Basildon University Hospital

Medical services

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 and 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).

Date of Assessment:

We carried out this assessment on 17 and 18 December 2024 as part of our system pathway pressures programme. We inspected 23 quality statements across the key questions Safe, Effective, Caring, Responsive and Well-led and have combined the score for each of these areas to give the overall rating.

During the inspection, we visited a number of wards and assessment units. We reviewed the environment and staffing levels and looked at care records and prescription records. We spoke with patients and family members, staff of different grades, including nurses, doctors, ward managers, therapists and the senior managers who were responsible for medical services. We reviewed performance information about the trust. We observed how care and treatment was provided.

There was a positive safety culture where events were investigated, and learning was embedded to promote good practice. Infection prevention and control processes enabled patients to be safer from the risks of infection. However, continued improvements to the general environment were required.

Safe systems and pathways were not always maintained and responding to risk still required some improvement.

Patients with mental health care needs did not always have sufficient numbers of staff available to meet their needs and keep them safe.

Staff were not always fully trained or had the right skills for their role, and they did not always provide safe care and treatment to patients.

Medicine optimisation remained unsafe at times.

Staff had made improvements to ensure patients were able to make informed decisions about their care and treatment.

Staff did not consistently complete comprehensive patient assessments to inform their care and treatment. Staff delivered evidence-based care and treatment to ensure patients had good experiences and outcomes.

Staff worked with other professionals when assessing patients. However, information sharing was sometimes limited, which impacted the effectiveness of collaborative working and continuity of patient care.

Staff were mostly kind, caring and compassionate with patients and their visitors.

The service supplied appropriate, accurate, and up-to-date information in formats that were tailored to individual needs.

Staff worked hard to provide equity in access. However, significant working pressures sometimes impacted patients being able to access care and treatment when they needed it.

The service had a shared vision and culture based on the strategic objectives and values of the organisation. Staff feedback about this was mixed and we saw organisational challenges impacted on staff being in a position to maintain this.

The department and staff were led by strong leaders who embodied the cultures and values of their workforce. However, some staff told us, leaders could be more visible.

Governance and risk management had improved, though further sustainable improvements were needed.

There was a continued focus on learning, innovation, and improvement with processes to support staff to speak up if they had any concerns.

Staff collaborated and worked in partnership to assist continuity of care and system improvement.

During this inspection, we found the service had continued to make improvements since the inspection in July 2023. We did find breaches of the legal regulations during this inspection, though it was evident that the service was on an improvement trajectory.

We found five breaches of the legal regulations concerning safe care and treatment, premises and equipment, and good governance.

Staff did not consistently assess the risk to the health and safety of service users receiving the care or treatment.

The service did not always ensure that persons providing care or treatment to service users had the competence, skill and experience to do so safely.

Staff did not always maintain the proper and safe use of medicines.

The service did not consistently maintain the environment.

While there had been some improvements in governance system, there were repeated breaches which reflected improvements were not always being sustained. Staff also did not maintain secure and accurate, complete and contemporaneous records in respect of each service user, including a record of the care and treatment provided to the service user and decisions taken in relation to the care and treatment provided.

We have asked the provider for an action plan in response to the concerns found during this assessment

This is the first full assessment for this service since it was merged in April 2020. We carried out this short notice assessment of the urgent and emergency care service as part of the system pathway pressures assessment programme between 17 and 18 December 2024. We undertook another site visit on 8 January 2025 to follow up the concerns we found on 17 and 18 December 2024 and, due to ongoing concerns we, visited again on 10 March 2025. We inspected all 34 quality statements across the 5 key questions, safe, effective, caring, responsive and well-led for urgent and emergency care department.

During this assessment, we visited the emergency department (ED). We reviewed the environment, staffing levels, looked at care records and prescription records. We spoke with staff members across various grades and patients and observed meetings. We reviewed performance information about the trust and observed how care and treatment was provided.

We rated safe and well-led as inadequate because people were at risk of serious harm and the leadership, oversight and governance was not effective in keeping people safe. We rated effective, caring and responsive as requires improvement.

As a result of this assessment, we served a Section 31 notice to impose conditions on the provider’s registration because people would be at risk of harm if we did not take this action. We found 2 breaches of the legal regulations in relation to safe care and treatment and governance. We requested an action plan to address these concerns.

We found significant concerns with the safety and quality of the service which meant patients were at risk of ongoing harm. We found a disjointed leadership team and a culture of distrust and low morale amongst staff. Systems to identify and manage risk were not effective and did not lead to improvements for patients. There was not a positive learning culture and staff were not always involved in making decisions about how to improve the service and were not given key information about concerns.

Whilst staff within the department in the same role worked well together, the service did not always work well with other teams and system partners. Nursing staff were not empowered to make referrals by medical staff which contributed to the overcrowding and delay to patient care.

