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Inspection carried out on 25, 26 and 27 July and 9 August 2017

During an inspection to make sure that the improvements required had been made

Northampton General Hospital (NGH) is an 800-bedded acute hospital. There are approximately 713 general and acute beds with 60 maternity beds, and 16 critical care beds. The trust employs 4,875 staff, including 531 doctors, 1,487 nursing staff and 2,857 other staff.

We carried out this inspection as part of our routine focused inspection programme. We completed a short notice focused inspection on the 25 to 27 July 2017and an unannounced inspection on 9 August 2017.

We determined the extent of this focused inspection following a review of information gathered and the findings from our previous inspection. This included an analysis of the trust’s performance and information from stakeholders. The hospital was previously inspected under our comprehensive methodology in January 2014, when the overall rating was requires improvement.

We found the trust has taken significant action to meet the concerns raised from the January 2014 inspection, particularly in establishing an inclusive and supportive staff culture with a clear focus on patient safety.

We rated the four core services we inspected (critical care, maternity and gynaecology, children and young people and outpatients and diagnostic imaging) as good overall. Combining these core service ratings with the ratings for the other four services we last inspected in February 2017, the overall rating for the hospital was good. All five key questions were rated as good (safe, effective, caring, responsive and well-led).

We found that:

  • Staff were friendly, professional, compassionate and helpful to patients in all interactions that we observed.
  • Patients told us that the staff had been caring towards them and all spoke positively about the staff in all areas inspected.
  • We observed care being delivered by nurses, play specialists, medical, therapy, and auxiliary staff that interacted with children and young people in a very positive and caring manner.
  • There was a positive culture towards reporting incidents and learning from these to improve patient safety in all areas inspected.
  • There were effective systems in place to ensure that standards of cleanliness and hygiene were maintained.
  • The design, maintenance, and use of facilities, premises, and equipment generally met all patients’ needs.
  • Improvements had been made in some areas in the outpatient environment, which included the expansion of the chemotherapy suite and new equipment in the diagnostic imaging department.
  • Medicines were generally stored and handled in line with the hospital’s medicines management policy.
  • There were generally effective processes in place to ensure that adults and children in vulnerable circumstances were safeguarded from abuse. Staff in all areas were aware of the processes to identify and respond to patient risk and there were systems in place to monitor and manage risks to patient safety.
  • Medical, nurse and midwife staffing levels met patients’ needs at the time of the inspection.
  • Patients’ outcomes were being measured and were generally in line with national average. Action plans were in place to drive improvements.
  • There was clear evidence and data upon which to base decisions and look for improvements and innovation. The unit participated in the Intensive Care National Audit and Research Centre (ICNARC) audit and performed better or as expected in six out of eight indicators.
  • The critical care outreach team provided 24 hour cover seven days a week and assisted with the monitoring and treatment planning of deteriorating patients throughout the hospital, ensuring risks were responded to appropriately.
  • Patients and their relatives were supported during their stay within critical care services and staff provided opportunities to discuss care and treatment. This was delivered in a way that promoted dignity and confidentiality at all times.
  • The maternity and gynaecology service completed the national maternity safety thermometer and monitored safety performance through clinical dashboards.
  • The children and young people’s service performed well in in a number of national audits including the National Neonatal Audit (2015) and the Epilepsy 12 audit (2014). Gosset ward was working towards achieving Bliss accreditation.
  • Policies were based on national guidance produced by National Institute for Health and Care Excellence (NICE) and the royal colleges.
  • Pain of individual patients was assessed and managed appropriately.
  • There were systems and processes in place to ensure that staff had the necessary qualifications, skills, knowledge and competencies to do their jobs.
  • Effective multidisciplinary working was clearly evident throughout the departments and services.
  • There were appropriate processes and systems in place to ensure that information needed to deliver care and treatment was available to relevant staff in a timely manner.
  • Patient’s consent was obtained in line with trust policy and statutory requirements.
  • Services had been planned to take into account the needs of different people, for example, on the grounds of age, disability, gender or religion.
  • Care and treatment was only cancelled or delayed when absolutely necessary.
  • Access to services was generally effective and timely.
  • Appointments were prioritised according to referral requests from GPs with urgent requests and cancer referrals booked within two weeks. The imaging department prioritised reporting higher risk examinations not seen by other clinicians.
  • The hospital consistently met the referral to treatment standards over time.
  • Waiting times for diagnostic procedures were better than England average.
  • The service managed complaints swiftly, openly and constructive as part of a co-ordinated patient feedback system.
  • The hospital staff worked with a variety of stakeholders and commissioners to plan delivery of care and treatment. There was a focus in providing integrated pathways of care, particularly for patients with multiple or complex needs.
  • The leadership teams were cohesive and inclusive and were focused on delivering safe, high quality care and treatment for all patients.
  • Staff felt there was a high level of staff engagement, which was positive and led to high levels of staff satisfaction.
  • Staff believed in the leadership of the hospital and were proud of the organisation and its culture.
  • Services had a clear vision, strategy, and objectives based on improving quality and safety in line with the overall trust vision.
  • Leadership in services was well established and there was a clear focus on improvements and patient safety.
  • Structured meetings were held throughout services to review all aspects of quality, risks and performance and high risks were escalated and monitored effectively.
  • Effective governance arrangements were in place. There were structured meetings to review all aspects of performance, quality and risks and high risks were escalated through the services.
  • Service risk registers reflected the risks within the service and there was evidence of ownership, mitigations having being implemented and ongoing monitoring.
  • Innovation throughout staff teams was encouraged.

