Northampton General Hospital

On this page

• 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

We looked for evidence that patients’ care, treatment, and support achieved good outcomes and promoted a good quality of life, based on the best available evidence. We assessed 7 quality statements.

At our last inspection, we rated this key question as ‘requires improvement.’ At this inspection, the rating has remained ‘requires improvement.’

While staff did have clear responsibilities, roles, systems of accountability, and governance, leaders did not always act on the best information about risk, performance, and outcomes. We could not be assured that action was taken to address concerns about the quality of care such as pressure ulcers and inpatient falls. The arrangements for the availability, integrity, and confidentiality of data, records, and data management systems were not always effective.

However, there was a vision and a strategy for the hospital to which the service was aligned. Most staff described a positive culture where they had opportunities to develop. The service had inclusive leaders at all levels up to the divisional level who understood the context in which they delivered care, treatment, and support and they embodied the culture and values of their workforce and organisation. The service fostered a positive culture where patients felt that they could speak up and that their voices would be heard. Leaders understood their duty to collaborate and work in partnership to ensure services worked seamlessly for patients. They shared information and learning with partners and collaborated for improvement. The service focused on continuous learning, innovation, and improvement across the organisation and the local system.

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.

There was a vision and a strategy for the hospital to which the service was aligned. Most staff described a positive culture where they had opportunities to develop.

There was a ‘Group Clinical Strategy (2022) which set out the aims to work with a neighbouring NHS hospital to provide ‘safe, compassionate, and clinically excellent care for patients in Northamptonshire’. The vision was also to offer a supportive culture that empowered staff to learn, develop, and innovate in partnership with the wider system. Service leaders were aware of the vision and strategy, discussed how they worked in line with the strategy within the confines of external challenges, such as population growth. They spoke of the importance of working across the whole healthcare system. Staff spoke of development opportunities to achieve their ambitions and how they were supported by the trust. Student nurses and trainee doctors said they felt welcome and had opportunities to achieve their learning objectives within the clinical areas.

It was recognised by trust leaders and the wider healthcare system that there was a ‘bed deficit’ across the two hospitals working together. Service leaders worked with hospital leaders and system partners to address the challenges. However, more could be done within medical care services to increase patient flow by working closer together and making discharge planning everybody’s responsibility.

Staff and leaders demonstrated a positive, compassionate, listening culture which promoted trust and understanding between them and the patients using the service. The staff we spoke with at all levels understood equality, diversity, and human rights, and they prioritised safe, high-quality, compassionate care. Staff told us they enjoyed working at the hospital although it was always busy. We saw they worked hard and were compassionate in their interactions with patients. However, some senior leaders sometimes felt overwhelmed by the daily challenges posed by patient flow.

We reviewed the 2024 NHS Staff Survey for the medical division based on a 56% response rate. The results were similar to the England national results across all 8 themes.

The service had inclusive leaders at all levels up to the divisional level who understood the context in which they delivered care, treatment, and support and embodied the culture and values of their workforce and organisation.

There was a clear leadership structure with a triumvirate leadership team. This consisted of a divisional director, an associate director of nursing, and a divisional general manager who came together to provide leadership at the divisional level. The ‘medicine and urgent care division’ was made of ‘urgent and emergency care,’ ‘inpatients specialties,’ and ‘outpatients, elderly and stroke’ care.

Divisional leaders had the experience, capacity, capability, and integrity to ensure the organisational vision could be delivered. Leaders were knowledgeable about issues and priorities for the quality of services and could access appropriate support and development in their role. However, risks concerned with patient flow through the hospital had not been recognised by divisional leaders and effective actions were not implemented. Leaders spoke of challenges concerned with high numbers of pressure ulcers developing and a high number of inpatient falls. It was not clear that risks to patients with no criteria to reside, such as deconditioning and hospital-acquired infections, were monitored and used to drive improvement.

Divisional leaders were visible and led by example, modelling inclusive behaviours. Staff told us they felt supported by their immediate managers but staff at different levels told us they never saw the executive leaders in their clinical areas.

Ward managers spoke of succession planning to support the development and ‘growing’ of their own staff. They spoke of the help available to support healthcare assistants to become registered nurses through apprenticeships and they told us about the support available for staff to ensure their skills, experience, and competence to reach promotions.

Most staff we spoke with described a positive culture, of effective and supportive team working and said that they enjoyed their jobs.

The service fostered a positive culture where patients felt that they could speak up and that their voices would be heard. Staff and leaders acted with openness, honesty, and transparency.

