You are here

Horton General Hospital Good

Reports


Inspection carried out on 19 - 21 November 2018

During a routine inspection

Our rating of services 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. 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
  • Reasonable adjustments were made and action taken to remove barriers when people found 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 services provided mandatory training in key skills to all staff but not everyone had completed it. Nursing staff compliance was significantly higher than medical staff.
  • Management and support arrangements for staff were not always effective. Appraisals were significantly below the trust target of 90% for all staff groups with the exception of medical staff.
  • The services did not always have enough nursing staff, with the right mix of qualification and skills, although they were working hard to remedy this.
  • While the trust took complaints seriously and ensured they were investigated the trust’s responses to complaints were not always completed in a timely manner.
  • A proportion of patients did experience a delay when medically fit for discharge or transfer.
  • 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.

Inspection carried out on 25 February and 2 March 2014

During a routine inspection

Horton General Hospital is an acute general hospital in Banbury in North Oxfordshire. The hospital has a long history from first opening with two wards in 1872. It became part of the Oxford University Hospital NHS Trust in 1998. It provides a range of services including an emergency department (A&E), general surgery, acute general medicine, trauma and orthopaedics, maternity services, a children’s ward and special care baby unit (SCBU), critical care, coronary care, a cancer resource centre, and dialysis. The hospital serves a catchment population of around 150,000 people in and around North Oxfordshire and neighbouring communities in south Northamptonshire and south east Warwickshire. There were 248 inpatient beds and the hospital saw around 120,000 patients as inpatients each year. The hospital arranged in the region of 90,000 outpatient appointments each year and saw 36,000 people each year in the emergency department.

To carry out this review of acute services we spoke to patients and those who cared or spoke for them. Patients and carers were able to talk with us or write to us before, during and after our visit. We listened to all these people and read what they said. We analysed information we held about the hospital and information from stakeholders and commissioners of services. People came to our two listening events in Banbury and Oxford to share their experiences. To complete the review we visited the hospital over two days, with specialists and experts. We spoke to more patients, carers, and staff from all areas of the hospital on our visits.

The services provided by Horton General Hospital were delivered to a good standard. Patient care in all the departments and services we visited was delivered safely, by caring staff who were well led. The hospital was delivering effective care although needed to review how patients in critical care were supported safely by consultants with the relevant training. Staff told us they were well supported by one another and their managers. The overriding comment from the nurses we met was them telling us the reason they came into work each day was the support they gave one another. Departments, wards and services were well led at a local level, but there was some concern around overall leadership of the hospital as staff told us they felt there was no one with overall responsibility. This was because the trust worked in directorates, and different senior staff were responsible for different parts or divisions of the hospital. Staff told us on occasion an issue in one department could impact another and it was sometimes hard to find a resolution without a general manager.

A number of people from the local community we met at our listening event in Banbury said they were not consulted by the trust about changes made to the provision of services. People, patients and staff were concerned specifically about the removal of emergency surgery from the hospital. The main concern of staff was feeling their voice was not heard by the trust. The trust told us about the communication exercise undertaken to inform all internal and external stakeholders about the decision and rationale to remove emergency abdominal surgery from the hospital. This involved meetings with the Community Partnership Network.

Staffing

The hospital was and had been actively recruiting staff, particularly to nursing posts. Some staff were concerned about the future of the hospital and rumours or discussions about its future. They said they knew this had deterred some staff from actively looking to work at the hospital and meant there was a high level of locum staff at times. Most staff felt the hospital was, however, well-staffed most of the time. Nurses and doctors said they felt they had enough time to spend with patients, although they said there could always be more. Nurse managers said they usually had time for their managerial duties, but would step in to direct care provision when the department or ward was short-staffed. Some staff said training was usually the first thing postponed if their area was short-staffed, but otherwise the training completion rate was high.

Cleanliness and infection control.

The hospital was clean on both our announced and unannounced visit. Staff followed cleaning schedules, paying attention to hard-to-reach areas, and most areas were organised to make cleaning as efficient as possible. We observed good infection control practices among staff. Staff were wearing appropriate personal protective equipment when delivering care to patients. There was a relatively good provision of hand gels across the site and we saw staff using them and asking patients to do the same. The number of MSRA bacteraemia infections and Clostridium difficile infections attributable to the hospital were within the acceptable range for a hospital of this size.