Patients were at risk of ongoing harm. The queuing system for patients entering the department was confusing and led to delays for patients. A lack of clinical oversight in the waiting room meant there was a risk patients could deteriorate without staff noticing. There were not enough staff with appropriate skills to safely assess or meet patients' needs or the clinical demand in the department.

Medical services

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 and 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).

Date of Assessment:

We carried out this assessment on 17 and 18 December 2024 as part of our system pathway pressures programme. We inspected 23 quality statements across the key questions Safe, Effective, Caring, Responsive and Well-led and have combined the score for each of these areas to give the overall rating.

During the inspection, we visited a number of wards and assessment units. We reviewed the environment and staffing levels and looked at care records and prescription records. We spoke with patients and family members, staff of different grades, including nurses, doctors, ward managers, therapists and the senior managers who were responsible for medical services. We reviewed performance information about the trust. We observed how care and treatment was provided.

There was a positive safety culture where events were investigated, and learning was embedded to promote good practice. Infection prevention and control processes enabled patients to be safer from the risks of infection. However, continued improvements to the general environment were required.

Safe systems and pathways were not always maintained and responding to risk still required some improvement.

Patients with mental health care needs did not always have sufficient numbers of staff available to meet their needs and keep them safe.

Staff were not always fully trained or had the right skills for their role, and they did not always provide safe care and treatment to patients.

Medicine optimisation remained unsafe at times.

Staff had made improvements to ensure patients were able to make informed decisions about their care and treatment.

Staff did not consistently complete comprehensive patient assessments to inform their care and treatment. Staff delivered evidence-based care and treatment to ensure patients had good experiences and outcomes.

Staff worked with other professionals when assessing patients. However, information sharing was sometimes limited, which impacted the effectiveness of collaborative working and continuity of patient care.

Staff were mostly kind, caring and compassionate with patients and their visitors.

The service supplied appropriate, accurate, and up-to-date information in formats that were tailored to individual needs.

Staff worked hard to provide equity in access. However, significant working pressures sometimes impacted patients being able to access care and treatment when they needed it.

The service had a shared vision and culture based on the strategic objectives and values of the organisation. Staff feedback about this was mixed and we saw organisational challenges impacted on staff being in a position to maintain this.

The department and staff were led by strong leaders who embodied the cultures and values of their workforce. However, some staff told us, leaders could be more visible.

Governance and risk management had improved, though further sustainable improvements were needed.

There was a continued focus on learning, innovation, and improvement with processes to support staff to speak up if they had any concerns.

Staff collaborated and worked in partnership to assist continuity of care and system improvement.

During this inspection, we found the service had continued to make improvements since the inspection in July 2023. We did find breaches of the legal regulations during this inspection, though it was evident that the service was on an improvement trajectory.

We found five breaches of the legal regulations concerning safe care and treatment, premises and equipment, and good governance.

Staff did not consistently assess the risk to the health and safety of service users receiving the care or treatment.

The service did not always ensure that persons providing care or treatment to service users had the competence, skill and experience to do so safely.

Staff did not always maintain the proper and safe use of medicines.

The service did not consistently maintain the environment.

While there had been some improvements in governance system, there were repeated breaches which reflected improvements were not always being sustained. Staff also did not maintain secure and accurate, complete and contemporaneous records in respect of each service user, including a record of the care and treatment provided to the service user and decisions taken in relation to the care and treatment provided.

We have asked the provider for an action plan in response to the concerns found during this assessment

This is the first full assessment for this service since it was merged in April 2020. We carried out this short notice assessment of the urgent and emergency care service as part of the system pathway pressures assessment programme between 17 and 18 December 2024. We undertook another site visit on 8 January 2025 to follow up the concerns we found on 17 and 18 December 2024 and, due to ongoing concerns we, visited again on 10 March 2025. We inspected all 34 quality statements across the 5 key questions, safe, effective, caring, responsive and well-led for urgent and emergency care department.

During this assessment, we visited the emergency department (ED). We reviewed the environment, staffing levels, looked at care records and prescription records. We spoke with staff members across various grades and patients and observed meetings. We reviewed performance information about the trust and observed how care and treatment was provided.

We rated safe and well-led as inadequate because people were at risk of serious harm and the leadership, oversight and governance was not effective in keeping people safe. We rated effective, caring and responsive as requires improvement.

As a result of this assessment, we served a Section 31 notice to impose conditions on the provider’s registration because people would be at risk of harm if we did not take this action. We found 2 breaches of the legal regulations in relation to safe care and treatment and governance. We requested an action plan to address these concerns.

We found significant concerns with the safety and quality of the service which meant patients were at risk of ongoing harm. We found a disjointed leadership team and a culture of distrust and low morale amongst staff. Systems to identify and manage risk were not effective and did not lead to improvements for patients. There was not a positive learning culture and staff were not always involved in making decisions about how to improve the service and were not given key information about concerns.

Whilst staff within the department in the same role worked well together, the service did not always work well with other teams and system partners. Nursing staff were not empowered to make referrals by medical staff which contributed to the overcrowding and delay to patient care.

