Basingstoke and North Hampshire Hospital

Updated 28 January 2022

Our rating of services improved. We rated it them as good because:

• Generally the service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and acted on them. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Not all staff had completed training in the Mental Capacity Act/Deprivation of Liberty.
• Not all staff had completed a yearly appraisal.
• Medicines were not always managed well.
• Safe staffing levels were not always achieved consistently across the hospital.
• Surgical patients did not always have their food intake and fluid balance recorded. The pre-operative fasting process did not always follow best practice guidelines. They did not have their risk of developing a blood clot reassessed within 24 hours of admission.
• Medical patients did not always have their personal, cultural, social and religious needs recorded.
• Staff did not always work effectively to manage patient flow within the hospital.

Updated 7 April 2020

Our rating of this service improved. We rated it as good because:

• Staff had safeguarding training on how to recognise and report abuse, and staff knew how to apply it.
• The service managed infection risk well. The wards were visibly clean and free from clutter. Staff used recognised infection prevention methods.
• The environment and equipment were suitable for the service provided including; access to necessary emergency equipment.
• The service assessed and mitigated patient risks. Each patient had risk assessments completed in their care plans and detailed actions against each risk.
• Patient records were clear, up-to-date and reflected the care needs of the patient. Patient records were stored securely.
• The service investigated incidents and lessons learnt shared with staff.
• The service monitored its safety performance and sought to improve performance of the service.
• Managers worked collaboratively and responsively to ensure staffing levels kept patients safe.
• Patient care and treatment were based on national guidance and evidence-based practice. Staff monitored performance against national guidelines and best practice.
• The service ensured staff were competent for their role. Staff had access to training and had regular supervisions and appraisals.
• The service worked in multidisciplinary teams to improve patient care and staff could refer for specialist advice.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and Mental Capacity Act 2005. Staff could access advice from the mental health liaison service.
• Staff treated patients and those close to them with dignity, respect, compassion and kindness. Patients we spoke with commented that their privacy and dignity was respected.
• Staff showed understanding and a non-judgmental attitude when caring for or discussing patients with mental health needs.
• Staff gave patients and those close to them help, emotional support and advice when they needed it. Staff sought specialist support from specialist teams for patients who required additional emotional support and care.
• Staff made sure patients and those close to them understood their care and treatment and supported patients to make informed decisions about their care.
• The service planned and provided a service which met the needs of the population.
• Staff treated complaints and concerns seriously; complaints were investigated, and lessons learnt were communicated to staff.
• Managers and staff worked hard to make sure that patients did not stay longer than they needed to. Managers and discharge teams in the hospital worked with agencies to facilitate discharge from the hospital.
• Managers were visible, approachable and had the skills and abilities to manage the service.
• Staff worked well as a team and had good morale. They felt respected and valued within their roles and worked hard to give good patient care.
• The service had effective governance processes to monitor performance and discuss learning. The service monitored risks, issues and performance effectively.
• The service was dedicated to quality improvement and innovation at all staff levels. Managers encouraged staff to improve the service.

However:

• Medicines were not always recorded and stored correctly.
• Compliance with mandatory training did not meet trust targets and this needed to improve.
• Medical staff compliance with safeguarding training did not meet trust targets and this needed to improve.
• Compliance with Mental Capacity Act 2005 and Deprivation of Liberty Safeguards training did not meet trust targets and this needed to improve.
• The service should continue to review nursing staffing in the medical care wards.
• We did not see consideration of personal, cultural, social and religious needs of patients documented in their care plan and how they related to the patients’ care needs. This meant staff may not be considering what is important to patients when planning care.

Updated 12 November 2015

We rated services for children and young people services as ‘good’ for providing safe, effective, responsive and well-led services. The service was outstanding for caring.

Incidents were reported and appropriately investigated. Lessons were learnt to support improvements. Staff had an understanding to be open and transparent when things go wrong and the new regulation of Duty of Candour was being followed. Clinical areas were visibly clean and staff were following infection control procedures. Medicines were appropriately managed and stored, and equipment was available and regularly tested to ensure it was fit for use.

