Basildon University Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At this assessment we rated this key question as requires improvement. This meant people needs were not always met.

The service did not always make sure people could access timely care, support and treatment when they needed it. There was crowding in the department from both increased patient numbers, but also the unmet demand for ward beds for emergency department patients in a hospital often at full capacity. Patients also remained on ambulances for several hours with the crew unable to return to patients in the community.

People’s individual needs were not always recognised and supported. Care plans and assessments we reviewed did not always reflect the patients physical, emotional and social needs. Patients living with dementia were accommodated out of sight of nursing staff and there were very limited dementia friendly initiatives for patients in the department.

The service did not always act on feedback from patients to improve the service and where patients had made a formal complaint the actions taken had not always led to improvement in care for patients. However, the service did offer apologies where it had recognised a need for improvement and gave feedback to people who made complaints.

Whilst the trust had identified in their strategy the need to engage with communities to design services, we did not see any evidence the service had worked with local community groups to deliver services tailored to the local population needs.

The service provided information to patients in a way they could understand and met the Accessible Information Standard (AIS). The service also offered a variety of ways of communicating with patients.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People’s individual needs were not always recognised and supported. We reviewed several assessments and care plans and found they were not always reflective of people’s individual physical, emotional, and social needs. This meant there was a risk that staff may not respond to any relevant changes in people’s needs.

We also observed patients living with dementia or confusion and were accommodated in seated areas or out of sight of nursing staff. This meant, staff were not always able to see when patients required help and, on some occasions, the assessment team had to intervene to help patients living with dementia to stop them hurting themselves.

The lack of permanent learning disability specific staff members created a risk that patient care for this patient group, would not be as person centred as it could have been.

Staff told us there was access to a quiet room if an autistic person or person with a learning disability needed it. This was important as individuals with autism and learning disabilities can experience sensory overload, where their senses become overwhelmed by external stimuli.

The provider had a range of religious support facilities and ways in which patients' faith could be supported if needed.
Digital flags could be added to patient records to highlight if the patient had specific needs. There was a flag available for patients living with dementia but no way to highlight if a patient had a learning disability.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Part of the trust strategy was to make sure the local communities they serve thrive and pledged to work with communities to design services to meet their current and future needs. However, we did not see any evidence the service had worked with local community groups to understand it’s population and deliver service tailored to the needs of local people. The strategy for care group 1 highlighted the need to relaunch patient engagement schemes, for example patient representation at key service meetings.

Apart from one sign on a toilet door, we did not see any consistent adaptions for patients living with dementia. For example, there was no changes to the décor or equipment such as accessible clocks to make the department more accessible for patients living with dementia. This meant patients living with dementia may not be able to access facilities as easily.

The provider recognised various patient groups who may attend the emergency with protected characteristics including those for age, gender, ethnicity and patients from areas of deprivation who were likely to need emergency treatments. This was a regular subject covered in board meeting public papers. In addition, various system partners within one local authority were supporting the provider with a public health officer in January 2025 to support work on health inequalities.

Patients with mental health support needs were being managed better with community care and support from system partners. This improved the quality of care, helped reduce or negated a need to attend the emergency department and benefited patients by being see and helped n by appropriate health professionals. The recent closure of the mental health suite in a short timeframe, meant the trust had recognised improvements were needed and they were making progress to address this matter.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The urgent and emergency care patient survey showed patients rated staff explanation about why tests needed to be carried out, the results of tests and information provided about the same as other services. However, patients rated the information provided more helpful than average to help them care for their condition at home.

The service offered a variety of systems and ways of communicating with patients. These included a text messaging appointment reminder, virtual video appointments, a digital health platform designed to give patients more control over their health information and care portal for patients aged over 16, and NHS Wi-Fi. This enabled access to multiple health and care system and a more equitable system to access healthcare.

