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

Assessment findings:

We looked for evidence that people were protected from abuse and avoidable harm and assessed seven quality statements.

At our last inspection we rated this key question requires improvement. At this inspection the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk people could be harmed.

The provider was in breach of legal regulations in relation to safe care and treatment - assessing the risks to the health and safety of service users receiving the care or treatment - ensuring that persons providing care or treatment to service users have the qualifications competence, skills and experience to do so safely - the proper and safe use of medicines, premises and equipment being properly maintained.

This service scored 56 (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 had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Assessment Findings:

The service promoted a culture of safety and continuous improvement, learning from events, incidents and complaints.

Patients told us they felt confident to raise concerns. A patient’s records demonstrated the services complaints procedure was followed.

Staff were open to learning and improvement approaches. There were systems in place to facilitate learning from incidents. For example, dedicated learning days, safety huddles and departmental meetings. The patient safety team also facilitated learning sessions following untoward incidents.

Specialist staff attended the wards to provide specific learning. For example, the practice education team supported learning from audits by delivering training to staff. They had recently delivered hydration refresher training across all wards as hydration risk assessments were identified as requiring improvement.

The service had systems and processes to identify and manage risks before safety events happened. For example, a multidisciplinary approach, aligned to the patient safety incident response framework (PSIRF) was used to review mortality and morbidity monthly.

The service used a clinician led systematic judgment review process for reviewing deaths. Leaders told us they benchmarked positively for mortality rates against their peers in the East of England. They were a pilot site for placement of in-house medical examiners and now had an established team of medical examiners who carried out the first review of all deaths.

Staff told us they reported incidents using the online electronic system. However, some staff told us they did not always receive feedback about the incident they had reported.

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

Assessment findings:

Mechanisms to proactively and effectively identify, manage and monitor risks to keep people safe were not fully effective. Pathways of care were not always effective in maintaining patients’ continuity of care.

At the time of our inspection, the service had implemented its full capacity protocol, which included caring for patients in the corridors of wards whilst waiting for a bed on the ward to become available. The trust board ratified a Full Capacity and Escalation policy in October 2024. A patient having mental health needs was listed as one of the exclusion criteria for corridor care. However, we saw patients with mental health care needs being cared for in corridors on the wards.

Most patients told us that care in the corridor of the ward was good, and we observed the use of privacy and dignity screening. However, some patients had to repeatedly ask for help, and it was noisy. We also observed care being given to a patient in the corridor, which limited the space should emergency equipment be required to be taken to another patient in an emergency.

The service used a national early warning score system (NEWS) to alert staff if a patient’s condition was deteriorating. This was a basic set of observations such as respiratory rate, temperature, blood pressure and pain score. From the information we reviewed between January 2024 and December 2024, an average of 80% of observations had been taken on time.

The Frailty Assessment Unit services were operational for a minimum of 10 hours a day Monday to Friday, with weekend service provision at Basildon and Southend hospitals. The service operated a pull model from the emergency department, with patients being seen by a senior clinical decision-maker to avoid any unnecessary admission. A multidisciplinary team performed a comprehensive geriatric assessment for the patient, aiming to improve their health sufficiently to enable discharge back to their place of residency. This could be with or without virtual ward or community care, transfer into the short stay ward or frailty ward.

However, we observed same-day emergency care units were not fully operational in line with the pathway protocol. These areas were full as beds had been used for overnight stays. Staff told us, there were times when they felt unsupported by senior leaders in implementing pathways where the service was at full capacity. This resulted in delayed transitions of care for patients.

We also saw patients were staying longer on ward areas designed to care for people for up to 24 hours before they would be moved to a specialist ward or discharged to their usual place of residency. Staff told us that patients could stay for up to 5 days and we saw that one patient had stayed there for 21 days. Some patients were also not always seen in line with national standards of review by specialty within 24 hours of referral. For example, a patient had been referred to the gastroenterology team on 6 December 2024 and had not been reviewed by the team until 10 December 2024. This meant that patients may not always be in the ward suitable for their care and treatment or receive care in line with national standards.

