Basildon University Hospital

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At this assessment we rated this key question as requires improvement. This meant people were not always treated with kindness, dignity and respect.

Staff were under significant pressure from the demand on the service during our assessments and we observed they did not always treat people with kindness and compassion.People did not always feel well-supported, cared for or treated with dignity and respect. We observed examples when patients’ immediate needs were not provided when needed or their dignity was compromised.
The service did not always provide care and treatment tailored to the individual needs of patients. We saw staff were under significant pressure due to the demand on the service and this meant they did not always treat people as individuals.

Whilst the trust had booklets to help patients living with dementia communicate their needs, we did not see these in use, despite observing patients who would benefit from these.
The service did not always support staff wellbeing effectively and staff told us they often felt undermined or not listened to by other senior health professionals. Staff did not always feel safe, and several staff told us about incidents of violence and aggression from patients and their relatives towards them. The staff survey showed staff in the department experienced more violence and aggression from patients and staff than the organisation average.

Staff arranged appropriate discharges where this was safe for people to return home, such as with prescribed medicines. Staff also made sure patients were not discharged into an unsafe environment and liaised with care organisations and community teams.

This service scored 50 (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 treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not treat colleagues from other organisations with kindness and respect.

Staff were under significant pressure from the demand on the service during our assessments and we observed they did not always treat people with kindness and compassion. We observed a patient laying on the floor of the waiting room for most of the afternoon on 17 December 2024. We spoke with the patient who told us they were unable to sit on a chair because they felt so ill. They also told us several staff had passed them but had not checked on them. We spoke to the patient again the next day. They had been accommodated in a seated area overnight but couldn’t sit up so laid on the floor to sleep. The patient and several other patients told us staff had shouted at him to get up in the morning, as a result other patients were moving from their seats to try and help the patient lay down.

We observed limited interaction between staff and patients in the waiting room. We saw patients in obvious distress who were not always being supported by staff. We were told by a relative that their loved one was in discomfort as they had soiled themselves and when they raised this with staff they were told ‘they will have to wait their turn’.

The 2024 urgent and emergency care survey showed that the trust had performed worse than expected, when compared to other trusts, for the question on while you were in the waiting room were you able to get help with your condition or symptoms from a member of staff.

Patients’ privacy and dignity was not always maintained. Due to overcrowding in the department patients were in close proximity with each other and were cared for in open spaces without privacy screens. We observed a doctor examine one patient's abdomen with their breasts exposed in the corridor with other patients present. We observed another patient ask for a urine bottle. After 8 minutes, they were provided with a device but had to urinate in a corridor with no privacy screen. There were 6 female and 6 male patients present, and they could see each other.

We also observed a patient with a hospital gown that had slipped off and left them exposed. The patient was asleep and was unaware their dignity was compromised. We observed staff making no effort to cover up the patient to maintain their dignity until we alerted staff. Privacy curtains were available in this area but not used on this occasion.

However, we did see some caring interactions between staff and patients. For example, we observed a staff member supporting and encouraging a patient who mobilised with a stick to the toilet.

The service submitted their friends and family test survey results for September to December 2024. The NHS friends and family test asks patients to rate their experience and allows them to leave comments. Patients gave mixed feedback on staff, while some patients commended the kindness and compassion shown to them others raised concerns over staff attitude for example, being ignored, poor communication or not having their health condition respected. Patients consistently wrote about staff doing their best under pressure and excess demand. We also spoke to a patient during our assessment who told us they felt the staff were “amazing” and “could only work with what they had”.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Independence, choice and control during this assessment. The score for this quality statement is based on the previous rating for Caring.

The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

We found there were significant delays for patients when they first arrived at the hospital due to the overcrowding in the department and the navigation process. This meant there was a delay in responding to people’s immediate needs which included care needs, pain relief and nutrition and hydration.

There were delays in responding to people's individual needs when patients needed support. For example, on the first day of our assessment we observed that a patient living with dementia had been able to climb over the bed rails which had been used to keep them safe. We also saw another patient who was confused and disorientated walking around the department whilst they were still attached to an intravenous fluid line. A member of the assessment team supported the patient to ensure they were not at risk of falling and alerted a healthcare assistant in the vicinity and asked for their help. The staff member stated, “I’m sorry, I don’t work here I am just passing through.” A member of the medical team and a nurse did eventually respond to our call for help. A similar incident happened on the second day of our assessment and after us supporting the patient a member of the frailty team attended to them.

