Arrowe Park Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

Patient safety outcomes showed areas requiring improvement. The division had only achieved the monitoring of the national early warning score (NEWS2) target on 2 occasions in the last 12 months. The service did not always make sure there were enough qualified, skilled and experienced staff due to shortfalls in mandatory training for medical staff and vacancies for therapy staff. The service did not consistently ensure medicines and treatments were safe and met people’s needs, capacities and preferences. However, staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

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 scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

All staff we spoke with could articulate how they would raise incidents and were encouraged to do so by senior leaders. All staff knew what constituted an incident and could give examples of incidents that they had raised. Incidents were investigated by senior leaders within the medical care division.

Managers informed us they shared lessons learned from incidents or complaints through daily safety huddles, handovers, emails and newsletters. Staff provided multiple examples of when improvements had been made following learning from patient safety events.

Trust data showed that there had been zero never events and 1 patient safety incident investigation reported in medical care in the last 12 months.

From November 2024 to April 2025, 36 incidents with a harm grading of moderate or severe were reported in relation to medical care. The most frequent type of incident reported was slips, trips and falls together with treatment, procedure and clinical care.

For the same reporting period, 529 inpatient falls and 177 hospital acquired pressure ulcers had been reported on the medical wards. Senior leaders told us that falls, and pressure ulcers had been identified as an issue, and the service had implemented improvement plans with identified themes to reduce these numbers. In addition, the care of the elderly wards had recently participated in a decaffeinated drinks trial which saw a reduction in inpatient falls.

Staff understood the duty of candour. There was an up-to-date duty of candour policy in place. There had been 51 incidents that required duty of candour between May 2024 and May 2025, whereby staff contact patients and their representatives to apologise when care and treatment did not go to plan.

The wards and areas we visited had noticeboards which provided examples of how the ward had learned from incidents. Displays also provided ways staff could reduce the risk of incidents such as a reminder for staff on falls risk assessments and skin checks

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Whilst there were systems and processes in place for continuity of care, including when people moved between services, during our assessment we observed patients experiencing long waits in the emergency department and assessment areas once a decision to admit had been made. This meant patients who required specialist treatment were not always directly admitted to the wards in a timely way.

Senior leaders acknowledged that patient flow was one of the biggest challenges within the hospital. We were told this was because the hospital bed occupancy rate was consistently above 95%.

During the assessment we observed inconsistencies in the oversight of patients within the emergency department and in transfer to specialities. In the Clinical Decision Unit (CDU) one patient was left 19 hours before medical review due to an administrative error which meant the patient was left under the ED consultant name overnight and not transferred. A computer-based platform gave oversight to the acute medical and had been in use within WUTH for over 7 years. All patients that had been referred and / or admitted to medicine were recorded. It described name, reference number, location, NEWS score, time waiting, responsible consultant, and triage speciality. The system also tracked whether the patient had received a senior and or consultant review, which enabled tracking of all medical patients in ED and new admissions in the UMAC.

We were advised that a number of revisions took place (December 2024) to the functionality of the page at the request of the acute medicine team. Several redundant columns were removed, and further changes were made to prevent patients in ED, waiting over 24 hours, from potentially not being immediately visible. A further piece of quality improvement work was underway which had been in process for at least 12-18 months but was not in place at the time of the assessment.

As part of the trust’s continuous flow process, staff on the wards identified patients who were suitable to “sit out” irrespective of their expected discharge date. Some patients who had been identified, still required a hospital bed and spent long periods of time in a recliner chair instead. This process was supported by a clear exclusion criteria. Following our assessment the trust took action and implemented a clear inclusion criteria.

The hospital had an urgent medical assessment centre (UMAC) which operated from 07:45am to 02:00am. The service primarily accepted GP and community referrals; however, we were told that patients were transferred to UMAC from the emergency department each morning. There was a UMAC document which outlined the clinical criteria and patient pathway.

The division had a team of Specialist Nurses for Older Persons (SNOP) who were based between the emergency department and the acute frailty unit. The SNOP team identified patients in the emergency department and urgent medical assessment centre who met the inclusion criteria for transfer to Same Day Emergency Care (SDEC). SDEC provided same day urgent assessment, tests, diagnosis and treatment for patients who would otherwise be admitted to hospital. Patients from SDEC were referred to community services, virtual wards and the frailty admissions unit. Following its implementation in March 2025, 196 patients had received care and treatment in SDEC with a same day discharge rate of 66%.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately.

