Colchester General Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked patients were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked patient’s liberty was protected where this was in their best interests and in line with legislation.

At our last assessment we rated this key question requires improvement. At this assessment, the rating changed to inadequate. Not all patients were safe and protected from avoidable harm at all times. The service did not always ensure that staff providing care or treatment to mental health patients had the appropriate training, competence and skill in relation to safeguarding patients. The service did not always make sure there were enough qualified, skilled and experienced staff to safely manage the department. There were long waiting times which meant not all transitions were managed safely, and specifically for those patients with mental health needs. The long delays for patients meant they were being cared for in circumstances that were not always safe, such as corridors and areas not designed for patients to stay for a long time.

However, when not using temporary escalation spaces, the environment was well maintained. Lessons were learned from incidents and complaints. The service had the necessary equipment to keep patients safe.

This service scored 38 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Although safety was a priority for staff and leaders in the service, staff were unable to tell us the process of logging an incident on the system. Staff we spoke with told us if an incident happened, they would raise concerns with the matron or their manager. However, staff said they sometimes struggled to find time to report things they knew they should escalate.

We spoke with staff about what they understood about duty of candour. Some of the nurses and health care assistants we spoke with did not understand what this meant. However, some staff did say they would be open with patients and their families when things went wrong. We saw the duty of candour policy which was in date and version controlled.

Staff were encouraged to raise concerns. Staff felt confident they would be treated with compassion and understanding. Most of the staff we asked said they did not feel blamed or treated negatively when things went wrong. Staff said they were supported by the managers and colleagues and treated with understanding. They felt lessons were learned from safety incidents and changes were made to reduce risks.

We saw the trust wide complaints and concerns handling policy which was in date and version controlled. Patients, relatives, carers or visitors to the service could raise a complaint. Complaints could be received in writing, by email, or completing a complaint form or verbally. Incidents and complaints were investigated and reported in line with the trust policy. The matron within the Emergency Department had a virtual newsletter which included information about complaints and learning from complaints. Lessons learnt were also shared in weekly virtual meetings. Staff told us complaints and incidents were looked at during team days and face to face workshops.

Staff had effective systems to raise concerns both formally and informally. Reports were analysed and urgent actions taken by leaders to manage or remove risks.

Staff told us if patients wanted to raise concerns, they would signpost them to the Patient Liaison Service (PALs).

In the last 6 months the service received 65 complaints received either directly to the ED or to PALs. The top themes being communication with patient, access to treatment or drugs and waiting times.

Safety and continuity of care was not a priority throughout patient’s care journey. Due to crowding and pressure on the capacity of the emergency department, there were not always safe transitions for patient. This was for all patients including patients living with a mental health condition who often had long waiting times in the emergency department.

There was a risk of patients’ transition to a ward or another service being problematic in terms of sharing information. Gaps in the patient’s records for risk assessments meant patients were transferred to wards with incomplete notes or assessments. This was not in accordance with the NHS Code of Practice for record keeping.

We saw the patient flow and escalation policy and procedure which was in date and had been verified. The policy was in place to deal with the fluctuations in demand and capacity so that any associated clinical risk could be managed. Patients who had been admitted to the emergency department with both physical health needs and mental health needs stayed in the department for too long.

The service did not always work well with people and health system partners to establish and maintain safe systems of care. However, the service had daily patient reviews with the Essex Partnership University Trust (EPUT). The site team liaised with EPUT and the Suffolk and North East Essex integrated care system (ICS) regarding bed allocations for patients awaiting a mental health bed and the service also held a mental health inter agency meeting attended by ESNEFT, EPUT and the police force to review data and concerns raised. Although these daily patient reviews were in place, during our assessment, we saw one mental health patient had been there for 100 hours. This patient was waiting for a mental health bed.

Staff were doing their best to care for patients. However, patients with poor mental health were outside of much of their skills and experience. The service did not always ensure that staff providing care or treatment to mental health patients had the appropriate training, competence and skill in relation to safeguarding patients. During our assessment, we spoke with 6 members of the nursing staff and 3 healthcare assistants who told us they did not receive any additional training to support mental health patients who attended the ED.

