• Hospital
  • NHS hospital

Basildon University Hospital

Overall: Requires improvement read more about inspection ratings

Nethermayne, Basildon, Essex, SS16 5NL (01268) 524900

Provided and run by:
Mid and South Essex NHS Foundation Trust

All Inspections

12/07/2023

During an inspection looking at part of the service

Basildon University Hospital is operated by Mid and South Essex NHS Foundation Trust. The hospital provides elective and emergency services to a local population of 450,000 living in and around the southwest Essex area.

Medical wards provided by Basildon University Hospital include general medicine, gastroenterology, endocrinology and diabetes, palliative medicine, cardiology, acute medicine, respiratory, renal, geriatric medicine, stroke with in-reach services provided by dermatology, rheumatology neurology.

Between January 2022 and December 2022 medical care had 30,213 admissions. The specialties with the highest number of admissions during the same period were general medicine (10,700), cardiology (6,376) and gastroenterology (5,611).

We carried out this short notice announced focused inspection of medical care on 12 July 2023.

The service was rated as inadequate following our previous inspection, in January and February 2023. Following our last inspection, we issued a warning notice under Section 29A of the Health and Social care Act 2008 because of concerns relating to poor governance, incomplete risk assessments, incomplete patient records, equipment not being maintained, patients’ nutrition and hydration needs not being met and medication not being managed in line with the service’s medicines policy.

As this inspection was a focused follow up inspection, we only looked at the key questions of safe, effective and well led. We carried out this inspection to determine whether improvements had been made against the requirements of the warning notice we issued at our previous inspection. Although the service had made improvements against the section 29A warning notice, this inspection did not look at the requirement notices that were issued at the previous inspection. As these requirement notices remain, this meant the ratings were limited to requires improvement.

Our rating of this service improved. We rated the service from inadequate to requires improvement . During this focused inspection, not all breaches identified at the last inspection were reassessed to include all potential improvements. We found:

  • The design, maintenance and use of facilities, premises and equipment kept people safe.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to obtain consent from patients.
  • Leaders operated effective governance processes, throughout the service. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

However:

The service needed to continue to embed processes and evidence this improvement through continued audit.

24-25 January and 7 February 2023

During an inspection looking at part of the service

Basildon University Hospital is operated by Mid and South Essex NHS Foundation Trust. The hospital provides elective and emergency services to a local population of 450,000 living in and around the southwest Essex area.

Medical wards provided by Basildon University Hospital include general medicine, gastroenterology, endocrinology and diabetes, palliative medicine, cardiology, acute medicine, dermatology, respiratory, renal, neurology, rheumatology, geriatric medicine and oncology.

Between January 2022 and December 2022 medical care had 30,213 admissions. The specialties with the highest number of admissions during the same period were general medicine (10,700), cardiology (6,376) and gastroenterology (5,611).

We carried out this unannounced focused inspection because we received information giving us concerns about the safety and quality of the services of medical care and older people’s services. The information of concern related to the quality of care provided including patient nutrition, hydration, pressure care and the management of risks.

As this was a focused inspection, we only inspected parts of our five key questions. We inspected parts of safe, effective, caring, responsive, and well-led.

We did not inspect all the core services provided by the service as this was a risk-based inspection. Basildon Hospital has been rated inadequate overall. As a result of the acquisition, Mid Essex Hospitals location and Basildon and Thurrock Hospitals locations did not retain their location level ratings. When one core service is rated inadequate out of three, this aggregates to an overall rating of inadequate. We continue to monitor all services as part of our ongoing engagement and will re-inspect them as appropriate.

How we carried out the inspection

The inspection team comprised of a lead CQC inspector, an inspection manager, 2 other CQC inspectors and CQC specialist advisor.

During the inspection we spoke with over 30 members of staff and carried out off site interviews with senior leaders, the services falls team, safeguarding lead, tissue viability nurse, dementia lead nurse, and the integrated discharge team. We spoke with 8 patients and 3 relatives. We observed care provided; attended site and staffing meetings, reviewed relevant policies and documents and reviewed 45 sets of patient records.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

20-21 September 2022

During a routine inspection

Our rating of this location stayed the same. We rated it as requires improvement because:

  • The service did not have enough staff to care for women and keep them safe. Staff had not completed their mandatory training in line with the trust target. The service was not meeting its target for staff appraisal.
  • The service did not always maintain robust equipment check records to provide oversight that all checks were completed in line with trust policy. Not all equipment had been tested in line with servicing requirements.
  • Some medicines were not stored appropriately and not all fridge temperature checks had been completed in line with trust policy.
  • Incidents and complaints were not always managed within the time frames set out in the trust policies.
  • Some staff did not follow the trust uniform policy.
  • The safety champions were not embedded within the service.
  • Staff we spoke with did not know who the freedom to speak up guardian was.
  • Regular staff meetings did not take place on the delivery suite or post-natal unit.

