St Mary's Hospital

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• 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

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment we assessed 5 quality statements and the rating has remained good. This meant people’s needs were met through good organisation and delivery.

People did not experience discrimination and staff worked hard to provide equity in access to care and treatment. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. However, there were some gaps identified. There was no formalised approach to address religious or culturally specific dietary needs and while translation services were available, these were not consistently utilised.

For the purposes of this inspection, hospital discharge pathways are described as follows: Pathway 0 applies to people who are medically fit and able to be discharged directly home without the need for additional support; Pathway 1 applies to people who can return home but require short-term support such as reablement, therapy services, or community care; Pathway 2 applies to people who are not yet able to return home and require discharge to a short-term care or rehabilitation setting for further recovery and assessment; and Pathway 3 applies to people with complex or long-term needs who are unlikely to return home and therefore require ongoing care planning, often involving multi-agency input and funding decisions.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The service planned and delivered care around individual patient circumstances, with clinicians demonstrating flexible, person-centred decision-making and a strong culture of treating patients as individuals.

Care was actively planned around individual circumstances. We saw evidence of personalised care planning that involved carers and social work. For example, on Appley ward we observed a consultant who worked to arrange specialist input on the ward itself to avoid an impractical transfer for the patient.

Staff described tailoring decisions that involved the patient and based on what was safest and most appropriate for them, rather than rigidly adhering to pathway protocols. Same Day Emergency Care (SDEC) staff also acknowledged that for patients who needed it, admission was a more compassionate option than a prolonged wait in a chair. Leaders confirmed with us the view that strict pathway adherence can sometimes work against patients with certain needs.

Patient experience care service group (CSG) data for January 2026 showed mainly positive results. For instance, Whippingham received a total of 31 comments, of which 23 were positive and 3 were negative. No comments were provided for the remaining 5. The endoscopy day ward had 77 comments (74 positive and 3 negative). Compton ward was shown to have consistently positive comments, with 0 negative comments in the reporting period. Whippingham patient response volume increased in that month, reflecting growing engagement with the patient voice mechanism. A particularly significant patient comment came from an Appley ward patient who said, “I have mental health issues and I feel safe here”. This highlighted that the service was successfully creating a psychologically safe environment for patients with mental health needs.

Catering arrangement supported some specialised needs but not religious diets consistently. The hospital canteen provided food for people with specialised diets including allergen-free options and period liquidised meals based on levels 4-6 of the International Dysphagia Diet Standardisation Initiative (IDDSI).

However, there was no documented provision for religious or cultural affiliated diets and staff did not raise this as routine consideration during conversations with the assessment team. We observed staff arranging a bespoke lunch for a patient who was being transferred to the discharge lounge, demonstrating personalised attention to patient preferences during transitions of care. Patients were positive about food and drink overall, with multiple patients telling us there was plenty of choice and that alternatives were offered when needed. The hospital restaurant operated extended opening hours Monday to Friday, 7am to 7pm and weekends 730am to 7pm, supporting patient and family access to refreshments throughout the day, including evenings.

Also, mandatory training requirement on learning disabilities and autism showed very low, tier 2 (face to face) compliance with 7% (124 of 1888 staff), only 10% of nursing and midwifery and 3% of medical and dental staff were compliant. Leaders and managers were aware of this and had identified ongoing challenges with unit capacity and room availability to provide training, but improvement actions had not yet translated into improved compliance.

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 scored the service as 2. The evidence showed some shortfalls. The service did not always supply appropriate information in formats that were tailored to individual needs.

Information was not always easy for all patients to access. The trust’s website had a range of patient leaflets listed A to Z, covering conditions, treatments, and procedures, with links to outside support organisations. However, the website was mainly in English and did not have a built-in option to translate into other languages. Some written information was available in other languages, but it was not easy to access through the trust’s own systems. Patients could find some translated leaflets through NHS resources or use online translation tools, but there was no translation feature on the trust’s digital platform. This meant patients and carers had to take extra steps to get information in their preferred language.

The service did provide interpreting and translation support, but it was not always easy to use in practice. The hospital used external providers, including telephone interpreters, which could be accessed straight away or booked in advance. Staff also told us that a video interpreting and translation service was due to launch in March 2026, which would improve access to visual interpretation, including British Sign Language.

However, the translation offer did not always provide timely access to face to face interpretation when patients needed it. Staff told us that face-to-face interpreters were not always used in practice, particularly when support was needed at a short notice, because additional travel time was required to access the island. This meant there was a risk that patients who needed interpreting support may not always have timely access to face to face interpreting services. The trust acknowledged that face to face provision at short notice was subject to logistical constraints, and alternative arrangements including telephone interpreting and prebooked face to face services were implemented to support patient communication.

Staff involved families and kept them updated about the patients care. During the assessment we saw staff actively keeping families informed about patient progress and we observed this during the assessment.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service actively listened to patients and demonstrated they learned from complaints, with responsive staff behaviour observed during the assessment and clear evidence of complaints data being used to drive specific service improvements.

