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

The service had a good learning culture and patients could raise concerns. Managers investigated incidents thoroughly. Patients were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of patients, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant patients were safe and protected from avoidable harm.

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 had a proactive and positive culture of safety, based on openness and honesty. Leaders and staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff knew what incidents to report and how to report them. They raised concerns and reported incidents and near misses in line with trust policy. Staff told us they received feedback from incidents they reported, and learning from incidents was shared in safety huddles, staff meetings and by email. We saw posters on notice boards in staff rooms with information about learning from recent incidents within critical care and also more widely across the trust and nationally.

Clinical incident trend analyses were undertaken to proactively address themes and trends. During the assessment a simulation exercise (practice of a procedure for patient management in an emergency) was being undertaken. This was to reduce the risks of harm to patients by applying learning from another trust’s experience.

Staff held monthly mortality meetings to review all deaths of critical care patients and showed a proactive learning culture. The meetings included a full review of each patient’s management by each professional group and identifying the care and actions required to improve future treatment. The review of patient deaths also highlighted when omissions were made prior to the patient’s admission to critical care and this was shared with other departments for learning. A monthly action log from mortality meetings was created, with progress monitored through the clinical quality management review meetings.

The service worked with patients and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. Staff made sure there was always continuity of care, including when people moved between different services.

Arrangements for emergency admission to critical care was agreed by a critical care consultant. Patients were admitted into critical care within 4 hours of deciding to admit which meant they received timely care and treatment.

Most patients admitted to critical care came through on an elective surgery pathway whereby surgery could only go ahead if a critical care bed as available. We saw there was a booking system (maximum 3 surgical patients booked each day) to ensure there were sufficient beds available for both elective and emergency admissions.

The service worked closely with other services to support patient pathways and transitions to other services. For example, Staff could access other professional services when needed such as dieticians, speech and language therapists, microbiologists and mental health professionals including psychologists.

The service worked well with patients and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. Staff had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff always shared concerns quickly and appropriately.

Staff had access to safeguarding policies for children and adults. All critical care staff had completed level 2 and level 3 safeguarding adults training and 95% had completed level 2 and level 3 safeguarding children training. Staff gave examples of when they had or when they would raise a safeguarding referral and felt able to ask the safeguarding team for advice. Staff also told us they would report any safeguarding concerns as an incident.

Safeguarding concerns were discussed during daily handovers and multidisciplinary meetings. Staff shared information, actions undertaken and considered if they needed to take further action.

Staff had a clear understanding of the Deprivation of Liberty Safeguards (DOLS), which staff only used when people lacked mental capacity to consent to care and treatment and decisions about their care needed to be made in their best interests. Staff received training in the Mental Capacity Act (MCA), were confident in its use and sought innovative ways to ensure they respected patients’ human and legal rights.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There was a 24/7 critical care outreach service with clear referral criteria. Leaders told us the outreach team had processes in place to ensure patients remained stable and their pain managed. A national Early Warning Score (NEWS) tool was used for the first 24 hours post discharge from the critical care unit. This helped identify patients who were at risk of deteriorating.

In November 2024 the hospital was identified as 1 of 5 pilot sites for the implementation of ‘Martha’s Rule’. ‘Martha’s Rule’ enables patients and their families to request an urgent second opinion if they are concerned about a deteriorating condition. There was a roll out plan in place, including posters and leaflets on display to publicise the inpatient ‘Call for Concern’ service which had been implemented in response to ‘Martha’s Rule’. Staff and leaders told us the outcomes of this pilot were so far positive and had been extended.

Staff assessed patients for clinical risk factors such as sepsis, pressure ulcers and nutrition. The assessments clearly identified any risk and mitigating actions. We saw evidence of escalation and medical review when a patient’s condition had deteriorated. Nursing staff told us there was always a medical presence on the ward to provide advice and intervention. Staff felt able to escalate concerns.