The Accessible Information Standard (AIS) is a legal requirement introduced in 2016 to ensure that adults and children who have a disability, impairment or sensory loss receive information in a way that they can access and understand, and any communication support that they need is identified, recorded and provided. Information provided by the service met this standard.

Whilst we observed and staff told us there were processes to translate information for patients, their families and carers into different languages and staff knew how to access these. Staff also told us they were regularly unable to get support in the language they required. The service had no oversight of this concern as there were no audits as to the interpreting services effectiveness.

The trust’s latest CQC urgent and emergency care survey (2024) showed patients’ experiences were worse than the NHS national average for being informed about the length of waiting times. We observed there were no facility to inform patients of waiting times for triage or to be seen by the doctor. This was also highlighted as a concern from patients in the friends and family survey data.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

There were various means for patients or their representative to provide feedback about the quality of their experience and treatment in the emergency department. These included the Patient Advice and Liaison Service (PALS) who offered confidential advice, support and information on health-related matters, written and verbal complaints, compliments, staff surveys, friends and family surveys and speaking with staff.

The service did not always act on feedback from patients to improve the service. The service submitted data showing their friends and family test (FTT) data for September to December 2024. This contained negative feedback from many patients regarding a lack of hot food and access to fresh water. Patients we spoke with complained of a lack of access to food and drink as well as how dirty the department was, 24-hour delays in the administration of medicines and also about delays over 24 hours to receive treatment. This not only increased the risk of harm it put people at risk of ongoing harm. This was a significant and consistent theme in concerns reported to, but the service did not act on concerns when they were raised.

Similarly, patients had raised concerns about the environment over a long period of time including in the FFT surveys throughout 2024. For example, people reported the environment as “disgusting” and “worst hospital facilities I have ever seen”, being unclean, poorly maintained, and littered with debris. Several people reported the ED toilets as being poorly managed or cleaned, despite reporting the condition of the toilets “numerous times”. These concerns had not been addressed by the service.

Patients could also feedback directly to staff treating them, such as if they were in pain, a lack of food and drink or the length of time spent waiting. Patients we spoke with on all 3 assessment days, had concerns about the length of time to be triaged, being ignored when in pain and a lack of dignity.

Where people had raised complaints, the actions taken had not always been effective. For example, themes of complaints included a lack of observing patients, the attitude of staff, the provision of effective pain relief, the standards of hygiene in the waiting area, and a lack of support for patients who required reasonable adjustments. However, we found examples of all these still occurring during our assessment.

The trust submitted data that showed 34 complaints had been made to the emergency department by patients from 1 July to 31 December 2024. Of the 34, 21 were classed as clinical treatment, 5 staff attitude and 3 related to admissions, discharges and transfers.12 of these mentioned a poor staff attitude or behaviour.

There were processes and means to learn from complaints, such as staff reflective practice, additional senior support and staff briefings. However, although these took place, the learning had not effectively implemented which we observed during our assessment.

The provider offered apologies where it had recognised a need to improve and fed back to complainants. Anonymity was also respected where this was requested. More general learning, where a patient needed to be anonymised, was shared with staff to protect identity. The provider had a system in place to monitor the length of time complaints had been open, who was addressing them and what actions needed to be taken.

The service did not always make sure that people could access the care, support, and treatment they needed when they needed it.

The service did not always make sure people could access timely care, support and treatment when they needed it. There was crowding in the department from both increased patient numbers, but also the unmet demand for ward beds for emergency department patients in a hospital often at full capacity. We saw patients were not always streamed to the correct area of the hospital. During our assessments, a significant number of patients had already seen their GP and some had a referral letter, but they were often not referred directly into services within the hospital.

People also remained on the back of the ambulance that brought them for many hours with the crew unable to handover the patient and return to the needs of the community.

The trust outlined in their 2024 winter plan that they would ensure these patients were seen by the same day emergency care (SDEC). However, we did not observe this happening in practice. We saw patients who could have been referred directly from the navigator nurse to surgery or medicine, in line with procedures, who were sent to triage instead. This meant there was a risk that access to timely appropriate services was compromised. We found that one of the reasons was that SDEC was being used for overnight beds due to an increased demand for beds in other services.

