Royal Cornwall 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

We reviewed the capable, compassionate and inclusive leaders, partnership and communities and governance management and sustainability quality statement for the well-led key question. There was an inclusive and positive culture of continuous learning and improvement. Leaders were capable, compassionate and inclusive and supported their staff in challenging and stressful times. There was a strong desire to meet the needs of the whole population and to provide safe, integrated person-centred care.

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.

There was a strong, committed and capable leadership team in the department. The leadership team had the skills, experience and knowledge to lead the department effectively and with credibility. They were open, honest and willing to learn and improve. All the staff we spoke with about the leadership were complementary about the support they received and how the department was run. There was support to the team from senior leaders in the trust, including the chief executive officer and director of nursing, who were regularly seen in the department. One of the deputy chief operating officers efficiently and effectively ran the morning safety briefing which was well attended by leaders in the department but also staff from other specialities who were asked to support on specific issues or cases. We observed a number of conversations between clinical staff after the briefing who were problem-solving and clearly committed to supporting the department ease the pressure of crowding. As well as the senior leaders, staff said they had support from their line managers or the clinical leaders on shift. This included the emergency physician in charge and the nurses in charge of various areas. Leaders had various initiatives to aid flow, virtual wards, community assessment and treatment units, urgent community response services and minor injury units.

The trust had processes to encourage talent management, career progression and succession planning. We saw that this was discussed at the People and Culture committee in February 2024 and noted at the executive leadership team meeting.

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.

The department had set out clear responsibilities, roles and systems of accountability for staff. Governance processes had improved since the last inspection. This included an improved induction for junior doctors leading to fewer patients going through the emergency department pathway with other injuries beyond the primary injury being missed. This was a programme the consultant leaders were particularly proud of. It was recognised through real-time audit and observation how there were a lot of patients in the ambulatory waiting room who were acutely unwell. New protocols had been developed for majors and minors patients which made it easier to recognise acutely unwell patients in minors and know what to do next.

Governance was understood for its essential relationship with safe care and improvement. There was a comprehensive, supported and effective governance programme. We were informed there had been a drive to improve attendance at governance meetings and input to the subject matter. There was a consultant clinical lead for governance, but at the time, although valued input from the nursing team, no nurse appointed as nursing lead for governance to lead the programme. There were various meetings in the governance programme including governance meetings, a regular safety meeting, mortality and morbidity reviews, and links to other related meetings such as the mortality and morbidity review for trauma patients. Once a month, the team reported and presented a summary of their serious incidents, other incident reporting and staffing metrics to the divisional care group for the wider group to be aware of the departmental pressures and emerging risks. Audits undertaken included clinical effectiveness including compliance with guidance from the National Institute of Health and Care Excellence (NICE). The team was also complying with the three audits commissioned each year by the Royal College of Emergency Medicine, which included the administration of time-critical medicines, which had become noted as problematic in emergency departments struggling with crowding. This was a feature of the departmental governance newsletter to highlight the need for time-critical medicines to be administered. Workforce planning was managed to support the emergency department during busy periods when there were high number of patients attending ED or ambulances waiting to hand over patients. There were protocols to follow such as the flow and escalation process and an ED surge plan.

People we spoke with were positive about the local ambulance trust staff as well as the emergency department staff.

Staff told us they felt listened to and heard by the relevant stakeholders and external partners. They were supported by clinical partners. For example, there was a good partnership with the local NHS mental health trust providing support to patients with mental ill health in the emergency department and staff said this was quick and good quality. However, there were often significant delays for patients assessed as needing transfer to a mental health ward due to capacity in those locations. This put additional pressure on the emergency department to care for patients without physiological illnesses. However, there was a concern from staff relating to the assessment by Child and Adolescent Mental Health Services (CAMHS) (provided by the NHS mental health trust) who would not see a child until they were deemed “medically fit.” This was not in line with NICE guidance.

The trust worked in partnership with the local system. This included the local community trust, the local ambulance trust, local volunteer groups, GP’s and the integrated care board. They met regularly on a monthly basis to discuss system initiatives to ensure processes and schemes were joined up as well as to discuss healthcare safety investigations. The trust had visited other trusts’ emergency departments, to review different urgent and emergency care provisions to see if this could inform any learning and aid improvements in their own departments.

Processes were in place for the trust to regularly meet with key partners in the system.

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.