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 patient and communities were always at the centre of how care was planned and delivered. We checked the health and care needs of patient and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence patient 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 ratings remained unchanged. This meant patient were not getting care and treatment in a timely way to meet their needs. There were significant delays in patients receiving care due to high demand, and over-capacity across the hospital for beds leading to poor flow and crowding leading to long and unacceptable delays for patients.

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 saw ward-bed capacity being often full which meant there were unacceptable waits for onward care for those patients with mental ill-health. As we have highlighted in the safe section above, there was a lack of parallel assessment of patients presenting with both mental and physical health needs, which did not follow the guidance of the Royal College of Emergency Medication mental health toolkit and the National Confidential Enquiry for Patient Outcomes and Death ‘Treat as One’ report. During our inspection we saw there had been a patient waiting for 100 hours waiting for discharge into the community.

We saw the patient experience, carers and co-production strategy from 2023 – 2028. The strategy discussed why patient experience is important and how the service plan to keep patient in control of their health, support and develop staff and drive technology to improve outcomes for each patient and their carers. However, we were not provided with information about how the strategy had been incorporated into practice. Although, since the implementation of the carer and co-production strategy, early indicators suggest this was having an impact on reducing the number of low and medium level complaints received.

Staff we spoke with told us if patients required reasonable adjustments, they would ensure the patient had those adjustments put in place. Staff told us they would note this in their patient record to ensure all staff were aware of the adjustments that were in place.

The service supplied appropriate, accurate and up-to-date information in formats tailored to individual needs. Information gathered about patients or others was held in secure systems which met data protection legislation requirements. Access to computerised patient records was password protected with a secure login. Patient information was generally held securely. However, during our assessment, we saw on the AECU patient records were kept in an unlocked cupboard which were accessible to anyone coming onto the unit.

Most information given to patients or their relatives in the emergency department was verbal. There were also a number of leaflets available for patient to take away. Staff said there were various ways in which they could provide information in a way patient could understand. This included being able to provide interpretation for patient who did not speak English as a first language.

The service made it easy for patient to share feedback and ideas, or raise complaints about their care, treatment and support. Complaints were taken seriously and used to improve care and treatment where possible. The key themes from conversations with patients were the length of time spent waiting for a bed and not getting regular updates from staff about next steps.

Feedback received from patients was shared with staff within weekly patient safety meetings. The service produces monthly reporting on themes from complaints and the patient liaison service (PALs) through its integrated patient safety and experience report, and this includes thematic reviews comprising of those with a protected characteristic. We saw in the last 6 months the service received 34 complaints with the main themes and trends being access to treatment or drugs, communications and lack of investigation/diagnostic test.

Patients and relatives told us they felt confident about making a complaint should they wish to. Most did not know how to go about it when we asked, but said they would just ask the staff or look it up on the trust’s website. One person said they would contact the Patient Advice and Liaison Service (PALs).

Staff said they recognised how complaints were opportunities for learning and making things better for patients.

Feedback from complaints was also discussed and shared as part of the bi-monthly patient experience, co-production & carers council (PECCC) meeting. In addition, all divisional areas had regular governance meetings where themes from complaints and PALS were reviewed.

The service did not make sure patient could access timely care, support and treatment when they needed it. There were signs of improvement from better streaming of patients within the emergency department. However, there remained too often crowding in the department from both increased patient numbers, but also the unmet demand for ward beds for emergency department patients. This was on the department’s risk register and graded at the highest level of risk with a recognition of all the risk factors for patients.

The crowding and delays to ambulance handovers led at times to patients being placed in a corridor. We were told when there were busy periods, patients arriving via ambulance would be reviewed and then reverse boarded back onto the ambulance to await a bed. During our assessment, we did not see any reverse boarding back onto the ambulances.

We reviewed the annual data for the percentage of ambulances remaining at hospital for more than 60 minutes. This percentage fluctuated from May 2024 to April 2025. We saw the highest number of ambulances remaining at the service for more than 60 minutes was in December 2024 at 32.7%. We saw the lowest number of ambulances remaining at the service for more than 60 minutes was in August 2024 with 2.9%.