However, we also found:

  • The critical care service was aware of the shortfall in band 8a specialist pharmacist support and was providing cover with a band 7 pharmacist. A business case had been put forward, which if successful, would ensure standards were being met.
  • Medicines were not always stored safely behind locked doors or in restricted areas in critical care. We raised this with the trust and this was rectified immediately by the trust.
  • There was effective working relationships and commitment to critical care between members of the multidisciplinary team. However, the trust was not meeting the national core standards for employment of allied professionals within critical care services.
  • The critical care unit did not comply with the Department of Health’s Health Building Note 04-02 critical care unit’s standards; however, this had been risk assessed and was under review. Refurbishment plans were in place to address this.
  • Not all medical staff in critical care had completed the required mandatory training.
  • Hospital wide bed capacity affected the ability of the service to discharge patients to wards at the most appropriate time. Over eight hour delayed discharges were higher than the national average, however, action had been taken and improvement observed for patients waiting 24 to 48 hours.
  • Single sex accommodation in critical care was not always maintained due to hospital wide bed pressures. Action was taken to protect patient’s dignity at all times.
  • Not all doctors, nurse and midwives had had annual refresher training for safeguarding adults at level two in the maternity and gynaecology service. Action plans were in place to address this.
  • The maternity service had had higher than expected caesarean rates and perinatal mortality rates over time. Whilst actions and mitigating actions had been taken, these had not always improved outcomes. The service continued to monitor and assess these potential risks to patients.
  • There were not always effective systems in place regarding the storage and handling of medicines in the children’s outpatient department. The trust took immediate action to address this once we raised it as an urgent concern.
  • Children or young people on Paddington ward could access the corridor to the delivery suite. This was a risk particularly for patients who may be at risk of self-harm or suicide. The trust took immediate action to address this once we raised it as an urgent concern.
  • The pathway for patients who needed to cross the road between buildings had not been reassessed to ensure opportunities to prevent or minimise further harm were not missed. The trust took immediate action to address this once we raised it as an urgent concern.
  • The child abduction policy was in draft and awareness was lacking in some areas of the service. The trust took immediate action to address this once we raised it as an urgent concern.
  • Paediatric wards did not have the appropriate facilities to care for the increasing number of patients with mental health issues who could be at risk of self-harm or suicide.
  • We found concerns about the fire exit in the fracture clinic. This had been addressed by the unannounced inspection and we found the service had also reviewed all fire exits throughout the service.
  • Not all staff were compliant with infection prevention and control measures in the blood taking unit. We raised this with the service, and immediate actions were taken to review infection control precautions to mitigate risk. This had been addressed by the unannounced inspection.
  • Not all staff had had the required frequency of mandatory training, including safeguarding.
  • The controlled drugs cupboard in the pain relief clinic contained a variety of non-controlled drugs. This was not in line with medicines storage guidelines. We raised this with the service and this had been rectified by the time of our unannounced inspection.
  • We observed poor infection control practices in both the blood-taking unit and the pain relief clinic. We raised this with the service and this had been rectified by the time of our unannounced inspection.
  • Some staff in the diagnostic imaging department had limited understanding of the ionizing radiation (medical exposure) regulations (IR(ME)R) regulations themselves and five members of staff we spoke to were unable to locate where the employers’ procedures were kept. We raised this with the service and senior staff took immediate action to address this.