However:

  • Staff had training in key skills. The service controlled infection risk well most of the time. Staff assessed risks to women, acted on them and kept good care records.
  • Staff provided good care and treatment. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of women.
  • The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems. Staff were focused on the needs of women receiving care.
  • The recently established substantive leadership team demonstrated an understanding of the service and had plans in place to deliver improvements.

28 July to 6August

During a routine inspection

Basildon University Hospital is operated by Mid and South Essex NHS Foundation trust. There are 25 inpatient wards and 637 inpatient beds at the main Basildon University Hospital site located in Basildon. The hospital serves a local population of 450,000 living in and around the south west Essex area.

We inspected maternity service due to ongoing concerns relating to performance. In June 2020, we issued the trust with a Section 29A warning notice and rated it as inadequate. This was because we identified a number of issues particularly around the staffing and safety of the service. We carried out a further focused inspection on 18 September 2020 to follow up on the concerns raised during engagement with the trust for monitoring their compliance to the warning notice. This focused inspection did not include all of our key lines of enquiry (KLOEs).

On 7 October 2020, we issued an urgent notice of decision, under Section 31 of the Health and Social Care Act 2008, to impose conditions on the trust’s registration as a service provider in respect of the regulated activity: maternity and midwifery services. The conditions set out specific actions to enable the improvement of safety within the service.

This inspection was completed as part of our routine regulatory action and to follow up on the safety of maternity services across the trust. We inspected Medical care and Surgery due to concerns around the management of risks and patient safety.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activities. Medical Care and Surgery had not been inspected since the merger to become the Mid and South Essex NHS Foundation Trust, and therefore there were no previous ratings. Maternity services had been rated as Inadequate at the October 2020 inspection.

During this inspection, we visited a number of wards and departments, including, Marjorie Warren ward, Pasteur Ward, Florence Nightingale Ward, Lionel Cosin Ward, Orsett Ward, William Harvey ward, Elizabeth Fry Ward and the Acute Medical Unit (AMU) West within medicine. We also inspected the Endoscopy Unit and Discharge lounge.

Within surgery we inspected the Same Day Emergency care, Pre-operative assessment unit, Day surgical unit, Day surgery theatres and main theatres, Recovery area, Surgical referral unit, and Bulphan, Chelmer (CTC), Horndon, Laindon and Linford.

Within Maternity services, we inspected two dedicated maternity theatres, Cedar Ward, and the Mulberry Suite.

We spoke with 113 members of staff including, nurses, doctors, 19 patients and reviewed 43 patients notes.

At this inspection, we rated Medicine, as requires improvement for safe and well led, and good for effective, caring and responsive. Surgery was rated, requires improvement for safe, responsive and well led and good for effective and caring. We rated Maternity services as requires improvement for safe, effective and well led, good for responsive and we did not inspect caring. The overall rating was Requires Improvement because:

Medicine:

  • Staff did not always complete and update risk assessments for each patient and removed or minimised risks.
  • Staff did not always keep detailed records of patients’ care and treatment. Records were not always clear, up to date, stored securely and easily available to all staff providing care.
  • Staff appraisals were not always completed annually.
  • Leaders did not always have oversight of risks in the service for example, bed rail risk assessment and record keeping.

Surgery:

  • Compliance with mandatory training was not in line with trust target.
  • Not all staff had completed training specific for their role on how to recognise and report abuse.
  • Equipment was not always maintained in all areas we visited.
  • Staff did not always complete and update risk assessments for each patient and removed or minimised risks.
  • The service did not have enough nursing and support staff with the right qualifications, skills, training and experience.
  • The service did not have enough medical staff with the right qualifications, skills, training and experience.
  • Medicines were not always stored in line with policies and procedures.
  • Not all staff had received an appraisal in the last 12 months.
  • Mental capacity assessments were not always clearly identified in patients notes.
  • Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards.
  • Governance processes were not fully embedded.
  • There were repeated never events within the service with similar themes.
  • Staff felt that there was a lack in consistency between electronic and paper records.

