Basildon University Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At this assessment we rated this key question as requires improvement. This meant that people’s care, treatment and support to achieve good outcomes were not always effective based on best available evidence. The service was in breach of legal regulations in relation to assessing risks to the health and safety of patients.

Patients did not always have a timely assessment of their needs. There were processes and policies in place to plan and deliver people’s care and treatment in line with legislation. However, staff did not always plan and deliver care in line with legislation and current evidence-based good practice and standards. Patient notes were often incomplete and confusing which meant staff could not always understand the health needs of the patient. Patients pain was not always effectively assessed and managed to minimise discomfort.

Patients did not always have their nutrition and hydration needs met. Patients were not offered or able to easily access food and drink in the form of anything substantive or light snacks and drinks apart from breakfast.
Whilst the service completed audits, we did not see evidence that the results were used to improve outcomes for patients.

There was no internal professional standards document which described the expected behaviours and values of all professionals and teams in the hospital and we saw that teams did not come to together to work in the best interests of patients. Staff told us and we observed that medical and nursing staff did not work together to ensure the needs of the patient were met.

The service used standardised tools for triage and identification of stroke which helped ensure the most critically ill patients were assessed and treated appropriately once they had been triaged. Readmissions within 7 days were lower than the national average.
The service provided information to patients after their visit in a way they could understand and use to care for their condition at home. This was reflected in the national urgent and emergency care survey.

The service had up-to-date policies and procedures regarding consent and the Mental Capacity Act 2005, Mental Capacity Act (MCA), mental health awareness and Deprivation of Liberty safeguards DOLs.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The trust’s intranet contained a wide range of up-to-date policies and standard operating procedures which reflected current practice. For example, staff could access key guidance to support collaboration with multi-disciplinary teams and for delegation of clinical tasks to ensure the right people delivered evidence-based care and treatment. We also saw there were updates to safety briefings and newsletters when new policies or guidance was implemented. However, we found staff did not always know the learning from the safety briefings so we could not be assured this was effective. We also saw that although the service had policies, these were not always followed particularly at times when the demand for treatment outstripped the capacity.

The service had a process of to ensure clinical guidelines and policies were developed and reviewed in line with National Institute for Health and Care Excellence (NICE), the Royal College of Emergency Medicine (RCEM) and other relevant bodies. Policies and protocols were accessible on the hospital’s intranet. The service aimed to complete a baseline assessment within 3 months of new clinical guidance being issued and progress to full implementation of guidelines and quality standards was tracked.
Patients at this service consistently spent longer in the emergency department (ED) than the national average and increased during the winter months. Data from the NHS national survey for urgent and emergency care patients showed the percentage of patients treated within 60 minutes at Basildon Hospital was lower than both the overall trust and national averages. The latest data, for 25 November 2024 showed that 21% of patients were treated within 60 minutes at Basildon compared with 32% for the trust overall.

Readmissions within 7 days, were higher at the time of our assessment than in 2023 and there had been an increase in January 2025, however they were still lower than the national average.

Many patients did not have their nutrition and hydration needs met. Patients were not offered or able to easily access food and drink in the form of anything substantive or light snacks and drinks apart from breakfast. Due to the long waits and number of patients in the department on Tuesday 18 December we were told by the senior team that patients would be given hot food. However, patients who had been in the department overnight told us they had not received food. The food and drink vending machine was out of order and the water dispenser was dirty.

The service had standardised assessments to help ensure the most critically ill patients were assessed and treated appropriately. The service used a standardised triage tool to assess patients after they had seen the navigation nurse. This helped stream the patients to the right area of the department. Apart from waiting times, most patients were positive about the triage assessment they received. We also found that due to a complex and ineffective booking process, the triage assessment could be significantly delayed and therefore less effective.

The service used the Recognition of Stroke in the Emergency Room (ROSIER) scoring system to distinguish between acute strokes and symptoms that mimic a stoke. If the patient’s score was above 1, staff could put out a stroke alert and the stroke team would come to the department to review the patient. The navigation nurses could carry out this assessment when they saw a patient. The trust December 2024 board minutes showcased a patient story who had received diagnosis and treatment of stroke within 38 minutes of attending the department.

The service did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services.

There was no internal professional standards document which described the expected behaviours and values of all professionals and teams in the hospital and we saw that teams did not come to together to work in the best interests of patients.

