), with significant concerns the resident doctor and patient voice were not heard by the consultant body (RQ1). Residents felt that risks in obstetrics were not made clear to patients: we heard that the consultant, when consenting for an epidural or a laparotomy, did not discuss the risks with the patient. For the trauma list, resident doctors were told not to frighten patients during consenting discussions (RQ1).

Sometimes on-call consultant supervision was inadequate (RQ1). Novice anaesthetics residents were frequently left alone in theatre without access to supervision, resulting in residents working outside of their scope of confidence and competence (RQ1).

Concerns with residents witnessing improper practice, giving rise to patient safety concerns

Resident doctors were concerned that training at Basildon would result in learning improper practice; this was underpinned by inadequate education and training. For example, resident doctors witnessed patients being woken prior to being in recovery, and we heard that a patient had fallen off the table within the last 3 months; this was distressing for both patients and residents (RQ1). Some residents were unaware of what action to take in these incidents. It was noted there was a governance meeting where serious incidents could be raised, but residents did not feel that resulted in resolved challenges.

Residents also raised concerns about processes associated with syringes (3-way taps). Examples were provided of patients not needing a full syringe of medication through a 3-way tap and the syringe being left on the side and considered for future use. We heard that this concern was escalated within the trust one year ago, but the practice had continued and occurred most recently one week prior to the engagement visit (RQ1). Risks to patient safety were perceived to be compounded by inadequate handover from the emergency department with residents’ concerns about the accuracy and completeness of referrals.

Residents raised concerns around the labelling of anaesthetic drugs and the processes. An example was provided of a consultant being warned by the residents that they were about to administer the incorrect drug to an adult patient, but this warning was not adhered to, and the incorrect drug was administered (the correct drug was administered later when it was located). This had also occurred with paediatric patients, for example Atropine was administered instead of Glycopyrrolate when the intention was to administer Glycopyrrolate. On at least one occasion, a consultant blamed a resident for causing incorrect drug administration because the drug label had not been put on the syringe in a spiral direction by the Resident.

Residents stated most of the incidents they witnessed were associated with the same consultant and were not escalated internally due to a perceived culture of incivility and blame towards residents if escalated (RQ1).

Culture and raising concerns

We heard that quality of care, training, and culture also had major scope for improvements in the Acute Medical Unit (AMU), based on a resident’s experience in August 2024.

Resident doctors also felt that some consultants were fantastic, but others would display repetitive unprofessional behaviours in front of residents, patients, and other colleagues, which residents were concerned about as well as potentially patients’ wellbeing. Overall, resident doctors felt subjected to very intense situations of repeated chaotic behaviours by consultants.

Resident doctors stated that anaesthetics consultants were rude to patients and nursing staff by shouting and not allowing others the opportunity to speak; one consultant was described as aggressive. Residents felt undermined by behaviours on placement and that some of the incivility by male consultants arose from a misogynistic lack of respect for women. For example, we heard that a female consultant asked to be relieved from her shift and that male consultants subsequently spoke negatively about the female consultant. In theatre, a test fire alarm went off and the consultant suggested the resident was hot and had set the alarm off.

Trust Directors were viewed as kind and well-meaning when concerns were escalated to them, however positive change failed to materialise. The resident doctor’s consensus was escalations did not yield results and the trust’s culture was perceived to be conducive to the following behaviours because they would frequently go unchallenged: incivility, rudeness, aggression, undermining, inappropriately blaming residents for medical errors, and misogyny.

Sexual safety

We heard examples of a lack of respect for women was associated with accounts of sexually inappropriate behaviours that were corroborated by multiple residents we met with. Female residents received inappropriate comments about their appearance with some reporting being subject to uncomfortable sexually inappropriate comments.

We also heard consultants were inappropriate to theatre staff. For example, a consultant had invited a member of theatre staff on holiday and stated that they would have sex with the theatre colleague, resident doctors who overheard this incident challenged the behaviour by asking the consultant to repeat their statement, which they did. Residents perceived a permissive attitude and culture that did not challenge inappropriate behaviours.