We also observed a patient who was living with dementia and accommodated in the majors’ seated area. The patient did not understand they needed to wait in the area or why they were there.

Patients and those close to them including relatives and family members’ views and experiences were mixed. Some told us that staff were attentive to their needs, but some others told us they were not always communicated with or responded to in a timely way when support was required. This was also a theme reported in feedback about not providing enough information in the provider’s October and December 2024 FFT surveys.

We spoke with a person who suspected a blood clot, and they were worried this would cause more serious harm. Although there may have been a legitimate reason to exclude a family member or chaperone, staff had not explained to them a reason why they could not have anyone accompany them to the treatment room.

The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

The service did not always support staff wellbeing effectively. Staff told us that when incidents had occurred there had been no reflection or debrief on the event to support staff after the incident. Reflection is a helpful tool to help staff think about their feelings concerning the incident and how something similar could be avoided in the future. We heard from staff after a recent distressing incident, they had to arrange their own support within the team. Senior nursing staff told us they had organised for a psychologist to hold debriefs for staff 3 or 4 times, but this was not usual practice and embedded in the culture. They also told us that the felt there had been little effective action taken to address their concerns to support them to deliver person-centred care. For example, the acuity of patients in the department and shortfalls in staffing.

One senior staff member told us they had felt they had not been supported when they represented the organisation in a stressful process.

Staff worked hard to foster relationships with other senior health professionals but told us they felt they were often undermined or not listened to. Staff told us they were under pressure from senior leaders to improve patient flow, reduce waiting times and to manage with an insufficient number of appropriately skilled staff. They felt there was a disconnect with senor leaders and raising concerns had not resulted in any progress. Also, we were told that there had been an impact on staff wellbeing due to changes to the overall management structure in the department being implemented without much consultation as to the date of this being put in place.

Staff did not always feel safe. They told us they sometimes found it challenging when managing escalating behaviours of patients with mental health needs and had experienced an increase in violence and aggression, which included assaults from patients and other visitors. Some staff had experienced serious injuries which had required them to take time off work. During our assessment, there was an incident where a member of the public had brought a dangerous dog into the department and was threatening staff. We also heard about an incident where a petrol can was thrown into a triage room.

The staff survey results for division 1 (emergency department and acute medicine) showed staff had experienced nearly 3 times more violence and aggression than the organisational average from patients and more violence and aggression from colleagues and managers. The results showed 30.3% of staff in division 1 had been subject to physical violence from patients, family members or the public compared to an average of 11.7% in the rest of the organisation. Over half of staff in division 1 (57%) had experience bullying or harassment from patients, their family or the public compared to an organisation average of 30%.

The staff survey showed that 5% staff had experienced violence from managers in the service as opposed to an average of 1% in the rest of the organisation. The survey also showed more staff had experienced bullying and harassment from managers (20.9% against an organisation average of 14.6%) and colleagues (28.8 against an organisational average of 22.7%).

Only 34% of staff within the ED had completed resilience training. However, the provider had recognised this in governance meetings and had plans to improve this level of compliance.

In response the service had agreed to fund and implement the use of body cameras to help support staff in any incidents. However, these had still not been provided at the time of the assessment.

Staff told us the department was “not a happy place to work” and recent benefits such as an extra day of birthday leave had been removed, and the study leave policy had changed to only fund 50% of leave. This lowered staff morale at a time when they were dealing with significant challenges in the department.

The trust submitted data which showed staff sickness rates were consistently above their target of 3.5%. Data submitted by the trust showed sickness rates were 9.82% for emergency nurse practitioners, 4.74% for nursing staff and 6.78% for administrative staff. The overall national rate is 5.6%. Staff survey results showed 41% of staff in the service had felt pressure from their manager to come to work when sick compared to an average of 24.5% in the rest of the organisation.

We did, however, find examples of good practice. These included examples of staff being supported on their return to work in positive way and appropriate support available for staff who had experienced trauma at work. Staff had access to an online or telephone employee assist programme with a variety of support mechanisms including, wellbeing, trauma and work or personal life related stress. Staff could also get support from occupational health teams.