There was a `Freedom to Speak Up: Raising Concerns at Work' policy (2022), which provided guidance for staff to raise concerns without fear of detriment. We reviewed the `Freedom to Speak Up' report for Quarter 1 to 3 2024/25. During these months, a total of 11 concerns had been raised in the urgent and emergency care division, including medical care. The most cited issues trust-wide were reported to be concerns about staff behaviours followed by worker safety. The report identified learning actions to address the concerns raised trust-wide. The report was presented to the Patients Committee in January 2025 and to the trust board in February 2025.

There was a team of Freedom to Speak Up Guardians (FTSU) who worked across the hospital, listening to staff who wanted to raise concerns. Information about the FTSU was displayed around the hospital.

Staff was aware of `duty of candour' responsibilities when things went wrong. There were designated stickers used to add to patients' paper-based notes when an incident had happened, and the duty of candour had been applied. Data showed staff had applied the duty of candour in 19 incidents between 1 January and 22 February 2025 across the hospital. There were 8 incidents in medical services listed where a duty of candour had been applied. The severity of harm ranged from no harm (7) to severe harm (1). The data did not confirm that the whole duty of candour process has been completed in 6 of 8 incidents, which included contact with the patients and their next of kin and a written apology. However, staff may not have had the opportunity to complete investigations and complete the duty of candour process at the time of the inspection.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The systems used to manage current and future performance and risks to the quality of the service were not always effective. The arrangements for the availability, integrity, and confidentiality of data, records, and data management systems were not always effective.

There was a divisional risk register which captured risks across urgent and emergency care and medical care, but risks associated with a high number of medically fit-for-discharge (MFFD) patients in the hospital had not been identified. The impact of the high percentage of the bed base being occupied such as patients no longer being medically fit for discharge, deconditioning and/or hospital-acquired infections, and patient flow had not been recognised and given the adequate focus to resolve.

We reviewed the divisional risk register and noted there were 21 risks for `Outpatients, Elderly, and Stroke Medicine' on the register. Mitigating actions were identified and implemented. The risk register showed that risk review dates were identified and there was evidence of these reviews. However, there was no delegated `risk owner' identified to ensure actions were taken and reviewed and 7 risks had not been reviewed when they should have been. We were unclear as to how the trust assured itself how and if risks were managed effectively.

There were monthly divisional governance meetings that followed a set agenda, which included the number of incidents, incident investigations carried out and overdue, and recommendations for closed investigations. The agenda also included learning from morbidity and mortality (M&M) meetings, risks, patient satisfaction and experience data, and an overview of extreme and corporate-level risks within the division. However, it was not clear that the M&M meetings were embedded across all medical specialties.

Leaders carried out some regular audits to evaluate the standards of care. We requested an overview of all audits, but we did not receive this. However, the trust shared audits concerning compliance with screening of patients for malnutrition and compliance with vital observations from Jan to December 2024. The vital observations audit demonstrated the average compliance score for vital observations being obtained at the right time across medical inpatient wards was an average of 74%, lower than the trust average of 76%. The audit also looked at the percentage of time over protocol time (when the observations should have been obtained depending on the patient's conditions). This showed that for some wards up to 16% of observations were taken 33% over the protocol time. The audit also looked at compliance with planned versus actual observations carried out at night time. While most of these were carried out as planned, some results showed that only 50% of the planned observations were taken. The audit did not include information about any actions planned to improve this where this was required.

Leaders of the service spoke of challenges concerned with high numbers of pressure ulcers developing and a high number of inpatient falls. We requested action plans to address these concerns and evidence of their effectiveness, but we did not receive any action plans to address these concerns to provide assurance. 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.

We reviewed a `Get it Right First Time (GIRFT) action plan from February 2024. The action plan included 27 actions across acute medicine, emergency medicine, and frailty services in the hospital. Implementation priorities (immediate, short-term term, and mid-to-long term') were identified but there were no target dates or information about the frequency of reviews. Following the inspection, we received an updated GIRFT plan (February 2025) with immediate, short term and mid-long-term actions. It was not clear that any of the actions had been closed but we did see that some new actions had been added following our inspection to address patients flow through the hospital. The plan did not include target dates or information about the frequency of when the actions should be reviewed.

We noted some policies and guidance had not been reviewed and updated when they should have been to ensure they were compliant with the best evidence and up-to-date national standards and guidelines. The minutes of the divisional meeting in December 2024 showed there were 3 policies overdue for the planned review: The `Ketoacidosis in adults `guideline should have been reviewed in May 2022, the `Diabetes Management during End of Life Care' guideline should have been reviewed in July 2022 and the `Ulcerative Colitis Management of an Acute Severe Episode in Adults' should have been reviewed in February 2023.

