Northampton General Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse, and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation. We assessed 8 quality statements.

At our last assessment we rated this key question ‘requires improvement.’ At this assessment, the rating has remained ‘requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk patients could be harmed.

The service did not always have effective processes to ensure patients were discharged when they were no longer required to remain in the hospital to receive medical treatment. Patients were not always cared for in environments designed to meet their needs. We found some concerns about infection prevention and control in inpatient wards. Processes for medicine management did not always ensure that medicine administration was safe and met national standards. However, staff had a good understanding of adult safeguarding processes, including deprivations of liberty safeguards and the Mental Capacity Act 2005. There were mostly enough staff who were supported to develop in their roles.

The provider was in breach of legal regulations in relation to safe care and treatment, infection prevention and control, medicines management, supporting staff with annual appraisals and training, and governance and risk management.

We have not awarded this service a score for Safe.

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

The service did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice. Staff we spoke with, who had been asked to investigate patient safety incidents, had not received training in how to investigate patient safety incidents

The service had a system to monitor all reported incidents and data was shared through governance processes to the board for oversight but the system was not always effective to drive improvement through learning. The Divisional Governance Report (December 2024) showed there were 111 open incidents across medical care services. The most reported incidents were pressure ulcer damage and falls. There had been 1873 incidents of pressure ulcer damage (including incidents when patients were admitted with pressure ulcers) and 381 falls reported between June and December 2024. Leaders spoke of initiatives to address pressure ulcers and fall prevention. We asked for information to demonstrate actions taken but we did not receive this. We were not assured the service implemented and embedded learning from incidents of pressure ulcers developing and to prevent inpatient falls. However, following the inspection, the trust shared further information about actions taken to address prevention of hospital-acquired pressure ulcers and inpatient falls. While many actions had been completed, the action plans did not provide assurance that all actions had been completed within the set time frames.

Senior nursing staff, who were responsible for investigating serious incidents, told us they did not receive training in incident investigations. We reviewed one serious incident investigation (INC-70897) which had been completed using a recognised framework and key lines of enquiry. The investigation was very concise, and some learning and immediate actions had been identified. The investigation was very concise, and some learning had been identified. However, the investigation did not include an action plan to support service improvement through the lessons learnt. However, following the inspection, we were informed that the investigation had not been concluded at the time of the inspection. This had been completed, and the full investigation was shared. Whilst some learning was identified, it was not clear how this would be shared to prevent similar incidents in the future.

Staff told us they reported incidents on the online electronic incident reporting system. Staff gave examples of lessons learned from safety incidents or complaints, resulting in changes, which had improved care for others.

Lessons learned from incidents were shared with staff in safety huddles, team meetings, and through emails. There were specific events for staff where learning was shared. For example, there was an upcoming multi-agency discharge event (MADE) planned with community partners. This would be looking at barriers to the effective discharge of patients who no longer needed to remain in the hospital.

There were effective systems to review deaths in the hospital. There was a clinician-led systematic review process using a nationally recognised standard judgement review process. Data showed the trust benchmarked against national standards and had the expected number of deaths.

The service did not have effective systems, processes, and pathways to enable staff to work well with people and healthcare partners to establish and maintain safe and timely discharges when patients no longer needed to be admitted to the hospital. Staff did not always manage or monitor people's safety. They did not always make sure there was continuity of care, including when people moved between different services. However, leaders shared some evidence of working with system partners to improve discharge pathways.

During our inspection, we found multiple challenges which impacted the timely discharge of patients when they no longer required medical treatment. Service leaders recognised that improvements were needed to ensure patient flow through the hospital was effective in addressing capacity in the emergency department at times of high demand. We raised concerns about ineffective flow through the hospital to leaders at the time of the inspection. Leaders provided additional information and assurance of ongoing workstreams and projects to improve patient flow. However, it was not evident from the information shared how the actions identified were reviewed for their effectiveness.

Patient flow through the hospital was not always effective. Data showed there was a high bed occupancy alongside a recognised bed deficit within the hospital. The service monitored length of stay, and the average length of stay was significantly longer for patients admitted (16.6 days) when compared to the England median length of stay (11.7 days).

Data also showed that patients who were medically fit for discharge were not always able to be discharged in a timely manner. At the time of our inspection, up to 30% of patients across the hospital did not need to be treated in the hospital and were medically fit for discharge. Information shared by the trust confirmed that 40% of vacated beds from patient discharges became available after 5 pm with low rates of discharges earlier in the day.

