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Archived provider: Basildon and Thurrock University Hospitals NHS Foundation Trust Good

On 10 July 2019, we published a report on how well Basildon and Thurrock University Hospitals NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Requires improvement  
  • Combined rating: Good  

Read more about use of resources ratings

Reports


Inspection carried out on 12 Feb to 20 Mar 2019

During a routine inspection

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

  • We rated safe and responsive as requires improvement. Effective, caring and well-led were rated as good.
  • We rated one of the trust’s four services we inspected as requires improvement and three as good. In rating the trust, we took into account the current ratings of the four core services not inspected this time. However, we also considered that the rating in Urgent and Emergency services within the safe domain had been in place since 2015. The trust presented updated information which meant it had a disproportionate effect on the trusts overall rating. Therefore, we have overridden the overall aggregation principles and rated the trust overall as good.
  • There were effective processes in place to ensure that learning from incidents was shared across divisions and embedded to minimise the risk of re-occurrence.
  • There were enough nursing and medical staff with the right mix of qualifications and skills, to keep patients safe and provide the right care and treatment. There were processes in place to address staffing shortages to deliver safe patient care.
  • Infection prevention and control policies and protocols were in place and regularly audited. Staff kept themselves and equipment clean.
  • There were effective systems and processes in place to conduct internal and external audits and teams acted on results.
  • There were robust processes in place to manage demand and capacity through performance monitoring and systems to manage access and flow.
  • The trust had developed a strategy to develop services in line with the over-arching strategy of a merger and clinical re-configuration. This meant that teams were able to link current activity to the trust’s future plans.
  • Managers worked hard to create a positive culture which was patient focussed and staff could raise concerns openly.

However, we also found:

  • Maternity services ratings for safe had declined from good to requires improvement. There had been a decline in safety practices in relation to women who were assessed as ‘high risk’ and the leadership team. The well-led rating for maternity services had declined from outstanding to requires improvement. There had been some changes in the leadership since our last inspection and the new maternity leadership team was developing.


CQC inspections of services

Inspection carried out on 17th and 18th March 2015 and 16 February 2016

During an inspection looking at part of the service

Basildon and Thurrock University Hospitals NHS Foundation Trust serves a population of around 405,000 in south west Essex covering Basildon and Thurrock, together with parts of Brentwood and Castle Point. The trust also provides services across south Essex. The trust provides an extensive range of acute medical services at Basildon University Hospital, which includes The Essex Cardiothoracic Centre and Orsett Hospital as well as x-ray and blood testing facilities at the St Andrew's Centre in Billericay. The trust employs more than 4,000 staff and has more than 10,000 public members. The trust became one of the first 10 NHS foundation trusts in April 2004.

The trust was placed into special measures following reviews by Sir Bruce Keogh June 2013 following concerns around quality of care and high mortality. The Care Quality Commission undertook a comprehensive inspection of the trust in March 2014 and rated the trust as Good. Following this inspection the Commission recommended to Monitor that the trust could come out of special measures.

We returned to inspect on 17th and 18th March 2015 and inspected those key questions where the service had been rated as requiring improvement which are reported in a separate report. We did not undertake a full comprehensive inspection. We undertook an inspection of the critical care service during this inspection due to concerns received about the leadership and responsiveness of the service.

In 2014 we inspected Basildon University Hospital and found significant improvements to the care delivered to the population. We found very good care in most of the services we inspected. We saw some very good examples of care and treatment in maternity and children’s services. When we returned in 2015, we saw that significant changes had been implemented across the medical care and surgery services and several areas of improvements, particularly on the management of medicines; overall we rated these services as good. We inspected critical care services and found this service has concerns relating safety with staffing shortages in the outreach team, responsiveness on patient pathways and leadership. The rating for this service overall has changed from ‘Good’ to ‘Requires Improvement’.

Ratings in A&E, Medicine and Surgery improved from requires improvement to good and the overall rating for Basildon University Hospital remains as Good. In 2014 we were not rating the effectiveness of urgent and emergency services. In 2015 we have now rated this as Good. Whilst the critical care service was rated requires improvement in terms of safety, effectiveness, leadership and responsiveness the aggregated rating for the hospital remains as good.

We undertook a responsive inspection to the critical care unit in March 2015 in response to concerns relating to safety with staffing shortages within the critical care outreach team, areas for improvement within the effectiveness of the service, responsiveness on patient pathways and the pace at which change had been implemented. Subsequently the rating for this service overall changed from ‘Good’ to ‘Requires Improvement’.

We returned to inspect on 16th February 2016 and inspected all the key questions in the critical care service with a view to providing a new rating. We did not undertake a full comprehensive inspection of the trust, this inspection focused solely on the general critical care unit. We found that the service had made significant improvement in the delivery of the service which we have detailed through this report, and we have changed the rating of the service to ‘Good’.

