Northampton General Hospital

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• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment we did not rate as we only looked at specific aspects in response to the Section 29a Warning Notice (WN). The rating has remained as requires improvement.

We assessed 2 quality statements and found improvements had been made in line with the WN.

There was evidence the trust was working with external stakeholders to develop a system wide coordinated approach to discharges in the community. Initiatives were in place to educate and inform staff of new the processes and learning was shared between trusts. New electronic systems had been introduced to improve records, monitor patient flow and identify bottlenecks. Plans were in place to monitor the effective of these changes and to identify further improvements. New roles had been introduced with responsibility to support prompt and safe discharges.

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.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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.

Quality Statement Score: not assessed

The use of new electronic systems had improved the accuracy and timeliness of records and prescriptions. Systems to monitor patient flow and improvements had been introduced but further data was required to identify sustained improvements.

The introduction of electronic tools to manage the patient flow process reduced the risk of delayed discharges. Since our last inspection the trust has introduced a new Electronic Patient Record (EPR) system. This includes a real time overview of patient flow in the hospital enabling immediate identification of any potential delays to patient discharges and risks to patient flows. Clinicians were now required to indicate on admission a patient’s proposed discharge date and pathway. This would enable the constant monitoring of a patient’s progress through the system, identifying immediately any variation to their proposed discharge date. These variations could be investigated and any suitable action taken to reduce avoidable delays.

The EPR system was updated at every ward round with each patient’s discharge status and any tasks required to prevent a delay to their proposed discharge date. The system would flag if patients’ discharge details have not been updated allowing immediate action. This information identified any bottlenecks or potential delays. This gave the trust an overview of how many discharges are planned and how many beds will be available for new patients. Senior nurses conducted a ‘Confirm and Challenge’, visit to areas the EPR system had identified as having patients beyond their planned discharge date.

The Electronic Discharge Note (EDN) automatically pulls in patient information (demographics, clinical details, medications, etc.) from the EPR system. This significantly reduces the manual effort and time required for clinicians to fill out discharge summaries and minimising the risk of duplication. The trust reported clinicians now spend less time writing EDNs, as core data is pre-filled, allowing faster completion and reduces the risk of data errors.

The trust reported the introduction of the electronic systems had resulted in a reduction in the number of patients who are fit for discharge remaining on wards. Figures from the trust show the proportion of patients with an allocated proposed discharge date is nearly 100%

The new EPR provided electronic timestamps for each step (EDN started, completed, medications prescribed, meds dispensed). This created an audit trail and identifies any delays or bottle necks in the patient pathway system. For example, the digital and pharmacy teams’ data review project will track the time between a patient being marked “medically fit for discharge” and the completion of their EDN and TTO and set improvement targets.

A new Discharge Matron post was created to provide dedicated leadership on patient flow and discharge processes across the trust. An experienced Discharge Matron from Kettering General Hospital (KGH) had begun working with the trust to review and improve discharge pathways. This had identified bottlenecks and shared best practices from KGH. For example, the Discharge Matron was standardising how wards notify Pharmacy of a pending discharge and ensuring that complex discharges were prioritised earlier in the day. The Discharge Matron-led team facilitated communication between doctors, pharmacists, and nurses intending to be the first point of contact to resolve any delays in discharge paperwork or medication.

The accuracy of patient discharge records had improved. The trust has reported a reduction in the number of EDN returned for correction or clarification since the new standardised system was introduced. Since August, the records template enforces key fields and checklists to be completed resulting in omissions such as allergy status or unclear medication instructions reducing. This had decreased the time taken to challenge records for accuracy/omissions and delays to preparing medicines.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Quality Statement Score: not assessed

Initiatives had been introduced to improve patient flow and reduce the risk of delayed discharges. There was improved working with external stakeholders and learning from other services.