Patient discharges were coordinated by staff situated in the discharge hub but often without the direct involvement of nursing and therapy staff caring for patients in the inpatient wards. Some nurses told us they were not involved in patient discharge planning. The flow coordinators were not managed by senior staff in the discharge hub, and this could lead to missed opportunities for effective working relationships. Staff therefore did not always work well together to plan patients' discharges.

Although processes to review patients in line with national guidance were in place, board rounds were not always carried out twice daily in line with the trust's standard operating procedures. Leaders had implemented a `board round project plan' to help improve the effectiveness of board rounds and support patient oversight and care journey. This project included a draft `Board Round Standard Operating Procedure' to provide standardised guidance on how these should be conducted and included the concept of `red and green' patient days designed to reduce internal and external delays. While the intense improvement program was designed to observe, review, and provide training for staff, we did not see that this was embedded and used to improve the patient journey. For example, we noted on Allebone Ward a request for an inpatient 24-hour heart monitor was first decided on 28 January 2025. However, this had not been initiated when we inspected the ward on 18 February 2025. This meant there had been a delay of 21 days since the initial request. We raised this with the staff who took prompt action to book this.

The trust introduced a standard operating procedure (SoP) for `reverse boarding of patients awaiting discharge' in January 2025. The SoP included action to take to move patients with a definite or potential discharge to a designated `reverse boarding space' in line with preset criteria to ensure patients were suitable. Areas identified for temporary escalation beds had been risk assessed to include clinical and non-clinical hazards which included clinical risks and patient experience risks.

Patients receiving medical care were sometimes admitted to escalation areas, escalation beds, or beds/chairs located in temporary spaces within the ward environment. This was as part of a `reverse boarding initiative' to free up bed spaces to accommodate admissions from the emergency department. This meant the environments were not always adequate to ensure patients' dignity, and confidentiality and meet their expectations.

Staff carried out a risk assessment for each patient who was transferred to escalation beds to ensure they were safe to be looked after in the designated escalation bed. Staffing levels were mostly adjusted to ensure staff could care for additional patients.

We observed a clinical emergency in one of the wards where additional escalation beds had been placed in patient bays. Staff attending ensured the privacy of the patient who had deteriorated and accessed emergency equipment as required. The space for additional staff and equipment was compromised but staff ensured this did not compromise the emergency care and treatment the patients needed.

There were 3 daily operational site/bed meetings. These meetings took place virtually and were well attended from across the hospital. The meetings were designed to review bed capacity, planned and actual discharges, and staffing levels to ensure safe care and treatment could be delivered. The trust's `Operational Pressure Escalation Policy' stated there should be 4 site team meetings when operational pressures reached the highest level (OPEL 4). We did not see leaders following this during our onsite visit when the trust was in OPEL 4 on both days.

Leaders did not collect data to evaluate potential risks to patients staying in the hospital longer than they needed to once they were medically fit for discharge. Divisional leaders did not monitor the rate of patients who were medically fit for discharge and were not discharged who became deconditioned or acquired a hospital infection resulting in them requiring hospital care again. However, the trust measured readmission rates within 30 days of discharge as part of the morbidity and mortality review process. Data showed that 13.65% of patients were readmitted to the hospital within 30 days of discharge and this was higher than the target of 12% (December 2024). This was reported to the Board, but it was not clear from the Board Papers (February 2025) what actions were taken to address this.

We requested data to review how many patients had been readmitted to the hospital within 24 hours of discharge, which could mean that the discharge process had failed. Data shared by the trust showed there had been 55 readmissions within 24 hours of discharge in the last 12 months (January to December 2024) across all medical wards. This was a low number when compared with the number of daily discharges. We observed an operational `bed meeting' on 18 February 2025 at 12 noon, which showed there had been 7 patients discharged, with another 11 definite discharges and a further 36 potential discharges on this day across the whole hospital but not specific to medical care."

Not all staff had completed the required safeguarding training. However, staff knew how to escalate safeguarding concerns and supported people who lacked capacity in line with national guidance.

Staff received training in safeguarding adults and children at a level required for their role. Data showed 89.2% of staff had completed Safeguarding Adults level 3 training and 91.2% had completed Safeguarding Adults level 2 training. We reviewed Safeguarding Children training compliance, which was 89.3% overall, although compliance for medical staff was between 25% (Foundation Year 1) to 51.5% for specialty registrar doctors.

