Northampton General Hospital

Updated 24 February 2023

We inspected the maternity service at Northampton General Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

The inspection was carried out using a post-inspection data submission and an on-site inspection where we observed the environment, observed care, conducted interviews with patients and staff, reviewed policies, care records medicines charts and documentation. Following the site visit, we conducted interviews with senior leaders and reviewed feedback from women and families about the trust.

We ran a poster campaign during our inspection to encourage pregnant women and mothers who had used the service to give us feedback regarding care. We analysed the results to identify themes and trends. 

Northampton General Hospital is the main site for maternity services for the trust. It comprises of a central birth suite which was midwife lead, a labour ward with maternity theatres and a close observation unit. Post and antenatal wards, day assessment unit, and maternity triage.

A higher proportion of mothers (16%) were in the second most deprived decile at booking compared to the national average. There were 75% white women, with 12% Asian or Asian British and 6% Black or Black British women. There was also an increasing community presence of an Afghanistan community.

Maternity services delivered 4,019 babies between January and December 2021.

We did not rate this hospital at this inspection. The previous rating of ​requires improvement remains.

How we carried out the inspection

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.

Updated 24 October 2019

Our rating of this service went down. We rated it as requires improvement because:

• Mandatory training in key skills was not completed by all staff. In particular, medical staff were not up to date with their safeguarding training, mental capacity training and mandatory training.
• The design, maintenance and use of facilities, premises and equipment kept people safe. However, we found clinical waste, such as aprons and gloves, in black bags in some medical wards we visited and there was insufficient assurance that this was appropriate. Chemical products deemed as hazardous to health were in locked cupboards but, some locked cupboards had the access code to the cupboard clearly identified, so unauthorised people could access hazardous chemicals.
• The service did not always use systems and processes to safely prescribe, administer, record and store medicines.
• The Heart Centre often had medical outliers occupying their beds. However, the facilities or the environment were not suitable for medical outliers. We also found medical outliers were not seen in a timely manner. We found the current system to review medical outliers was not effective, as some patients on outlier wards were not reviewed by a consultant daily.
• The use of beds in the Heart Centre for outlying patients meant heart patients could not be seen. There was inequity in the management of NHS and private patients within the centre as a result.
• Ambulatory care and the renal rooms did not have local safety standards for invasive procedures (LocSSIPs).
• Not all patients’ medical records were stored securely. We saw some medical notes trolleys left unlocked and unsupervised. This was raised as a concern during our last inspection.
• While the service provided care and treatment based on national guidance and best practice, some policies and guidance had expired their review date. This meant there was a risk that staff were referring to out-of-date guidance.
• The service culture did not always support staff to raise concerns. We generally observed good working relationships across the service and it was evident that staff morale was good in most areas we visited. However, in a few areas we visited, staff expressed low morale and lack of support from their managers. In addition, we observed poor staff interactions in some medical areas we visited.
• Although leaders understood and managed the strategic priorities and issues the service faced, there was lack of oversight in some operational matters.

However:

• The service generally had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well.
• The service generally controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could generally 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 and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 8 November 2017

We rated this service as good because:

• There was a well-embedded culture of incident reporting and staff said they received feedback and learning from incidents.
• Safety thermometer data from the last 12 months reported 100% of “harm free” care in the child health directorate.
• There were clear arrangements in place to safeguard children and young people from abuse, which reflected relevant legislation and local requirements. The majority of staff had undertaken the required level of safeguarding training.
• The service performed well in a number of national audits including the National Neonatal Audit (2015) and the epilepsy 12 audit (2014). Gosset ward was working towards achieving Bliss accreditation.
• Staff had the clinical skills, knowledge, and experience they needed to carry out their roles effectively. Mandatory training and appraisal levels were above trust targets.
• Actual nurse staffing levels met planned rotas during our inspection and patient’s needs were met. Medical staffing was appropriate and there was an effective level of cover to meet patients’ needs.
• Feedback from children and parents was consistently positive and parents told they were treated with dignity and respect.
• Services were responsive to the needs of patients, parents and families and were working towards delivering sustainable seven-day services.
• Staff felt that local leadership was strong with visible supportive and approachable managers.
• The child health directorate was continually developing patient services to ensure innovation, improvement, and sustainability.