We saw several areas of outstanding practice including:

  • The trust had a duty of candour sticker that would be placed into the patient’s notes when the duty of candour had been applied. This included, for example, staff name, date, name of person/patient receiving information, account of incident, details of incident and if an apology was offered.
  • Two members of the critical care team had been nominated for the ‘Best Possible Care’ Awards. Patients and those close to them, as well as work colleagues, voted for staff members who had gone above and beyond to exceed expectations and had made a real difference to patient care.
  • The ‘Chit Chat’ group was set up by the maternity service in 2016 to facilitate antenatal education, parenting advice and peer support for women with additional needs, including learning disabilities or anxiety. Staff said these meetings were two weekly and very well attended. This group meeting initiative had been nominated for two national awards and had won one at the time of the inspection.
  • The maternity service reviewed and evaluated the provision of multi-disciplinary training when the service was chosen as one of the 10 pilot sites for enhancing patient safety. As part of the pilot, the service chose to concentrate on the fetal monitoring and team working and skills drills sections with the outcome that the service was able to deliver these training programmes completely internally (including Practical Obstetrics Multi-professional Training (PROMPT).
  • Gosset ward was working towards achieving Bliss accreditation. This means the ward had undertaken exceptional work through the involvement of parents to encourage bonding with these very special babies which has helped to build the evidence for Bliss accreditation.
  • Staff had developed an assessment tool to improve the monitoring and assessment of baby’s skin on Gosset ward. The ward was working with neonatal services from across the world (Canada and Turkey) to further develop the tool.
  • The recruitment of 1.7 WTE advanced neonatal nurse practitioners (ANNP) onto the medical neonatal rota was helping to address recruitment issues in relation to junior doctors.
  • The superintendent sonographer was very passionate about their service and had developed an excellent team which provided image quality assurance and peer review. They were able to detect team members’ weaknesses and pair them with other sonographers to help them develop. The ultrasound department conducted many audits and fed these back to ultrasound community in England.

However, there were also areas of poor practice where the trust needs to make improvements.

The trust should:

  • Review pharmacy provision to meet the needs of the critical care service and be in line with national guidance.
  • Continue to review and monitor over eight hour delayed discharges in critical care and report incidents and mixed sex breaches using the electronic reporting system.
  • Monitor staff mandatory training to ensure compliance with the trust’s target including annual refresher training for safeguarding adults at level two and safeguarding children level two and three.
  • Continue to monitor caesarean rates and perinatal mortality rates in the maternity and gynaecology service.
  • Review multidisciplinary support to critical care services to ensure national best practice is following, in relation to therapy support.
  • To monitor allergy testing ampules ensuring use within their recommended expiry dates.
  • The trust should consider improving the facilities for parents to stay overnight on paediatric wards.
  • Continue to monitor and review the impact of patients admitted to paediatric wards with mental health issues.
  • Continue to monitor and review the effect on children’s services due to the limited availability of psychologist support, particularly for children with long term conditions.
  • Continue to monitor controlled drugs are effectively stored in outpatient areas.
  • Continue to monitor fire exits are accessible at all times.

Professor Edward Baker

Chief Inspector of Hospitals

Inspection carried out on 30 January and 7,8,9,17 February 2017

During an inspection to make sure that the improvements required had been made

Northampton General Hospital (NGH) is an 800-bedded acute hospital. There are approximately 713 general and acute beds with 60 maternity beds, and 18 critical care beds. The hospital employs 4,157 staff, including 496 doctors, 1,074 nursing staff and 2,587 other staff.

We carried out this inspection as part of our routine focused inspection programme. We announced the inspection on the 24 January 2017. We completed a short notice focused inspection on the 7, 8 and 9 February 2017. We carried out unannounced inspections on 30 January and 17 February 2017.

We determined the extent of this focused inspection following a review of information gathered and the findings from our previous inspection. This included an analysis of the trust’s performance and information from stakeholders. The hospital was previously inspected in January 2014, when the overall rating was requires improvement. In this inspection, we inspected four core services: urgent and emergency care, medical care, surgery and end of life care.

We found the trust has taken significant action to meet the concerns raised from the January 2014 inspection, particularly in establishing an inclusive and supportive staff culture with a clear focus on patient safety. This was notable in all four core services that we inspected with an inclusive, positive and compassionate whole team focus on the drive for improvements in the quality and safety of care and treatment being delivered by all staff, at every level.