Daily and weekly meetings were held to assess mental health waiting times and ensure the proper risk assessments were completed. However, staff we spoke with were also unclear on their role and responsibilities in relation to mental health patients. Mental health patients were triaged by ED nurses on arrival to briefly gauge their risk of self-harm, suicide, and risk of leaving the department before assessment or treatment was completed. This was used to determine what level of observation the patient required whilst in the ED. Staff from the mental health service came to assess the patient more formally but were not always treating or managing the mental health concerns alongside any physical health concerns.

We saw the ED and mental health teams did not have joint pathways which promoted parallel assessment of patients with both physical and mental health needs. This was not in accordance with the Royal College of Emergency Medicine mental health toolkit, which states mental health assistance should be delivered at the time that it is requested. This should not be delayed by waiting for the mental health patient to become “medically fit”. The service’s first priority was to ensure patients were medically fit before they were seen by staff who were employed by the mental health trust.

Staff we spoke with were not aware of whose responsibilities it was to look after patients with mental health needs once they have been deemed physically fit by the ED and referred to the mental health trust. We did not see any Standard Operating Procedures (SOP) that listed the roles and responsibilities of the ED staff. This meant some patient care was being missed, for example administration of critical medications and observations completed as supported by the trust’s harm review. However, following the assessment leaders told us that this SOP was being drafted.

We were provided with mandatory training for nursing and medical staff. We reviewed the mandatory training data which demonstrated medical and nursing staff did not complete any mandatory training for mental health. However, following the assessment leaders told us that training was being put in place.

During our assessment we reviewed a mental health patient record which did not include any mental health assessment information. This was against trust policy. In line with trust policy, ED staff should complete a section within the ED CAS card for all mental health patients including assessments on how mental health patients should be cared for within the ED. We spoke with staff who told us they did not complete any crisis mental health assessments; these are completed by staff who were employed by a mental health trust. Staff told us there was verbal communication with staff from the mental health trust, but this was not documented on the service’s patient records.

The service did not have a system from which staff could view a patient’s safeguarding information, for patients with a long history of attendance and needs. Therefore, staff were not aware of the patient’s background or alert to their needs from an early stage of the process, i.e. triage.

Staff compliance with safeguarding training did not always meet the trust target. We reviewed Urgent and Emergency Care (UEC) compliance for Safeguarding training. The department was below the trust target of 90%, with only 56% of medical staff completing safeguarding children level 3 training and 83% completing safeguarding adults level 3 training. Nursing staff had met the trust target of at least 90% compliance for safeguarding adults level 1 and 3 and safeguarding children level 1, 2 and 3.

The service provided an action plan to ensure the above mandatory training compliance rate increased for safeguarding training and basic life support training. The service told us the general manager and assistant general manager would liaise with the clinical lead and training lead to ensure allocated time would be given to complete basic life support training. Teaching sessions on a Tuesday, Wednesday and Thursday were to be used for 3 doctors per session to improve compliance to the service target of 90%. All consultants and doctors were asked to prioritise training.

We reviewed safeguarding policies for adults and children which were up to date and version controlled.

We did not see any safeguarding contact details in any of the waiting areas or corridors. Staff did not know who to contact externally if they faced a safeguarding concern. Staff explained they would contact their manager first and explain any concerns. However, staff in the emergency department understood what safeguarding was and how to take appropriate and immediate action when needed.

Staff were unaware of the level of safeguarding training they had completed. Reception staff we spoke with told us they were not safeguarding trained and would alert nursing staff if they had any concerns. However, we saw reception staff received mandatory training compliance in safeguarding adults and children level 1 and would alert nursing staff if they had any concerns. We saw nursing staff in the emergency department who were available to assist.

The data provided by the service did not include mandatory training for Mental Capacity Act or Deprivation of Liberty Safeguards (DoLS). These are legal procedures designed to protect people who may lack the capacity to make decision about their care and treatment in hospital. They ensure any restrictions on a person’s liberty are in their best interests and are the least restrictive way to ensure their safety.

Patient’s rights were understood, and staff did all they could to keep patient safe but recognised this was limited to what was in their power. They knew how their authority did not include detaining a patient who had capacity to make their own decisions, even if they were concerned the decisions were poorly made.

The service employed two security staff to remain in the emergency department for each shift. The service had agency staff for the rest of the hospital. The security office was located close to the emergency department. ED staff were not allowed to use any restraint on patients. Restraint was carried out by the security team. Staff told us that security were always prompt and would try and verbally de-escalate the situation first. We spoke with security staff who told us they did not have training in how to handle mental health patients and did not want to have any mental health training.