Our key findings from 2015 were as follows:

  • Within the A&E service improvements were noted in the waiting area with patients being routinely observed and monitored for signs of changing or deteriorating conditions. However we identified that the protocol for patients to be admitted to the CDU was not being adhered to at the time of the inspection as the trust was on black alert and nurse staffing levels were not appropriate.
  • The streaming process within A&E was now embedded and working effectively as a pathway for patients through the department.
  • Medicines management in all areas inspected had improved significantly and was safer for patients, though improvements in the recording of medicines administration was still required on Osler Ward.
  • We noted significant improvements in the care provided to patients in surgery. Patients’ privacy and dignity was respected and patients spoken to all felt well cared for.
  • The critical care outreach team had been depleted through maternity leave and resignation and the trust had commissioned a review prior to our inspection.
  • There were also significant delays on occasions in discharging patients from critical care unit which impacted on the responsiveness of the service.
  • The pace of change within the critical care, although improving, required further work to ensure that patients receive a timely service.
  • Patient outcomes as recorded by the Intensive Care National Audit and Research Centre were poor in four out of the seven areas reviewed.

Our key findings from Critical Care in 2016 were as follows:

  • There were significant improvements made to how safe, effective, responsive and well led the service was since our last inspection in March 2015.

  • Staffing levels for nursing, medical and therapies staff had improved and were at a safe level.

  • The mortality ratio for the unit has reduced significantly since our last inspection where it was 1.8 and is now 1.0 on the ICNARC SMR and 0.83 on the APACHE model.

  • The critical care unit acquired infection in the blood rates per 100 admissions was consistently in line with or better than the England average of four.

  • The critical care unit does not currently meet the core standard of 50% of registered nurses having a recognised critical care course with 27% of nursing staff who had completed their certificate in critical care, however a number of staff were currently on the course and the rates by the end of the year were expected to reach over 50%.

  • We observed good use of mental capacity assessments and deprivation of liberty safeguards during the inspection.

  • The completion of DNACPR forms has significantly improved since the previous inspection with a greater awareness of what is required of the medical staff with regards to DNACPR.

  • There had been notable improvements in the leadership of the critical care and outreach service.

  • Morale and culture within the critical care and outreach service had improved significantly since our previous inspection.

We identified the following areas of outstanding practice:

  • We found the innovation around development of medical staff in the A&E service with career progression to consultant level to be a very innovative response to a national shortage of emergency department medical staff.
  • The preparedness of staff for major or emergency incidents in the medical care areas was outstanding. Staff were very aware of their responsibilities and were engaged with the trust’s processes.

We identified the following areas of poor practice in 2015 where the trust needs to make improvements:

The trust should:

  • Improve the management of medicines across the medical care directorate. There is a particular need to improve the recording of medicines administration and storage and prescription of oxygen.
  • Improve the governance from the top at executive level to the local wards and departments and ensure that risk assessments and service plans are available to staff providing direct patient care in escalation areas.
  • Continue to work and improve on the skill mix and staffing levels throughout the hospital particularly in the critical care service.
  • Review staffing and management structures for the critical care outreach service to ensure that an appropriate number of outreach staff are on duty for each shift.

Following our 2016 inspection we found that the trust should:

  • Improve the mandatory training rates for the critical care outreach team.

  • Ensure all staff receive updated equipment competency training.

  • Reduce the delayed discharges over four hours from the critical care unit to the main wards.

  • Reduce the number of transfers out of hours between 10pm and 7am.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 17/03/2014

During a routine inspection

We inspected Basildon University Hospital and found that Basildon and Thurrock University Hospitals NHS Foundation Trust has made significant improvements to the care delivered to the population. We found very good care in most of the services we inspected. We saw some very good examples of care and treatment in maternity and children’s services. Patients who needed end of life care were supported by compassionate and caring staff. The service in A&E was improving and patients were mostly seen within the four-hour target.

We also found areas where the hospital needs to continue to improve. We have said that the hospital must improve some of the ways in which it manages medication.

We spoke with patients, public and staff as part of our inspection.

Staffing

The trust employs around 4,500 staff. It has difficulty recruiting and retaining sufficient staff, particularly nursing staff, mostly because of its proximity to London. The trust has an ongoing recruitment campaign and has recently recruited over 200 new staff. It employs agency and bank staff to make up the shortfalls, and permanent staff spoke positively about the skills of their temporary colleagues. We found wards were staffed appropriately, and staff were able to say when they needed extra staff to cover shortfalls. Recruitment of senior medical staff was in progress to boost the numbers of staff who provided care and treatment both in and out of hours.

Cleanliness and infection control.

The hospital was clean and we observed good infection control practices among staff. Staff were wearing appropriate personal protective equipment when delivering care to patients and they cleaned their hands between patients. There were suitable hand washing facilities in the hospitals and a good provision of hand gels. We saw staff using the gels and asking patients to do the same. We did see two occasions when staff disposed of water they had used to wash patients in the hand washing sink rather than the sluice as we would expect. Staff observed the hospital’s policy on being bare below the elbow. The number of methicillin resistant Staphylococcus Aureus (MRSA) bacteraemia infections and Clostridium difficile (C-diff) infections were within an acceptable range for a trust of this size. Each reported case had been reviewed in detail. The trust takes action to access its own performance with its policies and practices both for cleaning and infection control.

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.


Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Organisation Review of Compliance