Basingstoke and North Hampshire Hospital

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• 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

This means 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. At our last assessment we rated this key question as good. At this assessment the rating has changed to requires improvement. This meant leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The Emergency Department (ED) leadership team failed to always identify and effectively manage all safety risks in the department. While leaders had a shared direction, they did not address known safety risks or sustain corrective action. This was evidenced by some ongoing safety shortfalls from the previous inspection, and by non-improving compliance with safety audits. This meant incidents continued to occur, compromising the quality of care for vulnerable patient groups and indicated the service had not learned from previous shortfalls.

The service was in breach of regulation 17 under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance.

We have not awarded this service a score for Well-led.

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

Description: We have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

The trust’s strategy for 2022 to 2028 was underpinned by their vision to provide outstanding care for every patient. An urgent and emergency (unscheduled) care intensive support program incorporated the department’s improvement strategy. The focus at the time of assessment was to improve performance against national targets and continue to reconfigure the department so that patients received the right care, in the right place, at the right time.

Leaders were aware further improvement was needed to improve capacity and flow issues within the department as well as increasing safety for people with mental health needs. Plans were in place to make further improvements.

Leaders stressed the importance of ensuring a positive culture of transparency and openness was maintained throughout these changes. Some people and staff had provided input in the reconfiguration of the department; this was evident in the Urgent Treatment Centre that opened in November 2024. At the time of the inspection, staff were being consulted on the emergency department’s revised floor plan through in-person sessions and a wide range of communication media.

However, some staff reported they did not always feel their views were escalated and considered in all changes. Leaders acknowledged staff frustrations with the scale of change and continued to focus on enhancing staff experience and well-being whilst delivering person-centred patient care.

Description: We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

We scored the service as 2. The evidence showed some shortfalls. Leaders understood the context in which the service delivered care, treatment and support and embodied the culture and values of their workforce and organisation. However, leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

Service level leaders demonstrated high levels of compassion and commitment to the trust’s vision and quality of care. However, leaders had not independently identified and acted on the quality and risk issues we identified prior to our assessment. This meant some development was needed in their skills and knowledge to lead effectively. For example, leaders were aware of numerous risks but did not demonstrate embedded and sustainable changes to resolve these concerns. This included safety audits, environmental risks, hand hygiene, ligature risk assessments, and mandatory training compliance. Furthermore, several safety concerns persisted from the previous inspection in April 2020, such as unmet national waiting times, reduced mandatory and safeguarding training compliance, and an environment that was tired in appearance. This meant incidents continued to occur, particularly for vulnerable patient groups like those experiencing mental health conditions. This demonstrated that the service had not learned from previous shortfalls or fully implemented necessary changes.

However, staff described service-level leaders as supportive and helpful, particularly when the department was busy. Leaders told us they understood the challenges in the Emergency Department and would always strive to support their team. Leaders spoke highly of their staff’s commitment to providing care and working together.

The executive team supported a culture of safety by conducting safety walkarounds as part of the ‘Connecting with Care’ agenda, providing feedback to the team outlining observations and required actions. This helped create an environment with a clear management structure that focused on succession planning (recruiting an Associate Director of Mental Health).

Description: We create a positive culture where people feel that they can speak up and that their voice will be heard.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service aimed to foster a positive and safe culture where staff felt secure in their ability to raise concerns. The trust had appointed a Freedom to Speak Up (FTSU) Guardian, and staff across the department had an awareness of the whistleblowing process and the Guardian’s role. Leaders described an open-door policy and an eagerness to support staff, detailing how concerns were investigated and fed back. All staff reported feeling able to raise concerns without fear of retribution.

However, staff noted the combination of high patient acuity, and the rapid pace of change made their shifts challenging. In response, the service undertook a culture review to support the team in working collaboratively and addressing concerns raised within the department. An example of this was the reconfiguration work being paused for a period due to feedback from Emergency Department consultants.

In response, leaders undertook a culture review and increased the frequency of listening events, to better capture staff sentiment. The FTSU Guardian maintained a visible presence in the department, which included walkarounds and invitations to engage. Themes from the FTSU Guardian were being provided directly to the Board of Directors for oversight. Ongoing action included weekly department updates and staff consultation on departmental reconfigurations (floorplans) to embed their voice in future change. Time was needed for some of these newly introduced initiatives to embed and for the trust to evaluate their effectiveness.

Description: We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Policies and processes ensured the Emergency Department (ED) was inclusive and fair in the way it operated. The service promoted equality and diversity in daily work and provided opportunities for staff to develop.

