Basildon University Hospital

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation. This was the first assessment for this service. This key question has been rated Inadequate.

Staff understood risks but were not always supported with clear guidance and staffing numbers to manage these risks. The facilities and environment did not always meet young people’s needs. There were not always enough staff with the right skills, qualifications and experience to manage the demand on the service. Medical staff told us they supported each other well but safety was being compromised, and staff said senior trust leaders did not always engage and truly listen to staff’s concerns. Nursing managers aimed for staff to receive training and regular appraisals to maintain high-quality care, however, this was often not accommodated due to high demand on the service. The service did not always ensure medicines and treatments were safe to meet people’s needs, capacities, and preferences by enabling them to be involved in planning, including when changes happened.

The service did not always have a positive learning culture and staff said learning was not always prioritised. Children and young people were not always protected and kept safe.
The concerns demonstrate a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 34 (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 1. The evidence showed significant shortfalls. The service did not have a proactive and positive culture of safety based on openness and honesty. Leaders did not always listen to staff and lessons were not always learnt to continually identify and embed good practice.

Young people and their families using the service told us they were able to raise concerns about their care but were not always signposted to give feedback and make suggestions on improvements.

Staff told us they were informed of incidents and themes of learning via emails following incident investigations. However, the sharing of incident themes and identified learning were delayed meaning staff were not fully aware of current clinical and safety risks. Staff were signposted to external websites for learning and education. However, there was limited evidence how this free training was supportive and effective as this provision was not monitored by leaders.

Senior education leads told us they were unable to fulfil their role, particularly during times of high acuity and demand as they were often required to support clinically on the wards. They raised concerns this was having a direct impact on the staff’s learning and education and impacted on patient safety.

The service had systems in place to log incident management however there were delays in reporting processes. Evidence reviewed showed leaders did not always listen to concerns of staff and identified lessons learnt were not always actioned promptly and embedded in good practice. For example, there had been delays approving action plans after incident investigations, meaning months may have passed before meaningful changes and learning was implemented. Evidence provided also demonstrated there was inconsistent morbidity and mortality reviews after safety incidents, which further impacted the safety culture and recognition of learning.

We scored the service as 1. The evidence showed significant shortfalls. The service did not always work with people and health system partners to establish and maintain safe systems of care. They did not always monitor children and young people’s safety. There was limited oversight of continuity of care, including when people moved between different services.

Young people and their families using the service did not always feel pathways of care were clear and consistent. They could experience long waits to be transferred between departments and were not always given timescales for treatment. The service had guidance and procedures in place for transition of care between paediatric departments. However, staff told us safe care pathways and systems were not effective due to the lack of capacity, high acuity and demand on the service.

Systems used to identify capacity were not always effective. Staff told us they had limited space on the paediatric assessment unit, only having 6 beds but would often have 20 children in the unit. Staff said this was unsafe and they would often have to prioritise the most unwell children to allocate a bed space. Families and carers also told us their children could experience long stays on Paediatric Assessment Unit (PAU) as beds were not available on the wards. Leaders told us PAU could be utilised for short stays for up to 24 hours with an aim for discharge. However, there was a lack of consideration for patient experience and the ward environment could be more suitable to their needs. For example, we observed a child with additional needs waiting in a busy loud PAU, which impacted on their wellbeing. We saw a quieter alternative space not being utilised.

Staff raised concerns over the high numbers of children they discharged to return for treatment (ambulate) and said this was not always safe. There was no limit on how many children could be ambulated putting additional pressure on an already very busy unit. Staff said there was minimal clinical oversight of these children. At time of assessment over the previous 12 month the service had readmitted 420 children and young people within 30 days of discharge. Staff told us due to limited bed capacity; they were often ambulating children who met the admission criteria which at times they told us was unsafe. Staff stated they had escalated safety concerns to senior leadership teams who had acknowledged demand was high but had taken limited visible action to address the risk.

Evidence showed there was a backlog in completing discharge processes. At the time of assessment, the service had 169 outstanding paediatric discharge summaries. This meant information and details of transition of care were not always being shared with community partners in a timely way. Leaders said this backlog was due to shortages in medical staff and pressures on the service. Leaders were unable to demonstrate immediate actions taken to mitigate any risks because of the delayed discharge processes.

