Horton General Hospital

Updated 8 March 2024

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at Horton General Hospital.

We inspected the maternity service at Horton General Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

The Horton General Hospital provides maternity services to the population of Banbury and North Oxfordshire.

Maternity services include an outpatient department, maternity assessment centre and midwifery led birthing unit. Between January 2023 and October 2023, 141 babies were born at Horton Midwifery Led Unit.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

This location was last inspected under the maternity and gynaecology framework in 2014. Following a consultation process CQC split the assessment of maternity and gynaecology in 2018. As such the historical maternity and gynaecology rating is not comparable to the current maternity inspection and is therefore retired. This means that the resulting rating for Safe and Well-led from this inspection will be the first rating of maternity services for the location. This does not affect the overall Trust level rating.

We rated it as Requires Improvement:

• Our rating of Requires Improvement for maternity services changed ratings for the hospital overall. We rated safe and well-led as Requires Improvement.

Horton General Hospital – https://www.cqc.org.uk/location/RTH05

How we carried out the inspection

We provided the service with 2 working days notice of our inspection.

We visited the midwife led birthing unit and the outpatient’s departments. Women and birthing people attending the maternity assessment centre are seen in the midwife led birthing unit.

We spoke with 3 midwives and 3 support workers. We received 108 responses to our give feedback on care posters which were in place during the inspection.

We reviewed 5 patient care records, 1 'observation and escalation’ chart and 5 medicines records.

Following our onsite inspection, we spoke with senior leaders within the service; we also looked at a wide range of documents including standard operating procedures, guidelines, meeting minutes, risk assessments, recent reported incidents as well as audits and action plans. We then used this information to form our judgements.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 7 June 2019

Our rating of this service 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. All relevant teams were involved in assessing, planning and delivering people’s care and treatment. 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. People were treated with dignity, respect and kindness during all interactions with staff and relationships with staff are positive.
• Reasonable adjustments were made and action taken to remove barriers when people find 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 service provided mandatory training in key skills to all staff but not everyone had completed it. Nursing staff compliance was significantly higher than medical staff.
• Substances hazardous to health were not always stored safely.
• There was a gap in the management and support arrangements for staff. Appraisals were significantly below the trust target of 90% for all staff groups with the exception of medical staff. The medicine division had developed actions to address the gap in compliance, and action plans were in place at directorate level.
• Outcomes for stroke patients had deteriorated from grade C in 2017 to grade D in 2018.
• The trust’s responses to complaints were not always completed in a timely manner. The trust did not have a target for closing complex complaints, which some of these complaints may have been.
• A proportion of patients did experience a delay when medically fit with their transfer from hospital.

Updated 14 May 2014

Patients received care which was compassionate, dignified and delivered good outcomes. Clinical outcomes for patients were good. Mortality rates were below the national average and below the expected level for patients in a critical care unit. The caring and consideration of staff was excellent. The patients and relatives we spoke with praised the nursing and medical staff highly. Vulnerable patients were well supported and staff put the patient at the centre of their care.

The department was well-led at local and senior level and staff were supported and proud of their work. There were some issues with patient discharge not being timely or being delayed, but this was due to pressures on beds elsewhere in the hospital. On a national level, this problem was not significant.

However, the critical care department was not meeting the guidelines in relation to medical cover. There were skilled and experienced anaesthetists and consultants attached to the unit, but not all had critical care training. The lead medical consultant was trained in critical care, but this was not their substantive post and they were not available at all times. There was no evidence this had resulted in patients being put at risk, but the arrangements did not meet the national guidelines for medical care in intensive care units.

Updated 14 May 2014

Patients received effective and sensitive end of life care. Patients told us they felt safe with the staff and overall their needs were met. We were told medicines were prescribed to control patients’ pain and staff were using the fast-track process for early discharge. Patients said staff respected their rights: in particular privacy and dignity. Patients and their relatives told us where there were concerns staff were available for discussions.

