Basildon University Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Assessment findings:

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. We assessed 3 quality statements on leadership and governance.

At our last inspection, we rated this key question requires improvement.

The service was in breach of the legal Regulation for Good Governance following the inspection which took place July 2023. During this inspection, we found the service had continued its improvement trajectory, though there was still more to do.

At this inspection the rating has remained Requires Improvement, and the service remained in breach of the legal Regulation Good Governance.

The service had a shared vision and culture, based around the strategic intent and values of the organisation. Staff feedback was mixed regarding the effectiveness of this, and we saw organisational challenges sometimes impacted staff maintaining this.

Leaders had the skills, knowledge, experience, and credibility to lead well. However, at times they were not visible enough to staff and patients to understand the context in which the service delivered care, treatment and support and the impact of this.

There was a clear system of governance and risk management based around delivering safe and good quality care and treatment. While these had supported improvement, further improvements were required and these needed to be sustained.

This service scored 61 (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 clear shared vision and strategy, but not all staff felt empowered and involved in the direction of services and that they were supported in a positive, compassionate, and listening culture. Staff did not always feel able, under pressure and challenges, to provide care in line with the values of the service.

Assessment findings:

The service had a shared vision, strategy and culture which embraced diversity, inclusion and engagement, equity and human rights. The service had set goals with identified actions and timescale covering areas such as the provision of high-quality local services, equitable access, and opportunities for staff. For example, providing harm-free care, embedded processes for the completion of mental capacity assessment, and Deprivation of Liberty Safeguarding and patient engagement.

Staff feedback about the mechanisms to support the shared vision, strategy, and culture was mixed. For example, most leaders involved in strategic meetings felt involved and empowered in their role and understood the service’s vision. Other staff did not always feel supported within a positive, compassionate, and listening culture They told us this impacted their understanding of the service strategic direction and their roles within this.

During our inspection, the hospital was in escalation and under significant pressure with an increasingly full emergency department, ambulances queuing, escalation wards in use, and patients boarding under the Full Capacity Protocol. While staff told us there was a significant focus on discharge, we found there was no longer a focus on discharge from the time of admission. We saw patient discharges delayed on the wards and in the discharge lounge due to chasing discharge letters and take-home medicines.

Mechanisms to monitor progress against the organisations vision and Equality Diversity and Inclusion Strategy 2021-2025 were in place to facilitate progress of agreed aims and objectives. The Equality Diversity and Inclusion Strategy outlined an understanding and promotion of equality, diversity, and human rights to prioritise safe, high quality compassionate care and address any causes of workforce inequalities.

The organisation’s values were posted around the hospital. Staff when asked were generally able to tell us what these were. However, they told us they did not always feel they and their colleagues were able to meet all of the values when they were under pressure

The senior leadership team, including clinical and operational leadership were open and honest demonstrating an understanding of the challenges and risks faced within the service. They were working to mitigate these and put actions in place to address them going forward. However, we were not fully assured as recruitment was ongoing, and we found areas of concern during our inspection that the leadership structure did not always promote a collectively positive experience.

Assessment Findings:

Senior leaders explained the service was in the middle of a leadership restructure with some recruitment ongoing. Previous postholders remained in place with contingency plans to ensure there were no gaps in leadership while the process was being completed.

The service had mechanisms for recruitment and succession planning to promote high-quality leadership, organisational vision, and risk management. However, we were not assured of the effectiveness of these systems and processes as at the time of our inspection they were very new, not fully embedded and results were not yet visible.

In the new structure, acute medicine would sit alongside emergency medicine with the same leadership. The service planned to have a clinical director in post in January 2025.

Senior leaders aligned leadership responsibility of acute medicine, such as the acute medical unit, felt changes had been implemented very quickly with no clear plans for resolution. They expressed that the changes had happened very quickly, and communication could have been better.