There were a number of patients with additional mental health needs detained under a section of the Mental Health Act 1983 waiting for a suitable placement in another hospital at the time of our inspection. Staff reported that mental health liaison staff attended the ward to provide input for these patients. Staff on one ward explained how multi-agency meetings had taken place to try and find a placement or bed for a patient who required discharge. While matrons and managers had been supportive in trying to resolve this issue, the situation had impacted staff morale and there were times when insufficient staff were available to support the patient.

Staff carried out risk assessments on admission to wards to identify patients at risk of harm. These assessments included the risk of falls, tissue viability and adequate nutrition and hydration. We saw patient records were not consistently completed to ensure continuity of care and treatment.

Clinical records pathway tracked identified inconsistencies in the quality of care being provided in line with current guidance, such as NICE Clinical Guidance: Pressure Ulcers: prevention and management, Clinical guideline [CG179] Published: 23 April 2014 and NICE guidance Nutrition support in adults [QS24] Published: 30 November 2012. While tools for screening pressure prevention and management and nutrition and hydration needs were in place, we saw patient records were not consistently completed to ensure continuity of care and treatment, and staff did not always act on indicators of concerns and specialist advice. For example, one patient developed a hospital acquired pressure sore during the transition from the emergency department and acute medical unit to the ward. Records showed there had been a lack of oversight regarding this area of care delivery. Another patient’s records demonstrated staff had not delivered care and treatment in line with a dietitian’s advice.

The service provided audit information for a 12-month period, this information demonstrated areas where risk assessments had not been completed when required. For example, mental health risk assessments had been completed 19% of the time, wound assessments for pressure ulcers 69% of the time and cognitive impairment risk assessments 75% of the time. This meant patients were at risk of not receiving the required care and treatment to keep them safe.

The service’s latest completed record keeping audit also showed varying levels of assurance that patient records had been completed in line with best practice standards and national guidelines. The service had action plans in place to try and help improve standards.

Between September 2023 and September 2024, the percentage of patients who were discharged from the service on their agreed discharge date had been consistently higher than the national average. This generally suggests that the flow from hospital to patients’ homes or other services is better than most areas. However, the Hospitals Inpatient Survey 2023, demonstrated lower scores in patient experiences of hospital admission 6.5/10 and leaving hospital 6.6/10.

During our inspection, we found multiple challenges that impacted the timely discharge of patients when they were fit to do so. For example, some doctors told us the discharge process was fragmented and required a multidisciplinary approach, so all discharge letters were accurate and completed in a timely way. Nursing staff told us they spent a large amount of time chasing accurately completed discharge letters, which impacted on the amount of time they were able to spend with patients. These challenges impacted timely discharges and correct patient information being available on discharge to support ongoing care and treatment when required.

Some wards had a non-clinical discharge facilitator, who worked closely with the multidisciplinary team to prepare patients for discharge. They reported the biggest challenge to timely discharge was for mental health patients who required placements or mental health beds. As this was an area where the service was facing significant challenges, senior leaders worked closely with the local mental health trust, which also had some services on the same site, to try and find solutions.

Senior leaders explained the variance in availability in discharge to assess beds across different authorities which meant that patients were at times having to stay longer in the hospital.

The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They did not always share concerns quickly and appropriately.

Assessment Findings:

Mechanisms to ensure systems, processes and practices to protect people from abuse and neglect were not always effective.

The safeguarding policy outlined training requirements for staff, and these were in line with national guidance. The statutory and mandatory training policy identified that safeguarding training was mandatory. Staff confirmed they were supported to attend level 3 adult and children safeguarding as mandatory training though they did not receive any protected time for this. They were able to describe how to raise a safeguarding concern.