IT and equipment

Basildon anaesthetics trainers identified some challenges around IT, including timely login access for new starters.

Broomfield radiology

While major scope for improvement remained, there were improvements from the September 2023 NHS England WT&E quality engagement visit and increased mitigation of the impact of rapid placement expansion on education and training. Trainers were passionate about education and training and were keen to drive improvements. Resident doctors felt that patient safety was maintained in the department and praised the supportive culture within the learning environment. Consultant led general (non-subspecialty) teaching and the strong support for training from a consultant in paediatric radiology were highlighted by residents.

The key areas of improvement since the previous NHS England WT&E quality engagement visit were residents feeling that they worked within their scope of competence and confidence, that the College Tutor emphasised the importance of this and the plans in place which were corroborated by resident feedback, including a weekly resident doctor rota being in place.

Progress was also identified for general curriculum coverage, plain film checking sign-off, and quality of rota enabled access to ultrasound training, which was also supported by the rota.

However, there was still scope for improvement for these areas

Plain film checking

Each resident has two consultants assigned to check plain films, but residents felt, at times of high volume, the impact on consultants’ workload was significant and impacted the timeliness of plain film checking. For example, there were weeks where each resident would require 20-30 plain film checks by an individual consultant; the inclusion of plain film checking sign-off on the rota would be welcomed by residents (RQ2).

Administration – rotas and lists

Teaching, including ultrasound teaching and regional teaching, was felt not to be protected in the rota (RQ3). Residents noted that sometimes teaching cancellations would be on the day of teaching and sometimes the night before, the night before being more helpful from the residents’ perspective. Senior residents felt they had enough exposure to run lists and ask for help where necessary, but a dedicated outpatient list was required (RQ3). Residents felt that time on the inpatient lists was too limited to appropriately support residents’ learning; however, residents were keen to emphasise this has improved because there was previously no access to ultrasound training (RQ3).

We heard residents had to liaise with administrative colleagues to organise training and outpatient lists, but often a request would be put into administrators and this would require chasing (RQ3).

Trainer job planning

Although teaching was in the rota, some trainers felt there was scope for improvement in how this was formally reflected in job planning, it was noted that the job plan policy was recently updated, and colleagues were hopeful this would result in improvements. Residents also reported that some consultants provided push back when asked to check plain films: “it’s not in my job plan”. Residents felt that better job planning arrangements could improve the training experience, as residents felt they were relying on goodwill to receive a response as opposed to a structure in place (RQ4).

Escalating concern

Although the culture was positive and residents were generally enabled and confident in raising concerns, residents highlighted that the College Tutor and Service Director holds a split role giving rise to a conflict of interest which made some residents reluctant to raise concerns even though residents felt that the College Tutor was effective. The individual holding this split post was aware of this and indicated, at the appropriate time, that they would focus on one of these two roles (RQ5).

Sustainability of positive change

Residents were concerned about the sustainability of improvements, which had been implemented previously following School visits and NHS England WT&E quality engagements because they felt they were not being maintained. Residents felt that the rota would reflect teaching in place for the previous 3 months, but prior to this there was much less in place; and this was, in part, due to the NHS England WT&E quality engagement meeting (underpins all radiology requirements).

Southend medicine

Residents were generally positive about their training experience, trust colleagues, and the learning environment, with training felt to be on an improvement trajectory. We heard that consultant support was always available, educational opportunities were available, teaching was of high quality, the teaching rota was effective (when gaps were not present), and the

learning environment was cohesive. Residents knew who the Guardian of Safe Working was and how to access support. The induction experience was also positive. We heard that an increase in the number of resident doctors had supported improvements in cardiology, including significant improvements in patient handovers at the end of shifts. Trainers received 0.125 PA per resident doctor as a Clinical Supervisor and 0.25 PA as an Educational Supervisor in their job plans and the allocation of funding and PAs was clear in trainer job plans.

