Southampton General Hospital

Southampton General Hospital is part of University Hospital Southampton NHS Foundation Trust. It is an acute hospital and provides accident and emergency (A&E), medical care, surgery, critical care, children and young people’s services, end of life care, outpatients and diagnostic services, which are seven of the eight core services always inspected by the Care Quality Commission (CQC) as part of its new approach to hospital inspection. The eighth core service, maternity and gynaecology services, was inspected at the adjacent Princess Anne Hospital (PAH), and the findings are in the inspection report for that location.

Southampton General Hospital is an acute hospital with approximately 1,300 inpatient beds, and employs over 8,400 staff. It provides a full range of elective and non-elective medical and surgical services to the population of Southampton and South Hampshire. The hospital also provides paediatric and adult care specialist services (with the exception of burns, adult renal dialysis and transplantation) to more than three million people living in southern England and the Channel Islands. Specialist services include cardiac services, oncology, neurosciences, level 3 neonatal intensive care (at PAH), and paediatric intensive care. The hospital is a designated regional major trauma centre for paediatrics and adults. There was not a designated outpatients department; outpatient services were provided and managed by core and specialist services.

The team included CQC inspectors and analysts, doctors, nurses, allied healthcare professionals, ‘experts by experience’ and senior NHS managers. (Experts by experience are people who use hospital services, or have relatives who have used hospital care, and have first-hand experience of using acute care services.)

The inspection took place on 9 to 11 December 2014, with unannounced visits between 5 and 15 January 2015.

Overall, we rated this hospital as ‘requires improvement’. We rated caring and effective services as ‘good’. The hospital ‘requires improvement’ for safe, responsive and well-led services.

We rated, urgent and emergency services, medical care and children and young people’s services as ‘good’. We rated, critical care, surgery, end of life care, and outpatients and diagnostic imaging services, as ‘requires improvement’.

Our key findings were as follows:

Are services safe?

• National data indicated that the hospital was reporting more incidents than the national average. Staff were encouraged and found it easy to report incidents on the electronic system. The greatest proportion of incidents were low and no harm incidents. Slips, trips and falls and pressure ulcers were the top serious incident requiring investigation (SIRI) and action was being taken to reduce these across the hospital. We found that incidents were investigated and learning shared within services, but learning across services, such as in outpatients, could be improved. The reporting of incidents in diagnostic imaging services was not always robust and transparent.

• In most services there was a culture of openness and transparency when things went wrong, and the hospital was well placed to meet the new regulations relating to Duty of Candour. However, the diagnostic imaging services had not followed this statutory duty when there had been notifiable incidents around patient safety.

• The NHS Safety Thermometer is a monthly snapshot audit of the prevalence of avoidable harms, including new pressure ulcers, venous thromboembolism (VTE or blood clots), catheter urinary tract infections (C. UTIs) and falls. The information was monitored throughout the hospital and the results were displayed for the public in clinical areas.

• The hospital was working to reduce the prevalence of pressure ulcers incrementally over time. The trust had a target to reduce levels by 20% over the year; this had not been fully achieved in 2013-14. Hospital data indicated there was a slightly decreasing trend for avoidable grade 2, 3 and 4 pressure ulcers by the end of 2014