Basildon University Hospital

On this page

• 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 is the first assessment for 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 that some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of the legal regulation in relation to people’s safe care and treatment.

This service scored 16 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not work well with people and health system partners to establish and maintain safe systems of care. Staff did not manage or monitor people’s safety. They did not make sure there was continuity of care, including when people moved between different services.

Some families told us the PED was busy and that they could experience long waiting times to be seen. During our on-site assessment, we saw that the department was busy, which was impacting on waiting times to be seen. Data provided by the trust showed that children and young people were usually receiving a timely initial assessment (triage). The average time to triage in the 12 months prior to our assessment was 13 minutes. Data provided by the trust showed that children and young people were experiencing longer waiting times to be seen by a clinician within the PED. The average time from arrival to being seen by a clinician was 105 minutes in the 12 months prior to our assessment. This compared to 81 minutes at Broomfield Hospital and 87 minutes at Southend Hospital.

Some families said it took a long time once admitted to then be moved up to the paediatric ward and that communication to families was not consistent.

Children and young people had to book in via the main ED reception as the paediatric ED did not have allocated administrative staff. Some families expressed concerns around the booking in process, as adults and children waited in the same queue to be booked in. Some families felt that this was not safe and could mean an unwell child might wait longer to be assessed. A separate paediatric reception within an emergency department would have provided a more child-friendly environment and facilitated efficient triage and care for children and young people.

Systems for clerking in children and young people was not always consistent and safe. The PED Standard Operating Procedure (SOP) instructed receptionists to direct families straight to the PED if a child was “very unwell”. The SOP did not provide any further guidance for reception staff on how to determine whether a child was “very unwell”. This meant that there was a risk that deteriorating children and young people may not be identified and escalated as required.

The numbers of children and young people re-attending the Basildon Hospital PED within 7 days of their most recent discharge was more than double the numbers for Southend Hospital and Broomfield Hospital. Basildon Hospital had 3487 re-attendances within 7 days in the 12 months prior to our assessment. This compared to 1543 for Broomfield and 1920 for Southend. Re-attendance rates can indicate potential issues with the quality of the care provided during the initial visit. There was a standard operating procedure, which described the action staff should take when a child or young person had multiple attendances to the PED. However, we were not provided with evidence that compliance with this policy was being monitored.

When children and young people were transferred from the PED to another part of the hospital, staff completed a Situation, Background, Assessment, and Recommendation (SBAR) transfer form. SBAR is a communication framework used to structure conversations, to ensure clear and concise information transfer. An audit was carried out in November 2024 to review compliance with the SBAR transfer form and this showed high levels of compliance (97.8%).

The service did not always work well with people to understand and manage risks.

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 were only 2 nurses allocated to the PED at all times. Leaders had recognised, based on increased activity within the department, that an additional nurse needed to be allocated to the PED on an ongoing basis. As a result, an increase of 12 whole time equivalent nursing staff was required across PAU and PED. Leaders told us that in the interim, they prioritised staffing in PED and they moved staff from other areas when needed.

Leaders told us they monitored capacity and acuity daily across PED and worked across all departments to manage risk levels. However, staff felt some leaders did not have oversight of the escalation of risks in the department. A review of capacity trackers during our assessment demonstrated that capacity escalations at times of high demand were not always acted on effectively by leaders. Staff said some areas, such as PAU, were used as an overflow from PED and that they did not have the staff or facilities to safely cope. The workforce plan reviewed during our assessment recognised that activity within PAU had increased to 10-12 trolley spaces and an increase of 12 whole time equivalent nursing staff was required across PAU and PED as a result.

Staff used a track and trigger system to identify and respond to deteriorating children and young people. The patient records reviewed during our on-site assessment showed that physiological observations had mostly been recorded appropriately. However, records did not always clearly show whether appropriate escalation had taken place when physiological observations indicated that a patient was deteriorating. In addition, records did not always show that a clinical review had subsequently taken place. We were not assured that leaders monitored or had oversight of the track and trigger system within the PED. We were not provided with evidence to show that regular audits were completed. This meant that leaders could not be assured that deteriorating patients were escalated appropriately.

The service had processes to support staff to identify and respond to patients with sepsis. The patient records reviewed during our on-site visit showed that sepsis had mostly been appropriately considered where applicable. Sepsis audits completed between August and October 2024 showed high levels of compliance. There were high levels of compliance with sepsis training.

We were not assured that leaders monitored or had oversight of the completion of patient risk assessments within PED. As part of our assessment, we requested evidence of any audits which monitored the completion of patient risk assessments. We were not provided with evidence to show that regular audits were completed. This meant that leaders could not be assured that patient risk was being appropriately assessed and managed.

Staff had access to appropriate equipment to respond to patient deterioration. Resuscitation trolleys had mostly been regularly checked in line with the provider’s policy, although a small number of gaps in the completion of checks was identified. We were not assured that the completion of resuscitation trolley checks was regularly monitored by leaders. We requested the last 3 resuscitation trolley audits as part of our assessment; only 1 audit was provided. The audit had been completed in June 2024, 5 months prior to our assessment. However, the audit had shown that the service’s resuscitation trolley was fully compliant with provider policy.

The service did not assess or manage the risk of infection. Staff did not detect and control the risk of it spreading.

People did not always provide positive feedback about the cleanliness of the service. Leaders had raised these concerns with the domestic supervisor. However, the service had continued to receive some concerns from families regarding the cleanliness of the service.

The PED did not have dedicated domestic staff. This had been recognised as an area of concern by leaders, but had not yet been addressed at the time of our assessment.

Staff did not always follow infection control principles. Cubical curtains had not always been changed at the frequency set out in the provider policy. Some mattresses were torn and covered in medical tape, which posed an infection prevention and control risk. This was escalated to leaders during our on-site visit and immediate action was taken to replace the mattresses.

Clinical areas and toilet facilities were visibly clean during our on-site assessment.

The service did not always perform well for cleanliness. Audits showed low levels of compliance. For example, the November 2024 audit had a compliance rate of 65%. Audits were not always being completed at the monthly frequency set out in the provider policy. There had been no IPC audits carried out from January to June 2024, and no audit carried out in September 2024. It was not always clear what actions had been taken in response to areas of concern identified during the completion of audits.

Staff compliance levels for mandatory infection prevention control training (IPC) (79%) were below the trust target of 85%.

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 there was more limited pharmacy support out of hours due to staffing levels. Staff told us 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.

Medicines were not always stored safely and securely. We saw a clinical room door wedged open with an 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. There was a risk that medicines had not always been stored at temperatures in line with manufacturer’s recommendations, which may have impacted on the medicine’s efficacy.

Controlled drugs were stored in line with legislation and records of administration were mostly completed in line with guidance. However, some staff told us that unused controlled drugs were wasted in the sharps bin, which did not have absorbable material. This was not in line with national guidance.

The service performed well for medicines management, although audits were not completed at the monthly frequency set out in the provider policy. The last medicines management audit had been completed in August 2024. Timely audits help leaders to identify and respond to areas of non-compliance.

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 summary care records (SCR). This meant staff may not be able to access all relevant information from GP medical records relating to current medication and allergies. The service used paper prescriptions throughout the trust, and different prescription charts were used in the three hospitals.