The organisation’s Equality, Diversity and Inclusion Strategy 2021-2025 included the aim of inclusive leadership. The purpose of this was to champion equality and diversity through a consistently inclusive approach, including design and delivery of healthcare that understood and met diverse needs, and a valued workforce that felt able to perform to their full potential.

The triumvirate programme enabled medical, clinical and managerial leaders to come together to build upon personal and team leadership and change agent capabilities. These leaders told us they felt the executive team and leaders were visible to staff and patients.

During our inspection, we saw several leaders visit the wards, where they modelled inclusive behaviour and values.

Most staff spoke positively about the leadership team and the support offered to them. Other staff felt leaders lacked understanding of the context in which they delivered care and treatment and the impact this had on the quality of patients’ outcomes and experiences and staff wellbeing. These staff reported not feeling supported and guided effectively by the leadership team. For example, the concerns raised regarding the discharge process and changes instigated in the acute medical units without all leaders of the departments being included in the process.

The service fostered a positive culture where people felt they could speak up and their voices would be heard.

Assessment Findings:

The service had mechanisms to enable staff and leaders to act with openness, honesty and transparency, which actively promoted staff empowerment to drive improvement.

The service had established Freedom to Speak Up (FTSU) mechanisms which were displayed on the service’s website.

Staff were aware of how to raise concerns. The majority of staff felt supported to speak up. A few staff told us they did not always feel listened to which prevented improvements being made.

The service worked in partnership with the Guardian Service to support the Freedom to Speak Up agenda for its staff. A FTSU report was shared with the executive team monthly and discussed at a monthly meeting. This gave the executive team access to themes of concern that had been raised by staff and provided an opportunity to understand the issues being raised, reflect on themes emerging, and determine the next steps needed to support improvement on an ongoing basis.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

While the service did have clear responsibilities, roles, systems of accountability and good governance, they did not always act on the best information about risk, performance and outcomes. We found areas of concern during our assessment which in some cases demonstrated a downward trajectory in terms of performance and improvements not being sustained.

Assessment findings:

The service had systems of accountability and good governance, including current and future performance, and risk management.

Triumvirate leaders met weekly to discuss the winter plans. They acknowledged that the current plan still left a deficit of 400 beds by February 2025. They told us they had seen greater demand than expected, therefore they were reviewing elective activity to support flow through urgent and emergency pathways.

The service held regular governance meetings to investigate incidents with actions overdue, complaints, patient experience surveys, risks and operational performance.

The divisional governance group monitored the services risk register which included assurances in place, further assurances required and actions to mitigate the risk. However, we were not assured of the effectiveness of the oversight of the risk register as some actions and mitigations for identified risks had been on the risk register since 2021 with no resolution, demonstrating mitigations were either not working or incomplete. For example, mixed sex breaches in the acute medical unit and mental health patients being cared for within the acute settings. At the time of our inspection, the highest risk was mental health patients in acute beds and the lack of 7-day services for endocrinology patients.

National guidance for delivering same-sex accommodation states that providers of NHS-funded care are expected to have a zero-tolerance approach to mixed-sex accommodation, except where it is in the overall best interest of all patients affected. However, governance arrangements to effectively manage environmental design, system flow pressures and service demand resulted in AMU East sometimes having to flex the departmental model to accommodate demand. As a result, some patients received care and treatment in a mixed sex ward which was not conducive to maintaining people’s privacy and dignity. The service had already acknowledged this, giving patients letters to explain and apologise.

Staff had a systematic method of auditing and reporting a range of data to facilitate leaders’ understanding of performance, key risks, and any quality improvements. Leaders undertook audits for the compliance of completion of risk assessments for key elements of patients’ needs. However, throughout our inspection, we saw areas that needed improvement despite these processes being put in place. For example, compliance with IPC audits was on a downward trajectory and the completion rates for some risk assessments were low. This meant we were not assured that systems and processes were fully effective and allowed for improvements to be sustained.