Patients were at risk of ongoing harm. The queuing system for patients entering the department was confusing and led to delays for patients. A lack of clinical oversight in the waiting room meant there was a risk patients could deteriorate without staff noticing. There were not enough staff with appropriate skills to safely assess or meet patients' needs or the clinical demand in the department.

On the 26th of November 2024 we carried out a comprehensive assessment of Children and Young People services at Basildon University Hospital. This was a responsive assessment in relation to potential specific incidents and ongoing concerns over the safety of children and young people receiving care at the hospital. This was the first time the service has been assessed, and it was rated Inadequate overall. During our assessment we spoke to staff, children, young people and their families using the service. People we spoke to said staff did their best in a busy service to provide care.

People were not always provided with information and said the support for children/ young people was not always tailored to their needs. Staffing levels and skill mix were not always effective to deliver safe care. Demands on the service were high, and leaders did not always take timely action to mitigate the risk to children and young people using the service. The service was kept safe by the good will of staff, often having no breaks and working late. Staff did not always feel supported by senior trust leaders and were undervalued. There were limited opportunities for development and staff did not feel able to influence the future vision and values of the service.

As part of our assessment, we requested additional data and information. Some evidence was not provided or available. Due to information gaps in the services, we were not assured leaders had good oversight of care delivery and risk management.

Following our assessment the concerns demonstrate a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served a Section 29A Warning Notice for Regulation 17 outlining the breaches and that we required the service to make improvements.

On the 26th of November 2024 we carried out a responsive focused assessment of the Paediatric Emergency Department (PED) at Basildon University Hospital. The assessment was prompted in part by notifications of adverse incidents, which are subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this assessment did not examine the circumstances of the incidents. However, the information shared with CQC about the incidents indicated potential concerns about the quality and safety of the service. This assessment examined those concerns. We inspected 6 quality statements across the safe, responsive and well-led key questions. We have not previously rated this service. This assessment did not cover all parts of our assessment framework; therefore, we did not rate the service, and we have only given scores for those areas which we have assessed. We will carry out future assessments to cover other parts of the framework and will update our website with our findings. We found 2 breaches of the legal regulations in relation to safe care and treatment and governance. Our assessment found:

The management of risks to people across their care journey was not always effective. Staff told us the high level of demand within the department and staffing shortages impacted on their ability to maintain oversight of the patients in the department and to manage risk effectively. There was limited evidence that the service actively sought out, listened to and responded to information about children and young people who were most likely to experience inequality in experiences or outcomes. The service did not always have effective governance arrangements in place. Staff did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.

We have asked the provider for an action plan in response to concerns found at this assessment.

On the 26th of November 2024 we carried out a comprehensive assessment of Children and Young People services at Basildon University Hospital. This was a responsive assessment in relation to potential specific incidents and ongoing concerns over the safety of children and young people receiving care at the hospital. This was the first time the service has been assessed, and it was rated Inadequate overall. During our assessment we spoke to staff, children, young people and their families using the service. People we spoke to said staff did their best in a busy service to provide care.

People were not always provided with information and said the support for children/ young people was not always tailored to their needs. Staffing levels and skill mix were not always effective to deliver safe care. Demands on the service were high, and leaders did not always take timely action to mitigate the risk to children and young people using the service. The service was kept safe by the good will of staff, often having no breaks and working late. Staff did not always feel supported by senior trust leaders and were undervalued. There were limited opportunities for development and staff did not feel able to influence the future vision and values of the service.

As part of our assessment, we requested additional data and information. Some evidence was not provided or available. Due to information gaps in the services, we were not assured leaders had good oversight of care delivery and risk management.

Following our assessment the concerns demonstrate a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served a Section 29A Warning Notice for Regulation 17 outlining the breaches and that we required the service to make improvements.

On the 26th of November 2024 we carried out a responsive focused assessment of the Paediatric Emergency Department (PED) at Basildon University Hospital. The assessment was prompted in part by notifications of adverse incidents, which are subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this assessment did not examine the circumstances of the incidents. However, the information shared with CQC about the incidents indicated potential concerns about the quality and safety of the service. This assessment examined those concerns. We inspected 6 quality statements across the safe, responsive and well-led key questions. We have not previously rated this service. This assessment did not cover all parts of our assessment framework; therefore, we did not rate the service, and we have only given scores for those areas which we have assessed. We will carry out future assessments to cover other parts of the framework and will update our website with our findings. We found 2 breaches of the legal regulations in relation to safe care and treatment and governance. Our assessment found:

The management of risks to people across their care journey was not always effective. Staff told us the high level of demand within the department and staffing shortages impacted on their ability to maintain oversight of the patients in the department and to manage risk effectively. There was limited evidence that the service actively sought out, listened to and responded to information about children and young people who were most likely to experience inequality in experiences or outcomes. The service did not always have effective governance arrangements in place. Staff did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.

We have asked the provider for an action plan in response to concerns found at this assessment.