There were systems in place to minimise the risk patients experiencing psychological harm. Staff used patient diaries to enable patients to discuss and reflect on their experiences. The Critical Care Follow up Nurse said they were also used in the follow up clinic and were helpful for patients to understand some distressing memories.

The service was fully aware of all potential risks in the care environment and controlled them well. Staff made sure equipment, facilities and technology supported the delivery of safe care.

Facilities, premises and equipment were designed and used to meet the needs of patients who used the service. The design of the environment followed national guidance, and staff told us how they were involved in the design of the critical care unit before it opened.

Staff completed health and safety risk assessments. They identified mitigating actions where risks were identified. Staff carried out actions in line with Health and Safety Executive guidance. Assessments included fire safety, water safety, security and the management of other environmental risks.

There was sufficient equipment to meet the needs of critical care patients. We saw staff responded promptly and usually immediately to any requests for help. Staff were trained to use all equipment including specialist equipment.

Managers ensured the facilities, premises, equipment and technology were maintained. Managers supported staff to use the equipment to deliver safe and effective care. Critical care had key staff with a responsibility to maintain specialist equipment. There were arrangements for medical device servicing and decontamination, and staff received relevant training.

Leaders and staff as part of discussion around requirements for the new critical care had considered how the environment may minimise psychological harm. Critical care had been designed with windows to help patients’ orientation and determine night and day.

The service mainly made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs.

We observed medical and nursing staffing levels met Guidelines for the Provision of Intensive Care Services (GPICs) standards required. Whilst the availability of a critical care outreach service did meet GPICs with at least one critical care team member on duty at all times. Staff said that the number of outreach staff to cover the service was insufficient. Staff also raised concern about the size of team to deliver this service which was becoming an increasing challenge. The hospital trust identified a review of staffing for the critical care outreach team was being undertaken. The critical care outreach team (CCOT) was a nurse-led service that supported nurses and doctors who were caring for acutely ill adult patients on acute wards. They provided cover 24/7 and had 1 member of staff per shift to cover 790 beds. The number of allied health professionals such as physiotherapists did not fully meet GPICs standards. The allied health professionals team on critical care included 4 physiotherapists and 1 occupational therapist assisted by therapy assistants. The therapy team had recently introduced 7 day a week working which enabled the unit to meet the GPICs requirements for rehabilitation. However, therapy staff told us there was an expectation they also covered wards over the weekend which had reduced their availability for critical care patients. Information provided by the hospital trust following our inspection identified therapy staff were expected to cover 3 other wards at the weekend. Depending on the demand of the case load they prioritised the patients. All the ventilated patients were seen separately by on call physiotherapist. The regular therapy team would see the critical care patients either Saturday or Sunday and when possible on both days.

There was no dedicated critical care speech and language therapist. The speech and language team covered both acute wards and critical care. Critical care staff told us speech and language therapists visited the ward when requested.

Two specialist critical care dietitians provided cover five days a week. This was crucial, as research indicated that optimising nutritional service to the patients on critical care led to improved clinical outcomes.

Managers used an acuity tool to ensure that there were enough nursing staff to support the needs of patients and were flexible. Staff felt the service was safely staffed removing the need for agency staff who may be unfamiliar with the service.

Managers ensured critical care nurses completed required additional training and qualifications in line with national standards (GPICS). These guidelines require 50% of critical care nurses to be qualified in specific competencies and qualifications. At the time of our inspection 53% of the nurses had achieved the required qualification. Leaders said they supported staff to complete this course on an ongoing basis.

Critical care had a practice educator to support nurses achieve competencies New nursing staff were given a minimum of 12 weeks supernumerary time. This is protected time to allow staff to undertake personal learning and development. These were reviewed by qualified and experienced staff to ensure new staff had achieved the required level of knowledge

Critical care had a team of operating department practitioners (ODPs). ODPs are skilled healthcare professionals who provide care to patients who have had or will have surgery. ODPs provided a 24-hour service and helped with emergencies on the unit, transferring patients for Computerised Tomography scan (CT scans) and ‘out of hospital’ transfers. They attended emergencies throughout the hospital helping to maintain patient safety and support.

