Northampton General Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work. We assessed 4 quality statements.

At our last assessment, we rated this key question as ‘good.’ At this assessment, the rating has changed to ‘requires improvement'. This means the service did not always ensure people were receiving care in line with best practice or guidance.

We issued a Section 29A Warning Notice to the trust of 20 March 2025 as a result of some of the concerns raised within this domain.

Staff usually delivered evidence-based care and treatment in line with national guidance. Staff supported patients to understand their rights around consent and respected these when they delivered person-centred care and treatment. Staff and leaders worked with other services to provide best care to patients however, documentation challenges meant information was not always available. Staff and leaders did not always monitor care and treatment outcomes or respond to information found in audits.

We have not awarded this service a score for Effective.

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

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Guidelines were not always up to date or easily accessible for staff. However, the service usually planned and delivered people\u2019s care and treatment in line with legislation and evidence-based good practice and standards.

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People received care, treatment and support that was mostly evidence-based and in line with good practice standards. However, we noted that one guidance document was out of date; the guidance for diabetic ketoacidosis (DKA) should have been reviewed in 2022. However, a patient with DKA was noted by the inspection team to be managed appropriately in resus during the inspection.

Some of the resident doctors were not aware of where to find national and trust guidance. The trust and national guidelines were kept in multiple locations, on the intranet, in a shared folder and in various paper forms around the department. This made it difficult for the doctors to identify them at short notice and led to duplication and confusion.

Staff and leaders were encouraged to learn about new and innovative approaches that evidence showed could improve the way their service delivered care. There was time built into the staff rota for teaching and training. At the medical handover each morning, an interesting topic was discussed with a learning point for staff.

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The ED had been collecting data as part of the Royal College of Emergency Medicine (RCEM) audit for the mental health self-harm national quality improvement programme. At the time of inspection they were achieving 80%, demonstrating further need for improvement.

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The RCEM inter professional standards were upheld where referrals must be accepted by specialty teams. Most medical referrals did not have ward beds available hence the permanent presence of the medical team in ED. They took responsibility for the patient after referral. There have been incidents previously where referrals have been disputed between specialties, however learning had been disseminated following an incident.

People were told about current good practice that was relevant to their care and were involved in how this was reflected in their care plan. There were information leaflets for patients regarding a wide range of conditions available in the department, however, staff were not able to locate them when asked.

Patient\u2019s nutrition and hydration needs were not always met in line with current guidance. People we spoke with in Waiting Area 1 reported lack of food and drink, particularly overnight.

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Staff had identified a new approach that could improve the way their service delivered care. Those who were identified at risk of falling were put in a 6 bed bay at the back of the department where they had more nursing oversight compared to a cubicle. Here, the frailty team consisted of an advanced clinical professional (ACP) and therapists who did a comprehensive assessment. They made recommendations and referrals into the community or virtual ward as appropriate and referred to their own doctors in geriatrics with any concerns. The frailty team saw patients on referral and also actively looked for potentially frail patients (65+).

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The service worked well across teams and services to support people, however they did not always share their assessment of people\u2019s needs when moving between different services.

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When people moved between services, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care. Staff worked well across the team and with other services to support people. Advice and referrals were sought appropriately. For example, staff sought advice from psychiatrists\u2019 prior to delivering rapid tranquilisation, palliative care nurses were present at medical handovers and diabetic specialist nurses saw referrals in the ED and responded to diabetic emergencies. We observed the psychiatric liaison team completed assessments concurrently with waiting for a patient to be medically fit for discharge. However, in the paediatric ED, children and adolescent mental health services (CAMHS) were limited and not based on site. Referrals could be made 24 hours a day by phone. Assessments were not completed overnight, and we heard that some patients could wait for 4-6 hours in the emergency department awaiting a decision before being assessed in the community. The emergency department staff would seek advice where required.

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Staff spoke positively about working in collaboration with the other services. However, staff at services supporting the care of patients in the department did not always have access to the information they needed to appropriately assess, plan, and deliver people\u2019s care, treatment, and support due to lack of access to the electronic records. This included the psychiatric liaison team who was employed by another NHS provider.

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The emergency department was impacted by delays in other services within the wider system. We heard that the department received patients that could be better treated in the community. GP Patient survey data from 2024 shows 5% of respondents that couldn\u2019t get a GP appointment attended ED and 23% would attend ED if their GP practice was closed, both of which are better than national averages.

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Information was shared between teams and services in the hospital to ensure continuity of care. For example, when clinical tasks were delegated or when people were referred between services. Whilst the patients in the department remained the responsibility of the ED doctors, the medical team reviewed patients who were deteriorating or waiting for a bed.

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However, there was a risk that staff may not have access to the information they needed to appropriately assess, plan and deliver people\u2019s care, treatment and support. At the time of inspection, patient records were documented using both electronic and paper notes. We found that paper notes were not always scanned into electronic patient records, and therefore we could not be assured that all information was being passed to the relevant teams. Out of the 13 patient notes we reviewed, there were 2 patients who had no notes in their electronic patient record so we could not review their care. During a service led audit of the use of restraint, 2 electronic patient records did not contain the expected notes to review use of restraint in those cases. This could lead to subsequent staff not having all the information for continuation of care.

