Archived: Basildon and Thurrock University Hospitals NHS Foundation Trust

Updated 10 July 2019

Basildon and Thurrock University Hospitals NHS Foundation Trust provides services for 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. Services include urgent and emergency care, medical care (including older people’s care), surgery, maternity and gynaecology, critical care, services for children and young people, end of life care, outpatients and diagnostic imaging.

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 also provides dermatology services across the whole of south Essex.

The Essex Cardiothoracic Centre (CTC) provides a full range of tertiary cardiothoracic services for the whole county and further afield.

Basildon and Thurrock University Hospitals became a foundation trust in 2004. The trust began working closely with Southend University Hospital NHS Foundation Trust and Mid Essex Hospital Services NHS Trust in 2014. In 2015 the Essex Success Regime was launched. Further collaborative work was undertaken between the trusts with the aim of addressing the pressures on the local health and care system by tackling the gaps in clinical staffing, meeting the growing health demands of the population and enabling the system to achieve financial balance. In December 2016, the boards of the three acute trusts decided to enter into a formal collaborative governance framework and contractual joint venture. The partnership between the three trusts was formalised as of 1 January 2017 and shared governance arrangements took effect from March 2017. In November 2017, public consultation began on plans for clinical reconfiguration of the three trusts in line with STP. This was approved by commissioners in July 2018. The boards of the three trusts formally approved the proposal for a merger of the trusts in January 2018.

We previously inspected the trust in March 2015 under our comprehensive methodology and rated the trust as good overall. We conducted a focussed inspection of the critical care services in February 2016 to follow up on specific concerns and rated the service as good overall.

We inspected the trust under our current methodology in February 2019. We inspected the core services of medical care, surgery, maternity and outpatients’ services. A well led inspection took place in March 2019 and we issued requirement notices.

Updated 10 July 2019

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.

Updated 10 July 2019

Updated 10 July 2019