Mechanisms to ensure patients were not discriminated against and they understood their rights under the Mental Capacity Act 2005 and the Equality Act 2010 had improved. A mental health lead was part of the safeguarding team, and they reviewed all applications under the Mental Health Act 1983.

Further improvements were needed to ensure staff had a stronger understanding of safeguarding patients with mental health needs and undertaking enhanced supervision to keep patients safe.

The service had a service level agreement for Mental Health Act (1983) training, which was delivered once a month, but staff attendance was voluntary. Three yearly mandatory training in NHS conflict resolution (low risk) compliance rate was recorded at the time of our inspection at 89% and 3 yearly NHS conflict resolution (high risk) compliance rate was 63%. However, the compliance rates for 3 yearly enhanced Mental Capacity Act 2005 and Deprivation of Liberties safeguards were low with only 33% of staff completing this.

The service had an enhanced supervision policy and risk assessment processes. However, these processes were not consistently being followed, and out of the 12 enhanced supervision risk assessments we viewed, none of these had been fully completed.

Staff told us there were sometimes gaps in enhanced supervision arrangements and the use of agency staff led to variation in the quality of service. These inconsistencies meant patients were at risk of not receiving appropriate enhanced supervision in line with decisions made. This could leave patients and others at risk of harm, particularly given that at the time of our inspection, there were a lot of patients with complex needs and younger people due to a lack of children and young adults mental health (CAMHS) beds on medical wards.

The service held a risk summit with the integrated care board (ICB) following a patient safety incident in Summer 2024. While ligature training had been completed, re-considerations regarding staffing had not yet progressed.

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.

Assessment Findings:

People we spoke with had mixed views on the comfort of the environment and the levels of privacy and dignity they received.

There were dedicated estates and housekeeping staff deployed to maintain the environment, and housekeeping staff were able to describe the process for reporting and escalating issues of concern. However, the safety and upkeep of the environment were inconsistent, and potential risks to patients, staff and visitors were not always detected.

We saw the environment on the wards was mostly clutter-free. Clinical sinks were available for staff to wash their hands and call bells for patients to use if they required assistance.

However, we found inconsistent practices of storing medical gases in line with national guidance. On AMU East, we saw 3 oxygen cylinders not secured in line with Health and Safety Executive guidelines use of oxygen in the workplace. On Florence Nightingale, 5 oxygen cylinders were not secure and were stored in the corridor despite the nurse in charge requesting these be removed the previous day. Also, cleaning chemical products were not always secured in line with health and safety regulations (The Control of Substances Hazardous to Health Regulations 2002]. (COSHH)). This meant there was a risk of harm if patients, especially if confused, accessed and ingested this product.

We also found maintenance processes had not always been efficient. For example, on AMU East, there was a broken sink and a missing toilet door. The missing door was reported in November 2024 and not replaced. This indicated delays in maintenance work being completed promptly. There was also a broken macerator in the sluice room, with a notice to say this had broken again, indicating this was a regular occurrence.

On the majority of wards we visited we saw some fire doors had been wedged open. Fire doors, even those with retainers, should not be wedged open as they will be unable to close when a fire breaks out, even if they have the capacity to close themselves. This meant there was a risk to patients and staff in the event of a fire, especially for those patients being cared for in corridors, as staff may be unable to zone the ward appropriately.

We saw a blind with a loose pull-down cord in the waiting room on the Frailty Same Day Emergency Care (SDEC) Clinic, which could potentially be used as a ligature or result in accidental risk of harm. Blind cords and loops pose a potential danger to young children and vulnerable people. New blinds with looped cords must have child safety devices installed at the point of manufacture or be sold with the blind as outlined by the office for produce safety and standards. The services ligature risk assessment had been completed. This outlined the action for staff as visually inspecting and monitoring. It did not specifically outline any action regarding the cord on the blind.

