Royal Cornwall Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We reviewed the equity in access quality statement for the responsive key question. The main problem was with crowding and limited capacity. The whole hospital was exceptionally busy. Although policies and procedures were available to staff to help them respond to the continued increased attendance in the department, patients were not admitted, triaged or treated quickly to ensure they received care in the right place at the right time. The high numbers of patients attending the department put increased pressure on staff. The service maintained up to date policies and processes for patients requiring reasonable adjustments.

This service scored 50 (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 Person-centred Care during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The main problem for the emergency department was with crowding and limited capacity. The whole hospital as well as the emergency department was exceptionally busy as had been the case for many years. There were few available ward beds for patients being admitted from the emergency department and almost all patients who needed admission for further treatment were delayed waiting for a bed. This resulted in patients being cared for in the emergency department for extended periods which was not how the department was designed. Emergency patients were expected to have been triaged if they self-presented or assessed if they arrived by ambulance before receiving care and treatment. A decision about any onward care was expected to be made within four hours, including any input from specialty services. However, crowding in the department due to a lack of beds in the hospital meant the NHS four-hour constitutional standard had not been met for around half the patients who attended for many years. Patients were staying for extended periods in a department which was not designed for long stays. This resulted in patients needing to be found hospital beds rather than trolleys to prevent pressure damage to skin, and for care plans to be drawn up to provide nutrition, hydration and medicines for far longer periods than optimal.

There was a constant focus by staff on the issues with crowding and capacity pressures in the department. We were told by all those staff we met that the pressure they were under and how this affected their ability to provide safe and quality care was a constant worry. We recognised this had been relentless and with the summer months and with the tourist population arriving, this was unlikely to be easing. We were told there had been recognition and support from the wider health and social care community who understood the pressures of delayed discharges and the complexities of patients being ready to leave hospital, but without a safe onward placement. At the time of our visit, staff from the department, senior executives, and the ambulance personnel said they felt pressures had alleviated to an extent in the past weeks, yet this had not meant the situation was not still in constant focus. At the time of the site visit, even though there was reduced pressure to an extent on the department, it remained crowded and overfull. We observed some, but not a lengthy line of ambulances, holding patients as we have seen at times over the past few years. Data received from the trust stated the hospital bed base was regularly in the high 90’s for occupancy. The trust had a target of less than 92% bed occupancy. When the hospital has high bed occupancy it is more difficult to move patients from urgent and emergency care into the specialist wards where they can receive the specialist care that is required. The emergency department had patient passports for patients with learning disabilities and made adaptions to try and mitigate against any possible distress such as moving patients to a quieter area of the department or an area where lights could be dimmed. The service accessed a translation service for people who attended whose first language wasn’t English and there was an induction loop fitted at the reception desk to help patients with hearing aids.

We were not assured, despite staff best efforts, that patients were accessing the care, support and treatment they required when they needed it. Data from April 2024 indicated that only 40.6% of patients were being seen within the 4 hour standard. The national target was 76%. The trust was also ranked 112/118 for all attendances greater than 12 hours from arrival. There had been improvement since the last inspection where 80% of chest pain patients had an electrocardiogram recorded and reviewed within 15 minutes of arrival. At the previous inspection in March 2022 this figure was at 50%. Patients having an initial assessment within 15 minutes of arrival, as per the national standard, was not always occurring. However, the trust was improving its compliance against this target and as at April 2024, the 95 percentile of patients were being seen within 27 minutes which had improved from 50 minutes in December 2023.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.