Basildon University Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them. This was our first assessment we rated this key question Requires Improvement.

This meant young people and their families did not always feel well-supported, cared for or treated with dignity and respect. Young people and their families were treated with kindness and compassion; however, staff were not always able to respond in a timely way. They treated them as individuals but did not always have the facilities and resources to support their preferences. Staff said their wellbeing was being impacted due to demand on the service and told us they were not being able to deliver the standard of care they wanted to.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The staff always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Young people and their families told us staff were kind and showed compassion when providing their care. Families in the outpatient’s department said nursing staff and medics had taken extra time to support their children and had made the whole care experience easier. Staff were observed to be kind and friendly with children, young people and their families. We saw respectful and professional conversations between nursing and medical staff when discussing patients.

Staff told us they did their best to provide a high standard of care. However, they often left shifts feeling frustrated at not being able to give children and families the time and attention they needed due to the ongoing demand on the service.

The service did carry out the national friends and family test survey and results were published quarterly. The Friends and Family Test (FFT) is an important feedback tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. Recent results showed 85.7% of 3602 family’s surveyed had a positive experience of children and young people services within the trust. Some families commented that “staff were so kind and helpful and done their best to make my son feel comfortable”.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat children and young people as individuals or make sure care, support and treatment met their needs and preferences. They did not always take account of family’s culture and unique backgrounds and protected characteristics.

Young people and their families told us staff were not always able to treat them as individuals due to demands on the service. Older children on wards told us the environment and facilities did not always support their needs. They were not always asked what they needed, and care did not always feel tailored to them. This concern was also shared by staff; they told us children with additional needs would be identified but the ward environment was not always suitable to support any reasonable adjustments.

There was also limited resources and information available for parents and carers. During assessment we saw posters displays, but there was limited accessible information tailored to the needs of the children and was not always child focused. Also, the inpatient wards did not have a dedicated quiet space to facilitate children and young people with an additional sensory or neurodiverse need. During our assessment we observed staff supporting children individually and good communication with parents and carers. Nursing leaders acknowledged high demand on staff’s workloads, and they would seek support from all staff, for example the play leads when available to give individualised support to children where needed.

As part of our assessment, we asked for examples of ‘paediatric hospital passport’ resources, but staff were unable to demonstrate the use of these, despite being available to all staff. This resource was a tool to discuss and record children’s individual needs and requirements with families and carers. This lack of consistent processes meant care delivery was not always equitable across services.

We scored the service as 2. The evidence showed some shortfalls. The service did not always promote children and young people’s independence. People did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Most families and children we spoke with said options for their care were discussed. However, some families told us that medical staff did not always listen to parent’s requests regarding assessments. For example, for one family this meant blood tests had to be repeated and caused unnecessary distress to their child.

Most parents and families told us they were able to express opinions about their child’s or baby’s care. Families on the neonatal intensive care unit told us medical staff and nurses explained and involved them in all aspects of care decisions.

However, the trust did not have effective guidance for staff on how to support and promote children and young people’s independence and choice whilst they were in hospital, for example Gillick competency. Gillick competency is applied where a child under 16 can consent to their own treatment. We reviewed the consent policy which did not outline how staff would follow Gillick competency or access advocacy services. Although requested, there was limited evidence to demonstrate how the service monitored care in relation to child and young people’s independence, choice and control.

We scored the service as 3. The evidence showed some good practice.

Some parents and families on the inpatient ward and the neonatal unit told us staff were prompt at responding to call bells. However, at times of high demand, they may have to wait to be assisted but said there was no impact on their wellbeing.

During our assessment we saw staff were doing their best to respond children and young people’s needs in a timely way, but staff told us they would often have no breaks and would stay late when the service was busy. They also found it difficult to maintain regular clinical observations and checks during periods of high demand.

Leaders were aware of departments being busy and were monitoring the responsiveness of teams through audits and safety incident reviews. Ward leaders told us they would prioritise children’s safety and always assist nursing staff with any escalations or concerns.

We scored the service as 2. The evidence showed some shortfalls. The service did not always care about or promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff told us senior trust leaders did not always prioritise staff’s wellbeing and there was a lack of support when activity and demand was high. However, they praised local nursing leaders who would drop their oversight duties to support staff clinically. There was a permanent wellbeing hub located within the hospital, which was open for all staff, however this was difficult to access during busy shifts and staff often did not get breaks.

Senior trust leaders acknowledged staff would often not get breaks, but this was monitored daily by the rota coordinators. Staff were frustrated at the limited promotional and career development opportunities. Senior staff told us they were leaving to seek opportunities elsewhere. They shared concerns that any decrease in senior staff would leave a high proportion of junior staff putting additional pressure on existing senior team members to provide experienced support. There was no short-term plan to address skill shortfalls and leaders told us financial support was needed to increase recruitment. Leaders acknowledged staff morale was low and nursing sickness rates were 4.15% in line with trust target of 4%. Leaders told us staff’s wellbeing and enablement was identified as a priority, but this was not reflected by staff’s experience or senior leadership actions.

We requested evidence on how the service supported staff’s wellbeing and enablement. Information reviewed showed there was a Professional Nurse Advocates on each neonatal unit in the trust. The service had in house occupational health teams and had collaborated with local stakeholders to provide staff with a 24-hour wellbeing support phone line. Previously there had been a permanent Well-being hub for staff, however this provision had been downsized. Staff had limited knowledge of all services available to them and improved communication on well-being provisions was needed.