Basildon University Hospital

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.