There was a ‘Safeguarding Adults at Risk’ policy (v4. 2021). This policy should have been reviewed in June 2024 to ensure information and guidance were in line with national guidance and up to date. The policy did not include any information about expected training referred to as ‘Oliver McGowan training.’ This training is a government standardised mandatory training program for health and social care staff aimed to improve their skills and knowledge in supporting autistic people and people with a learning disability. However, following the inspection, we received further information from the trust that 354 clinical staff members across the hospital had received Oliver McGowan training. In addition, this training would be added to the list of mandatory training from September 2025

Staff did not always arrange safe discharges for patients who were discharged from the hospital to receive ongoing care in their usual place of living. We looked at incidents shared with us as part of the information requested following the inspection. We noted there had been 6 unsafe discharges reported between 28 November 2024 and 11 December 2024. These had also been raised as safeguarding concerns with the local authority and were still being investigated at the time of our inspection.

Staff had a good understanding of how to escalate safeguarding concerns, and they received mandatory training in safeguarding vulnerable adults at a level relevant to their role. Where applicable, there was a clear understanding of the Deprivation of Liberty Safeguards (DoLS). Staff understood their responsibilities regarding the DoLS, and this was used only when it was in the best interest of the patients. Staff had a good understanding of the Mental Capacity Act 2005 and ‘best interest’ decisions and recorded assessments in patients’ care records.

It was not always clear how involved patients were in managing risks to their well-being and plans for ongoing care, including discharge.

Staff did not always work well with patients to understand and manage risks. Staff did not always provide care to meet patients' needs that were safe, supportive, and enabled people to do the things that mattered to them.

Some patients told us they understood their condition and the care and treatment options that had been discussed with them during the admission, and they were aware of their plan of care and treatment. However, many of the patients we saw in the medical inpatient wards were unable to explain that they knew the reasons for their being in the hospital and their treatment plan due to the nature of their illness or general condition.

Data showed that many patients remained in hospital when they did not need further medical treatment. It was not clear how well the risks to patients such as deconditioning and developing hospital-acquired infections were monitored and understood by patients and their families.

Although we saw some risk assessments were completed, there were gaps in the paper-based patient records, including information obtained about discharge arrangements. We could not be assured how well this information was discussed and updated involving individual patients to keep them informed about their care.

Patients were not always aware of their plan of care. One patient told us they had not had clear communication with staff, and they were unaware of their discharge plan. "I don't know what the plan is, and I've been waiting all day." The ward nurse was present for this patient's interaction and went to find out more information, on their return it was explained that the patient had been in A&E for several nights and had only arrived in this ward last night.

However, we also spoke with some patients and their relatives who confirmed they had been involved in making decisions about their care and treatment as far as possible.

On the inpatient wards, we observed patient boards above the beds which had the patients' names, any dietary requirements, and information relating to mobility, including fall risks, and pressure ulcer prevention. Staff had easy access to identified risks about patients.

The service did not always detect and control potential risks in the care environment. Staff did not always make sure equipment, facilities and technology supported the delivery of safe care.

Patients were not always cared for in safe environments designed to meet their needs. Leaders had identified that the Eleanor Frailty Unit was `not fit for purpose' and had added this to the divisional risk register in July 2024. This risk was last reviewed on 31 August 2024, and the ward was still in use at the time when we inspected the service. Some mitigating actions had been taken but due to the high demand for beds, the unit was still being used as an inpatient ward at the time of our inspection.

The environmental design impacted the appropriate storage of equipment. This resulted in a cluttered environment as equipment was stored in corridors making it difficult for staff to navigate when moving beds around. Some wards were also crowded with limited space, which added to the difficulties staff faced in emergencies when more equipment was needed.

Some patients were cared for in additional beds placed in bays or designated temporary escalation spaces at times of high operational pressure. Staff told us this happened almost all the time, so measures were planned to make these permanent bed spaces.

Facilities, equipment, and technology were generally maintained, and consistently supported staff to deliver safe and effective care. There was signage within inpatient wards such as marked emergency exits. There were dedicated estate maintenance staff and wards had housekeepers employed to maintain the environment. However, we saw inconsistent use of `I am clean' stickers to demonstrate the equipment was clean and ready for use. Although the commode cleaning solution was stored in locked cupboards, a fresh solution was not always made up daily in line with hospital protocols. On Walter Tull Ward, a chart demonstrated a fresh solution had not been prepared for 12 days in February 2025. We raised this with staff at the time of our inspection. This meant there was a risk of ineffective infection prevention and control.