Staff took steps to safeguard children. Children’s risks were appropriately assessed and procedures were followed to identify if their condition might deteriorate. Children with mental health problems were, however, not always assessed and supported by mental health professionals in a timely way.

Action was being taken to ensure safe nurse staffing levels. Consultants were covering middle grade doctor vacancies but this practice was not sustainable in the long term

Care and treatment was based on national guidance and evidence based practice. The services was monitoring clinical standards and participated in local and national audits. The trust scored better than the England average for diabetes and asthma outcomes.

Children and young people had good pain relief, nutrition and hydration. The hospital had received the level 3 “Baby Friendly” Accreditation in the neonatal unit in October 2013 which supports parents to be partners in care.

Staff had appropriate training and were highly competent. Staff worked effectively in multi-disciplinary teams and with external providers to provide a holistic approach to care. The hospital, however, did not have sufficient inpatient paediatric physiotherapists to effectively support patients with cystic fibrosis at the weekends.

Seven day services had developed for medical staff and consultants were available seven days a week.

Staff were providing a compassionate and caring service. Feedback from people who use the service, and those who are close to them, was overwhelmingly positive. Children and their parents spoke of staff going “above and beyond” to provide care and keep them well informed, and of an “excellent” service. Children and their parents were involved in their care and treatment. Play leaders supported children to understand their care and reduce anxiety.

The service was being planned around managing service demands and responding to the needs and preferences of children, young people and their families. There was good access to the service, with open access for children with chronic conditions and those who had recently been discharged. There were good links with the community child health team, based in the hospital, leading to continuity and an integrated care approach. The service was meeting the needs of children with long-term chronic and life-limiting conditions by working in collaboration with other hospitals and hospices.

The trust needed to work with its partners to ensure there was a service level agreement for children and young people with mental health needs. There was support for children with a learning disability.

Governance processes appropriately managed quality and risks issues, although we did not see how risks were being escalated to the trust board. Staff were positive about the local leadership of services and demonstrated they were passionate and committed to delivering high quality, patient focused care.

There was evidence of cross site working, for example, to streamline services and share good practice although it was acknowledged that more work was required to develop consistent service across the trust.

Children and young people were encouraged to feedback ideas to improve the service

Updated 12 November 2015

We rated critical care services as ‘good’ for providing safe, effective, responsive and well-led services. The service was outstanding for caring.

There were areas of good, outstanding and innovative practice in the critical care services. Once a week, the librarian attended the ward round in order to source relevant literature to assist the professional development of staff.

To promote the development of the nursing team the senior nursing team and clinical educator had taken the initiative to develop a critical care career pathway for grades 5, 6 and & 7. The nursing team was split into four teams. In response to difficulties recruiting middle grade (registrar) doctors, the unit had developed a two year course in Advanced Critical Care Practice (ACCP), in conjunction with Southampton University.

There were effective risk management processes in place with processes to ensure learning from incidents was shared across the critical care units at both BNHH and RHCH.

Staffing levels and qualifications were in line with national guidance. This meant patients received care and treatment from staff who had the necessary specialist skills and experience.

Treatment and care followed current evidence-based guidelines with the exception of outreach services and critical care rehabilitation services. The risk to patients associated with not having these services was being monitored,and action was being taken to try to introduce these services. The critical care services participated in national and local audits and there were good outcomes for patients. Staff had effective training, supervision and appraisal and there was good multidisciplinary working to ensure that patients’ needs were met.

Data showed that outcomes for patients were comparable with those of similar critical care units.

There was strong leadership of the critical care service across the trust and in the units at BNHH. There was a culture of mutual support and respect, with staff willing to help the unit at RHCH when they were short staffed. Innovative ideas and approaches to care were encouraged and supported.

Updated 12 November 2015

End of life care at this hospital was “outstanding”. We rated it ‘good’ for safe, effective and responsive services and outstanding for caring and well-led services.

People were protected from avoidable harm and abuse. Reliable systems and process were in place to ensure the delivery of safe care.

