Horton General Hospital

Updated 4 June 2026

Date of assessment: 07-08/10/2026

Horton General Hospital is an acute general hospital and provides a wide range of services, including an emergency department (with an emergency admission unit), acute general medicine and elective day case surgery, trauma, maternity (midwifery-led unit) and gynaecology, paediatrics, critical care and a centre for cancer treatment.

This assessment looked at maternity services, to assess if improvements had been made since the last inspection in October 2023 when the maternity service was rated as requires improvement. At this assessment the rating had improved to good.

We found that improvements had been made in safe care and treatment and good governance.

The rating from the maternity service has been combined with ratings of the other services from the last assessments. See our previous reports to get a full picture of all other services at the Horton General Hospital.

The rating of the Horton General Hospital has changed to good.

Updated 11 August 2025

Date of Assessment: 07 - 08 October 2025

We carried out this assessment to assess if improvements had been made since the last inspection in October 2023 when the maternity service was rated as requires improvement. We assessed 32 quality statements across the safe, effective, caring, responsive and well-led key questions. We found the quality of care had improved. However, there were still areas where improvement was needed.

At the last assessment there were breaches of regulation relating to safe care and treatment and good governance.

At this assessment, improvements were found, and the service was no longer in breach of safe care and treatment or good governance.

At this assessment we found the service demonstrated a strong commitment to safety by working collaboratively with people and healthcare partners to understand what safety meant to them and how best to achieve it. They focused on improving people’s lives while protecting their rights to live free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Concerns were shared promptly and appropriately. The service adopted a holistic approach to risk management, providing care that was safe, supportive and enabled people to do what mattered most to them. There were sufficient numbers of qualified, skilled and experienced staff who received appropriate support, supervision and development, and teams worked effectively together to meet individual needs. The service also assessed and managed infection risks effectively, taking action to prevent the spread of infection. Medicines and treatments were managed safely, with people supported to be involved in planning their care, including when changes occurred.

The service demonstrated a strong commitment to delivering effective care and treatment. People’s health, care, wellbeing and communication needs were assessed and regularly reviewed in partnership with them. Care and treatment were planned and delivered collaboratively, reflecting what was important to individuals and aligned with legislation, current evidence-based guidance and recognised standards. The service supported people to manage their health and wellbeing in ways that maximised independence, choice and control, including supporting women to live healthier lives and reduce future care needs where possible. Care and treatment were routinely monitored to drive continuous improvement and ensure outcomes were consistently positive, meeting both clinical standards and people’s expectations. The service also promoted and respected people’s rights around consent when delivering person-centred care and treatment.

The service demonstrated a strong commitment to person-centred care. People were informed about their rights regarding consent, and these rights were respected in the delivery of care and treatment. The service promoted independence, ensuring people understood their rights and had choice and control over their care, treatment and wellbeing. Staff listened to and understood people’s needs, views and wishes, responding promptly to minimise discomfort, concern or distress. The service also prioritised staff wellbeing, supporting and enabling them to consistently deliver person-centred care.

The service placed people at the centre of decisions about their care and treatment, working in partnership with them to respond to changes in their needs. Care was delivered in an integrated way across maternity healthcare and community services, with a clear focus on continuity. People were provided with appropriate, accurate and up-to-date information in formats tailored to their individual needs. The service made it easy for people to provide feedback, share ideas or raise complaints, and demonstrated that it acted on this information. The provider ensured timely access to care, support and treatment. Staff and leaders also listened to the experiences of people most likely to face inequality in outcomes and adapted care and support accordingly.

The service demonstrated a shared vision, strategy, and culture, grounded in transparency, equity, equality and human rights, diversity and inclusion, engagement, and an understanding of community needs and challenges. Leaders were inclusive and values-driven, they understood the context of care delivery and the context in which they delivered care, treatment and support. They embodied the organisation’s culture and workforce values. Leaders had the skills, knowledge, experience, and credibility to lead effectively, acting with integrity, openness, and honesty. The service promoted a positive speaking-up culture, where staff felt confident their voices would be heard. There was a clear commitment to valuing diversity and fostering an inclusive and fair workforce culture. Leaders identified actions aimed at improving equality and equity for staff. The maternity service had a governance framework in place.

