Basildon University Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.This was our first assessment we rated this key question Requires Improvement.
Staff did not always have time to review assessments taking account of young people’s communication, personal and health needs. Staff did not always have time to work effectively with other agencies involved in young people’s care. Staff did involve parents and carers in decisions about their child’s care and treatment.

This service scored 46 (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 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Young people and their families told us individual needs were not always assessed. Children with additional, complex and mental health needs were not always fully reviewed to identify the need for additional support and reasonable adjustments. For example, the service did not support children with specific diets like coeliac disease, which left families having to bring food in for children to eat. Older children on wards did not feel the environment and facilities supported their needs. They told us staff did not always ask them what they needed and did not consider any additional support options.

Staff we spoke with told us they would do their best to assess individual needs during assessments, however they said facilities lacked sufficient space for children with sensory and additional needs. A ‘direct access’ system to the paediatric assessment unit was in place for children with complex medical and additional needs. However, there was limited oversight of this process to monitor its effectiveness and impact on outcomes.

The service had posters to prompt staff to offer hydration to families and children, but there were poor parent facilities in the outpatient department. Kitchen space allocated was cluttered and lacked adequate seating. There were audit processes in place to monitor nutrition and hydration requirements and an action plan to drive improvements, however this did not cover all elements of concern raised from audits.

We reviewed care records during assessment children and young people’s physical and emotional needs were not always documented or considered.

We asked for evidence how the trust monitored care for children with additional needs and any associated actions plans. The service provided an overview of actions to be taken in relation to national recommendations, but did not provide evidence of any current monitoring processes. Therefore, we were not assured the service had good oversight of assessing needs and care outcomes.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver children and young people’s care and treatment with them and their families.

Parents and carers told us staff were knowledgeable about care and treatment delivery. Some parents and carers who had children with additional needs, told us staff did not always consider the emotional impact of long wait times in the paediatric assessment unit (PAU) would have on their child. Staff also raised concerns regarding the impact and distress long wait times had on children and families.

Staff told us they were trained and used nationally recognised paediatric observations system to record children’s vital signs. The paediatric early warning score and paediatric sepsis screening tool were used by staff across all areas of paediatrics. The service had policies and guidance in place to support the tools us and monthly audits carried out to monitor these tools showed consistent compliance. Additional training would be offered if staff needed it.
On review of care records during assessment they showed good documentation and escalation of high early warning scores throughout departments.

Staff said that at times of high demand they found it difficult to maintain regular and timely observations in line with trust policy and national guidance. We were advised there had been a delay in updating in line with national guidance, with no clear timeframes or completion date for this work. Staff may not always have had access to the most up to date guidance and methodology around paediatric care.

Staff raised concerns over the lack of staff in speciality areas. Diabetic and sickle cell services had staff vacancies. There were 2 vacancies on the risk register. Caseloads were high and increasing, staff were looking at online technology to assist in the short term. They did work with system partners, but funding availability was limited, and recruitment was challenging.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support children and young people.

Parents and carers told us at times team working was not always consistent. They said communication between specialist teams and other hospitals was not always effective and their overall care experience at times had been poor as a result.

Medical staff said they worked well with nursing teams and their leads. They were able to escalate and had strong lines of communication which were positive. Nursing staff told us about their working relationship between senior leader’s teams were strained. They said communication had broken down and did not always feel leaders understood current systems and associated risks.

Some community partners told us there could be improvements in communication and team working between services. Community mental health services often held a coordination role to progress care for children and young people and worked closely with the safeguarding leads at Basildon. Capacity pressures on wider community services meant children could often present in a mental health crisis, which often was not the most appropriate location for their care.

We scored the service as 2. The evidence showed significant shortfalls. The service did not support children and young people to manage their health and wellbeing.

Young people said they didn’t always have the food options they liked, and specialist diets were not consistently catered for. For example, options for coeliacs were limited and catering services did not allow food to be separated for any child with additional sensory need. Parents often brought in food suitable for their child’s adequate nutritional input.

Staff told us they tried their best to support the overall health of all young children using their service. This however could be challenging at times of high service demand and with at times limited resources. Children did not have direct access to any outside play area for their wellbeing, which staff said would be beneficial during longer admission.

Information collated by the service regarding children and young people’s physical and mental health was sporadic and inconsistent throughout departments. There was no clear focus and workstream dedicated to this aspect of paediatric care.

We scored the service as 1. The evidence showed significant shortfalls. The service did not routinely monitor people’s care and treatment to continuously improve standards. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of young people and their families.

Local nursing leaders told us they had processes to audit care records, to identify themes and monitor care delivery standards. There had been a recent focus on the management of sepsis and escalation processes trust wide. Staff told us there had been refresher training around sepsis. They were being closely monitored by managers and told us senior leaders did not always see a potential link between service demand, acuity with poor outcomes for children and young people. The data submitted as part of this assessment did not demonstrate how the service were analysing proactively to identify themes and trends to improve outcomes.

We requested current evidence of any national benchmarking data collected in relation to babies, children and young people services. Reports provided were not current and associated action plans had not all been completed. There was a low compliance rates with national audits and data were not always submitted to monitor outcomes and support learning. Leaders told us there had been a lack of admin support and ongoing data issues that had caused this delay.

National audits, particularly in healthcare, offers several benefits, including improving patient care, identifying areas for improvement, and benchmarking performance against national standards. These audits can also influence funding decisions and demonstrate commitment to quality improvement.

Limited progress had been made by the service to improve low compliance, and we were not assured they had effective systems in place to monitor and benchmark care outcomes to drive improvement.

We scored the service as 2. The evidence showed some shortfalls. The service did not always tell people about their rights around consent and the service did not always provide staff with the right tools to support consent decisions.

Young people and their families told us staff had care plans; however, it was not always clear if procedures and treatments were discussed fully with parents and carers prior to delivery. Basildon Hospital took part in a national trial for breathing support for children under 12 months. This was carried out on a ‘Opt Out’ basis and it was not clear from discussions with parents and reviewing notes options had been fully explained.

Staff were aware of the need for informed consent when discussing assessments and treatment plans with families and carers. However, staff did not always have available guidance around paediatric care and consent. The service had a generic consent policy which lacked information relating to children and young people, and did not give staff guidance on what to do if treatment was being refused. The also lacked oversight of consent processes, they did not carry out any audits on mental capacity or consent assessments. Therefore, there was a failure to demonstrate current processes were effective and robust and in patient’s best interest.