Basingstoke and North Hampshire Hospital

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• 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

This means we looked for evidence that the service met people’s needs. At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to good. This meant people’s needs were met through good organisation and delivery.

The Emergency Department (ED) provided person-centred care, actively involving patients and families in treatment and service design. They ensured good communication and tailored support, including specialised services for the elderly and those with complex needs. However, the service faced shortfalls in equitable access, primarily due to long waiting times for general admissions and, notably, extended delays for patients needing external mental health beds. While the ED implemented improvement plans to address patient flow and rising ambulance handover times, these systemic challenges indicated constraints in delivering consistently timely care.

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.

Description: We make sure people are at the centre of their care and treatment choices and we decide, in partnership with them, how to respond to any relevant changes in their needs.

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The service demonstrated how they involved patients and their families in their care, adapting the level of support based on age, culture, and individual needs. The Emergency Department (ED) engaged patients through specialised resources, including an in-house play team that worked with children. This included children with learning disabilities and autism. For patients with diverse cultural backgrounds, the department had a policy on how to contact the kitchen to accommodate specific meal and religious preferences. Furthermore, the service involved patients in design through its Quality Improvement ethos, where patients co-designed and co-delivered improvements. This meant patients received care that respected their personal beliefs and developmental needs, leading to a more positive experience.

The ED provided family support and good communication. For example, one mother reported feeling fully involved in her child’s care, noting her views were considered, and she did not have to repeat her story to multiple staff members. She received information about her child’s head injury via a medical app, which helped to ensure consistent communication. This meant care was respectful and organised, supporting a better patient experience.

Staff provided emotional support during difficult times, such as when patients received life-changing diagnoses. Staff explained how they would support children during examinations where family members could remain present, if the child wanted this. The department further supported staff knowledge with access to a Learning Disability Team and an Autism Practitioner. This meant families felt heard and supported through good communication.

Description: We understand the diverse health and care needs of people and our local communities, so care is joined-up, flexible and supports choice and continuity.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The Emergency Department (ED) proactively supported care quality across multiple domains. Leaders acknowledged they had a high number of patients with mental health presentations seeking treatment, and understood the service was not designed in a way which always met the needs of this group of patients. Leaders collaboratively worked to strengthen care co-ordination by working closely with external mental health services to secure the appropriate specialist provision.

The department conducted multi-disciplinary team (MDT) ward rounds that included therapy staff (physiotherapists and occupational therapists). The purpose of the MDT rounds was to address clinical complexities where input from different specialties was required (for example, discharges). Staff told us specialty teams were responsive, and this helped to improve flow in the department.

The service was undertaking an infrastructure project to move the Paediatric Emergency Department (PED) to a new location, which was nearing completion at the time of the inspection. This move was intended to double paediatric capacity (from 2 to 4) and improve access to the resuscitation room. This meant staff were actively working on improving safety and capacity for the children’s demographic.

Description: We provide appropriate, accurate and up-to-date information in formats that we tailor to individual needs.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The Emergency Department (ED) maintained a good standard of general information access. For example, signage and information were sufficient for patients to navigate the department. The ED promoted awareness of facilities such as accessible drop-off, parking, and toilets. The service addressed feedback from patients who felt uninformed about delays by installing a new waiting room information screen to display up to date waiting times. Transparency was supported by staff who provided regular verbal updates, particularly during periods of increased waiting times. This meant patients benefitted from a clear physical environment and staff willingness to act on feedback to improve the patient experience.

The ED staff were proactive in ensuring inclusive communication for all patients, particularly those with additional needs. Staff had access to interpreting and advocacy services and ensured patient information was available in different formats. The department implemented specific accessible communication methods, such as the ‘Faces Pain Rating Scale’ for patients who could not verbalise their pain and posters advertising the availability of sensory boxes. The service had undertaken an assessment of compliance with the Accessible Information Standards (AIS) and continued to take action to close any identified gaps. This meant vulnerable patients with communication, sensory, or language barriers received equitable care because staff could identify their needs, such as pain levels, and involve them in decisions. The work on the AIS ensured all individuals could access essential health information and support.

The ED utilised its digital platform to include the public and ensured patients accessed the most appropriate level of care. For example, the trust’s website provided detailed information aimed at helping the public choose the right healthcare service for their needs. This included guidance on when to use services other than the ED. This helped the community by diverting non-emergency cases.