However, we found that advice‑only calls to the 24‑hour telephone advice and screening service, which did not progress to labour assessment, lacked formal triage prioritisation and had limited audit oversight. This reduced assurance regarding consistency and governance. Handovers did not incorporate safety huddle methodology to systematically review patient safety incidents, current risks and shared learning. Documentation was not always completed to the expected standard reducing assurance that care decisions, risk assessments, and actions were clearly recorded and communicated. The service did not consistently detect and mitigate potential risks within the care environment, and aspects of the facilities did not always fully support the delivery of safe care. There were gaps in audit coverage and associated assurance processes. While actions to improve equality and equity were described, detailed local plans outlining how objectives would be delivered and monitored were not clearly articulated. Although a governance framework existed, it was unclear how local governance and risk management operated in practice. Furthermore, it was unclear what specific measures were being implemented at a local level to drive quality improvement and development within the service.

Updated 7 June 2019

Our rating of this service stayed the same. We rated it as good because:

• People were protected from harm. Lessons were learned and communicated widely to support improvement in other areas where relevant, as well as services that are directly affected.
• When people received care from a range of different staff, teams or services, it was co-ordinated. All relevant teams were involved in assessing, planning and delivering people’s care and treatment. Staff worked collaboratively to understand and meet the range and complexity of people’s needs.
• People were supported, treated with dignity and respect and were involved as partners in their care. People were treated with dignity, respect and kindness during all interactions with staff and relationships with staff are positive.
• Reasonable adjustments were made and action taken to remove barriers when people find it hard to access or use services.
• Consent to care and treatment was obtained in line with legislation and guidance, including the Mental Capacity Act 2005. People were supported to make decisions and, where appropriate, their mental capacity was assessed and recorded.
• Leaders were visible and approachable. Leaders modelled and encouraged compassionate, inclusive and supportive relationships among staff so that they felt respected, valued and supported.
• There was an effective and comprehensive process to identify, understand, monitor and address future and current risk.

However,

• The service provided mandatory training in key skills to all staff but not everyone had completed it. Nursing staff compliance was significantly higher than medical staff.
• Substances hazardous to health were not always stored safely.
• There was a gap in the management and support arrangements for staff. Appraisals were significantly below the trust target of 90% for all staff groups with the exception of medical staff. The medicine division had developed actions to address the gap in compliance, and action plans were in place at directorate level.
• Outcomes for stroke patients had deteriorated from grade C in 2017 to grade D in 2018.
• The trust’s responses to complaints were not always completed in a timely manner. The trust did not have a target for closing complex complaints, which some of these complaints may have been.
• A proportion of patients did experience a delay when medically fit with their transfer from hospital.

Updated 14 May 2014

Patients received care which was compassionate, dignified and delivered good outcomes. Clinical outcomes for patients were good. Mortality rates were below the national average and below the expected level for patients in a critical care unit. The caring and consideration of staff was excellent. The patients and relatives we spoke with praised the nursing and medical staff highly. Vulnerable patients were well supported and staff put the patient at the centre of their care.

The department was well-led at local and senior level and staff were supported and proud of their work. There were some issues with patient discharge not being timely or being delayed, but this was due to pressures on beds elsewhere in the hospital. On a national level, this problem was not significant.

However, the critical care department was not meeting the guidelines in relation to medical cover. There were skilled and experienced anaesthetists and consultants attached to the unit, but not all had critical care training. The lead medical consultant was trained in critical care, but this was not their substantive post and they were not available at all times. There was no evidence this had resulted in patients being put at risk, but the arrangements did not meet the national guidelines for medical care in intensive care units.

Updated 14 May 2014

Patients received effective and sensitive end of life care. Patients told us they felt safe with the staff and overall their needs were met. We were told medicines were prescribed to control patients’ pain and staff were using the fast-track process for early discharge. Patients said staff respected their rights: in particular privacy and dignity. Patients and their relatives told us where there were concerns staff were available for discussions.