The service used a clear system to manage and learn from complaints between 1 October and 31 December 2025. The Urgent and Emergency Care (UEC) division, which encompasses the medical care service groups, received a total of 51 complaints. Of these, 43 (84%) were resolved through the hospital’s early resolution route and 8 progressed to a “closer look” detailed investigation. The acute assessment unit received approximately 6 complaints across October 2025 to December 2025.

We observed a patient raise a concern about noise at night from another patient’s radio. Staff responded immediately and when the patient suggested headphones as a practical solution, staff obliged the request. We reviewed care plan folders across the wards and found that documentation on Whippingham ward was particularly strong in documenting individual patient needs. We also observed call bells being answered promptly by nursing staff, even on Whippingham, which was operating as a busy ward at a time, demonstrating that responsiveness was maintained under operational pressure.

The service used complaints to identify themes and share learning, but some recurring themes showed improvements were not yet fully embedded. The main complaint themes across the division for the quarter was access to treatment or medicines, patient care including nutrition and hydration, and staff values and behaviours. Leaders told us complaint themes were translated into learning and reminders across the service. For example, the SDEC team were to leave a glass of water on the table next to patients unable to access a water cooler themselves, ensuring fluids were always appropriately available. However, while this showed learning was being acted on, the continued recurrence of patient care concerns including nutrition and hydration, suggested these issues had not yet been fully resolved at system level.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

The service worked with people and partners to address barriers to equitable access, with demonstrating active integration with system partners to reduce inequity in patient experience and outcomes.

Staff demonstrated a clear understanding of the needs of patients from LGBT+ backgrounds, and the service visibly promoted an inclusive culture through signage and staff worn symbols.

Leaders had a clear understanding of demand, capacity issues, and discharge delays. Leaders described a close working relationship with the transfer of care team, the local authority, the local community trust and the Integrated Care Board (ICB). Leaders told us that a new shared digital platform had been introduced, which enabled system partners to view each patient’s next step, and that this had improved clarity amongst teams and reduced duplication.

A thematic review was in progress, with an aim to identify and address discharge delays. Themes identified had included delays in medication, the provision of equipment, and late-stage diagnostics. In response, ward huddles now checked medication needs and estimated discharge dates for every patient. Staff told us that equipment ordering had been improved through ‘click-and-collect’ arrangements and some diagnostic services were protected to support timely discharges.

Managers and leaders told us how 7-day working had improved. The service had a dedicated weekend consultant role that worked to support discharge and ward progression. Saturday discharge processes worked well, with clear plans for these having been agreed on Fridays.

Directors on call took part in weekend system calls with the ICB to escalate concerns. However, data demonstrated that Sunday discharges remained significantly lower than other days. Leaders told us this was poor because care homes and community service providers were less likely to assess or accept patients on Sundays.

The hospital used a secure patient tracking application to support with real time discharge oversight. The application tracked all admitted patients and discharge related tasks in real time through their hospital journey. Staff and leaders said this had helped with patient tracking.

A national Referral to Treatment (RTT) aligned access policy was in place. We saw that the service operated an 18-week RTT patient access policy aligned with national RTT rules and covering the core principles of consistent waiting time application.

There was no specific escalation pathway for communication needs, but wards could use the bleep system to get help from learning disability and dementia teams. Communication packs included picture cards to support non-verbal patients and those with communication issues. Staff could refer to the Speech and Language Therapy (SLT) team through their intranet e-system for urgent or routine review, supplemented by a phone call.

Staff and leaders identified waiting times for Pathway 1 (discharged home with support) and Pathway 2 (to short term bedded rehabilitation) as their biggest operational challenge. Repeated assessments and delays linked to private market placements were described as ongoing problems. Moreover, variation in length of stay indicated potential inequity in patient flow. Colwell ward had the highest length of stay for both non elective and elective patients of all wards visited between January and December 2025, with the highest average length of stay of 11.4 days. The service did not currently use Treatment Function Code (TFC) for Acute Medicine, instead recording their activity under General Medicine specialty code, which limited the ability to distinguish acute medicine activity within length of stay reporting. The service had recognised this and confirmed the coding approach would be corrected from the 1 April 2026.

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.

The evidence showed a good standard. People were supported to plan for important life changes, so they We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff followed the trust’s Do Not Attempt Cardio Pulmonary Resuscitation (DNA CPR) adult policy, which ensured they appropriately considered, discussed and documented decisions about resuscitation for all patients aged 16 and over. They clearly understood their roles and responsibilities.

The stroke rehabilitation for patients in the hospital was delivered through a patient centred pathway that begins in the acute stroke unit and continues into community services. Senior staff told us rehabilitation is initiated at the earliest clinically appropriate point, supported by a multidisciplinary team and tailored to individual recovery goals. Ongoing support was further strengthened through partnership with the Stroke Association “Life After Stroke” Service, enabling sustained recovery, improved self-management and reduced risk of re admission. This integrated approach demonstrates strong service responsiveness and partnership working.

In the wards, we also saw that staff ensured patients and those close to them can take part in sensitive discussions in a private, appropriate environment supporting dignity, respect and open communication.