Rotas and staffing

Achieving minimum rota staffing was cited as a challenge as was the impact of rota gaps on clinic access. This was also a challenge at the July 2022 NHS England WT&E quality engagement meeting. Residents indicated that the rate of rota gaps being covered by locums had reduced (but were aware of financial constraints) and that a decrease in the amount of time taken for HR to process new posts would be helpful. When operating at minimum, staffing, study and annual leave requests were challenging, even when provided more than 6 weeks in advance (RQ6). Residents felt that additional workforce at post take level was required to ensure patient safety and felt a lack of consultant review post-take gave rise to potential patient safety concerns (RQ6).

Trainers acknowledged that staffing was occasionally challenged including rota gap challenges (especially for Foundation residents); the rota coordinator reviews staffing each morning to identify gaps and support residents by redistributing them where appropriate. Staff sickness was identified by trainers as a key contributor to staffing challenges (RQ6). It was noted that the education centre staff administrator was very good, but their workload was very high.

Exception/Datix reporting

Datix reporting was generally encouraged by the trust, but some consultants discouraged it, which contributed to residents feeling they had to work additional hours, and many feeling this was normalised. Some residents were reluctant to exception report due to the lack of an outcome after exception reporting in the past and not seeing anything change as a result (RQ7). Trainers emphasised they encouraged exception reporting and when residents were more than 30 minutes late leaving their shift they were asked to handover to a consultant if needed (RQ7).

Acute medicine post-take

Residents were keen to access additional learning opportunities for acute-medicine post take, and it was felt that the introduction of a structured robust post take system, informing residents when the consultant will be there, and for how long, would ensure residents were better supported (RC1). F2 residents felt deprioritised for formal training post-take. IMT1s would welcome additional support on post-take as it was challenging if they were alone (RC1).

ED interface

Residents felt that emergency department colleagues insisted on one-way referrals, often to the medical team, and this resulted in some inappropriate referrals. This was also a challenge at the July 2022 NHS England WT&E education quality engagement meeting. It was compounded by a recently introduced policy which means that once a patient had been through the GP route they

could not go back to the emergency department, so patients tended to be referred to medicine. Residents noted that patients could be reviewed by medicine in the emergency department if needed (acute chest pain etc.). Trainers stated that the interface was set up and there were regular meetings between medicine and emergency department on Fridays to discuss issues, and active steps were taken to address challenges, including those raised by residents (RC2).

Patient management

Residents raised concerns about the department’s use of paper charts which could lead to patients who have been seen overnight and put on the electronic system being re-prescribed (double dosed) medications (RQ8). Residents had to keep a log of patients to mitigate against paper notes being moved. The main concern raised was the out of hours (morning) and late evening/night with residents reporting they must find time and read what’s happened to their patients, feeling that there should be a structured post take, so they didn’t have to do this for every single patient (RC1).

Curriculum coverage

Residents felt consultant feedback could be better standardised and noted some consultants will base their feedback on what residents have written in tickets on the acute medical take.

Specialty residents (STs) had concerns about acquiring some of the basic skills required for Annual Review of Competence Progression In cardiology, to improve continuity of learning, STs were keen to do General Internal Medicine in blocks of 3-4 months and cardiology for 9 months, STs were trying to address this with cardiology consultants across MSEFT with most consultants happy to help and willing to discuss it. Residents felt this would improve training.

Trust-wide paediatrics

Some key challenges identified at the March 2024 engagement meeting continue including facilities, rotas, and multiprofessional working relationships. There were some noted improvements including the quality of consultant support for residents. Residents were positive about teaching, when it was delivered, and felt that consultants were supportive and attentive, which was an improvement from the feedback at the March 2024 NHS England WT&E engagement meetings. Educators were remunerated with 0.25 PA per resident and non- resident, and job planning was felt to be appropriate. Trainers also outlined wellbeing provision in place for residents and staff.

Broomfield and Basildon residents felt that exception reporting was encouraged; in Southend it was neither encouraged nor discouraged.

Skill mix

Two out of fifteen residents were ST2s, the remainder were FY and GP residents which caused challenges from a skill mix perspective. Residents and trainers were very keen to receive more registrars but were aware there were no planned increases to national paediatrics training numbers following discussion with the School of Paediatrics. Some resident doctors had limited ability to attend planned education sessions due to rota pressures and cancellations (RQ9) Residents also reported a heavy administrative workload in Paediatric Assessment Unit.