Staff had training on how to recognise and report abuse, and they knew how to apply it. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them. They knew how to make a safeguarding referral and who they could contact if they had concerns.

Nursing staff training compliance for level 1, 2 and 3 adults and children was 92%. However, medical staff compliance was 79%. This was below the trust target of 90%.

The trust had designated safeguarding practitioners who supported staff completing risk assessments for patients who presented as a risk to staff and other patients.

Nursing staff and medical staff compliance for The Oliver McGowan Mandatory Training on Learning Disability and Autism was 76%. This was below the trust target of 90%.

Safeguarding compliance audits were completed across the medical wards. Results showed 88% compliance between November 2024 and April 2025.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff used a nationally recognised tool to identify deteriorating patients and escalated them accordingly. Observations of vital signs were recorded by staff and the National Early Warning Score (NEWS2) was calculated. These were recorded electronically. The service had a policy for the deteriorating patient. The trust told us they had not undertaken a NEWS2 compliance audit, however NEWS2 monitoring was part of the deteriorating patient improvement programme. Results from the improvement programme showed that between March 2024 and March 2025, the medical wards achieved 89% compliance.

Staff knew about and dealt with any specific risk issues such as possible sepsis. Medical wards had posters which alerted staff to the sepsis screening tool and the urgency for antibiotics of patients who had shown red flags. However, the trust could not provide sepsis compliance audit data for the last 12 months. The trust told us they were in the process of completing the sepsis compliance audit. Staff completed deteriorating patient and sepsis training as part of their mandatory training requirements. Nursing staff compliance was 94%, however medical staff compliance was 59%.

As part of the trust’s continuous flow process, staff were required to risk assess patients and identify the patient who was least at risk and could “sit out” to create bed capacity. Staff did not consistently record these risk assessments within individual patient records.

Staff completed risk assessments for each patient on admission using a recognised tool, and reviewed this regularly, including after any incident. Risk assessments included falls, pressure ulcers and nutrition. Results from the risk assessment compliance audits showed 95% for falls, 93% for pressure ulcers and 96% for nutrition and hydration in the last 6 months.

The medical wards achieved 98% compliance for VTE assessment completion from April 2024 to March 2025.

Managers were able to describe their top risks for their ward and division and clearly articulate the mitigating plans to address each of these risks. This information was recorded on quality improvement boards on the wards.

Patients who had a particular enhanced need were identified by discreet symbols on patient boards and side room doors. Tissue viability nurses were available to advise, for example, on pressure relieving mattresses or frequency of need for repositioning.

Staff shared key information to keep patients safe when handing over their care to others. Shift changes and handovers included all necessary key information to keep patients safe.

Patients requiring specialist support such as non-invasive ventilation, were nursed in areas where staff had the correct competencies.

We scored the service as 1. The evidence showed significant shortfalls. The service did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities, and technology supported the delivery of safe care.

As part of the trust’s continuous flow process, staff on the wards were required to complete a daily continuous flow room risk assessment prior to the room being utilised for patients. However, the risk assessment was more of an environmental checklist and staff could not explain how they would remove a patient from the room if they deteriorated or became unconscious. In addition, recliner chairs had been placed in these rooms for patient comfort. However, the chairs could not recline flat which posed a risk in the event of cardiopulmonary resuscitation. This was escalated at the time of assessment and the trust produced new risk assessments. Areas on some wards previously used as “sit out” spaces were exempted from this requirement.

We saw one room that was used for patients to “sit out” and did not include environmental adaptations such as a call bell. This was escalated at the time of assessment, and the room was taken out of use.

We saw areas requiring maintenance such as broken call bells on ward 33 and ward 37, a broken shower head on ward 26 and a broken intercom on ward 21.

We found oxygen was not always stored securely. Empty oxygen cylinders were stored alongside full cylinders. Oxygen in one area was stored near electrical equipment presenting a fire risk.

The service had enough suitable equipment to help them safely care for patients. We reviewed a sample of equipment such as defibrillators, suction machines and blood pressure monitors which had stickers to indicate that they had been serviced within the last 12 months. Staff completed daily safety checks of specialist equipment. We saw portable computers across the wards which allowed staff to access electronic systems in all areas.