Patients at the end of their life were able to make decisions about the medical procedures to be followed in the event of cardiopulmonary arrest. If the decision made was not to attempt to resuscitate the patient, it was recorded and brought to the attention of all medical staff involved in the delivery of care.

Patients were treated with compassion and were not expected to wait for pain medication. Doctors prescribed medicines in advance to prevent delays in administering medicines to patients in pain. Medicines to be taken as required were prescribed to ensure patients were comfortable between other scheduled medicines.

Patients were cared for by staff with an understanding of end of life care. There were nurses on each ward who specialised in specific topics including end of life care. These staff were able to support other staff who needed guidance or advice. Doctors completed mandatory training on end of life care during their teaching.

Updated 8 March 2024

Updated 14 May 2014

Patients received safe care. Staff were skilled and caring and knew their responsibilities to keep patients safe. Risk assessments had been completed and actions identified to improve the service. The clinic was clean and a refurbishment programme had started. Capacity remained a concern because demand had increased by 10% over the year prior to our inspection. The trust was planning to improve capacity at the Horton by providing two additional clinic rooms in the refurbishment. Audits for the “choose and book” system had taken place and the trust was in the process of re-profiling outpatients to improve the patient experience.

We spoke with ten patients and the majority had no problem getting an appointment and all tests and x-rays had been completed in a timely manner. Eight patients were complimentary about the service and two told us the service was excellent overall. Two patients had problems getting an appointment in a timely manner.

There was a culture between staff to improve the patient experience and be the best they could be. Patient views and experience had been sought to help improve the service. Staff had endeavoured to answer any verbal concerns raised with them immediately.

The trust were keen to develop directly bookable appointments that relieved pressure on staff and the time it took patients to book individual appointments over the phone. The plan was to improve the time automatic letters were sent for appointments and cancellations.

Updated 14 May 2014

There was consensus among patients, carers and staff that staff were dedicated and provided compassionate, empathetic care. Processes were followed to reduce any risks to patients undergoing surgical treatment. There were processes to ensure patients who moved to different wards received consistent and safe care and treatment. Staff made use of the language line facility and interpreters to ensure patients had good understanding of their treatment and were able to make informed decisions. Staff had a good understanding of the Mental Capacity Act 2005 which meant patients received the appropriate support to be able to make their own decision, or where required decisions involving appropriate people were made in the best interest of the patient.

Generally, there was sufficient equipment available to meet the needs of patents. However, concerns were expressed about access to MRI imaging. Patients had to go to the John Radcliffe Hospital in Oxford to access MRI imaging; we were told that difficulties in arranging appointments meant there was a risk that some patients’ treatment would be delayed.

We saw good evidence of team working at ward and departmental level. However, with some of the clinicians, there was a feeling that despite being part of Oxford University Hospitals NHS Trust, the views and opinions of staff at Horton General Hospital were not always heard.

Updated 7 June 2019

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

• The service provided mandatory training in key skills to all staff but not everyone had completed it.
• Staff were not always given the opportunity to have an annual appraisal.
• The service did not always control infection risk well. Staff did not always keep equipment and the premises clean. Control measures to prevent the spread of infection were not always in use in the ED.
• Staff did not always adhere to trust medicines management policy.
• The environment was not always suitable for services provided.
• Privacy and dignity was compromised for some patients in the ED.
• The service did not always have enough nursing staff, with the right mix of qualification and skills, although they were working hard to remedy this.
• 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.

However:

• The service provided care and treatment based on national guidance and monitored evidence of its effectiveness.
• Leaders on the wards had the skills, knowledge, experience and integrity they needed to fulfil their roles.
• The service had enough medical staff with the right qualifications, skills, training and experience to keep people safe.
• The trust had processes to ensure care and treatment was aligned with current evidence-based practice.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• The trust planned and provided services in a way that met the needs of local people and took account of patients’ individual needs.