Care and treatment was delivered in line with local and national guidance and, a holistic patient-centred approach was evident.

Staff involved and treated people with compassion, kindness, dignity and respect. Feedback from patients and their families was mostly positive and we observed many examples of outstanding compassionate care.

The leadership for end of life care was strong. There were robust governance arrangements and an engaged staff culture all of which contributed to driving and improving the delivery of high quality person-centred care.

This was an innovative service with a clear vision and a strong focus on patient centred care which was supported by a board structure that believed in the importance of excellent end of life care for the local population.

There was good multidisciplinary working, staff were appropriately qualified and had good access to a comprehensive training programme dedicated to end of life care. However we were concerned about the uptake of mandatory training by the specialist palliative care team and the low staffing levels in the mortuary.

Patient outcomes were routinely monitored and where these were lower than expected comprehensive plans had been put in place to improve. However, ‘Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) decisions were not always made appropriately and in line with national guidance.

Staff treated people with compassion, kindness, dignity and respect and feedback from patients and their families were consistently positive.

Patient’s needs were mostly met through the way end of life care was organised and delivered. However, the rapid discharge of those patients expressing a wish to die at home did not always happen in a timely way. The specialist palliative care team identified rapid discharge as a challenge. We saw where recommendations and actions to address these audit results had been made and results had been discussed at board level. There was an identified shortage of side rooms for those patients identified as being in the last hours of life.

Updated 28 January 2022

Updated 12 November 2015

The outpatient and diagnostics imaging services were ‘good‘for safe, responsive services, and well-led services. It was ‘outstanding’ for the delivery of a caring service.

Staff were encouraged to report incidents and the learning was shared to improve services. In diagnostic imaging, staff were confident in reporting ionised radiation medical exposure (IR(ME)R) incidents and followed procedures to report incidents to the radiation protection team and the care quality commission.

The environments were visibly clean and staff followed infection control procedures. Equipment was well maintained and medicines were appropriately managed and stored. Most records were available for clinics and, if not available, temporary files and test results from the electronic patient record were used. Patients were assessed and observations were performed, where appropriate. However, there was not a tool in use to identify patient’s whose condition might deteriorate in outpatients. Interventional radiology there was evidence of the WHO checklist being completed and patient protocols in place. However, in the Candover Unit national guidelines for interventional radiology were not always followed regarding the availability of specific staff to be available in an emergency.

Nurse staffing levels were appropriate as there were few vacancies. Radiographer vacancies were higher and they reported a heavy workload. There was an ongoing recruitment plan.

There was evidence of National Institute for Health and Care Excellence (NICE) guidelines being adhered to in rheumatology and ophthalmology. However, there was not a local audit programme to monitor clinical standards. Staff had access to training and had annual supervision but did not have formal clinical supervision.

Staff followed consent procedures but did not have an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards which ensures that decisions are made in patients’ best interests.

Patients consistently told us that they had experienced a good standard of care from staff across outpatients and diagnostic imaging services. We observed compassionate, caring interactions from nursing and radiography staff. Patients told us that they were included in the decision making regarding their care and treatment and staff recognised when a patient required extra support to be able to be included in understanding their treatment plans.

There was some evidence of service planning to meet people’s needs. For example, the breast unit offered access to one stop clinics where patients could see a clinician, have a biopsy and see a radiologist if required. National waiting times were met for outpatient appointments, cancer referrals and treatment and diagnostic imaging. However, the trust had a higher number of cancelled clinics, many of which were at short notice. The reasons for this varied and included cancellation for staff sickness, training and annual leave. There was a plan to address this but this was in development. Patients were not reviewed to ensure the timeliness of re-appointments for their condition.

There was good support for patients with a learning disability or living with dementia. Patients whose first language might not be English had access to interpreters although some staff were not aware of how to access this service. The service received very few complaints and concerns were resolved locally. Staff were not aware of complaints across the trust or the learning from complaints.