Governance structures did not always maintain securely an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided.

Mechanisms for records and data management, including integrity and confidentiality, needed improvement. Leaders acknowledging this had awarded a new contract for an electronic patient record which was due to go live in 2026.

Throughout our inspection, we saw potential breaches of data protection legislation in several wards where records were not secure. For example, patients’ handwritten notes were stored in open trolleys and the central monitoring screens, which displayed patient names were in public areas. We also saw there was potential for the public to access consumables, patient identifiable information and controlled drug registers as doors to rooms where these were contained were propped open.

On a number of wards, whiteboards and screens could be observed by the public and we found an unattended and logged on computer with patient handover details displayed, together with patient notes in slots in the ward corridors. We also observed a staff member recording a patient’s test results on a paper towel and leaving a handover sheet unattended on a trolley. This meant there was a risk that patient information could be accessed, amended or destroyed by those not authorised to do so.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Assessment findings:

The service was committed to working in partnerships with the local communities so it could understand the needs of the local populations when planning, developing and implementing improvements in the service. Current and previous patients, carers and staff were invited to become members of the service so they could support this approach too. There were more than 35,000 public members and over 15,000 staff members who were kept informed about achievements and plans for the healthcare services delivered.

Services worked together with key stakeholders. For example, Healthwatch and patient safety partners. This enabled the service to hear the voice of the patient and report on and share information.

There were a variety of services that supported alternative admission and admission avoidance, particularly for frail older people. As part of these arrangements, community and hospital teams worked together to raise awareness of the Frailty Virtual ward and how to refer and develop referral pathways.

The service had a system for identifying and engaging community partners to support discharge. At the daily discharge meeting people from across the hospital, including the integrated discharge team and the Hospital at Home team worked together to discharge patients, particularly those with more complex needs. We observed discussions about reaching out to community services to prepare a home for hospital equipment, identifying ambulances and care homes in the community that could accept bariatric patients, and liaising to support a European, non-English speaking patient.

Shortage of packages of care within the community sometimes impacted on patients being discharged in a timely way. Nevertheless, we observed staff had good relationships with care providers and ambulance staff so they could negotiate patients being discharged in the community as quickly and safely as possible.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Assessment findings:

The organisation had a service wide Quality Improvement (QI) program. The improvement team supported several priority improvement programs. For example, a program to improve discharge 'home for lunch'. This programme aimed to discharge one patient from each ward every day before lunchtime. We saw signs on wards about the program and staff were aware of it. The team was also supporting programs as part of the urgent and emergency care improvement plan to make the daily discharge meeting more efficient, improve length of stay and improve discharge summaries on wards where audits reflected improvement was required.

The Unplanned Care and Flow Portfolio Group incorporated workstreams aimed at improving service design and delivery to improve end-to-end patient flow throughout the Integrated Care System. Oversight of the delivery of these programmes of work were all led by senior responsible officers assigned to delivery.

The service undertook research projects such as Understanding Cardiac Fibrosis to support improved patient outcomes.

Patients, their families, and friends were able to complete feedback forms. The Inpatient Survey 2023 highlighted feedback on care was worse than expected. While we saw inconsistencies in scores across the department, leaders were aware of these and had plans to improve patient experiences and outcomes.

Nurse ‘grand rounds’ which all nursing staff could attend, included topics such as the research strategy, dementia and falls which all nursing staff could attend. ‘Grand rounds’ are a methodology of medical education and inpatient care, consisting of presenting the medical problems and treatment of a particular patient to an audience of specified staff or a multidisciplinary grand round.

Leaders were part of a frailty task and finish group, working with other system partners. This had identified a need to expand virtual wards, both in terms of capacity and access, as they currently closed at 6pm. Leaders told us 5 quality improvement workstreams included virtual wards and an element of this was to implement a single point of access. This would enable care home staff to refer to the virtual ward and prevent hospital admission.

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 for any learning.