Arrowe Park 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

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

Evidence showed significant delays in emergency care and prolonged corridor stays in the service. Patients with complex needs, such as those with mental health conditions, often experienced longer wait times and longer stays in ED resulting in an overall poorer experience.

This service scored 57 (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 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.

We observed staff providing a patient with an update of the plan of care. They were kind and compassionate with the patient who was transferring to the Critical Care Unit (CCU). The patient had been in resus for 47 hours waiting for the CCU bed. In addition, another patient told us she has been in HD majors since the previous day. The patient had been triaged quickly and moved in a side room straight away (isolated due to increased infection risk). She had been transferred onto a hospital bed instead of a trolley for comfort. Had been offered food & drink, and both the patient and her daughter had been kept up to date with the plan and next steps as she found it difficult to take it all in. The patient had found this helpful for them both.

However, due to the pressure in the department, patients did not always feel they received patient-centred care. We received mixed responses with some patients saying they were well informed and others lacking information and understanding about their treatment plans or the next stage of their care. We received two examples of patients and their families feeling forgotten in the waiting room, and raising concerns of worry about their health condition, the potential wait and lack of plan or information for reassurance. Both families escalated their concerns to the assessment team.

The CQC invited 1250 patients to take part in the CQC Urgent and Emergency Care Survey 2024. We received 300 completed surveys at a response rate of 25% (average response rate for all trusts 29%). Figures showed that people completing the survey rated the ED about the same as the national average for the care and treatment they received, communication about tests, and their interactions with doctors and nurses.

We scored the service as 2. The evidence showed some shortfalls. There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Leaders understood the needs of the community of the area and worked with partners to ensure that health and care needs were understood and met. For example, the Urgent and Emergency Care Upgrade Programme (UECUP) planned to create efficient patient management and improve flow for those who attended either the emergency department or the urgent treatment centre.

There were systems and pathways in place for ED clinicians to access same day emergency care (SDEC) services across the trust. The pathways that were available were the acute frailty unit, early pregnancy unit, gynaecology assessment unit, surgery, and urgent medical assessment centre (UMAC). There were 624 patients admitted to the acute frailty unit or frailty SDEC from 24th March to 20th May 2025, this was lower than expected when compared regionally. The trust advised that all patients that were conveyed to UMAC (SDEC) were recorded as a GP referral, therefore the system would not allow a split of figures between walk-in and ambulance conveyance. We were told this would be resolved through an electronic system update from Q3 2025/26.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

We were told by staff that some signage being used for rooms and locations in the department did not correlate with what the area or room was currently being used for. This was because of ongoing building work and frequent changes to the use and purpose of areas. This made navigating the department challenging for patients, relatives, and staff. For example, in the ambulance arrival corridor there was a cubicle signed as 'triage room' this was currently being used for investigations such as bloods / ECGs and the personal care of patients in the 'conservatory and ambulance corridor'. The environment was not dementia friendly.

In 2025 the trust took the decision to commission its non-verbal language interpretation (BSL) separately from the spoken language interpretation in order to better meet the needs of patients. The was a response to patient feedback and engagement. The trust had contracted with a third party provider created by the local deaf community. This service allowed patients to book their own BSL interpreter whether for a routine or emergency appointment. It provided a portal which kept the patient informed about their upcoming appointment and regularly messaged in relation to who would be supporting them. Feedback was sought from patients during their appointment relating to the interpretation support provided.

We heard it was easy to access translation services using language line, staff we spoke with also knew how to request in person interpreters or translators if needed but said this can be a longer process.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support.

The ED received 333 concerns and 65 complaints between May 2024 and April 2025. The performance overview of responding to complaints in the appropriate timescale showed that the trust did not meet its target for a response under 40 working days during the last 6 months for the ED. The worst compliance month was January at 20% and the best compliance month was February at 75%.

When complaints were received, they were progressed through a governance structure. To maximise learning, complaints and feedback data was triangulated with multiple sources of available information supporting the identification of themes and trends. This informed the development of strategic plans, maximising impact, and outcomes. In addition, complaints were incorporated into the trust’s patient safety incident response data analysis, informing the annual Patient Safety Incident Response Framework (PSIRF) plan.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support, and treatment they needed when they needed it.

There were 2,197 ED attendees admitted to the hospital as inpatients from the ED department in April 2025, 2,171 admitted in March and 1,762 admitted in February 2025. In the last 12 months there were 14,217 hospital admissions from ED majors and 8,236 admissions from ED minors.

The average time to triage for adult patients in the ED in the 12 months prior to assessment was 17 minutes. The average paediatric triage over the same period was 10 minutes. The target for triage times is within 15 minutes.

People could not always access care, treatment, and support in a timely manner due to capacity constraints and patient flow across the hospital. The percentage of admissions within 4hrs over the same 12 month period was 18.9%. The highest achieving month was December 2024 with 33.9% and the lowest achieving month was July 2024 with 13.6%. This places the trust 13th out of 45 trust regionally and 47th out of 125 trust nationally. The 4hr performance figures for type 1 patients the trust compliance figures were 30th out of 45 trust regionally and 98th out of 125 nationally. Type 3 patients 4 hr performance figures were regionally 26 out of 45 trust and 85 out of 125 trust nationally for the same week in May 2025.