We rated all four core services we inspected as good overall. We found that:

  • Staff were friendly, professional, compassionate and helpful to patients in all interactions that we observed.
  • Patients told us that the staff had been caring towards them and all spoke positively about the staff in all areas inspected.
  • There was a positive culture towards reporting incidents and learning from these to improve patient safety in all areas inspected.
  • There were effective systems in place to ensure that standards of cleanliness and hygiene were maintained.
  • The design, maintenance, and use of facilities, premises, and equipment generally met all patients’ needs.
  • Medicines were stored and handled in line with the hospital’s medicines management policy.
  • There were effective processes in place to ensure that adults and children in vulnerable circumstances were safeguarded from abuse. Staff in all areas were aware of the processes to identify and respond to patient risk and there were systems in place to monitor and manage risks to patient safety.
  • Medical and nurse staffing levels met patients’ needs at the time of the inspection.
  • The hospital staff worked with a variety of stakeholders and commissioners to plan delivery of care and treatment. There was a focus in providing integrated pathways of care, particularly for patients with multiple or complex needs.
  • The leadership teams were cohesive and inclusive and were focused on delivering safe, high quality care and treatment for all patients.
  • Staff felt there was a high level of staff engagement, which was positive and led to high levels of staff satisfaction.
  • Staff believed in the leadership of the hospital and were proud of the organisation and its culture.
  • The emergency department (ED) had a recovery plan to improve performance to meet the national standard for patients being seen by a doctor within four hours following arrival, which had been agreed with local commissioners and other stakeholders. Performance had declined and was below the national average.
  • In December 2016, the hospital’s referral to treatment time (RTT) for admitted pathways for medical services was 97%, which was better than the England average of 90%.
  • Between January 2016 and December 2016, the hospital’s referral to treatment time (RTT) for admitted pathways for surgical services was about the same as the England overall performance.
  • From October 2015 to September 2016, the number of patients whose operation was cancelled on the day of surgery was 4%, below the England average of 8%.
  • Due to ongoing bed capacity issues in the hospital, the trust had implemented safety driven bed escalation and management process to address patient flow concerns in the hospital. This kept patients safe, even at times of significant pressure on bed capacity.
  • Despite very high bed occupancy over time and on the days of the inspection, the commitment to the safety and quality of care and treatment for patients was clearly demonstrated by all staff at all levels.
  • The hospital had a well-defined process for the management of medically outlying patients.
  • The hospital’s discharge team supported staff with complex discharge arrangements and senior managers were continually working to improve patient flow out of hospital.
  • Staff we spoke with had an effective awareness of patients with complex needs and those patients who required additional support. The adjustments made by staff and facilities provided met patients’ needs effectively.
  • The overall time from arrival to initial assessment for patients arriving by ambulance at this ED was consistently worse than the England average from December 2015 to November 2016 and ranged between 11 and 30 minutes, whilst the England average was consistently less than ten minutes. An action plan was in place to improve this.
  • During our inspection, the average time to initial clinical assessment for all patients was between 19 and 22 minutes. From information provided by the trust for the six months to the end of February 2017, the average time to initial clinical assessment for all patients was 15 minutes. An action plan had been developed for three specific areas that the emergency department had identified as areas for improvement.
  • The hospital did not have a system in place to de-nature liquid controlled medications. The hospital immediately rectified this during the inspection.
  • Not all patients’ records were stored appropriately but the trust took immediate action to address this concern.
  • There were 300 patients in trauma and orthopaedics and 180 patients in ophthalmology who waited over 18 weeks for surgery. Some patients waited over 35 weeks for surgery. These patients had been risk assessed to check if their condition had deteriorated whilst waiting.
  • The 24 hour reviews of venous thromboembolism assessments were not always recorded. We raised this on inspection and the trust rectified this immediately.
  • Whilst the hospital did collect information on the numbers of patients who were rapidly discharged (from regional data), h

    owever, it was not systematically used within the whole SPCT to drive improvements.

  • There was not always a clear record of discussions about do not attempt cardiopulmonary resuscitation (DNAPCR) with patients who had capacity. Mental capacity assessments were not always clearly recorded to underpin decisions about ‘do not attempt cardio-pulmonary resuscitation’ DNACPR.