Patients could reach call bells from their beds and call bells in the toilets and wash areas which were in suitable places to reach if they needed assistance. During our assessment we observed staff attending to patients promptly when a call bell had sounded.

Medical wards were made up of a mix of side rooms and bays. A number of medical wards had side rooms and bays which were not visible from the nurse’s station. Staff told us that bay nursing was used as this allowed for increased observation of patients who may be at risk of falls.

At the entrance to each ward there was a notice board which displayed staffing numbers for each shift. There were clinical governance boards which highlighted the number of days since the last fall incident, hospital acquired pressure ulcer and healthcare-associated infection.

Staff disposed of clinical waste safely. Sharps bins were clean, not overfilled and were partially closed when not in use.

Hand gel was present throughout the wards and staff were observed to use it appropriately. Control of Substances Hazardous to Health (COSHH) was observed to be stored securely and properly.

From November 2024 to April 2025, the medical wards achieved 95% compliance for environmental safety.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Nursing staff kept up to date with their mandatory training. At the time of our assessment, mandatory training compliance for nursing staff within the division was 92%. This was above the trust target of 90%. However, mandatory training compliance overall for medical staff was below the trust target at 82%.

The mandatory training for staff was comprehensive and met the needs of patients and staff. The training covered topics such as infection prevention control, moving and handling, fire safety, equality diversity and inclusion, health and safety and information governance.

Staff received life support training for adults and children; however not all staff completed it. The nursing staff compliance rate for basic life support (BLS) was 89%, paediatric basic life support (PBLS) was 83%, immediate life support (ILS) was 72% and advanced life support (ALS) was 87%. The medical staff compliance rate for BLS was 75%, ALS was 83% and advanced paediatric life support (APLS) was 73%.

Senior leaders calculated and reviewed the number and grade of nurses and clinical support workers needed for each shift using a safer staffing tool. The staffing tool included skill mix capabilities, which enabled senior leaders to check whether staff had the appropriate skills to provide care and treatment on a specific ward.

Staffing charts were clearly displayed on all wards displaying the planned and actual staffing levels for the ward. Overall, wards had the planned level of staff present on the days of assessment; there were occasional instances of staffing being slightly under the planned level. Managers acted appropriately where unanticipated absence had occurred and staff were transferred from other areas where appropriate. There was a process in place to obtain additional staff for patients who required one-to-one care.

We reviewed staffing fill rates from February 2025 to April 2025. For registered nurses, the average staffing rate during the day was 94% and 96% at night. For unregistered staff, the average fill rate was 90% during the day and 105% at night. Staff across the wards told us that staffing was a challenge and impacted registered nurse to patient ratios. Trust data showed that between November 2024 and April 2025, around 55% of staffing incidents related to staffing levels not meeting national guidance.

The average fill rate for allied health professional (AHP) staff was 57%, this excluded speech and language therapy (SALT) staff and dietetic staff. The average fill rates for general SALT staff was 63% and for stroke SALT staff was 78%. The average fill rate for dietetic staff was 78%.

For medical staffing, senior leaders used a dashboard that included the minimum staffing requirements for each ward. The dashboard was populated daily and circulated to all senior leaders. Staff were transferred from other areas where appropriate. From February 2025 to April 2025, minimum medical staffing levels were achieved across 92% of shifts. The fill rate for on call rotas was 92%. The service had high rates of locum staff. Trust data showed that 21% of shifts were filled by locum staff. In addition, 2 of the medical wards were covered by locum staff only.

Senior leaders told us that medical staffing was one of the biggest challenges for the division. There was a shortage of doctors and this impacted patient discharges. Medical staffing capacity and the impact on patient outcomes and patient harm was recorded on the divisional risk register. Plans were in place to mitigate risk including weekly meetings to review and plan staffing rotas in advance. We were told that a business case had been approved for 4 additional trust grade doctors and 2 advanced medical practitioners.

Leaders covered staffing gaps with bank workers. From February 2025 to April 2025, around 11% of shifts were filled by bank nurses and around 23% of shifts were filled by bank clinical support workers.

The service had safe recruitment practices to make sure all staff were suitably experienced, competent, and able to carry out their role. Staff underwent induction and completed competency-based training. We reviewed the Safe Recruitment and Selection Policy and Corporate, Medical and Local Induction Policy; both were up to date and appropriate in content.