Culture

Higher residents indicated that relationships with surgery colleagues were usually very good, however some residents felt that clarity was required regarding where the professional responsibility lays in the trust for the under 5 years patient group who may require abdomen surgery. (RQ10). There was a perception that the surgery team were not following Addenbrookes’ guidance on further monitoring of patients under 5; when the initial patient assessment was undertaken by Addenbrookes (RQ10).

Less senior residents perceived incivility from senior nursing staff, citing examples when they felt pressured into postponing breaks or finishing them early (RQ10).

Trust-wide obstetrics and gynaecology 

Concerns remained for some areas on the open improvement plan including rotas and support for exception reporting, although support for exception reporting has improved. There were positive elements to the teaching at Southend, however cultural challenges (including perceived misogyny) were identified. Basildon’s culture was more positive, but residents felt less positively about the quality of teaching. Broomfield residents were the most positive group in terms of their training experience and learning environment though they felt culture and pastoral care quality was variable by consultant and placement site.

Many residents felt they were able to raise concerns, but we heard some concerns that were not escalated internally by residents. We heard there was generally a lack of available facilities for clinics and that there was very limited access to Supporting Professional Activities (SPA) sessions.

Southend Hospital

Residents highlighted the good quality of clinical learning and felt that good evidence-based practice was delivered according to guidelines. Generally, access to learning opportunities was good and STs felt that handovers were learning opportunities. Covering lists was providing good opportunities provided there was clinical support available to discuss care planning.

Culture

Although there were positive elements to the teaching at Southend, residents felt that the culture had significant scope for improvement. The Foundation/GP/Core group felt that midwives took male residents’ patient plans more seriously than female residents’ patient plans (RQ11).

Higher residents indicated that Southend was a good unit from a work point of view but lacked team spirit due to seniors/consultant treatment of residents and midwives. Consultants were perceived to belittle people publicly and make fun of others’ job plans. Some female residents felt intimidated during teaching, residents also felt that there was misogyny in the department, and this was widely known and accepted, with midwives also reporting misogynistic behaviours (RQ11).

Supervision

We heard that supervision in clinics was inadequate, and this had been escalated internally at a consultant meeting and the Medical Education Board meeting. Some instances were described of clinics covered by higher resident doctors due to consultant leave where there was no line of escalation (RQ12). We also heard reports of difficulty accessing support from consultants if they felt it was not their patient (RQ12). Higher residents felt that the resident doctor voice could be better represented in the department escalation protocol policy, which was last updated in 2015.

The rota being split into AM and PM sessions resulted in residents feeling there was no continuity for patients or their training, for example residents would prefer a day of theatres instead of four AM sessions across a month, but this had not yet been escalated to the rota coordinator (RC3). Some ST1-3 residents felt that senior staff had addressed some of their concerns about training but future ST1s could benefit from a competency sign-off log to ensure appropriate sign offs (RC4).

Access to planned teaching sessions seemed to be most challenged at the Southend site, one resident indicated they had been to less than 5 clinics in a year.

Basildon

Residents were more positive about the culture but less positive about the quality of teaching; this was due to limited consultant feedback, with residents suggesting more formal feedback structures would support education and training. Although scope for improvement in some areas was identified, residents perceived an improvement trajectory for education and training. On call consultants were supportive and most residents felt the unit was comfortable to work in.

Higher residents had good opportunities for surgical theatres, but this seemed to be reduced in recent months. Residents were reluctant to recommend their placement for care due to the perceived high rate of infections as well as readmissions from previous procedures, which has been escalated internally.

Culture

Overall, the culture at Basildon was positive with colleagues quick to highlight positives and the opportunity to learn lessons from adverse events. Higher residents indicated there was multi-professional respect between residents, nurses, and midwives. However, GP/Foundation/Core residents indicated that, rarely, multi-professional relationships with midwives were challenged. For example, we heard that, following a disagreement between a midwife and a consultant regarding the consultant’s plan, midwives announced this disagreement and would not constructively engage regarding the area of disagreement (RQ11). Residents felt that concerns raised were generally addressed proactively to the best of the trusts ability.