We saw patients being triaged by an emergency department (ED) nurse or consultant on arrival to gauge their risk of self-harm, suicide and risk of leaving the department. Staff completed this to assess what level of observation the patient required whilst in the ED. However, the increased demand and poor flow in the department was a consequence from beds not being vacated by patients with complex discharges from hospital ward beds and delays for patient who were medically fit to go home but had no immediate care provision in the community. This had a significant impact on the performance of the emergency department, and the ability to be responsive to patients and meet their needs in a timely way, as patients could not be moved forward. However, we did see services like the ambulatory emergency care unit (AECU) help to divert patients who did not require full admission in an attempt to have quicker access to appropriate care but this was not always effective.

The service provided data of the percentage of patients that were triaged within 15 minutes of attending the emergency department for adults. This percentage varied during the year. At the lowest, in October 2024, we saw the service triaged 64% of patients within 15 minutes of attending the emergency department. At the highest, in April 2025, we saw the service triaged 78% within 15 minutes. The service provided data of the percentage of patients that were triaged within 15 minutes of attending the children’s emergency department from May 2024 to April 2025. At the lowest, in December 2024, we saw the service triaged 50.6% within 15 minutes. At the highest, in August 2024, we saw the service triaged 67.9%.

The service provided data for the percentage of patients leaving the emergency department before being seen. We were provided data from May 2024 to April 2025. This fluctuated over time with the highest number of patients leaving in July 2024 with 1% and the lowest number of patients leaving in April 2025 with 0.21%.

We saw the service’s performance for patients seen within one hour by a consultant. This fluctuated from May 2024 to April 2025. We saw the highest percentage of patients seen within one hour by a consultant was in April 2025 which was 76.5% and the lowest percentage was in May 2024 which was 51.6%.

The service made efforts to improve daily operational management including daily site meetings to monitor patient flow and length of stay. The transfer to care (TOC) team were introduced to help reduce delays for patients needing social care support. Virtual wards were being used to manage and monitor patients remotely to reduce physical bed demand and improve patient throughput. However, leaders and staff acknowledged that patient could not always access support and treatment in a timely manner due to patient flow and capacity issues. Delayed discharges on wards for patients awaiting social care provision were partly responsible for this. Staff we spoke with said patient flow issues had become normalised and that this was demoralising.

We saw data for the percentage of patients returning to the emergency department following discharge. We were provided with data from May 2024 to April 2025. We saw the data fluctuated over time. The highest number of patients returning to the emergency department following discharge was in July 2024 which was 3.1%. The lowest number of patients was 1.9% in January 2025.

The bed management team held meetings with leaders throughout the hospital sometimes 5 times a day to review resources available to patients and staffing needs. However, due to factors described here, the department was not treating, discharging or admitting patient to wards within the standards required by the NHS constitution which was known as the 4-hour standard. The standard was to admit, transfer or discharge 95% of patient within 4 hours. We reviewed the data provided by the service which told us these figures fluctuated from May 2024 to April 2025. At the lowest, in December 2024, the service admitted, transferred or discharged 45.1% of patients within 4 hours. At the highest, in August 2024, the service admitted, transferred or discharged 60.5% of patients within 4 hours.

We looked for evidence that patient and communities had the best possible outcomes because their needs were assessed. We checked patient’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring patient were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

We saw patients who were waiting in the corridor, some for considerable periods of time, did not have sufficient access to water, hot drinks or food. We were told that food and drinks were available within the emergency department three times per day, however this was not evidenced in the patient notes we reviewed. The patient notes highlighted either a discussion of food was offered but unconfirmed whether food was given or not, or no documented discussion of food or drink offered. We asked the nurse in charge what the process was, and we were shown a stamp should be put into the emergency department patient booklet and filled in. The 6 patient notes we reviewed did not have any stamps in them.

We spoke with staff following the inspection who told us they had a breakfast grab bag now which included croissant, yoghurt, fruit and juice. They also had a lunch grab bag which includes a sandwich. We were told there was a team going around asking if patients wanted tea and coffee. Staff told us anyone who was in the emergency department for over 24 hours would receive a hot meal once a day.

During our assessment, some patients in the corridor told us they were not offered food. Evidence submitted for January 2025 and February 2025 harm reviews, showed only 3 of the 16 patients were documented as offered food and drink. This was not sufficient to ensure patients did not become dehydrated, especially during hot weather.

Staff told us mental health patients were often left until last to receive any food and patients rarely received hot food. Staff gave an example of a patient who was there for 9 days and only received sandwiches for the duration of the care provided within the emergency department.