The outpatient department had a strategy in development. There were plans to deliver, local consultant led services, including more one stop, nurse led and complex procedure clinics for outpatient services. Staff were not aware of how the strategy would develop in their departments. The hospital had plans to address issues regarding clinic cancellations. In diagnostic imaging there was an action plan to increase the skill mix of staff, the capacity of services and service integration across sites. This had had yet to be considered at divisional and trust board levels and interim actions were not specified.

Governance processes required further development in the outpatient department to monitor risks and quality although these were well developed in diagnostic imaging.

Staff were not clear about the overall vision and values of the trust but told us that the patient experience and the provision of high quality care was their main concern. Nurses and radiographers spoke highly of their immediate line managers and told us they worked in strong, supportive teams which they valued.

There were some examples of local innovation and improvement to services. The breast unit had fully integrated to provide a coordinated service across trust sites. In diagnostic imaging, a staff representative role was being introduced following to support and implement positive changes within the department that staff members themselves had recommended.

Public and patient engagement occurred through feedback such as surveys and comment cards.

Updated 7 April 2020

Basingstoke and North Hampshire Hospital

Basingstoke and North Hampshire Hospital hosts the Peritoneal Malignancy Unit for the treatment of pseudomyxoma (a rare form of abdominal cancer) which spreads cancerous cells to the lining of the abdominal cavity. Additionally, the hospital has a Diagnostic Treatment Centre (DTC), four endoscopy rooms, the Eye Day Care Unit (EDCU) with one eye theatre (local anaesthetic cases only) and a pre-assessment unit.

The trust had 36,223 surgical admissions from July 2018 to June 2019. Of these, 10,620 (29.3%) were emergency admissions, 20,105 (55.5%) were day case, and the remaining 5,498 (15.2%) were elective

We inspected this service using our comprehensive inspection methodology. We carried out this unannounced inspection (people did not know we were coming) on 15 and 16 January 2020.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

During this inspection we visited the following services-–

• C2 – Liver and peritoneal malignancy ward
• C3 – Non- elective surgery ward
• C4 – Elective surgery ward
• Admission ward
• EDCU – Emergency day care unit
• D1 – Elective orthopaedic ward
• D3 & D4 – orthopaedic/ trauma wards
• Diagnosis and Treatment Centre
• Eye day care unit

The inspection team spoke with 18 patients and their relatives, appropriately 24 members of staff including nurses, health care assistants, allied health care staff such as physiotherapists and pharmacist, doctors, receptionists, and domestic staff. We observed care and treatment and reviewed 14 patients’ records. We also reviewed information, documents and data provided by the trust both before and after the inspection.

Our rating of this service improved. We rated it as good because:

The staff looked after the equipment well and infection control procedures were followed to minimise the risks of cross infection.

Incidents were reported, and these were investigated. Action plans were developed, and lessons learnt were shared widely to effect learning and practices changed.

The service used systems and processes to safely prescribe, administer, record and store medicines. Patients medicines were reviewed, and any changes were discussed with the consultants.

The service controlled infection risks well. Staff followed guidance used control measures to protect patients, and others from infection. They maintained equipment and the premises were visibly clean and used methods to identify clean equipment.

The service had policy and procedures which staff followed to recognise and respond to sepsis, a severe blood infection in line with national guidance which staff followed.

Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff supported those unable to communicate using suitable assessment tools. and gave additional pain relief to ease pain.

Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.

The service provided care and treatment based on national guidance and evidence-based practice.

There was effective multi-disciplinary working where staff of different roles such as dieticians and specialist nurses worked cohesively for the benefits of patients. They supported each other to provide good care.

Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

Staff supported patients to make informed decisions about their care and treatment. They followed guidance to gain their consent written and verbally.

Patients who lacked capacity or were suffering from mental ill health were effectively supported to make their decisions about their care. Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act 1983 and the Mental Capacity Act 2005.

The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. Data or notifications were consistently submitted to external organisations as required.

Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment. Families were supported to remain with the patients during their treatment.

The staff were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.

