Colchester General 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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last inspection we rated responsive as requires improvement. At this assessment, the rating remained unchanged. This meant people were not getting care and treatment in a timely way to meet their needs. There were significant delays in patients receiving care due to a lack of staff and flow within the hospital. Plans were not always documented to record people’s choices and preferences.

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.

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 completed ‘My Health Passports’ for patients with learning disabilities (LD) or autism to help support staff to understand what reasonable adjustments needed to be made. We saw evidence of these in 3 patients care records during assessment. However, they lacked detail, were not completed fully and staff who were carrying out 1:1 supervision were not aware of the document to tailor care to their preferences.

There was mixed feedback from people we spoke with during the assessment regarding choices in their treatment and care. One patient described how staff supported his personal care stating “staff followed my specific instructions and were very respectful”. However a relative reported they had not been involved in their father’s care planning and would be raising their concerns with PALS. Another patient had been moved at 2am and was unsure of the reason for his admission to the ward and what treatment he could expect.

Therapy staff engaged with patients and their family, once referred, to discuss discharge plans. Plans were communicated with the multidisciplinary team daily at board round to effectively discharge plan and reduce delays.

Staff worked with people to make sure they are appropriately involved in planning their care. However, senior leaders acknowledged that staffing levels and seasonal pressures on the service resulted in their inability to deliver person centred care at times.

A new process called ‘fundamentals of care’ had been implemented on the Emergency Assessment Unit in April 2024 and more recently implemented onto medical wards. The ward leader was required to talk to every patient every day to ensure they were involved in the care planning and that patients were fully aware of what it will take to get them home to their loved ones. Senior leaders audited this to ensure fundamentals of care had been addressed and patients were being involved. A patient we spoke with had confirmed that he had this conversation the morning of our assessment. Audits demonstrated that patients were aware of their plan of care and management, scoring 100% in the 3 months prior to our assessment.

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.

People’s care and treatment was not always delivered in a way that met their assessed needs from services that were coordinated and responsive. For example, people told us they experienced delays in staff attending to care and there were delays in administering medications to optimise them in a timely manner. The hospital had a vacancy for an LD specialist nurse, although there was support from Ipswich Hospital if required.

When patients moved between wards and departments, we observed a verbal handover given from the nurse, we also saw handover sheets within the care records from the emergency department to ensure continuity of care. However, this handover was not always relayed to all staff. For example, a patient told us he was on a fluid restriction plan, but a nurse gave fluids despite them saying they were on a restriction.

Staff reported consistent staffing shortages on the ward, which often led to an inability to support choice and continuity to patients on their ward. We were told that a lack of therapy staff resulted in delays in completing referrals and often ongoing rehabilitation needs were not met. Incidents showed a lack of timely district nursing referrals completed on discharge, impacting on continuity of care and treatment in the management of pressure ulcers.

Respiratory and Diabetes Specialist nurses supported patients whilst in hospital and on discharge. The service linked with specialist hospitals, community services and hospice to ensure continuity of care. However, staffing shortages within the respiratory service meant that referrals were not always timely and were not always able to see all patients before they were discharged. These patients were followed up in the community and complex patients were seen in consultant clinics.

There were delays in patient flow through the hospital, staff reported these were mainly caused by social care and medication delays. Other causes included delays in mental health reviews, and occasional speciality reviews. The trust had a Red Day Tracker system, which logged all patients on the wards for 7 days or over. This enabled managers and leaders to monitor and identify delays in the patient journey.

There were also delays in discharges. Recent bed occupancy at Colchester General Hospital had been above 90%, which is against the NICE recommendation and higher than the national average.
The Transfer of Care Hub (ToCH) arranged the recovery care and support that patients needed once they left the hospital. Almost 50% of their caseload were patients awaiting or had ongoing assessments for discharge. Other causes of delay were patients awaiting packages of care and social care placement.

Primarily the ToCH worked alongside the county council and Integrated Care Board to support with discharges and flow out of Colchester Hospital. They also liaised with other parties such as the local mental health trust and other external agencies to support with the provision of care/support for patients.

The service had a patient discharge lounge for use by patients waiting for transport or medicines before going home. Staff told us that the lounge was well utilised, however funding was due to run out and they were not sure if this would continue to support flow. Staff reported that medications were often not always prepared and discharge letters were not always ready. This was supported within complaints reviewed. They had a discharge process to ensure cannulas were removed and patients were in their own clothes. These checks were carried out in response to recent complaints.

The frailty team invited newly frail patients from the local area who had a frailty score of 5 or 6 to have a comprehensive geriatric assessment and were signposted to preventive measures to slow down further deterioration.

We reviewed NHS England experimental data on the percentage of admissions to any hospital in England that occurred within 30 days of the last admission. Data from 2019/2020 through to 2023/2024, showed that the percentage of emergency readmissions at this trust was significantly lower than the national average in all five reporting periods.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People told us they felt confident about making a complaint should they wish to. Most did not know how to but said they would ask to speak to the manager or tell staff. One person told us they had raised concerns about a lack of side room for their relative that had been placed on end of life care pathway. They had logged this complaint via the patient advise and liaison service (PALS) and observed staff taking action to resolve this. We reviewed complaints and saw that letters were sent following an investigation with apologies for their experience.

