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Horton General Hospital Good


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.


  • 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.


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.

Inspection carried out on 21 August 2012

During a themed inspection looking at Dignity and Nutrition

Patients told us what it was like to stay at this hospital and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether patients staying in hospitals are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector and joined by an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

We visited four wards as part of our inspection. We went to two acute general medicine wards, a surgical ward, and a trauma and orthopaedics ward. We talked to 39 patients during our visit.

Patients were positive in their views of how they were supported by the staff team. Examples of comments they made included, �the nurses are excellent and so are the doctors�.� This is a very good hospital�. �The nurses are fine, I�ve got no problems with any of them�. �They are very good staff and they take their time helping patients with their meals�. � Meals have been fine in quantity and quality�. �At first I didn�t feel like eating, but the staff have encouraged me�.

Inspection carried out on 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 12 July 2011

During an inspection looking at part of the service

During our visit on 12 July 2011, patients at the Horton General Hospital were very positive about their experiences of care and treatment.

Patients felt involved in making decisions about their care and treatment and stated that staff kept them informed about the care they could expect to receive. They also told us that staff responded promptly when called and that staff took time to help and support them.

Inspection carried out on 14 September 2010 and 4 October 2011

During a routine inspection

During our visit on 14 September 2010, we interviewed patients at the Horton General Hospital. Patients, on the whole, were very positive about their experiences of care and treatment.

Patients reported that they were involved in their care and treatment decisions and that they were given sufficient information. They stated that staff ensured that their privacy and dignity was maintained. Staff were seen to treat patients with respect and focused on meeting their personal care needs.

The trust also asks patients for their views and experiences of care on a regular basis, and the Commission reviewed these surveys.

The majority of these comments reflected well on the trust, although there were some recurring themes around dissatisfaction with long waiting times for screening and diagnostic procedures and concerns about the attitudes and care delivered by staff in some instances.

In summary, while many patients have provided positive feedback, further work is required by the trust to ensure that patient experience of their care is of a consistently high standard.