We requested to see the policies regarding restraint and rapid tranquilisation. We were provided with the Reducing Restrictive Interventions Policy. This was version controlled and in date. The policy advises mandatory training should be completed by all staff in conflict resolution. Staff we spoke with said they had received information and training on restraint. We saw the mandatory training compliance for conflict resolution for medical staff was 84% and for nursing staff this was 94%.

The service did not have effective processes to ensure staff were reviewing patient’s National Early Warning Score (NEWS) to detect and respond to any clinical deterioration. We were not assured that patients were obtaining the appropriate clinical interventions and the escalation of care they required in line with trust policy and best practice.

Staff identified deteriorating patients using tools such as NEWS. The service had a NEWS policy, which stated that all patients with a NEWS score of five to six or three in a single parameter would need an additional review. We reviewed 6 patients’ records for completion of the above, and found 2 records did not have this completed. The trust did not audit NEWS2 compliance. The service provided us with audit data for the escalation of patients who triggered with a NEWS >5 or 3 in 1 parameter, which showed variable performance for observations taken within 15 minutes of arrival. However, the rolling sepsis screening compliance was 98%. This monitored the NEWS timings on arrival and whether a full set of observations were completed within the first 15 minutes of arrival to the emergency department. The audit also monitored whether for patients with NEWS >5 are screed for sepsis. This did not monitor the completion of ceiling of care, DNAR or ReSPECT forms being completed. DNR stands for do not resuscitate. It was a medical order indicating that, in the event of cardiac or respiratory arrest, a patient did not want to be revived using cardiopulmonary resuscitation (CPR). A ReSPECT form stands for recommended summary plan for emergency care and treatment. The document recorded a patient's preferences for emergency care and treatment.

We requested the number of Datix in relation to failure to escalate sepsis/deteriorating patients. There were 27 Datix incidents in relation to failure to escalate sepsis/deteriorating patients in last 12 months. Therefore, we were not assured that patients were obtaining the appropriate clinical interventions and the escalation of care they require in line with trust policy.

We reviewed 6 patient records and found in all 6 records repeated observations were not in line with trust policy. There was a delay in the review of the patients’ NEWS. For example, we saw 2 patients had a delay in observations of over 2 hours.

NEWS scores should be completed at all initial assessments and 4 hourly minimum for the first 24 hours after hospital admission unless stated otherwise in a senior medical plan.

During our assessment we did not see any impact on these patients.

We saw harm care reviews for January and February 2025 supported the lack of NEWS completion in line with trust policy. 14 out of 16 harm reviews showed NEWS observations were not reviewed in line with trust policy. The harm reviews included a summary which highlighted what could have been better and the level of harm caused. From the harm reviews we saw, it was regularly identified the frequency of observations, and documenting of observations could have been better. However, no harm was identified.

Leaders told us any decision to use corridors to care for patients was made collaboratively between clinical staff, the matron, site team, and operations. Reverse boarding (moving a patient, who is ready for discharge or transfer to another ward, out of their bed to create space for a newly admitted patient) and patient movement were explored first before approving corridor use. However, the service did not have systems and processes in place to ensure safe and effective corridor care in line with the Emergency Department Care in Corridor (ED) Colchester Hospital Standard Operating Policy (SOP). During our assessment, we reviewed 9 patient records for evidence of the corridor risk assessment. We found all 9 patients did not have any corridor risk assessments included. This meant that patients were not being reassessed after their initial assessment as to whether they were still suitable for corridor care. We spoke with nursing staff who told us they did not know what the corridor risk assessment was. This means staff were not working in line with trust policy and expected practice.

The harm review for January and February 2025 showed that none of the 16 patient records had this risk assessment completed.

All patients in the department over 6 hours were to have an Extended Length of Stay Checklist (ELOSC) completed and 2 hourly rounding completed as per ward level care. On review of the January and February 2025 harm reviews, only 5 out of 16 patients had rounding in line with policy. Extended length of stay checklists had only been completed for 2 out of the 8 patients. This meant patients were not adequately risk assessed in line with trust policy.