In August 2025, the trust set up an Integrated Discharge HUB Programme with the other trusts in its group, community providers, the ICB, and local authorities. This was in response to both internal improvement goals and an external NHS England review. The review recommended a single, integrated model for managing transfers of care involving the trust, Kettering General Hospital, the community providers, the ICB, and local authorities. The aim was to produce a single discharge model for all stakeholders and improve the discharge pathway for patients who need rehabilitation or long-term care.

It was intended a single discharge model will speed up the discharge process while ensuring patients care needs are meet in a timely manner. This included a single Transfer of Care (TOC) form to be used across all stakeholder organisations. Additionally, it was intended for all stakeholders to use a single discharge tracking database, so all agencies had knowledge of delays and complex cases in real time. A Trusted Assessor model was being developed, where a qualified assessor can act on behalf of care homes to assess patients in hospital. Thus, care homes could be provided with the information need to accept patients without waiting for their own staff to attend the hospital.

The trust reported in November 2025 the programme was on track with stakeholders having agreed shared objectives, timeframes and quality monitoring measures.

The trust had improved discharge processes by increasing involvement with other stakeholders involved with patient care. Council social workers are on-site in the hospital more frequently and attend the ward multidisciplinary meetings (MDTs) to review patients with complex needs. Social workers now have access to patients’ discharge plans on the trust’s data bases allowing for the early identification of any issues which may cause discharges to be delayed. The trust reported the local councils were also considering increasing their out-of-hours support for discharges to increase the number of safe discharges at weekends and later in the day.

A dedicated NHSE improvement manager has been working at the trust 2 days a week since January 2025. Their role was to support the implementation of projects to improve patient flows such as board rounds and the monthly reporting and monitoring on improvement initiatives. The ICB’s Urgent Care leadership also escalated system issues regionally when needed such as challenges with patient transport services or accessing community services.

The trust had established several cross-organisation forums to share best practices. The Emergency Care Shared Learning Group with University Hospitals of Leicester is a forum to exchange initiatives that improve emergency pathways, including flow and discharge, across multiple trusts. An urgent and emergency care event was held in September 2025, bringing together operational staff from acute, community, and primary care to discuss winter planning and discharge. This promoted collaborative working across the system with designing processes to avoid admissions and speed up discharges.

The medical care group had worked with other areas to share learning and improve patient flow. In November, a new purpose-built Rapid Assessment Unit (RAU) was commissioned providing 8 additional trolley spaces. This aimed to handover patients within 15 minutes to a dedicated area for the primary assessment of patients. Patients in this area, identified as being suitable for 72-hour medical short stay are sent to a dedicated Acute Assessment Unit (AAU) on Walter Tull and Esther White wards. The trust had reported this improvement in patient pathway has enabled suitable patients to be identified within the RAU and streamed directly into the AAU reducing the demand into the ED, further reducing handover delays. Early performance data from the trust suggests this new process has resulted in an improvement in handover times, 4hr/12hr performance as well as reducing the number of patients being cared for in temporary escalation spaces in the emergency department. The trust reported that after the first week of following the process the number of patients handed over in less than 45 mins increased to 85%, which was the best hospital performance in the East Midlands. Average handover time reduced to 32 minutes performance. The number of handovers achieved within 15 minutes increased from 16% to 30%.

The trust had piloted the use of dedicated staff to focus on the completion of Electronic Discharge Notes (EDNs), especially during busy periods. For example, on winter weekends a designated “Discharge Doctor” is assigned to wards just to write EDNs for patients ready for discharge. This would help to ensure when ward teams are busy, discharges aren’t delayed and more patients can access the ward. The Weekend Discharge Team conducted ward rounds to identify patients who could go home and immediately completes EDNs and TTO prescriptions for those patients. The trust internal audits showed weekend discharge times improved when these roles were in place, and incidents of late-day discharge delays due to missing EDNs reduced. The trust was considering a plan to extend this initiative to weekday late afternoons, so that everyone identified as suitable for discharge the previous evening will be “home by lunch”.