Information relating to patient records was not always kept confidential as we found patient records trolleys were not locked and staff did not always close computer screens when they left them. There was a risk that personal information about patients was available to patients who did not have permission to access patients' records. We raised this with hospital leaders following the inspection who took action to remind staff about patient confidentiality.

There were clear structures of how the information would flow from the wards to the Quality and Safety Committee, the board, and back. Leaders and staff were aware of their roles and the mechanisms to support governance.

Some inpatient wards displayed information about patient safety on `Patient Safety boards." For example, we reviewed the information displayed on Benham Ward which included compliance with hand washing (100%), cleaning audits (98%), and the number of days since the last patient safety incident such as pressure ulcer (25 days) and inpatients falls (2 days). The board displayed feedback through the `Friends and Family' test and the number of planned versus actual staff on duty. The ward also displayed a 5-star rating for cleaning standards in line with national guidance, but we did not see this displayed in all inpatient wards we visited.

Staff recorded patients' care and treatment in paper-based records but used multiple electronic records alongside the paper-based records. There was a risk of information not being recorded or duplication of information. For example, information about discharge planning, which was intended to start at the point of admission, was not always recorded in the care plan designed to capture discharge planning information. To avoid duplication, staff recorded information using the electronic oversight system used for board rounds. We attended a board round during the inspection and staff did not use the electronic oversight system and there was a risk that not all up-to-date information was considered and used to plan ongoing care and treatment. We asked for documentation audits to ascertain how well patient documentation was being completed, but we did not receive this information, and it was not clear if the trust audited patient documentation records. The trust was planning to move to electronic care records during the spring of 2025.

Leaders understood their duty to collaborate and work in partnership to ensure services worked seamlessly for patients. They shared information and learning with partners and collaborated for improvement.

Leaders collaborated with relevant external stakeholders and agencies. Following the inspection, we received information to demonstrate how they worked with relevant system partners to support care provision, service development, and joined-up care.

Staff worked with system partners to arrange discharge planning for patients who needed additional support after their stay in the hospital.

The service worked with the local integrated care system and NHS England in line with monitoring agreements and to make improvements.

The service did not always focus on continuous learning, innovation, and improvement across our organisation and the local system. There was a lack of evidence of how the service planned to take action to make improvements.

Staff and leaders understood where improvements were needed. However, the approach was not always effective in ensuring actions were identified, monitored, and reviewed to achieve outcomes and intended impact. The service recognised there were concerns about ineffective patient flow through the hospital from admission to discharge. Leaders had worked with external agencies to review patient flow and identified actions to improve patient flow such as the ‘board round project’ and re-introducing the concept of ‘red and green’ patient days designed to reduce internal and external delays.

The service held monthly morbidity and mortality (MM) meetings where all in-hospital deaths across most specialties were reviewed in line with national guidance across most specialties The divisional governance report (December 2024) showed that the MM plan for the remainder of 2024/24 was yet to be confirmed for some elderly care wards, and inpatient specialty wards for diabetes and cardiology. The main aim of these meetings was to learn from clinical outcomes to identify service improvements. There was a ‘Divisional Morbidity and Mortality Dashboard’ which showed the number of deaths and any thematic learning from all mortality reviews. We looked at the MM Dashboard from November 2024 to January 2025 and found the identified ‘top improvement points’ were unchanged over the 3 months. It was not clear how the identified ‘top improvement points’ translated into an action plan to evidence how improvements were made and how the effectiveness of the actions was assured. However, the mortality rate for inpatients receiving medical care was in line with the national average.

The trust had a continuous improvement strategy for 2024-2029. Leaders spoke of improvements that focused on work to align concerns about the deteriorating patients. There were existing actions to review specific patient safety incidents regarding falls and hospital-acquired pressure ulcers as discussed by leaders but these were not translated into action plans to drive improvement. We asked for but did not receive any specific information concerning innovation within medical inpatient services.

Medical care services were engaged with research activity across different specialties including neurology, diabetes, rheumatology, cardiology, and stroke care.

Staff and leaders used feedback from patients and their next of kin to implement improvements, but this was not consistent across all medical inpatient wards. We saw on some wards that feedback from the NHS Family and Friends test was displayed alongside actions covered under the heading; ‘You said, We did.’

The service had external relationships that supported improvement and innovation. Staff and leaders engaged with external work, including research, and embedded evidence-based practice in the organisation.