The York 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

People and communities are always at the centre of how care is planned and delivered. The health and care needs of people and communities are understood, and they are actively involved in planning care that meets these needs. Care, support and treatment is easily accessible, including physical access. People can access care in ways that meet their personal circumstances and protected equality characteristics.

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

The service was previously in breach of the legal regulations relating to dignity and respect. While improvements had been made in that area, and the service was no longer in breach of that legal regulation, capacity and flow issues across the hospital meant that patients did not always receive timely care. Performance metrics showed that the hospital was underperforming compared to national statistics.

However, patients were involved in decisions about their care. The service provided information patients could understand. Patients knew how to give feedback and were confident the service took it seriously and acted on it. Patients always had enough to eat and drink to stay healthy. The service was easy to access and worked to eliminate discrimination. The service worked to reduce health and care inequalities through training and feedback.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure patients were at the centre of their care and treatment choices and decided, in partnership with patients, how to respond to any relevant changes in patients’ needs.

Patients told us they had an appropriate assessment of their health needs. Patients told us their personal, emotional and health care needs were being met by staff.

Staff considered patients individuals needs and preferences. They undertook risk assessments to identify specific needs such as nutrition, hydration, and pressure care. Staff provided patients with food, blankets, pressure relieving equipment and additional pillows. Nursing staff were allocated to care for patients in the waiting room at times of high demand. Patients who were waiting a long time to see a consulting clinician were offered analgesia if needed. Staff did not use formal documented person-centred care plans, but patients’ needs and preferences were recorded in the daily notes in the patient’s records.

The frailty in-reach teams attended daily to identify patients suitable for transfer to the frailty unit. Chronic pain, dementia, and learning difficulties teams were available for consultation upon request.

Staff completed equality and diversity training. The service had clear pathways for patients with dementia, mental health difficulties, autism and learning difficulties and made reasonable adjustments for patients when required.

Staff were aware how to make reasonable adjustments for patients and had access to language and British sign language interpreters. Leaders and staff were alert to discrimination and inequality that could disadvantage certain groups of patients. Leaders were knowledgeable about the impacts of local demographics and availability of services that impacted the population they served.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Signage and information for patients was sufficient and the department was easy to navigate around. The urgent care centre was not situated in the main department but there were plans to integrate this. However, it was well signposted and patients had no difficulty finding the urgent care centre.

Patients in the waiting room were able to access up to date information regarding estimated waiting time that was relevant to them.

Patients were given regular verbal advice during their time in the emergency department. Patient information was available in a format appropriate for the patient.

The treating clinician was responsible for providing the discharge advice and ensured it was in an accessible format for the patient. There was, however, a backlog of discharge letters waiting to be processed that was reducing in numbers but worried senior clinicians.

Staff used effective tools to support good clinical practice with patients who had difficulties with communication. This included tools for patients who had cognitive impairment, and interactive tools for understanding pain experienced by children. The trust had undertaken an assessment of compliance with accessible information standards. Patients who used the service, including disabled patients, said it was easily accessible. Patients we spoke with did not experience any physical or digital barriers when using the service.

Patients could not always access the care, support and treatment they needed when they needed it. While the urgent and emergency care service was taking action to improve patient flow, patients could not always access care, treatment, and support in a timely manner due to capacity constraints and flow across the hospital.

Staff said patient flow issues had become normalised and that this was demoralising. The trust had a continuous flow model but all staff we spoke with were concerned about patient safety in the department when it was busy.

Patients we spoke with told us about long waiting times they had experienced whilst in the department. When we arrived at department, the longest waiting time for a bed or admission was 22 hours at 10am. A larger percentage of patients at York Hospital were spending more than 12 hours in the emergency department compared to other sites in the region and nationally. Patients and their loved ones told us that more clarity regarding timescales would have helped manage expectations and relieved any uncertainties they had.

Staff followed the streaming pathways to manage patient flow pressures. They understood the full capacity protocol and worked to admit patients in a timely manner where possible, however, not all patients had an initial assessment within 15 minutes of arrival.

The Same Day Emergency Care unit (SDEC) was not supporting flow at the hospital. Staff who coordinated the emergency department told us the admission criteria were narrow, and challenges in medical staffing meant it was not always open. This impacted on the capacity within the department. Patients who arrived at the emergency department having been sent and assessed by their GP could not be seen immediately in the SDEC but had to undergo triage and wait. This caused challenges and meant patients were not always treated and cared for in the right place, at the right time, by the right staff.

Difficulties with discharging ward patients was impacting on ambulance handover targets. Patients at York Hospital had longer ambulance handovers compared to other sites. The ambulance service reported a consistently larger percentage of handovers taking more than 60 minutes at York Hospital when compared to the average for all hospitals served by the ambulance trust. The percentage of handovers taking more than 60 minutes at the site increased during periods of winter pressure.

In October 2024, the hospital was in the poorest performing quartile for handover delays over 30 minutes with 49.9% of handovers taking over 30 minutes. This compared poorly to the England average of 33.2%. However, an improved ambulance handover and ‘cohorting’ process was implemented in December 2024 which had started to see a reduction in wait times.

The clinical leads in the department utilised the electronic patient record system which allowed them to see the status of each patient. All patients were discussed at board rounds which were attended by the lead clinicians in the department. Flow coordinators had been used since November 2024 to proactively manage the number of patients waiting in the department unnecessarily.