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We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service did not routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The service was able to demonstrate some audit activity and programmes, however there was a lack of response to outcomes of these. The service were unable to demonstrate how they were auditing continuously against evidenced based guidance to improve clinical outcomes for patients.

Trust strategic ambitions from 2022 included a proposal to improve emergency pathways with indicators such as, no patients waiting over 12 hours in the emergency department and develop pathways in partnerships with other services in out of hours and community setting to support right team, first time. Long waits as detailed in “how staff and teams work together” indicate that these ambitions were not being met.

Patient care was audited against evidence-based clinical guidance, however these were not always effective. There was an audit lead in the department, however it was unclear how audits were being used to monitor and improve outcomes. For example, we saw audits for initial pain assessment and management in line the Royal College of Emergency Medicine (RCEM) Management of Pain in Adults (2021), vital signs and escalation audits and post registration triage time audits (the time taken from registering at the front desk to being triaged by a healthcare professional). It was not clear what the targets were, what actions were being taken where performance was below expected and how these generated improvements in outcomes for patients. We requested audit results/data for the monitoring and improving outcomes for deteriorating patients at the time of the inspection, but the trust did not provide them. Following this feedback, the trust provided evidence they had set up a deteriorating patients oversight group in October 2024. The trust had started some audit activity on deteriorating patients but it was limited, trust wide data and nonspecific to the department. We spoke with some resident doctors who reported they were not involved in or didn’t know of any audits being undertaken. This meant that continuous improvement to the care and treatment of people using the service may not be made.

We did not see clear evidence of some appropriate clinical audits underway in the emergency department. In particular, the monitoring of mortality or harm related to reattendance and long waits. We asked staff for evidence the department assesses the link between long waits and mortality and were told this does not happen. The department would only report long waits if there had been a safety incident occur. There did not appear to be a proactive approach to identifying and addressing harm for long-waiting patients in the department or learning from their outcomes.

Where audits were carried out, we did not always see this was being used to make improvement. We reviewed the ‘vital signs and escalation’ audit for January 2025. This showed that 70% of patients had their vital observations recorded within 15 minutes of arrival and 43% of patients had their second observations recorded at the expected frequency. This means patients were not always assessed in a timely way to inform their continued care.

The department had not acted on recommendations to improve patient care and outcomes. The last ‘Getting It Right First Time’ (GIRFT) report and recommendations for the trust was received in February 2024. At the time of inspection, we did not find evidence that these recommendations had been acted on and that the safety concerns remained. We found additional spaces with no facilities for privacy or dignity had been opened (for example, the Pod, temporary escalation spaces) since the recommendations were made. Although use of the Pod was suspended on 27 February 2025, following our inspection feedback, further escalation areas were being reviewed to reduce the need for the Pod space. The closure of the Pod remained an ongoing review with the final decision on this due at the next oversight meeting. On 17 March 2025, we were provided evidence of a GIRFT action plan, which had been updated on 24 February 2025. Although the action plan had aligned the actions to workstreams, it is unclear what progress had been made, what the estimated timescales were and how any actions would be audited for efficacy.

Leaders carried out monthly sepsis audits completed by the sepsis and acute kidney injury (AKI) specialist improvement practitioner in the emergency department, which included how quickly sepsis screening was completed and required actions such as administering intravenous (IV) antibiotics. However, where the emergency department performed poorly, the trust did not provide evidence of what action had been taken to improve outcomes.

There were processes in place to support people’s rights around consent when delivering person-centred care and treatment, however, the department could not be assured that all patients had capacity assessments and were appropriately consented due to lack of audit.

Staff understood legislation relating to consent. There was a consent process for patients with and without capacity for invasive procedures which would be recorded in the patient notes. Staff knew how to manage patients wanting to leave the department with regards to capacity and consent and there was a form which detailed this.

Processes supported how decisions could be made within the requirements of the Mental Capacity Act (MCA) 2005. This included the duty to consult others such as carers, families and/or advocates, where appropriate. All use of detention under the Mental Health Act allowing a doctor or approved clinical to detain an inpatient for 72 hours was recorded.

When patients did not have capacity to consent, staff made decisions in their best interests and documented them. There was a mental health and Mental Capacity Act lead who could help support best interest decisions.

Consent was included on the mental health risk assessment and a capacity assessment was prompted. If a patient lacked capacity this was escalated, and a MCA form was required to be completed. However, staff compliance for Mental Capacity Act (2005) training was below the trust target (85%) at 83%.

Leaders could not be assured consent to treatment processes were effective. We heard from the mental capacity act lead that work to encourage staff to routinely complete capacity assessments.

During a review of the use of restraint in December 2024, although it was not a set question asked during the review, it was noted that 1 patient did not have their capacity status recorded. It was unclear if any action was to be taken following this finding.

It was within the ICB Joint forward plan that all Do not attempt cardiopulmonary resuscitation (DNACPR) forms were to be replaced with Recommended Summary plan for Emergency Care and Treatment (ReSPECT) to aid communication across the system area, which the trust was working towards.