Leaders had considered how environmental design, and the use of technology may support patient flow through the hospital to the most appropriate setting for their needs. For example, AMU East had an area designated as a bay for cardiac monitoring, and staff had access to up to 10 portable cardiac monitors if patients required this.

However, some wards were crowded, and the environmental design impacted the appropriate storage of equipment. For example, in the short stay/discharge lounge, we saw the adult resuscitation trolley repeatedly turned so the drawers faced the wall, impeding easy access. A senior nurse told us this was due to the design of the environment, as passing beds and trolleys kept knocking the tag seal off. Staff felt this was causing unnecessary checks as they had to complete a full check again to make sure there was no missing equipment and consumables that may be needed in an emergency.

The service did not always make sure there were enough qualified, skilled, and experienced staff. They did not always make sure staff received effective support, supervision, and development.

Assessment findings:

The service planned and managed staffing in line with a nationally recognised and evidenced-based safe staffing tool, considered the use of bank staff when staffing levels fell below these requirements, and had undertaken an annual staffing review with actions to be taken. However, we were not always assured staff had the required capability, skills, and training to adequately support patients with mental ill health.

Patients told us staff were busy, but this had not impacted in them being supported to meet their needs.

All but one ward we visited was fully staffed in line with requirements, though we saw staff working under significant pressure at times which impacted their availability to spend time with patients. Some staff told us they had not had a break and/or they found it difficult at times to take one.

We observed patients with mental health needs required additional support while in hospital or at the time of discharge. Staff with the right skills and capabilities to support these patients were not always available. However, ward staff could access specialist advice and support from the mental health liaison team 24 hours a day 7 days a week.

Managers told us they were able to access additional bank staff if patients required 1 to 1 support and we saw this happened during our inspection.

A medical staffing model was used for the acute medical unit with on-site consultant presence until 5 pm, with access to an on-call consultant, medical registrar, a middle grade, and junior grade doctor out of hours.

Leaders told us the service’s financial position impacted the available spend for the workforce and this presented challenges in the quality and skill mix of the medical workforce, with 18 percent of the medical workforce being locums. Leaders acknowledged challenges with the skill mix in both the nursing and medical workforce and they said staffing levels were discussed, reviewed, and amended daily. The service undertook a nursing staffing and establishment review in February 2024 with risks and options on future ways of working identified. The turnover rate for nursing staff was now decreasing and leaders stated there were few nursing vacancies across the trust.

Ward sisters had a process to track additional specialty competencies for staff and practice education facilitators supported staff to access any additional training required. For example, the respiratory ward accepted patients who required non-invasive ventilation (a breathing support delivering air). This non-invasive ventilation was only carried out by level 1 trained nurses who had undergone a competency check with the respiratory ward sister to ensure they could carry out the intervention safely.

However, staff did not always receive the support they needed to deliver safe care and treatment or undertake appropriate training relevant to their roles with opportunities to learn.

The services staff appraisal rates were showing 77% at the end of October 2024, and though this was improving picture, there was still improvement to be made.

We saw an incident on Florence Nightingale ward where de-escalation techniques would have benefitted both patient and staff member and avoided the incident escalating.

Staff had mixed views regarding the levels of training available to them. Some staff told us there was good access to mandatory training. Others expressed concerns about access to mental health training and sufficient training to manage and de-escalate situations when the need arose. Leaders acknowledged there were gaps in training for staff in managing ill health and de-escalation.

Training compliance for medical staff demonstrated compliance rates for mandatory training were mostly above 81%, except for dementia awareness, enhanced Mental Capacity Ace and Deprivation of Liberty safeguards which were at 37% and 33%, respectively.

Leaders told us there was a strong escalation process for incidents of poor practice involving temporary staff.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Assessment findings:

People we spoke with had mixed views on the cleanliness of the environment.

Staff assessed and managed the risk of infection control in line with national guidance.

Staff had clear roles and responsibilities regarding infection prevention and control (IPC) and each ward had infection control champions. Staff knew who the IPC champions were and could clearly describe the process for reporting infections.