Description: We make it easy for people to share feedback and ideas or raise complaints about their care, treatment and support. We involve them in decisions about their care and tell them what’s changed as a result.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The Emergency Department (ED) demonstrated a transparent framework for managing complaints, learning, and a timely response. The service had a Complaints and Concerns Policy, supported by a Standard Operating Procedure (SOP). All complaints were logged using the trust’s incident reporting system. We saw evidence that leaders monitored complaint responses. For example, in June 2025, the unscheduled care division achieved a 71% compliance rate with response timeframes, sharing responses an average of 3 working days prior to the deadline.

The service used complaint themes to drive improvements and embedded patient feedback into daily operational learning. Complaint themes, including treatment, values and behaviour, and long waiting times, were fed back to the team through daily handovers, and email. By channelling feedback directly into daily routines, the service ensured the patient voice led to tangible change. For patients, this meant complaints were incorporated into staff development, resulting in better care for future service users. However, some of these issues remained ongoing, such as long waiting times.

The service engaged directly with patients to co-design and improve. Following a complaint regarding a lack of British Sign Language (BSL) interpretation, the patient was invited to a meeting (with BSL support provided) to explore what effective BSL support should look like in the hospital setting. Actions taken included sharing information about BSL services and scheduling basic BSL training for nursing, administrative, and medical teams. This direct involvement empowered the patient to shape service delivery, ensuring BSL provision is user centred.

Description: We make sure that everyone can access the care, support and treatment they need when they need it.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The Emergency Department (ED) demonstrated a commitment to service improvement through measures to address patient flow challenges. The service implemented operational changes which helped to improve flow for specific patient groups (for example, elderly and frail patients). Although these changes did not resolve shortfalls for all patient groups in overall 4-hour performance, the hospital engaged with national recovery efforts. This was evidenced by its participation in the NHS England phased improvement targets, which established a more achievable trajectory for performance by aiming for 76% of patients to be admitted, transferred, or discharged within 4 hours by March 2025. The service showed an improving picture with a performance of 57% in August 2024, to 69% in June 2025. This approach acknowledged the systemic challenges and the broader national context of recovery from the COVID pandemic, ensuring that performance targets were realistic while continuing to drive progress towards the pre-COVID national standard of 95%.

The service had experienced an increase in the number of patients facing delays in being admitted to a ward after a clinical decision to admit had been made. The total number of patients waiting more than 12 hours from the decision to admit to actual admission increased from 541 (July 2023 to June 2024) to 843 (July 2024 to June 2025). In line with national trends, the percentage of patients spending more than 12 hours in the department had been much higher in recent months compared with historic trends. Waiting times peaked in January 2025, with 15.5% of patients waiting more than 12 hours from arrival. At the time, this was higher than both the regional and national average. However, waiting times have since improved and in May 2025, just over 8% of patients waited more than 12 hours. And reattendance rates showed a fluctuation (between 6.4% and 7.5%), which was below national levels (between 8.5% and 9.1%). This meant fewer people reattended the service within 7 days.

Patients with mental health needs experienced a delay in accessing treatment, indicating a lack of equitable access compared to those with physical health needs. Patients we spoke with expressed concerns about long wait times, particularly those who were waiting for external mental health services. During 2025, the number of delays of greater than 12 hours in the emergency department was 10.5% (of all 12-hour reportable delays). These long waits were predominately for reasons of awaiting an inpatient bed in a specialist mental health trust. Staff assessed these patients and often deemed it safer and more appropriate for them to remain in the ED than to be placed on a ward. However, the ED environment, which was often busy and overcrowded meant this group of people did not receive the right care in the right setting when they needed it.

The service held meetings to discuss the number of patients experiencing mental health conditions in the hospital, and external meetings with mental health partners to ensure these patients were continuously reviewed. The focus of these discussions was to accelerate the transfer to a suitable mental health facility. However, due to a lack of external mental health services, these patients still had longer waits. For example, during our inspection all 3 patients experiencing mental health distress had been in the department for over 15 hours. This meant staff were limited in their ability to provide equitable treatment to this cohort of patients.

The department faced longer ambulance handover times compared to other providers. The number of ambulance handover delays over 60 minutes had remained consistently lower than national rates from June 2024 to October 2024. However, from April to July 2025, there had been an increase in longer handovers, especially between 30 and 60 minutes. In response to this, the service implemented the W45 protocol (ambulance withdrawal at 45 minutes). We did not see this in practice at the time of the inspection, but staff told us they had seen improvements in ambulance handover delays as a result.

During our inspection, staff told us they had seen some improvements in waiting times for older patients. This was evidenced by data we received, with the average time for patients aged 70 or older decreasing to under 7 hours. This was particularly important in this patient cohort.