At the time of our assessment, the vacancy rate for nursing staff was 34.94 Whole Time Equivalent (WTE). The consultant vacancy rate was 22.05 WTE. The rest of the medical staffing workforce was over established by 7.08 WTE. Senior leaders told us that stroke consultant vacancies was one of the highest scoring risks on the divisional risk register.

From November 2024 to April 2025, the average staff turnover rate for this service for nursing staff was 1%. The average staff turnover rate for medical staff was 0.5%.

The sickness rate for nursing staff was 4.7% and medical staff was 1.4%.

Managers supported staff to develop through yearly, constructive appraisals of their work. The data provided showed that 90% of nursing staff and 93% of medical staff across the medicine division had received an appraisal in the last 12 months.

We scored the service as 2. The evidence showed some shortfalls. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service monitored key metrics in relation to infection rates, including C. diff (Clostridioides difficile, MRSA (Methicillin-resistant Staphylococcus aureus), MSSA (Methicillin-susceptible Staphylococcus aureus) and E. coli (Escherichia coli). From November 2024 to April 2025, there were 161 instances of hospital attributed infections. Around 50% of these infections related to C. diff. In July 2024, the trust commenced the C. diff improvement programme in order to reduce the number of hospital attributed C. diff cases. Trust data showed that from January 2025 onwards there had been a decrease in the number of hospital attributed cases.

The side rooms where patients were being treated for an infection, or were at risk of infection, had doors which could be closed. All doors were closed during the time of assessment. However, during our assessment we observed staff providing care to a patient requiring a side room and staff were told to source a side room by calling other wards within the hospital. On ward 33 there were 26 patients with access to 4 toilets. Staff on ward 33 told us that the toilets were regularly out of order.

The premises and equipment were kept visibly clean and hygienic. Cleaning records were up to date and demonstrated that all areas were cleaned regularly, and equipment was cleaned after each patient contact. We observed staff following Infection, Prevention and Control (IPC) principles, including the use of personal protective equipment, effective handwashing and being bare below the elbows. Hand hygiene signage was displayed throughout the wards. All waste and clinical specimens were observed to have been managed appropriately.

Infection, prevention and control compliance was monitored as part of monthly audits. From January 2025 to March 2025 compliance across medical care was 98%.

Infection prevention and control level 1 and level 2 training compliance for nursing staff was 88%. Medical staff compliance was 70%. This was below the trust target of 90%.

The were many shortfalls within the service highlighting that medicines and treatments were not consistently safe and did not always meet people’s needs, capacities and preferences.

We found medicines records were not always completed when people had thickening powder added to their drinks to reduce the risk of choking. Therefore, there people may not having their drinks thickened correctly, which meant they were at risk of choking. We found the thickening powder was not always stored securely and in line with the Patient Safety Alert published in 2015.

We saw people were prescribed medicated patches that should not be re-applied to the same area for 14 days. There was no record of the site of application of medicated patches, and staff told us they did not record the site of patches, this placed people at risk of skin irritation.

When people were prescribed a medicine that required a specified time interval between doses, the records showed this was observed. However, when people were prescribed medicines to be given before food, the manufacturer’s directions were not always followed.

We found 1 patient on a medical ward had received rapid tranquilization. The reasons for the use of rapid tranquilization were not clearly recorded. Staff had not completed and recorded regular checks of the patient’s physical health following the administration of rapid tranquilization in line with national guidance. We escalated this to the trust who took immediate action, including a review and reissue of the trust’s rapid tranquilisation policy.

The wards were supported by the pharmacy team to complete medicines reconciliation. The pharmacy team discussed new medicines and provided counselling when people were prescribed new, high-risk medicines.

The trust had completed an audit on the administration of critical medicines; critical medicines are medicines that should not be delayed or omitted. The audit identified this was an area that required improvement, and the trust had a plan to re-audit this area.

We reviewed the trust’s safe and secure storage of medicines audit dated December 2024. It showed medicines were not always stored safely and securely. The Trust had produced an action plan to drive improvements. Results from one of the secure storage audits showed there had been no improvement in one area of the audit in quarter 4 of 2024-25 when compared to the same audit for quarter 3 of 2024-25.

Records showed staff compliance with medicines management mandatory training was 72%.