Healthwatch Essex had received concerns from children and their families around unclear pathways for ADHD and autism care. Concerns raised over unclear communication particularly if care involved multiple departments.

We scored the service as 2. The evidence showed some shortfalls. The service did always not work with staff and healthcare partners to provide good oversight of safeguarding processes and training.

Staff told us they received annual training for safeguarding and had clear guidance to follow. However, staff did not aways receive safeguarding supervision or attend live skills and drills training in line with trust policy. Evidence reviewed showed Basildon had low compliance with supervision rates and an action plan had been implemented to increase compliance. Permanent and bank staff were not always compliant with safeguarding training. It was not always clear when children were admitted to adult areas that staff caring for them were appropriately child safeguarding trained. We requested evidence of guidance or procedures for staff to follow when children and young people were admitted to adult wards; this was not provided. Therefore, we were not assured leaders had good oversight of any associated safeguarding risk.

Staff used a designated safeguarding booklet to log concerns, document escalation and referrals. Staff told us they had good communication between teams when discussing safeguarding and they addressed concerns promptly. Information was shared with teams and appropriate timely referrals were made. However, leaders did not carry out monthly safeguarding audits and there was limited evidence they met regularly to discuss safeguarding concerns.

Policies relating to safeguarding were not always tailored for children and young people, meaning staff lacked clear guidance to keep children and young people safe. For example, the service had a patient abscond policy, however, this was adult focused and offered little guidance to staff around children who may try and leave a ward or department.

We scored the service as 1. The evidence showed significant shortfalls. The service did not work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We received inconsistent feedback about involving people to manage risks. Most families told us they were included in decision making about their care. Some older children said they were not always included in discussion and were not informed of their own care plans. However, young people and their families within the paediatric outpatient’s department said staff were good at explaining processes and provided all the relevant information in a timely way.

Staff also told us they had limited influence in the overall management of risk and safety. Staff said they went above and beyond to try and keep departments safe and worked across teams to manage high acuity and demand. Medical staff said safety was often compromised due to shortage of nursing staff and a lack of senior presence and availability, particularly at nights and weekends. They told us they had escalated concerns to senior trust leaders but said there was limited real time action taken to address the risk. We also requested evidence of staff rota’s and how low staffing numbers were escalated and managed, this was not provided.

Oversight systems used to monitor unwell children within the PAU were not always effective. For example, the units white board lacked mandatory fields for monitoring, red flags and attendance time information. Leaders told us they monitored risk daily across paediatrics and worked with all departments to manage risk levels. However, staff told us some areas were used as an overflow from paediatrics emergency department and did they did not have the staff or facilities to safely cope with the demand.

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care

Families using the service raised concerns over the layout of outpatient department and the lack of restricted access. For example, families with children with additional needs were concerned children might be able to leave the unit as doors were not locked or monitored by staff.

Families we spoke to in the PAU found the environment crowded and very noisy and said it was not a nice place to take your unwell child. Leaders acknowledges PAU was restricted for space and did not meet current demands on the service. This had been acknowledged by leaders as a risk however there was no clear timescales to improve this. Parents / carers on the neonatal intensive care unit told us the environment was warm, visibly clean and inviting. They told us there was a robust security system in place and they said the environment supported all their needs.

During our assessment we observed the wards and paediatric departments were not always laid out to be suitably and safe for children and young people. Areas had dated décor and were not always child friendly. Leaders acknowledged the aging estate at Basildon but were limited with financial restrictions and were unable to make the improvements that were needed. The service shared its legionella, ligature and sharps risk assessments which were in date and comprehensive. However, we requested evidence of environment fire risk assessments for all children and young people areas. At time of assessment a large proportion of the recommendations from these reports had not been completed.

We scored the service as 1. The evidence showed significant shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff to meet demand. They did not always make sure staff received effective support, supervision and development. Leaders and staff did not work together well to provide safe care that met people’s individual needs.

Parents / carers on the paediatric assessment unit (PAU) said the unit was busy and appeared understaffed. At time of assessment the PAU was full, and we observed nursing staff rushing around constantly trying to see everyone. On the paediatric wards it was not always clear to families which staff were available and who to approach for assistance. However, within the neonatal intensive care unit, staff identification notice boards were accessible allowing families to identify the staff treating their baby. In the outpatient’s department parents / carers told us staff were very supportive of their children who had additional needs and said they were very knowledgeable and understanding. They told us their care experience was made easier thanks to the nursing staff.