Staff told us they had seen improvements in waiting times since the opening of the Urgent Treatment Centre and quick initial assessments by senior clinicians. These changes allowed them to more effectively direct patients to the right area. Staff followed the streaming pathways to manage patient flow pressures. They understood the full capacity protocol and worked to admit patients in a timely manner where possible. The planned departmental footprint reconfiguration was also part of the wider improvement plans for the ED, facilitating better flow through the department and a better experience for patients and staff.

Leaders had made some improvements to meet nationally agreed-upon wait times through a formal improvement plan. Although improvements have been seen in the number of patients waiting more than 12 hours to be admitted, there were still notable shortfalls in the number of patients not meeting the 4-hour target.

Staff made reasonable adjustments for specific patient groups to support their ability to access the service. For example, staff told us they often booked hospital transport for patients with additional mobility needs. This was utilised for patients attending the Same Day Emergency Care (SDEC) Unit and staff could plan for booking transport. This action ensured mobility issues would not create an access barrier to care.

Leaders understood the challenges with patient flow, which were documented in the department’s risk register. Staff told us how they had worked with a specialist health care improvement consultancy to support the department’s transformation, which provided them with a detailed understanding of the factors affecting their performance.

Whilst improvements were underway, there were several initiatives to support patients to remain safe and comfortable while they waited. The paediatric waiting area was designed to be child-friendly with books, games, and television. In the wider ED, staff told us they provided tea, coffee, and sandwiches to patients and their families during long waits and gave pain relief to those experiencing pain. We observed regular meetings took place throughout the day to monitor each patient’s status. These meetings helped staff proactively manage the number of people waiting unnecessarily in the department and prioritise those who needed to be discharged or transferred.

Description: We actively seek out and listen to information about people who are most likely to experience inequality in experience or outcomes. We tailor the care, support and treatment in response to this.

We scored the service as 3. The evidence showed a good standard. 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.

Emergency Department (ED) leaders told us they recognised Hampshire as having an older population of people aged 65 and over, compared to the England national average. As a result, the service worked to improve outcomes and experiences for its older patient population. For example, the presence of the Acute Frailty Service within the ED was a significant equity measure, catering directly to the needs of patients aged 70 and over. Staff reported this service led to a reduction in the average time older patients spent in the department and decreased the number of overall admissions. The frailty service was accessible via a dedicated phone line for advice. This meant older patients received care tailored to their needs.

Staff and leaders told us they prioritised the use of single rooms for patients experiencing mental health problems when possible. Leaders described a 4 bedded bay within the unit for cohorting multiple patients when demand exceeded the availability of single rooms. This measure was a response to the initial lack of mental health space, which demonstrated an effort to prevent these patients from being treated in the general ED area. This meant staff and leaders had an awareness of how an ED environment could impact on people experiencing psychological distress. However, it was not always possible when there were high numbers of patients in the department, which meant some patients experiencing mental health distress had to be cared for in the general ED environment.

Staff demonstrated a clear understanding of the principles of human rights, equality, diversity, and inclusion. For instance, staff we spoke with described the importance of a patient’s right to communication, ensuring that dignity and autonomy were respected. Staff described making practical adjustments for accessibility, such as an agreement with an external patient transport service. Staff told us this service could be used by eligible patients who required specialist transport, such as bariatric equipment or multiple crews, to ensure they could attend appointments. The practical application of reasonable adjustments, such as this, removed barriers to care, ensuring patients with complex mobility needs received the same access to treatment as others.

Staff informed us the oncology team served as a responsive resource for patients undergoing cancer treatment who have weakened immune systems. This meant quicker access to care and treatment which was vital for preventing minor issues from developing into more serious complications.

Description: We support people to plan for important life changes, so they can have enough time to make informed decisions about their future, including at the end of their life.

We scored the service as 3. The evidence showed a good standard. People were 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.

The hospital used ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) forms to support patients with planning for the future. We saw this process created personal recommendations for clinical care in a future emergency, allowing patients to collaborate with their families and clinicians on a ‘ceiling of care’ that might include decisions about CPR (Cardiopulmonary Resuscitation), assisted ventilation, and other treatments. The hospital continued to recognise older Do Not Attempt CPR forms brought in by patients, but the ReSPECT policy aimed to provide a more comprehensive, easily identifiable, and accessible record of a patient’s wishes in emergency situations. All staff we spoke with had an awareness of this policy and fully understood how to apply this in practice.