We saw several areas of outstanding practice including:

  • The geriatric emergency medicine service (GEMS) was outstanding in terms of providing awareness of and responding to the needs of patients within this group and developing a service that provided a multi-agency approach at the front door.
  • Physician associate programmes were being developed to provide a larger group of decision-making clinicians and provide developmental opportunities for staff.
  • The emergency department (ED) worked with external organisations to develop an on-site psychiatric liaison service within the ED, 24 hours a day, seven days a week.
  • The ED was actively working with local educational institutions to develop courses that were specific to areas that were difficult to recruit to such as geriatric and paediatric emergency medicine and the ED had a robust leadership development programme in place.
  • In the Sentinel Stroke National Audit Programme (SSNAP) the hospital was rated as band A overall (A being the best and E the worst), in the April to June 2016 audit, which indicated a world-class stroke service.
  • We visited patients being cared for in two out of the three care homes that the hospital used to place patients that were fit for discharge and awaiting their return back to the community. There was a weekly consultant led ward round once a week for these patients and a hospital doctor also visited both homes on three other days of the week. We saw in all there was excellent level of clinical oversight and detailed records of all input from the service’s doctors.
  • Staff were focused on continually improving the quality of care and the patient experience. For example, we saw evidence that the service was committed to improving the care of elderly patients, such as those living with dementia. Colour-coded bays were evident on some of the wards we visited and finger food boxes had been introduced, which made it easier for patients to eat when they wanted and helped them to maintain independence. Directorate leads told us of plans that were being developed in collaboration with primary care and community services to support the care of elderly patients at home.
  • The end of life care service had piloted, evaluated and fully implemented an end of life companion volunteer scheme for dying patients who may not have any visitors. The service had support from the local community in caring for patients at the end of their life.
  • The ED had developed an end of life care room that was situated adjacent to the resuscitation area. There was a specific pathway and guidance for managing these situations when the patient was a child or young person. The ED had developed a specific continuation of care record for patients who were in the end of life care room; this included ensuring that they had received consultation and timely review for symptom control.
  • The trust had a duty of candour sticker that would be placed into the patient’s notes when the duty of candour had been applied. This included, for example, staff name, date, name of person/patient receiving information, account of incident, details of incident and if an apology was offered.

However, there were also areas of poor practice where the trust needs to make improvements. The trust must:

  • Ensure that mental capacity assessments underpinning decisions about cardiopulmonary resuscitation are being evidenced in patients’ records for end of life care decisions.

The trust should:

  • Continue to work to improve performance in meeting the national four-hour performance measure.
  • Review the planned daily consultant cover in ED as it was below national recommendations of 16 hours per day at 14 hours.
  • Monitor the security and ensure access to medical care entrances are secured to reduce the risk of unauthorised access and vulnerable patients leaving unaccompanied.
  • Monitor compliance with guidelines for documenting monitoring of invasive devices including peripheral vascular devices and urinary catheters.
  • Monitor the number of cancelled patient procedures in cardiology.
  • Review systems so that patients have their venous thromboembolism (VTE) re-assessment 24 hours after admission.
  • Review systems so that patients with hip fracture have a perioperative medical assessment within 72 hours of admission.
  • Review systems so that patients whose operations are cancelled on the day of surgery are rebooked to be treated within 28 days.
  • Monitor that medication is stored at the correct temperature in all rooms and fridges.
  • Monitor the systems for denaturing controlled drugs.
  • Continue to monitor the time to initial clinical assessment in the emergency department so patients receive this assessment within 15 minutes.
  • Consider sharing outcomes of national audits with all surgical staff to improve patient outcomes.
  • Review the provision of information leaflets for the most commonly used languages in the area.
  • Review the facilities in the chapel so it is inclusive to those of other faiths.
  • Review systems for collecting information on the percentage of patients who are discharged to their preferred place of death and how many are discharged to their preferred place within 24 hours.
  • Monitor that records are stored securely preventing unauthorised people accessing patient records.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 23 September 2014

During an inspection to make sure that the improvements required had been made

We carried out a focused inspection on 23 September 2014 to review the trust’s progress in meeting the requirements of the warning notice that was issued on 28 March 2014 for regulation 10 (Quality monitoring of the services provided) against the regulated activity of ‘Treatment of Disease, Disorder or Injury’, specifically to sections 10(1)(a)(b), (2)(c)(i). We inspected the Accident and Emergency Service and the Medical Care service. As this was a focused inspection, we did not inspect every key line of enquiry under the five key questions.