There was a dedicated pharmacy team who worked on the unit Monday to Friday. Outside these times, there were arrangements for staff to access pharmacy support

Information provided by the trust showed most (96%) staff had received all required mandatory training and role specific training (94%). Most staff (95%) had received a staff appraisal.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was a comprehensive system for assessing and managing infection control risks, incorporating policies, procedures, roles and responsibilities, training and monitoring. Managers oversaw infection prevention and control (IPC) audits which were done routinely. Managers took immediate action if infection prevention and control procedures fell below expected standards.

The service-controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. Most staff (98%) had received infection prevention and control training in the last 12 months. Hand hygiene audits undertaken between April and June 2025 confirmed staff met required hand hygiene standards. Staff had sufficient personal protective equipment (PPE), such as gloves and aprons to carry out procedures and personal care activities. Staff were observed to be ‘arms bare below the elbow.’ Handwashing sinks and hand sanitizer dispensers were accessible and were available throughout the service. We observed staff washing their hands and using hand sanitiser between contact with patients. Overall infection control compliance (over 90%) met the trust target providing assurance the risk of infection to patients was minimised.

Infection rates were very low with just 1 infection reported between July and September 2025 which was confirmed to be unpreventable.

The service was visibly clean and had suitable furnishings which were easy to clean and well-maintained. The trust identified between April and June 2025 cleanliness was slightly below the required standard of 98 % (between 96% and 97%). The trust identified cleanliness scores may have been affected by recent staff changes in the department with no permanent staff replacement. Cleanliness scores for July, August and September 2025 had subsequently improved and met the trust targets.

Cleaning records were up-to-date and demonstrated all areas were cleaned regularly. There were schedules and checking systems in place to ensure all areas were cleaned in line with cleaning schedules. There were facilities to support good infection prevention control in the toilets, corridors and clinical rooms.

The storage areas were clean and tidy. Stock was stored neatly so it could be checked and cleaned efficiently.

Staff disposed of clinical waste safely. We observed appropriate segregation of clinical and non-clinical waste. Sharps containers were clean, labelled and not overfilled.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines were appropriately prescribed and administered in line with the relevant legislation and current national guidance. Staff maintained accurate and clear records of medicines given to patients and recorded when medicines were not given and the reason for this. Staff recorded patients’ allergies on their treatment charts.

There were safe and secure storage arrangements for medicines. However, medicines audits undertaken for March, June and July 2025 identify some intravenous fluids were not stored appropriately. Patient’s medicines were securely stored within patient individual rooms with digital access for authorised clinical staff which was monitored. We did not observe any meds storage concerns during our inspection.

There were appropriate policies, systems and processes in place to ensure safe and appropriate antibiotic prescribing. Critical care medical staff worked closely with microbiologists to ensure appropriate antibiotic prescribing. In addition, the critical care unit were part of a research study to review regimes for shorter antibiotic prescribing which was providing positive findings.

Critical care pharmacists checked patient medicines charts to ensure correct medicines were available and administered.

Staff discussed patients’ medicines during the multi-disciplinary team meeting to ensure medicines were appropriately prescribed for patients. Critical care pharmacists also attended daily ward rounds to provide advice on patient’s medicines when needed.

Staff completed an incident report if medicines were not given as prescribed. Medicines errors were reported monthly at the clinical practice forum. Managers shared learning from medicine errors with all clinical staff.

When a member of staff was involved with a medication error, duty of candour was conducted and the patient and/or next of kin was informed of the error and an apology made. Action was taken to improve learning and staff knowledge to reduce the risk of similar errors from reoccurring. When appropriate, this learning was shared with other services in the trust.

Accurate, up-to-date information about patients’ medicines was available. When patients moved between health and care settings staff shared or requested information about patients’ medicines, in line with current national guidance.

There were appropriate and safe arrangements for the management, use and oversight of controlled drugs. Controlled drugs are medicines which require additional arrangements for their storage and administration under the Misuse of Drugs legislation (and subsequent amendments).