- NHS hospital
Royal Cornwall Hospital
Report from 16 May 2024 assessment
Contents
Ratings
Our view of the service
Date of on-site assessment 2 May 2024. Dates of desktop assessment between 6 to 31 May 2024. We carried out a responsive assessment of Urgent & Emergency Care (UEC) at Royal Cornwall Hospitals NHS trust in response to concerns regarding its performance against the NHS constitutional standards for emergency care. We reviewed evidence categories in the 5 key questions: Safe, Effective, Caring, Responsive and Well-led. The overall rating for this service is requires improvement. We last inspected UEC on 8th March 2022 where it was inspected but not rated. At this site visit, we saw there had been some improvement against the areas of concern found at the previous inspection. We found two breaches of regulation where care and treatment was not always provided in a safe and timely way in line with clinical guidance and in an area of the department or correct specialty where it is safe to do so. Patients were not always admitted from the emergency department to a ward bed in a timely manner. Patients experienced waits in ambulances when the emergency department was at capacity. The issues found were linked to the crowding of the emergency department and the lack of care packages available in the local community which meant people in the hospital who were fit for discharge remained being cared for in the hospital setting. We also found that appraisals for staff were not completed regularly which was also an issue at the previous inspection. The major area of concern was crowding. As with other hospitals, due to a crisis in capacity for ward beds, there were often patients being held on ambulances in the care of ambulance staff. This was due to the emergency department being full and patients who needed admission or specialty review being managed in an overflow area. Delaying ambulances led to delays for patients waiting in the community. These delays resulted in staff caring for patients longer than required in the emergency department.
People's experience of this service
Most of the people we spoke with felt they had been treated well and with kindness from caring staff. Those patients who were waiting on ambulances, which were fewer in number during our time in the department than we have observed in the past, said they felt safe and understood the pressures on the department leading to their long wait at times. There were a few comments made to us about a lack of communication to patients on what was happening to them and what they were waiting for. We observed staff would come and explain to patients about delays when asked, but a couple of patients said they felt uncomfortable with asking, recognising how busy staff were. The department’s senior nurse was developing a chart for patients to provide information for them and their families on what was happening and the next steps. This would be updated by staff and form a ‘live’ and personalised source of information.