Our key findings were as follows:

  • The trust had taken significant actions to meet the concerns contained in the warning notice and that the warning notice was now to be removed.

Recommendations for improvement for the trust were:

  • The trust should continue to embed effective training and staff appraisals systems in place to ensure trust targets are met
  • The trust should continue to monitor the capacity and demand of the ED to ensure all patients are assessed within the 4 hour target time.
  • The trust should continue to review all areas of patient risk and ensure all areas of risk highlighted on the corporate risk register are reviewed within the prescribed timescales.
  • The trust should continue to monitor all out of hours patient moves and embed the risk assessment process to achieve its target for 100% completion of these risk assessments.

Professor Sir Mike Richards, Chief Inspector of Hospitals

Inspection carried out on 16, 17 and 29 January 2014

During an inspection to make sure that the improvements required had been made

Northampton General Hospital NHS Trust (NGH) is an acute trust with 800 bedded acute hospitals. At the time of our inspection, it had an income of about £250 million and a workforce of 4,300 staff. It provided general acute services to a population of 380,000 and hyper acute stroke, vascular and renal services to people living throughout Northamptonshire, a population of 691,952. Between 2001 and 2012,  there was a 9% growth in the population of Northampton, with significant increases in the 0 to 4 year and 60 to 64 year age groups (30% and 45% respectively). The trust’s main hospital site is Northampton General Hospital (NGH). It also provides services at three community hospitals in Northamptonshire: Danetre Hospital in Daventry, Corby Community Hospital and Hazelwood Ward in Wellingborough.

Before visiting, we looked at a wide range of information we held about the trust and asked other organisations to share what they knew about it. We carried out an announced visit on 16 and 17 January 2014, and during that visit we held focus groups with different staff members from all areas of the hospital. We looked at the personal care or treatment records of patients, observed how staff were caring for people and talked with patients, carers, family members and staff. We reviewed information that we asked the trust to provide. We also held a public listening event where patients and members of the public shared their views and experiences of the trust and we continued to receive and review information from various sources during and after our inspection. We carried out a further unannounced inspection at night on 29 January 2014.

During our inspection, NGH appeared to be very clean throughout.  In a national survey the trust was noted to have been performing well in relation to infection prevention and control.

The trust had a recent history of poor staffing levels on some wards. During our inspection, we saw that action had begun to address staffing issues. Staff told us that improvements in staffing levels were already having a positive impact on services. The trust was also experiencing a shortfall in consultant cover in the Accident and Emergency (A&E) department and the maternity labour ward. This was known by the trust and it had taken action in A&E. The trust had also responded to recent concerns around staffing and care on two medical wards and had taken action by increasing the staffing establishment to address those concerns.

Many of the executive post holders are either new to post or in interim positions. This had an impact on the trust’s leadership as staff reported that senior leaders, with the exception of the chief executive, were rarely visible on wards. Staff were unaware of the positions and responsibilities of most executive post holders. There have been significant changes at the executive level of the trust for some time, and the chief executive was aware of the need for stability among this group in order to address the leadership concerns across the trust. A substantive post of director of finance had been appointed and was due to start imminently, and both the chief operating officer and medical director posts were being advertised around the time of the inspection.

Areas of poor governance, specifically in relation to the management and maintenance of equipment, and to the dispensing of medications to patients on discharge, were identified during our inspection. Both areas were taken up with the trust and the trust has actively responded since our inspection.

Our inspection revealed that end of life care was an area where the trust required more focus and commitment to improve.

Inspection carried out on 16, 17 and 29 January 2014

During a routine inspection

Northampton General Hospital NHS Trust (NGH) is an acute trust with 800 bedded acute hospitals. At the time of our inspection, it had an income of about £250 million and a workforce of 4,300 staff. It provided general acute services to a population of 380,000 and hyper acute stroke, vascular and renal services to people living throughout Northamptonshire, a population of 691,952. Between 2001 and 2012,  there was a 9% growth in the population of Northampton, with significant increases in the 0 to 4 year and 60 to 64 year age groups (30% and 45% respectively). The trust’s main hospital site is Northampton General Hospital (NGH). It also provides services at three community hospitals in Northamptonshire: Danetre Hospital in Daventry, Corby Community Hospital and Hazelwood Ward in Wellingborough.