However:

• There were not always effective systems in place regarding the storage and handling of medicines in the children’s outpatient department. The trust took immediate action to address this once we raised it as an urgent concern.
• Children or young people on Paddington ward could access the corridor to the delivery suite. This was a risk particularly for patients who may be at risk of self-harm or suicide. The trust took immediate action to address this once we raised it as an urgent concern.

• The pathway for patients who needed to cross the road between buildings had not been reassessed to ensure opportunities to prevent or minimise further harm were not missed. The trust took immediate action to address this once we raised it as an urgent concern.
• The child abduction policy was in draft and awareness was lacking in some areas of the service. The trust took immediate action to address this once we raised it as an urgent concern.

Updated 8 November 2017

We rated this service as good because:

• There was a strong culture of reporting, investigating and learning from incidents. Learning was shared throughout the team.
• Adequate medical and nursing staff was provided to meet the recommended staff to patient ratio, as defined in the core standards for intensive care units.
• There were effective systems in place to protect patients from avoidable harm and improve compliance with standards on a continuous basis. The principles of the duty of candour were well understood by all staff.
• There was clear evidence and data upon which to base decisions and look for improvements and innovation. The unit participated in the Intensive Care National Audit and Research Centre (ICNARC) audit and performed better or as expected in six out of eight indicators.
• The critical care outreach team provided 24 hour cover seven days a week cover and assisted with the monitoring and treatment planning of deteriorating patients throughout the hospital, ensuring risks were responded to appropriately.
• Staff were very caring and kind and provided emotional support for patients and relatives, for example, through the use of patient diaries.
• Leadership was well established and there was a clear focus on improvements and patient safety.
• Structured meetings were held throughout the directorate to review all aspects of quality, risks and performance and high risks were escalated and monitored effectively.
• Effective governance arrangements were in place. There were structured meetings to review all aspects of performance, quality and risks and high risks were escalated through the directorate. Innovation throughout the staff team was encouraged.

However:

• The pharmacy team were aware of the shortfall in band 8a specialist pharmacist support and were providing cover with a band 7 pharmacist. A business case had been put forward, which if successful, would ensure standards were being met.
• Medicines were not always stored safely behind locked doors or in restricted areas. We raised this with the trust and this was rectified immediately by the trust.
• The unit did not comply with the Department of Health’s Health Building Note 04-02 critical care unit’s standards; however, this had been risk assessed and was under review. Refurbishment plans were in place to address this.
• Not all medical staff had completed the required mandatory training.
• Hospital wide bed capacity affected the ability of the service to discharge patients to wards at the most appropriate time. Over eight hour delayed discharges were higher than the national average, however, action had been taken and improvement observed for patients waiting 24 to 48 hours.

Updated 23 May 2017

We rated the service as good overall. Many improvements had been made to raise the profile for the end of life care service in the trust and this had led to improvements in the way patients received safe, compassionate care in their last days. However, more work was required to collect performance information about the service and ensure that mental capacity assessments underpinning decisions about cardiopulmonary resuscitation were being evidenced in patients’ records.

Updated 24 February 2023

Updated 8 November 2017

Overall, we rated outpatients and diagnostics as good. We inspected but did not rate the effectiveness of the service, as we are currently not confident that we are collecting sufficient evidence to rate this key question for outpatients and diagnostic imaging. We rated this service as good because:

