Northampton General Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

There were up to date polices in place for staff to refer to. However, these were not followed consistently. Monthly falls audits were not conducted and not all staff we aware of this requirement. When falls audits had been conducted by the hospital's falls prevention team these were not always dated or completed fully. Therefore we were not assured that actions required to reduce the risks of falls could be identified promptly. Staff knew how to assess peoples care needs and mitigate risks. There were effective processes in place to report and learn from incidents.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff knew how to assess patients needs and minimise the risk of harm. Information about patients’ specific needs, including risks, were shared at daily ward meetings. Staff knew how to identify risk and report incidents. Information provided by the service before our visited showed that incidents were investigated and any learning was shared with staff. There was not a routine programme of ward-based audits that included falls prevention and usage of bedrails. Routine audits of falls prevention and bed rail usage were not completed. During our assessment, managers told us they did not undertake routine falls quality and safety audits. Senior ward staff were not aware of the requirement to complete falls audit. The sister told us they did spot checks of records to ensure risk assessments and care plans were completed but did not document this. Therefore, senior staff could not be assured the trust’s falls prevention policies and procedures were being effectively implemented or check that learning from incidents had been effective. Staff confirmed they had detailed daily handovers to identify the care needs of each patient and how best to mitigate any risks associated with their specific conditions.

A trust wide falls audit programme was in place, but this was not implemented on the head and neck ward. A Trust wide falls audit was undertaken in March 2024 to review falls processes across adult inpatient ward areas. The aim of the audit was to provide further insight into falls prevention assessments and provision of falls prevention aids on individual ward areas and identify any areas of improvement. This was completed by the falls prevention team and reviewed follow up actions and concerns highlighted at previous audits. However, the outcome of previous audits was unknown and it was unclear how often this had been completed for the head and neck ward. Following our assessment, we were provided with a copy of the audit outcome. However, it was not dated, therefore we did not know when the audit had been undertaken. This audit showed 100% compliance with falls risk assessment and care plan completion as well as lying and standing blood pressure. There were effective processes to identify deteriorating patients and involve other specialties, such as physiotherapy staff in people's care when necessary. Effective processes were in place to identify risk and report incidents. There were processes in place to ensure staff had the skills and knowledge to support patients. The service reported that 94% of staff had completed their mandatory training in December 2023.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.