Maternity:

  • Compliance with mandatory training was below the trust target for most topics.
  • Some compliance with safeguarding training was below the trust target.
  • Some staff did not follow the trust uniform policy.
  • Annual equipment checks were not always completed.
  • Triage was not always completed by a designated midwife.
  • The service did not have enough maternity staff with the right qualifications, skills, training and experience.
  • Not all staff had completed speciality specific training or had an appraisal within the last year.
  • The trust wide governance structure was under review and not embedded.
  • Staff did not always feel respected, supported or valued.

However:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service generally controlled infection risk well. Staff mainly used equipment and control measures to protect patients, themselves and others from infection. They generally kept equipment and the premises visibly clean. COVID-19 precautions were in place.
  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • The service provided care and treatment based on national guidance and evidence-based practice.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Key services were available seven days a week to support timely patient care.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff understood and respected the personal, cultural, social and religious needs of patients and how they may relate to care needs.
  • Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. Local leaders were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.
  • The service collected reliable data and analysed it. Staff mainly could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. Information systems were secure. but were not fully integrated.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

12/06/2020

During an inspection looking at part of the service

Basildon University Hospital is operated by Mid and South Essex NHS Foundation trust. The maternity unit at Basildon University Hospital provides a comprehensive range of services including; ambulatory care assessment, prenatal diagnostic screening, antenatal care services, perinatal mental health and counselling service, midwife led birthing unit, delivery suite and home birth service.

The maternity unit offers women the following birth options:

  • Home birth: around 3% of all trust births are home births.
  • Midwife-led birthing unit: Located on the Willow suite, consists of five delivery rooms (including two pool rooms) and four postnatal beds.
  • Delivery suite: eight birthing beds and four enhanced care beds. There are two dedicated maternity theatres.

The maternity unit also includes Cedar Ward, a 33-bedded postnatal ward that also provides antenatal care and the Mulberry Suite, which is a seven-bedded ambulatory care assessment unit for all women from 14 weeks gestation.

From April 2019 to March 2020 there were 4,304 deliveries at Basildon University Hospital.

We last inspected the maternity service at Basildon Hospital in February 2019. The service was rated requires improvement overall; safe and well led were rated requires improvement, effective, caring and responsive were rated good.

During the 2019 inspection, we identified a number of concerns in the maternity service. As a result, requirement notices for breaches of regulation 12 and 17 of the health and social care act (2014), were issued against the trust. The requirement notices informed the action the trust must take to comply with its legal obligation, and we requested an action plan from the trust, outlining steps that had been taken to address the concerns we raised. The trust submitted an action plan following publication of the inspection report in July 2019. The trust submitted regular updates on the progress of the action plan and in February 2020, the actions relating to the maternity service were all signed off as completed by the trust.

In May 2020 we received information from an anonymous whistle-blower, raising safety concerns at Basildon Hospital maternity services. The information received and a review of the trust’s incident reporting data highlighted a cluster of six serious incidents where babies were born in poor condition and subsequently transferred out for cooling therapy from March and April 2020. Cooling therapy is a procedure which can be offered as a treatment option for newborn babies with brain injury caused by oxygen shortage during birth. It involves bringing baby’s temperature from the normal body temperature of 37°C to a temperature between 33°C and 35°C soon after birth and for a few days afterwards.

In response to the information we carried out a focused inspection on 12 June 2020 to follow up on the concerns raised.

During this inspection we:

  • Spoke with 16 staff members; including service leads, matrons, midwives, doctors, midwifery care assistants and administrative staff.
  • Checked 12 pieces of equipment.
  • Reviewed 12 medical records.
  • Reviewed five prescription charts.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activities. We carried out a focused inspection related to the concerns raised, this does not include all of our key lines of enquiry (KLOEs). As a result of this inspection we rated safe, effective and well-led as inadequate, and overall the service was rated inadequate.

We found some improvements from our last inspection. There were continued concerns in relation to requirement notices we served to the trust at our inspection February 2019. Following the focused inspection, we undertook enforcement action in relation to the maternity service, and told the trust it must improve. We issued a warning notice, on the 23 June 2020, under Section 29A of the Health and Social Care Act 2008. This identified specific areas that the trust must improve and set a date for compliance as 14 August 2020. The trust initiated an immediate action improvement plan.

The link below is our report published following our last inspection:

https://www.cqc.org.uk/location/RDDH0/reports