Before visiting, we looked at a wide range of information we held about the trust and asked other organisations to share what they knew about it. We carried out an announced visit on 16 and 17 January 2014, and during that visit we held focus groups with different staff members from all areas of the hospital. We looked at the personal care or treatment records of patients, observed how staff were caring for people and talked with patients, carers, family members and staff. We reviewed information that we asked the trust to provide. We also held a public listening event where patients and members of the public shared their views and experiences of the trust and we continued to receive and review information from various sources during and after our inspection. We carried out a further unannounced inspection at night on 29 January 2014.

During our inspection, NGH appeared to be very clean throughout.  In a national survey the trust was noted to have been performing well in relation to infection prevention and control.

The trust had a recent history of poor staffing levels on some wards. During our inspection, we saw that action had begun to address staffing issues. Staff told us that improvements in staffing levels were already having a positive impact on services. The trust was also experiencing a shortfall in consultant cover in the Accident and Emergency (A&E) department and the maternity labour ward. This was known by the trust and it had taken action in A&E. The trust had also responded to recent concerns around staffing and care on two medical wards and had taken action by increasing the staffing establishment to address those concerns.

Many of the executive post holders are either new to post or in interim positions. This had an impact on the trust’s leadership as staff reported that senior leaders, with the exception of the chief executive, were rarely visible on wards. Staff were unaware of the positions and responsibilities of most executive post holders. There have been significant changes at the executive level of the trust for some time, and the chief executive was aware of the need for stability among this group in order to address the leadership concerns across the trust. A substantive post of director of finance had been appointed and was due to start imminently, and both the chief operating officer and medical director posts were being advertised around the time of the inspection.

Areas of poor governance, specifically in relation to the management and maintenance of equipment, and to the dispensing of medications to patients on discharge, were identified during our inspection. Both areas were taken up with the trust and the trust has actively responded since our inspection.

Our inspection revealed that end of life care was an area where the trust required more focus and commitment to improve.

Inspection carried out on 16, 17, 18, 19, 20 July 2012

During a routine inspection

We carried out five inspection visits to Northampton General hospital on consecutive days. Our first inspection visit was unannounced and covered the afternoon and early evening period. The main focus of our inspections was on emergency care; however during our inspection in addition to visiting the accident and emergency department and emergency assessment unit we visited six wards and the eye department.

We spoke to several patients and in some cases their relatives on each of the wards and departments visited. Some of the patients we spoke with had experienced lengthy delays in the accident and emergency department, waiting for a bed to be available on a ward. In spite of this we found that the majority of patients were satisfied with their care and treatment.

Patients told us that their care and treatment had been discussed with them and they had been kept informed. Patients and relatives gave us examples of the care of patients acutely unwell being prioritised. Two patients who had been in hospital earlier in the year told us that this time the care and treatment was much better and that there had been an improvement in their experience in the accident and emergency department. One of the comments we received from a relative was echoed by others we spoke with; “the care has been excellent this time, staff have communicated with me every step of the way, we have not been left alone for very long”.

Inspection carried out on 20, 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 29, 30 June and 4 July 2011

During an inspection in response to concerns

We spoke with patients using the service on 10 wards over a period of two and a half days and received a lot of positive comments about the care and treatment that people were receiving.

Patients told us that nurses and health care assistants treat them with respect and remember to close the bed area curtains to preserve their privacy and dignity. They also told us that when they are taken to other departments in the hospital for treatment or tests and are not fully clothed, then staff make sure that they are covered with a blanket.

Patients were positive about the care and treatment that they were receiving. The comments included; “The doctors know what they were doing”, “Although staff are very busy, patients get the help and care that they need”, “We cannot fault the care and attention”, “Staff are kind and caring”.

Patients told us that patients who need help with their meals get it. One patient said that it was unpleasant to have the meal that they had been unable to eat left in front of them when they were feeling unwell and would like staff to take it away a bit quicker.

Patients told us that it can sometimes be difficult for them and their relatives to get the information that they need. One relative had been particularly distressed as they were unable to find out why the patient had not returned from theatre when expected. A patient also told us that they had experienced difficulties and a long delay in getting the medication they needed when they were discharged from hospital. They thought this may be as a result of poor communication between departments.

However another patient told us that they had found communication to be very good. They told us that their planned operation had been cancelled, but they were satisfied that they had received a very good explanation why the operation could not go ahead as planned.