The trust had established 7 (BAME/Ethnic Minority, Disability, LGBTQAI+, Women’s Inclusivity, Neurodivergent, Armed Forces Community and International Workforce) Staff Networks. Staff Networks representatives working in the department told us the networks facilitated a two-way exchange of information, allowing for sharing of best practices, raising concerns, and providing support in achieving the trust’s equality objectives.

The trust annually reviewed its performance for patients and staff with protected characteristics under the Equality Act 2010. To meet its equality objectives for staff, the trust implemented several initiatives. It offered menopause workshops and a menopause policy to support women in the workplace and continued to promote flexible working and shared parental leave for all staff. The trust also reviewed its talent management framework to maximise inclusivity and improved the understanding and management of reasonable adjustments. Staff told us when developing its strategy for violence and aggression, the trust considered concerns raised by staff with protected characteristics to ensure a diverse perspective.

Description: We have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

We scored the service as 1. The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes.

Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss, and learn from service performance. Regular quality audits took place, and some improvements had been made. However, shortfalls and risks had not been consistently identified through the trust’s internal governance processes and some of these continued concerns such as poor mandatory training compliance and environmental issues were identified at our previous inspection in April 2020. The lack of clinical oversight in essential risk assessments such as physical observation compliance showed no improvement from August 2024 to July 2025. The service did not demonstrate they had acted on these audit results. This meant service-level leaders could not be assured that patient deterioration was being reliably tracked. Similarly, our concerns about hand hygiene and infection prevention and control remained despite leaders telling us they had implemented additional measures to address shortfalls in this area.

The service faced challenges with their statutory and mandatory training compliance levels, as well as their compliance with life support training. Systems to monitor and improve staff training compliance were therefore not fully effective. This contributed to a systemic weakness in governance oversight and a lack of improvement over time to previously identified risks.

We raised these concerns directly with the trust leadership who implemented immediate mitigations. However, the governance processes at service level had either not identified or acted on these risks. In response, the trust launched a multi-agency approach with the Mental Health Lead, Medicine Governance Lead, and the Managing Director of a local mental health facility. They engaged in regular liaison meetings to establish a planning model. And the ED prioritised the co-design and implementation of individualised environmental risk assessments for patients experiencing mental health conditions by the end of November 2025, specifically tailored to minimise risk during periods of estate work. The Specialist Mental Health Liaison Team was strengthened and began placing practitioners in the ED each night from 15 October 2025 to provide on-the-ground support and assessments.

Description: We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The service demonstrated a commitment to integrated care by aligning its strategy with local and regional plans and engaging with external stakeholders to meet population health needs. The trust’s strategy was aligned with local plans across the wider health and social care economy, including active involvement with the Integrated Care Board (ICB), and an increasing focus on delivering unscheduled care in the community. Strategic partners offered positive commentary on the trust’s passion for improving the patient experience system-wide, specifically highlighting the strong collaboration, communication, and information sharing with their colleagues.

This partnership approach ensured services were planned and designed collaboratively to help prevent fragmentation of care. For example, working closely with the local ambulance service to improve handover times, and collaboration with social care commissioners and teams (via workshops with Adult Social Care and the Integrated Care Board) streamlined the discharge process for complex patients. The launch of the Urgent Treatment Centre (UTC) helped to reduce pressure on the ED and led to an increase in performance against the national 4-hour target for non-admitted patients.

The service was working with the police, commissioners, and local mental health services to improve care for patients with mental health needs. However, staff noted high-intensity users often tagged with care plans directing support to community mental health services in the first instance, yet these patients frequently presented at the ED via police or ambulance. The framework established the correct clinical pathway (referral to community mental health), but the lack of accessible or effective alternative services limited the full potential of these care plans. This resulted in preventable, high-risk patients continuously returning to the ED, making it difficult to achieve consistent patient care and adding avoidable strain to the acute service.

Description: We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

We scored the service as 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system.

We found concerns which demonstrated the service did not always translate learning into sustained improvements. Evidence included the non-improving trend in compliance with NEWS2 and PEWS documentation, shortfalls in mandatory training completion, and the ongoing known environmental risks for mental health and other service users. Collectively, these recurring shortfalls indicated improvement efforts were not sustained at the level necessary to guarantee the reliability of safe care.

However, the department demonstrated initiative in improving patient safety through various multidisciplinary Quality Improvement (QI) projects. Projects spanned key clinical pathways, including enhancing care for frail patients with head injuries, optimizing management for renal stones, and improving time-critical procedures such as arterial line setup, alcohol withdrawal, sepsis, and pain management. These efforts were supported by the trust’s patient engagement and participation program. The trust was making strides towards reducing the impact it had on the environment through a number of green initiatives led by a dedicated sustainability manager.