Resuscitation equipment was stored in tamper-evident trolleys in line with Resuscitation Council (UK) guidelines and had mostly been checked daily. Although on Brampton Ward we noted the resuscitation trolley had not been checked for 2 days between 1 and 19 February 2025. Oxygen cylinders were mostly stored safely in crates.

Staff told us they had enough equipment to care for patients. We saw that technology was used to support the monitoring of patients. For example, staff on the Walter Tull Ward had access to electronic monitoring facilities for patients which also connected to central monitors. Staff could therefore monitor patients remotely and any abnormalities were displayed in the nurse's station. Staff across inpatient wards used handheld devices to record patients' vital observations which also highlighted when specific risk assessments such as nutritional risk scores were due.

We reviewed a Patients-Led Assessment of the Care Environment (PLACE) score (2024) across the hospital which showed these had declined slightly when compared to the scores for 2023. The audit showed a score of 83.3% for maintaining patients' privacy, dignity, and well-being, 77.3% for meeting the needs of patients with dementia, and 83.9% for meeting the needs of patients with a disability. The score of the condition and appearance of the environment was 96.9%.

Staff did not always receive annual appraisals. However, there was mostly enough qualified, skilled, and experienced staff, who received the training they needed to carry out their roles.

Staff did not always receive appropriate supervision and appraisal. Appraisal compliance data showed an annual appraisal rate of 85.6%, which met the trust target of 85%. However, there was poor compliance with annual appraisals for some healthcare staff. Data showed only 50% of receptionists and Healthcare Science Assistants and none of the Physician Associates and Trainee Clinical Scientists had received an appraisal in the last 12 months.

There was mostly enough nursing staff with the right skill mix to make sure patients received consistently safe, good quality care that mostly met their needs. However, nursing staffing levels were not always increased to reflect additional patients located within their ward spaces as part of the ‘reverse boarding’ initiative. We were told there was also not always enough therapy staff to meet national guidance (Seven Day Services Clinical Standards, 2022). This was because services had been extended to cover 7 days but had left some therapies such as speech and language therapies short staffed. Some consultants told us there were not enough consultants to provide cover in line with national standards in, for example, stroke care.

We reviewed the ‘Annual Establishment Review (2024) which assured the trust board of the nursing and midwifery staffing review carried out in November 2024. While the review did not cover all individual wards, it showed there was a recommended investment in increased nursing staffing levels in Esther White Ward, Walter Tull Ward, Abingdon Ward, Dryden Ward, and the Discharge Suite. The report showed there had been 55 reported incidents where registered nurses on shift fell below 25% or more of the planned registered nurses on duty across the trust between March and October 2024. There was a vacancy rate of 11% (October 2024) across the trust within the registered nursing and midwifery workforce and 4% within the health care assistant/unregistered workforce. This was partly due to the uplift in staffing levels.

Staff told us they received the training they needed to carry out their role and had development opportunities. For example, healthcare assistants had opportunities to develop through apprenticeships, and some registered nurses were supported to complete master’s degree courses. Training compliance data from February 2025 showed the target was above 85% in all medical wards for nutritional malnutrition risk assessment.

However, the service did not always monitor how many staff (in percentages) had completed training modules. For example, we requested data to show the percentage of staff who had completed training in managing the deteriorating patient. The service returned information about the number of staff who had completed training in the last 12 months, but this did not assess compliance against a target to ensure enough staff had received the required training.

The approach to assessing and managing the risk of infection was not always in line with the best evidence-based practice. However, staff received training in infection prevention and control.

During our inspection, we found infection prevention and control measures placed patients at risk as these did not always follow best practices. For example, we found that light cords were made of material which was not easy to clean, and these were not cleaned between patients. In addition, there was minimal oversight of the effectiveness of how these were cleaned. Following the inspection, we received assurance about the actions taken to make improvements following our feedback.

We observed nursing staff did not always cap off intravenous infusion lines when they disconnected these from patients, and then staff did not always clean the ends before reconnecting the infusion lines. There was a risk of patients developing an infection because of this.

Documentation to demonstrate weekly flushing of water systems was not always clearly documented to show these were carried out where needed, to prevent the build-up of conditions favourable to the growth of Legionella and other bacteria within water systems.