The provider limited patients’ ability to have equal access to care, such as a lack dementia friendly decor including that for accessing the date and time. There was also very limited information to support any person with a learning disability.

On speaking with patients, we found 1 person had been sat in a wheelchair for 17 hours and staff had not sought more comfortable seating arrangements or asked them if they were able to access and use toilet facilities. The patient said, “17 hours in this chair is torture.”

Inappropriate areas were being used to care for patients because demand had outstripped capacity. The staff were trying their best to find places to put people, but areas were not being risk assessed to try and ensure the safety of the patient. Areas were used that did not have access to medical gas, and staff didn't have the physical space to move monitoring equipment or respond quickly in the event of an emergency.

Similarly, we observed, and patients told us they were being asked to stand in the waiting room after seeing the doctor and receiving treatment because there were no beds available in the department and no chairs available in the waiting room. We did not observe staff ensuring patients in the waiting room had seats.

The trust included information on accessibility on their website and this included Basildon hospital but there was no specific information available for Basildon hospital. We saw the trust website included a video for patients on what to expect when attending the emergency department and this was particularly focussed on patients with additional needs. However, this was filmed at another hospital site within the trust so although it may be viewed by patients at Basildon, it was not specific to the hospital.

The provider’s February 2025 board paper statistics showed that for Urgent and Emergency Care (UEC), the December 2024’s performance deteriorated by 6.1% to 62.8% against the 4-hour standard. This was worse than same month for 2023 (65.2%). Challenged performance had been driven by high acuity, high flu demand and norovirus outbreaks at Basildon and Broomfield hospitals. Average ambulance handover time worsened to 37 minutes, however, this remained in line with same month in 2023 (34 minutes). The ICB had implemented a new ‘Flow and Discharge Cell’ with responsibility for supporting patient flow and hospital discharges across the system. Medically optimised and delayed discharges improved to 126 patients (trajectory 140 patients). This was the lowest since December 2021.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The provider had recognised in its public board papers regarding
clarification around mental health training for staff to help ensure there was no discrimination for patients. This was for a continued reliance on agency staff for mental health nurse specialist to undertake enhanced supervision. This risk item
was to be addressed through their safeguarding committee.

The provider also provided information, and analysed data, for armed forces veterans attending the emergency department. The provider trust had received ‘Veteran's Aware Accreditation’ in March 2024. This was helping them to identify and act on issues such as post-traumatic stress disorder (PTSD), and the increase in women attending the department corresponding with more females being employed and needing support as former members of the Armed Forces. This helped make sure these patients were treated with the utmost respect and fairness.

The trust supported all staff groups to take part in equality and diversity events, such as Pride month. This was to help in promoting various patient groups associated with various sexual and gender identities to help patients benefit from their understanding, knowledge and experiences. This facility was open to all staff, were organised by the trust’s LGBTQ+ network to help raise awareness of issues facing the community.

The provider was working on an improvement plan with their local Integrated Care Board (ICB) for more community interventions. This was for the care of regular attenders for example and to have processes to access appropriate care and avoid inappropriate use of the department.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff had end of life training including for anxiety, pain relief and dignity. The records we reviewed showed staff recorded decisions about resuscitation at end of life and these were respected

Due to our observations of an individuals care whilst on assessment, we were not assured that patients coming through the department with a terminal diagnosis would be supported to plan for the future in a timely way. For example, we observed a patient with stage 4 terminal cancer accommodated in the resuscitation area for approximately 24 hours. The patient and their family were extremely distressed and voiced they did not want their life to end in the emergency department. Staff caring for the patient had not discussed the plan of care with the patient.

Medicines for anxieties and pain relief were in place should they need to be administered. The provider worked well with other organisations such as palliative care services, and where people chose to die at home.