Staff did not always feel confident to deal with a complaint raised directly to them, to resolve these locally in line with trust policy. However, staff told us that they would escalate any complaints to the senior nurse in charge. Staff reported that they did not gather feedback from patients on discharge. However, they told us that learning from complaints led to changes to improve. For example, the discharge lounge had a checklist to ensure patients were not sent home wearing hospital gowns and had cannulas removed.

The trust had introduced ‘Fundamentals of Care’ and ‘Every bay, Every day’, to reduce the number of complaints and offer people the opportunity to address concerns in real time. Results had shown a reduction in complaints within emergency assessment unit and this was being rolled out across all the inpatient wards. We requested give feedback on care results for medical care. We were provided with Friends and Family Test (FFT) results for the last 18 months which showed a low response rate of 14%, of which 84% were positive.

The service did not always make sure people could access timely care, support and treatment when they needed it. People we spoke with said they had long waits in the emergency department and on emergency assessment unit prior to admission to medical care wards.

We requested evidence of how equity in access of care, support and treatment for all patients was met. We were given policies that support this but no data to demonstrate that these policies or processes were being implemented to reduce inequality.

There was a lack of nursing and allied health professionals when compared to budgeted staffing across all medical care wards. All staff we spoke to told us that this had a direct impact on the timeliness of care they could deliver, such as, an inability to toilet patients when they request or send referrals required to support continuing care on discharge. This was supported by people we spoke with, and evidenced in complaints and incident reports we reviewed following the on-site assessment.

The use of the ‘Health Passport’ held by patients and ‘This is me’ document helps better understand who the person really is, which can help staff deliver care that is tailored to the person's needs. Audit data for the last 2024/2025 quarter showed a lack of completion of the Health Passport by 5 of the 8 wards within medical care. Audits showed that compliance had increased from 49% to 79%.

The service considered the needs and preferences of different people. For example, staff could access interpreters to support patients who had language barriers to ensure that care was coordinated. However, staff acknowledged this was not always the most suitable method for a person with dementia. Staff could also support patients that spoke their native language.

During the time of our assessment, Colchester General hospital did not have a learning disability (LD) and autism nurse. Leaders acknowledged the gap in expertise but told us they had systems in place such as ‘This is me’ and mandatory LD disability and autism level 2 training. Staff told us they were informed of patients with LD needs at handover but did not always have access to documentation to support their preferences to care.

The emergency assessment unit staff told us that length of stay was variable on the unit. Although the unit was intended for a patient stay of 24 – 78 hours, patients in mental health crisis would stay for longer periods of time due to limited access to community mental health beds. They told us the process was slow and one patient had stayed for 7 months.

Portering services were managed by an external company, this was a new change during our assessment. Staff told us “they are no longer helpful. If there is a delay they will leave and staff need to re-refer for a porter to transport them. This means patient’s care is delayed”.

Patients were not always placed on wards most appropriate to their needs due to bed capacity. We asked for the number of medical outliers and were told there were 7 on 20 March 2025. To mitigate risk an outlier medical consultant was assigned on every shift to review these patients. This meant that reviews were delayed and care delivered may not be by individuals that have the specific training to manage the patient’s condition.

A weekend and out of hours service was available from diagnostics, therapies, pharmacy and social services. However, these services were run with limited staff and some services were only available from 9am-1pm. This meant that patients admitted over the weekend could be waiting longer for services than those admitted at the beginning of the week, increasing their overall length of stay.
The integrated rapid assessment service (IRAS) and frailty teams identified patients based on their service criteria to identify discharge needs such as care and equipment to reduce length of stay during admission.

Dementia advisors were based at Colchester General Hospital to support a person with dementia diagnosis were supported through discharge once medically optimised. Therapists told us they used a variety of charities to support patient care.. Referrals were made through the discharge team.
The emergency assessment unit (EAU) were proud of changes made to the day room. Adaptions were made to support LD patients with music and lighting to create a calm space within a busy department. We observed a dedicated trolley for dementia patients with twiddle/fidget blankets. There was a future plan to paint each bay with a specific colour in consultation with the dementia nurse.

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.

People were not always 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 service did not have effective processes to record clear and accessible history of decision making about an individual’s preferred care and treatment in line with trust policy and national guidance. We reviewed 8 care records in relation to completion of Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms. We found 5 of these records were not completed in line with trust policy and did not follow best practice guidance. For example, there was a lack of evidence to show that discussions took place with individuals and those involved in their care and a failure to demonstrate a compliance with the Mental Capacity Act 2005 to support decisions made.

We reviewed 7 care records for evidence of advanced care planning in line with trust policy and national guidance. We found 5 records where service user’s capacity was fluctuating. The records did not demonstrate evidence of advanced care planning. This meant clinical staff were not aware of preferred choice of care when service users were not able to make specific decisions for themselves.
Staff told us ReSPECT forms were not always completed prior to discharge home. This had resulted in ambulance staff not being aware of people’s resuscitation status for 2 patient’s that suffered a cardiac arrest whilst transporting.

We reviewed data collected by the resus team for compliance of the ReSPECT forms found in deceased patients’ notes, for the last 3 months prior to assessment. Compliance was improving from 87% in January 2025 to 93% in March 2025.

Individual care plans for the last days of life were used to focus on the person's needs, preferences, and wishes, ensuring comfort, dignity, and support for both the individual and their loved ones. We saw this document within a patient’s care records to support delivering care in line with their preferences.