Staff received training in infection prevention and control. The trust shared staff training compliance which was generally above the trust target at 85% except for Holcot Ward. Data showed staff training compliance was 80.4% in November 2024. Following the inspection. the trust provided further information to show the staff training compliance had improved to exceed the trust target in June 2025 (90%). Staff compliance with face mask testing (ensuring that certain facemasks fit tightly in line with manufacturer’s guidance) compliance was below the trust target (85%) on both Esther White Ward (73%) and Walter Tull Ward (69%) in December 2024.

The ‘Matrons’ IPC Reports’ for Urgent Care (January 2025) and inpatient wards (December 2024) showed there had been few incidents of healthcare-associated infections and when these occurred there was information included that these were investigated.

We reviewed cleaning audits carried out across medical inpatient wards between January 2024 and February 2025. The audits showed generally good compliance but highlighted there has been no report submitted for 3 months on Victoria Ward and the Heart Centre, and 10 months for the Respiratory Support Unit (RSU). The report showed that most scores reached the expected level of cleanliness with only 4 of 217 results falling far below (red) the expected standard and 29 results scoring an ‘amber’ result.

The service did not always make sure that medicines and treatments were safe and met patients' needs, capacities, and preferences.

Staff did not always record the time of medicines administration in line with the service's policy. Patients could be put at risk of adverse effects if medicines required minimum intervals of time between doses. For example, we saw an instance where times of paracetamol doses were not recorded. Staff told us they relied on memory to ensure there were appropriate gaps in the timings of administration. The service had identified this as an area of improvement. They were scheduled to roll out electronic recording systems later in 2025 which would help address this concern.

Staff did not always assess the risks of venous thromboembolism (VTE) on admission and re-assess the risks within 24 hours in line with national guidance. Audit data across 5 wards showed variable compliance from April 2024 to February 2025. Compliance with VTE assessment on admission ranged from 40% to 100% with an average compliance score of 87%. Compliance with reassessment within 24 hours was more variable and ranged from 0% to 100% with an average compliance score of 61%. The audit did not demonstrate how many patients' records were audited and what actions had been taken to ensure improved compliance. The trust could not, therefore, assure itself that continuous improvements were made to minimise risks to patients' care and treatment. However, following the inspection, the service informed us that they were introducing further measures to ensure compliance within the trust target.

Processes to manage medicines were set out by the trust to ensure patients received their medicines as prescribed. Medicines, including controlled drugs, were disposed of safely when no longer required and suitable records were made. Medicines used for resuscitation and other medical emergencies were available, accessible for immediate use, and tamperproof.

When prescribing antibiotics, staff sought appropriate antimicrobial advice from a consultant microbiologist. Antimicrobial medicines were appropriately prescribed, reviewed, and verified on the prescription chart. There was evidence of antimicrobial agents being reviewed 48-72 hours after the start of treatment in line with national guidance.

Staff told us they knew how to contact the pharmacy for advice and processes were in place for the supply of medicines out of hours. Pharmacy teams supported staff to reconcile medicines when they moved between services in line with national guidance. The performance of this varied month on month (For example, 55% of patients admitted to medical wards in January 2025 and their medicines reconciled within 24 hours but fell to 44% in February 2025.

The service had ward-based dispensing to support arrangements for patients' medicines at discharge. This helped reduce the average time to prepare "to-take-out" (TTO) medicines from 120 minutes to 36 minutes. Discharge information was shared with patients' community pharmacies through the "Discharge Medication Service" (DMS). The DMS is an NHS collaborative communication scheme that aims to improve medicine-related outcomes and reduce readmission for patients on discharge from the hospital. We saw evidence that areas with ward-based dispensing had increased rates of patients discharged through the DMS.

Whilst the service had introduced these new processes to support medicine optimisation for patients on discharge, staff told us the delays in discharge were because of wider system issues including delays when writing discharge prescriptions.

Staff told us they received regular training, and they knew how to access relevant local medicines policies, procedures, and guidelines.

Pharmacy staff completed regular medicine management and compliance with national safety alert audits. We saw the service generally audited and where issues were identified, they were discussed and actioned at relevant medicines safety meetings. We saw medicine-related risks had been documented on the trust's risk register. This included risks around the trust's electronic storage cabinets. However, while risks were acknowledged, we did not see evidence of clear mitigating actions to reduce these risks. We did not see evidence of ownership of risks to ensure the actions taken to mitigate risks were being completed.