Broomfield

Of the three sites, Broomfield O&G residents were the most positive about their training experience and learning environment. Broomfield residents were generally positive about their experience and welcomed their protected week for training. The culture was positive with no perceived incivility. GP residents were positive about clinic rota arrangements.

Trust-wide midwifery

Learners spoke highly of midwives and had access to a Professional Midwifery Advocate. Most midwifery learners we met had concerns about employment post-registration, these anxieties had impacted their overall experience and while learners recognised that the trusts’ financial situation was challenging, they would welcome additional support, including guidance on how to maintain their registration status during periods of unemployment. WT&E nursing and midwifery team colleagues provided some additional support on this during the quality visit.

Supervision

The absence of oversight from a centralised monitoring system (CTG), increased the risk of learners being left unsupervised on the antenatal ward and the risk of the patient to staff ratio being high, this led to women being left on the telemetry CTG without being monitored (RQ13).

Supernumerary status

Learners from all sites felt that their supernumerary status was not maintained due to service pressures (RQ14). Many issues identified by learners were underpinned by midwives being overworked; some midwives at all sites were perceived to work incredibly hard but were burnt out, which impacted their passion for the profession. The educators we met stated they would like more time with learners to support learners’ development; however, this was not possible due to system pressures. Due to the emphasis on service delivery, educators did not feel valued by the trust in delivering education and training.

We heard there were breaches in Birmingham Symptom-specific Triage system (BSOTS). The breaches include women with reduced foetal movements not being seen within the 15-minute guideline, with reports of women being seen after 4-6 hours (RC5).

Learners would welcome being included on Practical Obstetric Multi-professional Training days, being involved in communications regarding the vacancy situation, and increased Practice Education Facilitator provision (noting there was only one currently) (RC6). Learners also had concerns about equipment availability and accessibility. For example, we heard there were no bedpans on the labour ward and that Foetal Scalp Electrodes, CTG belts and neonatal stethoscopes were difficult to locate.

ePAD sign off processes were not supporting learners appropriately. We heard reports of learners writing their own with the practice assessor signing it without review; this was underpinned by significant service pressures and a perception that some practice assessors did not understand the ePAD. Learners felt like an irritation chasing for sign off (RQ15).

Southend midwifery learners

Some learners felt that the culture had improved during their time at the site, although the culture was never negative there were previously some midwives who did not want to teach. One learner indicated that they were on placement for one and a half years before midwives would call them by name (RC7). Subtle comments made learners feel that midwives exerted a feeling of superiority and would revel in feeling more important than a learner; learners did not know if midwives were aware they exhibited these behaviours.

We heard an example when the midwifery ward was used for dementia overflow due to service pressures and midwifery learners had to support with healthcare assistant tasks, such as bed baths, but once escalated the practice educator was very effective at addressing the situation.

Although Southend learners were concerned their supernumerary status was not maintained, they were incredibly sympathetic to midwives who were trying their best; a learner witnessed midwives crying on shift after caring for 8 patients each plus their babies (RQ14).

Southend facilities were felt to be good.

Basildon midwifery learners

Basildon learners indicated that support was generally good, and midwifery educators were present and provided very positive feedback regarding a Practice Education Facilitator’s contribution to education and training. Paediatrics resident doctors also felt that Basildon midwives were very helpful and collaborative. Learners knew there was a library but did not feel that they had received an induction or guidance on how to utilise it effectively (RC8).

Culture

Learners indicated that the midwifery and obstetric team were well integrated with a positive culture where Obstetric staff were supportive of midwifery learners. Cultural concerns at Basildon Hospital include support from management in addressing escalated concerns regarding education and training (RQ16). Midwifery learners described the culture between maternity staff and maternity managers as “toxic”, with accusations of bullying and staff being unable to speak up. One student was concerned for midwives having heard that managers were dismissive to staff concerns, with managers allegedly rolling their eyes, tutting and telling midwives to stop moaning when concerns were raised (RQ16).