The senior managers and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues. They developed and reviewed action plans to reduce and mitigate their impact

Services were available 24 hours a day, seven days a week to support timely patient scare. Arrangements were in place for out of hours services through their on- call service such as consultants, theatre staff and mental health services.

The senior managers and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues. They developed and reviewed action plans to reduce and mitigate their impact.

Leaders had the integrity, skills and abilities to run the service. They were visible and approachable in the service for patients and staff. They understood and managed the priorities and issues the service faced. Risks were managed, and strategy developed to mitigate risks.

However:

In surgery medical staff did not meet the trust’s target for any of the mandatory training modules for which they were eligible, and this included safeguarding adults training.

Nursing staff compliance with safeguarding training was below the target as set by the trust.

On two of the surgical wards, emergency equipment was not consistently checked to ensure they were safe to use and in line with guidance.

The service did not always manage prescriptions forms (FP10) safely and there was a lack of oversight on their usage.

The system for storing oxygen cylinders was not safe as these were stored on the floor and may pose safety risks.

The food and fluid charts were not consistently completed to inform staff’s practices and enabling them to support patients’ dietary needs.

The service did not always follow fasting process prior to surgery in line with good practice guidelines.

Updated 7 April 2020

Our last inspection of Basingstoke and North Hampshire Hospital’s emergency department was in June 2018. We followed this up with two unannounced focussed inspections in February and April 2019. 

In February and April 2019, we visited the department and looked at issues raised in a warning notice under Section 29A that was issued in June 2018. We noted that the trust had made many improvements and this resulted in the conditions of the notice being removed in December 2019. 

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This inspection was unannounced. We looked at the environment, equipment and observed care. We reviewed 12 sets of patients notes and looked at information provided by the trust before and after the inspection. The inspection team spoke with 10 patients and relatives, 32 members of staff including consultants, junior doctors, nurses of several grades, health care support workers, managers, allied healthcare professionals, security and domestic staff and reception staff.

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

• Overall, the department was tired in appearance, with some damage to plasterwork on walls. Storage cupboards were cluttered and untidy. In the main department, the main storage cupboard was small but fitted with shelving. The shelves were labelled but, in some cases, the items in boxes did not match the label. 
• Nursing and medical staff did not keep up to date with all their mandatory, medicines management and safeguarding training. 
• The department had challenges in medical staff vacancies. The medical staff did not match the planned number with a shortage of middle grade doctors. 
• The service did not meet the nationally agreed wait times which meant that some patients did not receive their planned care in a timely way or in the right place. We noted there was limited pull from other wards to alleviate pressure for beds in emergency department, no proactive action plan to deliver more beds and there did not seem to be efficient use of the discharge lounge. Patients were treated on trolleys in the corridor in times of pressure, but this was noted to be managed by staff within the department.  
• Management of medicines paperwork was not consistent.  FP10 forms that patients were able to take to community pharmacies, were not always recorded when they were issued. Up to date patient group directive paperwork was not always available on the intranet. Prescriptions were completed online and on paper. Some medications were not routinely prescribed in the department and the patients possibly had to wait for a review before receiving their regular medication.  

However: 

• The service had enough staff to care for patients and keep them safe, using bank and locum staff. Staff were trained in key skills and understood how to protect patients from abuse. The service controlled infection risk well, staff assessed risks to patients, acted on them quickly. The service managed safety incidents effectively, learned and shared lessons from them. Staff collected safety information and used it to improve the service.  
• Staff provided good care and treatment, supported patients in their pain relief when they needed it and meet their nutritional needs. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them in how to make decisions about their care, and had access to good information. Key services were available seven days a week, including x-rays, CT scans, access to psychiatric liaison and mental health services.  
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. 
• The service planned care to meet the needs of local people, took account of patients’ individual needs and made it easy for people to give feedback.   
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s values, and how to apply them in their work. Leaders planned to involve staff in the planning of future vision and strategy for the service. Staff felt respected, supported and valued. Staff and leaders were clear on how to meet the needs of patients receiving care and were clear about their roles and accountabilities. Leaders were committed to improving services continually and were clear in how they planned to achieve this.