The percentage of admissions waiting 4-12 hours from decision to admit, to admission over the last 12 months was on average 24.6%. Figures showed that the percentage of admissions waiting over 12 hours from decision to admit for the last 12 months was on average 35.2%.

We reviewed the percentage of patients leaving ED before being seen for the last 12 months. The average number of patients leaving the department was 8.1%. The number of reattendances to the ED between November 2024 and April 2025 was 4,082. These figures were based on winter months.

There were lengthy waits for diagnostic tests in ED. The longest average wait times were for Immunology (459 minutes), Echocardiogram (316 minutes), CT scan (71 minutes), CT cardiac (66 minutes), CT stroke (52 minutes), ECG digital (112 minutes), MRI (49 minutes), and X-ray (47 minutes). The wait times across the last 12 months were mostly static, apart from Immunology which was variable.

The previous week’s ED performance up to the date 11 May 2025 showed the following figures:

• Percentage of Ambulance attendances taking 30 – 60 mins to handover were worse than regional and national figures at 28.4%.
• Percentage of Ambulance attendances taking over 60 minutes to handover better than worse than regional and national figures at 3.3%.
• Percentage of attendances treated within first hour of arrival were worse than worse than regional and national figures at 13.7%.
• Percentage of attendances treated within first 4 hours of arrival were slightly worse than worse than regional and national figures at 65.4%.
• Average number of patients in corridor was 59 against a target of 35.
• Number of 12 hour DTA (decision to admit) breaches (admitted) was 146 patients.
• Number of 12 hour DTA breaches (non-admitted) was 21 patients.

In the months of February, March and April 2025, figures showed high numbers of patients remaining in the corridor over 24 hours. Across the 3 month period a total of 1,651patients remained on the corridor over 24 hrs, 1,892 remained over 12 hours and 441 patients were either admitted or discharged within 12 hours.

We scored the service as 1. The evidence showed significant shortfalls. Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

During the inspection we escalated concerns with the trust that ED flow was not coordinated, and operational grip was not consistent which compromised flow through and out of the department. This was made more challenging by the demand and acuity of patients resulting in continuous escalation, de-escalation, and transfer of patients within the department. The patient criteria for areas within ED did not appear well-defined resulting in staff managing high acuity patients across multiple areas of the department, particularly monitored majors.

The trust provided a response stating that the emergency department had established and embedded processes to manage flow and ensure that patients were cared for in clinically appropriate areas. We were advised that patients triaged as high risk were prioritised for monitored or higher-acuity spaces and were not placed in escalation areas unless clinically appropriate and reviewed by senior decision-makers.

The trust stated that during periods of significant demand, the department followed the standard operating procedure (SOP) for the Management of Emergency Patients When Volume Exceeds Capacity, which outlined the structured response to maintain safety, clinical oversight, and appropriate allocation of patients across available spaces. Flow meetings that took place throughout the day ensured that escalations were documented, and appropriate action was taken. Patient flow meetings were undertaken at 9am, 12pm, 3pm, 6pm, 8pm.

We reviewed the SOP for Management of Emergency Patients When Volume Exceeds Capacity. It was being revised following our onsite assessment. The purpose of the standard operating procedure was to ensure a correct and standardised approach when the emergency department exceeded its clinical capacity resulting in corridor care and / or crowded waiting room. This SOP was relevant to the current layout of ED and would therefore be reviewed ahead of phase 3 opening of the Urgent and Emergency Care Upgrade programme (UECUP) in July 2025.

We requested patient inclusion / exclusion criteria for all areas of the ED department at the time of assessment (resus, ambulance arrival zone, ambulance arrival corridor, HD majors, monitored majors, green majors, reverse cohort area, clinical decision unit, and initial assessment area). We received information which included specific referral pathways for the clinical decision unit (CDU) for multiple presentations. For other areas of the department, the trust stated that decisions depended on the outcome of triage and the patients NEWs score. Patients were then allocated to appropriate areas. The criteria for the different areas of majors (green & HD majors) were not outlined or the criteria for patients in initial assessment area bays. It was not clear how the dependency of patients was assessed and suitably matched to areas of the department, with appropriate staffing levels, to provide safe and effective care.

In the 3 months prior to the onsite assessment 179 patients had been transferred to resus from monitored majors. Staff were concerned about the acuity and nursing ratios of patients in this area of the department and could not differentiate how patients were triaged between the areas.

We observed that the emergency department was undergoing a major redevelopment, which had required a flexible operational approach over the past two years to accommodate ongoing construction. Additional construction works were scheduled for summer, marking the final phase of the redevelopment programme. Completion of the new emergency department was anticipated in quarter 2 of the 2026/27 financial year.

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.

The CQC Urgent and Emergency Care Survey 2024 highlighted that support and care after leaving the ED was better than expected within the region. When patients were asked if hospital staff informed them who to contact if they were worried about their condition or treatment after leaving the ED, the department scored about the same as the national average. Patients being asked during the survey if hospital staff discussed whether they may require further health or social care after leaving the ED, scored the department better than the national average.

The CQC Urgent and Emergency Care Survey 2024 also looked at information to support recovery at home. The ED scored about the same as the national average for providing information on how the patient should care for their condition at home.