Leaders shared the challenges in making sure there were enough qualified, skilled and experienced staff. For example, staff told us they could be pulled from other departments to cover staffing gaps, however they had limited experience and knowledge working in paediatrics. Staff did not feel this was a suitable solution and impacted on wellbeing of staff and there was not always internal agreement about the skill mix needed.

Some staff in PAU said they enjoyed working there but there was not enough staff or capacity to provide an efficient service. Staff said they often struggled at night and weekend when staffing cover was a challenge. Staff told us there had been a restriction placed on the use of bank and agency staff due to financial restraints on the service.

Leaders acknowledged there had been an increase on demand on the service and at times staffing could feel unsafe. They told us they would review cover each day and confirmed staff would be taken from other departments to fill the gaps in staffing. Information shared by the service showed medical staffing numbers were up to capacity and nursing staff vacancies were at 7.7% below the trusts 11.5 % target.

Although having good staff provision leaders recognised the service was often run on the good will of staff and this was not a long-term solution. As part of our assessment, we requested evidence of the last formal staffing review for children and young people services, this was not provided.

We requested information around staffing rota’s showing staff planned and actual numbers on shifts. This was not provided. We also asked for evidence of escalation processes and action taken to mitigate staffing gaps. Evidence provided did not demonstrate clear management and oversight of staffing and skills gaps.

We scored the service as 1. The evidence showed significant shortfalls. The service did not assess or manage the risk of infection. They did not always risk assess and control the risk of it spreading or act on parents and families concerns.

There was inconsistent feedback around infection prevention control (IPC) measures. Parents / carers and young people told us at times the wards, kitchen areas and toilets could be dirty. They found the décor to be dated and needed a refresh. During assessment we found patient bathrooms within some paediatric wards were not regularly cleaned. However, the neonatal intensive care unit was visibly clean and inviting throughout. Parents / carers said the environment catered for all their needs and felt safe bring young children to visit. The unit had robust cleaning schedules in place and were fully complaint.

There was also continued issues with leaking flat roofs across multiple areas. On a paediatric inpatient ward, a bed space was not being used as a roof leak was still awaiting repair. A ‘leak bucket system’ was in place but this lacked proper robust risk assessments and IPC measures. We observed a bucket system with visible mould in a bay with vulnerable new-born babies and child, all receiving treatment. Leaders told us they had continual issues with roof leaks during wet weather and the bucket system was a temporary measure. However, staff told us these buckets had been used over many years and there had been limited action to permanently fix the problem. This had a direct impact on bed capacity and posed a potential IPC risk to children and young people.

The service had an overarching infection prevention policy. Some IPC audit results for in patient wards showed compliance had been declining since September 2024, falling from 92% to 73% and there were some gaps in reporting. Therefore, we were not assured there were effective monitoring and actions being taken in relation to IPC.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Clinical pharmacy services, medicines advice and supply were available from the pharmacy team. An on-call pharmacist was available outside of core working hours. Staff told us that out of hours pharmacy support could be better. Staff told us that they had received competency assessed medicines management training including sepsis management training. Staff told us they were encouraged to report incidents and learning from incidents were shared widely.

Some paediatric areas shared medicine cupboards and processes with the paediatric emergency departments. Medicines were not always stored safely and securely. We saw a clinical room wedged open with unlocked medicines cupboard, containing paediatric infusion fluids.

We saw gaps in the monitoring of ambient room and fridge temperatures in clinical rooms where medicines were stored.

Controlled drugs were stored in line with legislation and records of administration were mostly completed in line with guidance. However, staff told us that unused CD were wasted in the sharps pin that does have absorbable material.

The service had a process for obtaining relevant patient history; however, staff nurses and doctors we spoke to did not have access to nationally held patient summery care records (SCR). The service used paper prescriptions throughout the Trust, and this is yet to be harmonised. Different prescription charts were used in the three hospitals.

The service had medicine management policies and guidance for staff to follow. Medicine management audits for inpatient areas showed good compliance.