Staff told us and we observed that medical and nursing staff did not work together to ensure the needs of the patient were met. Nursing staff from different areas of the department repeatedly told us doctors would not accept referrals or give support because they were “just nurses”. We saw patients who met the criteria for referral pathways, but nurses would not refer them because they thought their referrals would not be accepted. This meant that patients often waited longer in the emergency department than needed.

The service did not have an effective working relationship with medical specialities in the hospital. Staff told us, and we observed, that there was often a delay in specialities reviewing patients who had been referred to them in the department and speciality doctors did not view the emergency department as a priority.

In addition, where patients had been referred to the department by a healthcare professional, such as a GP, these patients had to queue to be seen and subsequently reassessed. The complex booking in and triage process created further delays to assessment and any subsequent treatment.

The service did not always work well with other medical specialities to support patients. There as a lack of multi-disciplinary team communication with the GPs that were reviewing patients in the department. This meant some patients moved between the emergency department without their needs being handed over to staff. Whilst specialty staff reviewed patients following referral, this regularly took longer than 30 minutes which delayed specialist care and slowed admission to a ward area.

Staff did not always have access to the full patient records, although they could access some information to support patient care. For example, only medical staff could access patients’ medical records and prescribed medicines on the electronic system. This caused unnecessary delays and risks for patients who experienced delays for up to 24 hours. Agency staff could not access records and had to ask permanent staff to do this for them. This meant delays in accessing patient information.

The service worked with the local community trust to care for patients with mental health needs. Staff and leaders in the emergency department had significant concerns about the provision of care for patients with mental health needs and recently closed the suite used to assess and treat patients presenting with a mental health complaint. However, there was a mental health urgent treatment centre run by the community trust, which was open 24 hours a day, 7 days a week. If a patient was attending the emergency department with a physical and mental health need, they would need to be treated physically before going to the mental health urgent treatment centre.

We heard there was not always a good working relationship with the community trust, and we heard there was no communication for some patient handovers and at times the mental health urgent treatment centre closed but did not give the department any warning.

The executive team was aware of the challenges in managing care for the high number of mental health patients, whose length of stay had increased significantly. Senior leadership teams were working with NHS England who were organising an urgent risk summit and system partners regarding this issue.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

There was insufficient evidence to show the service routinely monitored people’s care and treatment to continuously improve it, or if it was monitored, it was not being effectively reported. Staff did not always ensure evidence showed outcomes were positive and consistent, or they met both clinical expectations and the expectations of people themselves.

The service collected data in line with the Royal College of Emergency Medicine (RCEM) standards which tracked their performance against key indicators such as infection prevention and control, care of older people, pain in children, consultant sign off and mental health. However, the action plans associated with these audits were brief and did not always document the action taken and how this was reviewed to show improvement. For example, one infection prevention and control (IPC) audited stated that IPC guidelines could not always be adhered to due to overcrowding in the department. However, the action plan was sparse and did not document how this would be addressed and reviewed.

The service completed local audits in the department such as the time taken for ECGs to be performed, medicines and infection prevention and control but we did not see evidence that the results from these reports were used to improve outcomes for patients. For example, the infection prevention and control audit data showed low compliance but there were no clear actions to address this. The audit for performing clinical observations showed consistently low compliance throughout 2024 and whilst actions had been identified, this did not improve patient care.

The service participated in the urgent and emergency care survey 2024. Its aim was to assess patient experience in the emergency department including wait times, communication and overall quality of service. The service was rated as worse than expected for waiting, better than expected for providing information to support patients’ recovery at home and about the same in the other 9 sections of the survey. Whilst there was evidence the service had identified patients were waiting longer, the focus of the actions had not addressed the wait for navigation and to book in at reception which was a significant concern raised by patients.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service had up-to-date policies and procedures regarding consent and the Mental Capacity Act 2005, Mental Capacity Act (MCA), mental health awareness and Deprivation of Liberty safeguards DOLs.

Staff received training on the Mental capacity Act (2005) (MCA)) and they understood how to apply this legislation relating to consent. However, we found that patients’ mental capacity and consent were not always recorded on patient assessment records. Also, as part of the provider’s December 2024 MCA audit assessment summary, the average score to questions answered correctly averaged only 80%. There had been some improvement from the previous month where some scores were 0%.

Staff understood the importance of consent when delivering care to patients. We observed staff seeking consent from patients and documenting this where needed.
Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.

In addition, the number of patients subject to an appropriate Deprivation of Liberty Safeguard (DoLS) had increased, showing a good understanding of the MCA and its application in helping to keep patients safe.