• Staff were aware of their responsibilities and understood the need to raise concerns and report incidents. Staff told us they felt fully supported when raising concerns.
• Generally, the design, maintenance, and use of facilities and premises met patients’ needs. The maintenance and use of equipment kept patients safe from avoidable harm. Improvements had been made in some areas in the outpatient environment, which included the expansion of the chemotherapy suite and new equipment in the diagnostic imaging department.
• Appointments were prioritised according to referral requests from GPs with urgent requests and cancer referrals booked within two weeks. The imaging department prioritised reporting higher risk examinations not seen by other clinicians.
• We found that medical and nursing staffing levels and skill mix were planned and reviewed so that patients received safe care and treatment.
• Care and treatment was delivered in line with national guidelines. Staff within the service had the appropriate skills, qualifications, and knowledge to complete their roles safely.
• All teams reported effective multidisciplinary working.
• Patients were treated with compassion, dignity, and respect.
• Feedback from patients and those close to them was positive about the way they were treated.
• Staff made patients’ appointments according to the needs of the individual. This included moving them to allow work and other appointments to take place.
• The service consistently met the referral to treatment standards over time. Waiting times for diagnostic procedures was lower than England average. The service was meeting cancer targets for referral to treatment times at the time of the inspection.
• The "did not attend" (DNA) rate for the trust from June 2016 to May 2017 was 7% and this was same as the England average of 7%.
• Outpatient specialties ran additional evening and weekend clinic lists to reduce the length of time patients were waiting. The radiology department offered a walk in service for all plain film examinations.
• Services were tailored to meet the needs of individuals and offered flexibility in choice with appointments being flexed across a seven day service within the diagnostic imaging department.
• The service had a challenging and innovative strategy that supported the trust vision. This included redesign of departments, introduction of support systems to improve performance and repatriation of services to improve patient experience.
• Staff had awareness of the trust vision and strategy. Staff were aware of the risks within their departments. Staff were proud to work at the hospital and passionate about the care they provided.
• The service had leadership, governance and a culture which were used to drive and improve the delivery of quality person-centred care.
• Staff felt that managers were visible, supportive and approachable. Specialties were focused on developing services to improve patient care.

However, we also found that:

• We found concerns about the fire exit in the fracture clinic. This had been addressed by the unannounced inspection and we found the service had also reviewed all fire exits throughout the service.
• We observed poor infection control practices in both the blood-taking unit and the pain relief clinic. We raised this with the service, and immediate actions were taken to review infection control precautions to mitigate risk. This had been addressed by the unannounced inspection.
• We found issues with the storage of controlled drugs in the pain relief clinic. However, when we raised this with the service, senior managers took immediate action to address storage of these drugs. This had been addressed by the unannounced inspection.
• Not all staff had received the required frequency of mandatory training, including safeguarding. Plans were in place to address this.
• We observed poor infection control practices in both the blood-taking unit and the pain relief clinic. We raised this with the service and this had been rectified by the time of our unannounced inspection.

Updated 23 May 2017

We rated the service as good overall. Many patient outcomes were better than the national average and a strong safety culture was prevalent in wards and theatres. Staff delivered safe, effective care and treatment with compassion and respect. 

Updated 24 October 2019

Our rating of this service stayed the same. We rated it as good because:

• The service provided mandatory training in key skills including the highest level of life support training to all staff and made sure everyone completed it.
• Staff completed risk assessments for each patient promptly. They removed or minimised risks and updated the assessments. Staff identified and quickly acted when patients were at risk of deterioration.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
• The service provided care and treatment based on national guidance and best practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patient’s subject to the Mental Health Act 1983.
• Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
• Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• 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.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
• Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
• 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.

However:

• Safeguarding children level 3 training compliance for medical staff was worse than trust targets. However, when we spoke with staff, all knew about the processes and policies to protect patients from abuse and worked well with other agencies to do so.
• Patient group directions were not updated on the trust internal website.
• The paediatric emergency department was too small to accommodate the numbers of children’s attendances. However, children were kept safe.
• People could access the service when they needed it but did not always receive care promptly. The trust did not meet national standards for the percentage of patients admitted, transferred or discharged within four hours from August 2018 to March 2019. The median time from arrival to treatment was worse than the national average. However, during the inspection period they met the targets and no patients were at risk.