Staff followed appropriate infection control measures when nursing patients with infections. Patients needing isolation were cared for in single rooms or were cohorted in bays.

There were handwashing facilities and personal protective equipment available. We observed staff mostly followed infection prevention and control (IPC) guidance, were bare below the elbows, washed their hands between patient contact and wore appropriate PPE.

We saw cleaning taking place and most of the environment was visibly clean and clutter free. The ward staff had documented evidence of daily cleaning of equipment, though staff told us there was sometimes a shortage of basic cleaning equipment such as mops and cloths.

There were isolated instances where the cleanliness and infection control procedures could be improved. For example, eradicating mould in shower areas on the short stay/discharge lounge and Florence Nightingale ward.

Monthly infection, prevention, and control (IPC) audits were undertaken across all wards which looked at standards. We looked at the results of these audits for two wards which showed not all wards were meeting the standards required. For example, in July 2024 only 1 ward was meeting the standards and again in September 2024 only 1 ward was meeting the standard. This occurred again in December 2024. There was only one month between January 2024 and December 2024 where all medical wards apart from one met the standards required. An example of the standards looked at in IPC audits are hand hygiene, bare below elbows and the use of personal protective equipment.

Monthly cleaning audits were carried out by a cleaning team supervisor, with staff given immediate feedback and actions for any improvements needed. On review of the audits these showed that compliance rates were in all cases meeting the NHS specification of cleanliness target score. These standards are for hospitals to assess the effectiveness of their cleaning services.

Information about the risk of infection was shared appropriately with relevant partners, people and visitors. For example, on the short stay/discharge lounge, there was clear signage throughout the ward and staff used green ‘I am clean’ stickers to indicate equipment had been cleaned and was ready for use and where people were being cared for in isolation, there was clear signage to demonstrate this and the actions to take.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

Assessment findings:

Systems and processes were in place to support the safe management and oversight of medicines in line with relevant legislation, best practice, and professional guidance, including the MCA 2005.

Staff used the Electronic Medicines Administration System [EPMA] system for detailing patients medicine records and allergies and recording administration of medicines. Staff had to complete training and be signed off by the pharmacist for them to be able to access this system.

Controlled drugs were checked every 24 hours and emergency medicines were checked daily and in the event of use, replaced immediately.

Pharmacists and ward staff completed audits, the results of which were discussed at a monthly governance meeting and with champion link nurses and ward staff. A specialist pharmacy team managed drug errors and missed and late doses visiting wards appropriate to these incidents. Staff on Lionel Cosins ward told us the main issue were staff shortage impacting timely administration of medicines.

However, we found inconsistencies in storage and administration of medicines on the three wards/units we visited. For example, while medicines on AMU East were administered and stored correctly and securely, on Florence Nightingale we found concerns. For example, loose strips of medicines, an insulin pen with no date opened or the name of the patient on it and an empty insulin pen in the drawer. We also found patients’ blood glucose levels had not been recorded accurately or consistently which meant the records were not clear regarding the blood glucose management.

Patients did not always receive their medicines as prescribed when transitioning through their pathway. For example, patients often arrived on Lionel Cosins ward from the emergency department having been there 24 hours without having time sensitive and high-risk medicines such as Parkinsons disease, epilepsy medicines, and insulin. Staff had raised an incident each time but there had been no improvement.

The discharge coordinators liaised with other partners such as care homes to make sure patients had the required medicines on discharge. While discharge letters were sent to GPs, staff on AMU East told us that sometimes medicines were missed so they would correct the documentation and resend this as needed.

Adult resuscitation trolleys on Laindon West and AMU West were stored in line with Resuscitation Council (UK) guidelines with the drawers sealed with a tamper evident tag. There were no gaps in daily and weekly checks and all items were present. Staff could access ligature cutters, stored in the emergency trolley.