Patients at the end of their life were able to make decisions about the medical procedures to be followed in the event of cardiopulmonary arrest. If the decision made was not to attempt to resuscitate the patient, it was recorded and brought to the attention of all medical staff involved in the delivery of care.

Patients were treated with compassion and were not expected to wait for pain medication. Doctors prescribed medicines in advance to prevent delays in administering medicines to patients in pain. Medicines to be taken as required were prescribed to ensure patients were comfortable between other scheduled medicines.

Patients were cared for by staff with an understanding of end of life care. There were nurses on each ward who specialised in specific topics including end of life care. These staff were able to support other staff who needed guidance or advice. Doctors completed mandatory training on end of life care during their teaching.

Updated 14 May 2014

Patients received safe care. Staff were skilled and caring and knew their responsibilities to keep patients safe. Risk assessments had been completed and actions identified to improve the service. The clinic was clean and a refurbishment programme had started. Capacity remained a concern because demand had increased by 10% over the year prior to our inspection. The trust was planning to improve capacity at the Horton by providing two additional clinic rooms in the refurbishment. Audits for the “choose and book” system had taken place and the trust was in the process of re-profiling outpatients to improve the patient experience.

We spoke with ten patients and the majority had no problem getting an appointment and all tests and x-rays had been completed in a timely manner. Eight patients were complimentary about the service and two told us the service was excellent overall. Two patients had problems getting an appointment in a timely manner.

There was a culture between staff to improve the patient experience and be the best they could be. Patient views and experience had been sought to help improve the service. Staff had endeavoured to answer any verbal concerns raised with them immediately.

The trust were keen to develop directly bookable appointments that relieved pressure on staff and the time it took patients to book individual appointments over the phone. The plan was to improve the time automatic letters were sent for appointments and cancellations.

Updated 14 May 2014

There was consensus among patients, carers and staff that staff were dedicated and provided compassionate, empathetic care. Processes were followed to reduce any risks to patients undergoing surgical treatment. There were processes to ensure patients who moved to different wards received consistent and safe care and treatment. Staff made use of the language line facility and interpreters to ensure patients had good understanding of their treatment and were able to make informed decisions. Staff had a good understanding of the Mental Capacity Act 2005 which meant patients received the appropriate support to be able to make their own decision, or where required decisions involving appropriate people were made in the best interest of the patient.

Generally, there was sufficient equipment available to meet the needs of patents. However, concerns were expressed about access to MRI imaging. Patients had to go to the John Radcliffe Hospital in Oxford to access MRI imaging; we were told that difficulties in arranging appointments meant there was a risk that some patients’ treatment would be delayed.

We saw good evidence of team working at ward and departmental level. However, with some of the clinicians, there was a feeling that despite being part of Oxford University Hospitals NHS Trust, the views and opinions of staff at Horton General Hospital were not always heard.

Updated 7 June 2019

Our rating of this service went down. We rated it as requires improvement because:

• The service provided mandatory training in key skills to all staff but not everyone had completed it.
• Staff were not always given the opportunity to have an annual appraisal.
• The service did not always control infection risk well. Staff did not always keep equipment and the premises clean. Control measures to prevent the spread of infection were not always in use in the ED.
• Staff did not always adhere to trust medicines management policy.
• The environment was not always suitable for services provided.
• Privacy and dignity was compromised for some patients in the ED.
• The service did not always have enough nursing staff, with the right mix of qualification and skills, although they were working hard to remedy this.
• There was no vision for what the ED at the Horton General Hospital wanted to achieve and no workable plans developed with involvement from staff, patients, and key groups representing the local community.

However:

• The service provided care and treatment based on national guidance and monitored evidence of its effectiveness.
• Leaders on the wards had the skills, knowledge, experience and integrity they needed to fulfil their roles.
• The service had enough medical staff with the right qualifications, skills, training and experience to keep people safe.
• The trust had processes to ensure care and treatment was aligned with current evidence-based practice.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs.