Arrowe Park Hospital

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated this key question good. At this assessment, the rating has changed to requires improvement.

The service was in breach of legal regulation in relation to how people were not always supported in a private or dignified way. Patients’ privacy was frequently compromised, especially for patients cared for in corridors. Independence was not always promoted and the overall environment often failed to meet patients’ immediate emotional and physical needs.

This service scored 60 (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 always treated people with kindness, empathy and compassion. Staff treated colleagues from other organisations with kindness and respect. However, we observed some shortfalls in privacy and dignity.

Patient-Led Assessments of the Care Environment (PLACE) assessments held in October 2024 looked at privacy, dignity & wellbeing and found the reception and waiting areas were not large enough so that there was sufficient seating. The assessment identified there were not appropriate measures in place to ensure privacy and dignity for patients at reception desks. There were no action plans provided to evidence change or improvement to these areas.

The trust did not have a specific privacy and dignity audit. However, we were informed that privacy and dignity was monitored within the trust through a variety of measures. Some of the main measures included the privacy and dignity questions included in the audits, and privacy and dignity compliance were also being monitored through patient feedback, in particular Friends and Family Test (FFT).

There was a specific thematic privacy and dignity report completed based on FFT feedback that was presented to patient and family experience group (PFEG). Privacy and dignity was also part of CQC National Patient Experience Surveys. However, data was embargoed at the time of assessment. We were advised that the patient and family experience group received regular updates in relation to formal complaints and concerns.

However, we found patients’ privacy and dignity was not always maintained. During the assessment, the escalation area in initial assessment in ED compromised privacy, dignity, and patient confidentiality. In monitored majors we found several male and female patients in varying stages of undress. Patients in the eye corridor did not have access to call bells. Patients in this corridor were required to use a commode or bedpan regardless of their level of need. These concerns were highlighted to the trust at the time of the assessment.

Staff did not have access to buzzers or alternative means to call for assistance in an emergency. The trust conducted a rapid review of the staff and patient buzzer system within the eye corridor. At the time of the assessment communication was improved as devices were provided for staff such as hand-held radios and a telephone. The trust took immediate action in response to the feedback and portable patient call bells were immediately procured and were in place and operational within the eye corridor clinic. Additional privacy screens were provided to the initial assessment escalation areas to assure standards of privacy and dignity.

Following the assessment on site, we reviewed Friends and Family Test data and saw that for the month of April 2025 the trust had received 231 very good or good patient feedback responses. One patient said “Everyone was caring and kept me very calm. I was reassured from the moment I arrived and felt the department was running like a well-oiled machine. I can’t fault the service and thank you for looking after me”. Another patient said, “I had wonderful treatment from wonderful caring people”.

Patients we to spoke with during our assessment had arrived via ambulance and spoke positively about the care received from staff who they said had been kind and caring. For example, both patient and spouse were offered food and drink. Staff were responsive to needs. They were aware of the treatment plan and what they were waiting for in resus before potentially being discharged or moved to a ward.

We observed staff being kind and compassionate and provide a patient with an update of their plan of care. Privacy and dignity of the patient were preserved.

We saw feedback from patients who commented on their care and treatment and had stated that a doctor had been ‘considerate of my discomfort and validated my pain immediately.’ Another family member stated that a ‘Resus (staff members) wonderful gentle, caring approach took us all through the most traumatic 24hrs’.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

We observed one patient in the ED waiting room who had been waiting 8 hours in a wheelchair, had a diagnosed long-term condition and an IV bag in place. The family had received limited updates from nursing/medical staff, but their last update was that their family member would have an approximate wait of 50hrs for a medical bed, following a decision to admit earlier in the day. We did not see consideration for the patient as an individual or for the long-term condition they were individually dealing with. We escalated this with the nurse in charge and the patient was moved to a more suitable location within the ED.

We observed 3 patients being cared for in the middle of the monitored majors area, the patient trolleys were close together, approximately 1-2 feet apart. 1 patient was partially dressed, and 1 patient receiving IV treatment. There was no privacy for these patients and no use of screens.