Cedar Ward

We received some feedback specific to Cedar Ward, which was described as a great place to learn when there were enough staff. The midwives based in the ward were described as passionate about the ward, however, when staff were pulled from other areas to work on the ward the environment would become negative as many midwives were open about their dislike for working on Cedar Ward. It was reported some midwives did not like working on Cedar Ward because they knew they would have too many patients to be able to deliver the high-quality patient centred care wanted, leaving them feeling frustrated which negatively impacted the wider ward. We heard that patients had recognised this in the past. For example, a learner

received feedback from patients who had been treated on the ward before saying they felt ignored or that they were an inconvenience to the midwife because they did not have time to address the patient’s issues.

Most of the ward’s challenges were attributed to understaffing, with the band 5 to 6 ratio sometimes being unequal and leaving band 5s on rotation feeling unsupported. At times of high service pressure understaffing would limit learning opportunities. Learners perceived a lack of managerial support for staff on Cedar Ward and indicated that if they gained employment at the trust, they would have concerns about working on the ward due to the perceived lack of managerial support for staff (RQ17).

Support for midwifery educators

Midwifery educators were unclear whether their performance as an educator was assessed through appraisals with constructive feedback and support provided for development and progression (RQ18). We also heard that there was a lack of support for educators to undertake their roles, such as continuous professional development time, although this was variable across sites. Educators indicated that they were often pulled to cover wards, with no support to complete education related tasks which they could no longer complete (RQ18). Educator midwives would welcome additional support from the senior leadership team, for example increased senior understanding of the Practice Educator Facilitator (PEF) role, for example, it was perceived that senior leadership did not believe that midwifery educators were embedding the Safe Learning Environment Charter although Midwifery educators had been working on this since June 2024.

Broomfield midwifery learners

Midwives made a daily effort to check in with learners to encourage learning and encourage attendance at online and external sessions. Learners cited examples where concerns had been raised and addressed by the trust, and felt the PEF provided good support when concerns were raised and assisted learners with reflection.

We heard an example on Gosfield Ward where multiple learners had to repeat their placement due to lack of attendance arising from concerns about behaviours on the ward, but the trust took remedial action and put plans in place to ensure learners felt valued, and learners felt that the ward was much improved now.

Braintree Community Hospital

We heard good practice from a learner with placement experience at Braintree Community Hospital who reported learners would be asked at the beginning of their shift what they needed and wanted to learn on the day, and the Education Lead would send emails to learners signposting to internal and external learning opportunities.

Trust-wide nursing and AHP

Most learners would recommend training at the trust, and felt there were interprofessional learning opportunities, and reporting experiences of culture were mixed but mainly positive. Some nursing and AHP educators felt that only essential training was being supported, with continuing professional development courses full. Nursing learners’ supernumerary status was not always maintained with reports of learners being used as healthcare assistants s when staffing was challenged (RQ14).

Some nursing learners described that it was difficult to get sign off and some students felt that the practice assessor would sign off ePADS without review due to workload pressures (RQ15).

Some learners felt their practice assessors’ understanding of the ePAD could be improved.

Although culture was generally positive, there were some reports of learners fearing being targeted if concerns were escalated or whistle blown (RQ19).

Nursing associate learners felt there was no clear understanding around their role by multiprofessional colleagues and nursing associates lacked an understanding of a clear career pathway within the trust (RC9).

Areas that are working well

Good practice 

Areas for improvement

Immediate mandatory requirements

Mandatory requirements

Because Basildon anaesthetics resident doctors have been removed and relocated within MSEFT, there is no anaesthetics training provision at Basildon and therefore requirements have not been issued to this area but are under review with the GMC and WTE quality are working closely with the GMC on next steps.

Recommendations

Report approval

Report completed by: Education quality team, regional lead for education quality and panel members
Review lead: Regional Lead for Education Quality – East of England Date approved by review lead: 30th July 2025

NHS England authorised signature: Professor Bill Irish, Regional Postgraduate Dean
Date authorised: 30 July 2025

Final report submitted to organisation: 12 September 2025