Northampton General Hospital NHS Trust

Updated 24 October 2019

Northampton General Hospital is a major acute hospital offering a range of acute services and has delivered care from its current main hospital site since 1793. The trust also provides a range of specialist services to prevent patients having to travel out of Northamptonshire and a range of secondary care services delivered in facilities around the local area to ensure care closer to home. The trust trains a range of clinical staff, including doctors, nurses, therapists, scientists and other professionals.

Northampton General Hospital NHS Trust provides general acute services for a population of 380,000 and hyper-acute stroke, vascular and renal services to people living throughout whole of Northamptonshire, a population of 692,000. The trust is an accredited cancer centre and provides cancer services to a wider population of 880,000 who live in Northamptonshire and parts of Buckinghamshire. The trust has focussed its recent developments on developing its hyper acute services capacity on the main Northampton site. Hyper acute service development has included cancer, renal in-patient provision, hyperacute stroke services, vascular services and cardiology services.

In addition to the main hospital site, which is located close to Northampton town centre, the trust provides outpatient and day surgery services at Danetre Hospital in Daventry and has dedicated beds at the Cliftonville Care Home, Spencer Care Home for patients who no longer require acute inpatient care. The trust is responsible for the medical care of patients transferred to these care homes, whilst all nursing care and management is the responsibility of the home.

Regulated activities delivered by the trust are:

• Assessment or medical treatment for persons detained under the 1983 Act
• Diagnostic and screening procedures
• Maternity and midwifery services
• Surgical procedures
• Termination of pregnancies
• Treatment of disease, disorder or injury

The trust’s bed compliment is:

• 794 general and acute beds,
• 60 maternity beds, and
• 18 critical care beds

The hospital employs 4,409 staff, including 532 medical staff, 1,121 nursing staff and 2,756 other staff.

From March 2018 to February 2019, there were:

• 94,775 inpatient admissions
• 656,606 outpatient appointments
• 132,307 accident and emergency attendances
• 4,383 births
• 1,372 deaths

During 2018-19, Northampton General Hospital NHS Trust provided and/ or sub-contracted NHS services with 13 relevant Health service providers and held two key contracts with NHS commissioners. The trust‘s lead commissioner is NHS Nene Clinical Commissioning Group who also commissions on behalf of NHS Corby CCG, NHS Milton Keynes CCG, NHS Bedfordshire CCG, NHS Leicester City CCG, NHS East Leicester and Rutland CCG and NHS West Leicester CCG. This contract constitutes a range of acute hospital services including elective, non-elective, day case and outpatients. The trust also holds a contract with NHS England for prescribed specialised services.

The principal activity of the trust is the provision of free at point of delivery healthcare to eligible patients. The trust also provides a very small amount of healthcare to private patients.

The trust was last inspected in 2017 during two focused inspections, one in January and one in July. Eight core services were inspected in total, four during each focused inspection. The trust rating for each core service was Good, and the rating for each of the five key questions (safe, effective, caring, responsive and well-led) was Good, with a trust overall rating of Good.

Updated 24 October 2019

Our rating of the trust went down. We rated it as requires improvement because:

• We rated safe and well led as requires improvement, and responsive, effective and caring as good. We rated two of the trust’s eight core services as requires improvement and one as good. In rating the trust, we took into account the current ratings of the five services not inspected this time dating from 2017.
• We rated well-led for the trust overall as requires improvement.
• The trust provided mandatory training in key skills to all staff but did not ensure that everyone completed it.
• The design, maintenance and use of facilities, premises and equipment generally kept people safe. However, staff did not always manage clinical waste or hazardous chemicals well.
• The trust did not always have enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. However, managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
• Staff kept detailed records of patients’ care and treatment. Records were clear, and up-to-date; however, they were not always easily available to all staff providing care in maternity.
• Trust staff did not always follow its systems and processes to safely administer, record and store medicines.
• The trust managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents although they did not consistently share lessons learned with the whole team and the wider service.
• When things went wrong, staff apologised and gave patients honest information and suitable support.
• Managers did not always ensure that actions from patient safety alerts were implemented and monitored.
• The trust provided care and treatment based on national guidance and best practice. However, some guidance on the trust intranet was not always up to date.
• The trust planned and provided care in a way that met the needs of local people and the communities served. However, it did not always work effectively with others in the wider system and local organisations to plan longer term care needs.
• People could not always access services when they needed it and as a result did not always receive the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were consistently worse than national standards. The trust did not achieve NHS constitutional standards in its urgent care service.
• The trust treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. However, complaints were not always managed in line with the trust’s own timescales. Not all clinical areas displayed information about how to raise a concern or make a complaint.
• Leaders had the, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They supported staff to develop their skills and take on more senior roles. However, not all staff reported that senior leaders were visible and approachable.
• Staff did not all feel respected, supported and valued, staff feedback and experience showed a culture of bullying behaviour. However, staff were focused on the needs of patients receiving care. Not all staff felt that they were kept fully informed or had their views listened to and acted upon.
• Leaders and teams generally used systems to manage performance effectively. However, quality measures were not consistently collected in the maternity service.

However:

• Staff understood how to protect patients from abuse and services worked well with other agencies to do so. Most, but not all staff, had training on how to recognise and report abuse, and they knew how to apply it.
• The trust generally controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• Staff completed and updated risk assessments for each patient and took action to remove or minimise risks. Staff identified and quickly acted upon patients at risk of deterioration.
• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
• Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
• The trust made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
• Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
• Key services were available seven days a week to support timely patient care.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• The trust provided services that were inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
• The trust had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
• Leaders operated effective governance processes, throughout the trust and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
• The trust collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
• The trust promoted equality and diversity in daily work and provided opportunities for career development for those with protected characteristics. The trust had an open culture where patients, their families and staff could raise concerns without fear.
• Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients
• All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.
• Staff identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

Updated 24 October 2019

Updated 24 October 2019