During the morning of assessment day 2 we observed in monitored majors (mixed sex bay), patients’ dignity was not preserved, there was a young woman with babies in the bay, with partially dressed male patients. This did not meet the individual needs or preferences of any of the patients. It also did not show consideration for the culture or backgrounds of each patient.

The trust utilised a Health and Wellbeing Passport for all Children in the CED. The aim of the Health & Wellbeing Passport was to provide staff with all the necessary information about a child when using CED services. This passport helped staff work in partnership with parents in meeting the child's needs.

We scored the service as 2. The evidence showed some shortfalls. The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment, and wellbeing.

Patient-Led Assessments of the Care Environment (PLACE) assessments were held in October 2024 and identified that the ED was not dementia friendly as signs to the toilet could not be seen from all areas and were not clearly identifiable, At the time of the PLACE assessment there was not a correct day and date displayed and clearly visible in all patient areas, signs were not fixed at a height that made viewing easy and there were no points of interest such as artwork on the walls.

We reviewed the outcome of 2 PLACE environmental audits which were inconsistently and inadequately completed. We saw areas marked as ‘not applicable’ which should have been appliable and had no reasoning for the choice. For example, the question asked if there was space in the ED waiting room for wheelchairs and for those accompanying patients to sit together. Answer given was no - not applicable. Wheelchair users regularly attend ED accompanied by family or a care support workers.

The trust had a learning disabilities (LD) nurse in post who ensured that those with learning difficulties were reviewed each day. There were hospital passports in use and the trust worked with the community LD team who liaised closely with inpatients or outpatients to discuss and organise reasonable adjustments.

There was access to a local network for LD Liverpool, Leighton, Warrington, and Chester as well as a new network between the trust, the local Mental Health trust and LD social work team.

We saw that there were 3-4 care bags which had been created for patients and contained sensory aids (eye mask, headphones, and fidget tools) for autistic people and patients with disabilities. These could be accessed by patients in ED or assessments areas.

We scored the service as 2. The evidence showed some shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern, or distress.

Senior leaders advised that the ED team were good at identifying vulnerable patients. Patients with learning disabilities and identified that those with additional needs may require enhanced support and would not be cared for on the escalation areas.

We escalated concerns that we had seen patients being taken from eye corridor to use a commode / bed pan in radiology room with curtains pulled around. We were told by multiple staff that there were no toilets for these patients to use. Staff could be heard turning taps on to encourage patients to pass urine. The trust responded and advised that there were toilets in the x-ray department that patients could use, if mobile, and that staff should be encouraging and promoting this.

We found across ED that care staff worked hard to meet the needs of all patients. Patients were appropriately and quickly triaged and initiated on appropriate care pathways.

We also reviewed 1 patient journey video footage provided by the trust, following consent from a family member. The information showed that the emergency department had responded to the patient’s immediate need, staff were kind, compassionate and supportive to both the patient and their family members at a time of high distress.

We requested the time to analgesia audit and pain score audit and were advised this was not currently part of the ED audit plan. This has now been added to the ED audit plan.

The trust had Acute Pain Analgesia Guidelines for Adult Patients in the Emergency Department in place. It was up to date and due for review September 2025.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

There was support in place to prevent and address anxiety, stress and depression related absences including, but not exclusive to mental health and wellbeing sessions led by a clinical psychologist. An employee assistance programme was available and, flexible working approach embedded, increased occupational health clinical capacity, and health and wellbeing pages on the intranet available for all staff. There was an occupational Health and Wellbeing policy in place.

The Road to Wellbeing Map was a new infographic developed by the senior nursing team within the surgical division for Mental Health Awareness week. The aim was to highlight and signpost staff to all the diverse types of wellbeing support the trust offered. The poster displayed in the staff areas and was available for email or print format and given to staff who may benefit.

As part of the Urgent and Emergency Care Upgrade Programme (UECUP), a new staff floor has been built, providing urgent and emergency care teams with a dedicated entrance, workspace, and wellbeing area.