A risk assessment was carried out for all patients to determine what level of mental health support they need while in ED. During our inspection, the patients in the ED bays were on level 1 observations, which meant they should be checked hourly. Sometimes patients may be on level 3 observations, so ED staff and staff from the mental health trust worked together in these cases.

Patient said the department was clean but was overcrowded in the corridors. Patient told us there were long waiting times to be seen and patient were not checked on regularly whilst waiting in the corridors.

Leaders told us the chief nurse lead a weekly forum focused on corridor care, involving wider multidisciplinary teams in solution-focused discussions. However, the service did not have suitable premises to care for patients in the corridor. We saw the corridor housed 17 beds. The corridor environment particularly from beds 9 – 17 were out of sight and were congested. We observed the difficulty of moving beds around when patients were being transferred to the wards. Staff had to manoeuvre other corridor beds to make space for the outgoing corridor bed. We saw the corridors were crowded with patients’ family members and in a medical emergency it could be challenging to get the required assistance to a patient in the corridor.

Following our assessment, the service provided the risk assessment for the use of corridor beds. The enhanced boarding environment risk assessment was completed on 28 January 2025. The risk assessment identified the lack of adequate space but did not include any mitigation or additional control measures if there was a medical emergency, or a patient deteriorated. However, we were told in the event of a medical emergency (Such as a cardiac arrest) patients would be initially managed and moved to resuscitation for further management however this was not clear from the risk assessment. This meant corridor care patients were at risk of delayed recognition of deterioration, difficulty providing timely interventions, and potential for increased risk of adverse events.

There was a separate area for children and their families which were safe and secure and there were toys to keep children occupied. Anyone attending the children’s emergency department had to be buzzed onto the ward and buzzed out of the ward.

The emergency department (ED) had a mental health suite which had an assessment room. Staff told us they rarely used this room as it was not soundproof and therefore lacked privacy for patients. The mental health suite had a toilet, but showers were located in the emergency assessment unit (EAU). Staff told us they had to walk patients there if they wanted a shower.

During our assessment there was one patient in the mental health suite. Staff told us it was unsafe to have other patients in there with the patient so other patients were in bays on the ED. The mental health assessment room conformed to the guidance from the Royal College of Psychiatrists as it was ligature free and had doors which were not lockable. The furniture was safe from being used as a form of weapon.

There was a fully equipped resuscitation room and staff told us they had the equipment they needed to keep patients safe. Equipment used to deliver care and treatment was safe and suitable for the intended purpose. There was strategically sited emergency equipment, such as resuscitation trolleys, emergency suction and oxygen across the department and staff could tell us where the nearest equipment was located.

Daily safety checks of specialist equipment including equipment on resuscitation trolleys were completed in all areas of the emergency department.

The emergency department was located close to the x-ray department.

At our previous inspection we said the trust should ensure that there were adequate numbers of medical and nursing staff to ensure provision of safe patient care and treatment. During this assessment we saw the service did not always make sure there were enough qualified, skilled and experienced staff to safely manage the department. Not all staff received updated training, and development. However, they worked well together to provide care that met patient’s individual needs as much as possible.

The service provided the paediatric staffing template. The service proposed a nursing (band 5, band 6, band 7) staff template of 24.39 whole time equivalent (WTE) and their current template was 23.71 WTE. The total staffing proposed against the current staffing template was slightly short by 0.68 WTE.

The service had had four shift patterns, which were a long day (7am-7.30pm) and should have 12 registered nurses, 2 nursing associates and 3 healthcare assistants. A middle shift (10am – 6pm), which had 2 registered nurses and 2 healthcare assistants. A twilight shift (6pm-2am), which included 2 band 6 patient safety nurses. The service had an evening shift (4pm – midnight), which had 4 registered nurses and 2 healthcare assistants. The service had a night shift (7pm – 7.30am), which had 12 registered nurses, 2 nursing associates and 3 healthcare assistants.

For the in-bound corridor (when care was provided in the corridor) the template increases to an additional 3 registered nurses on the long day shift and night shift resulting in a template of 15 registered nurses, 2 nursing associates and 3 healthcare assistants.

When the remaining corridor (Outbound corridor) was open the template increased to 17 registered nurses, 2 nursing associates and 3 healthcare assistants.

We saw staffing numbers fluctuated from the planned vs actual staffing numbers for each area of the emergency department in January 2025, February 2025 and March 2025. We saw the service were sometimes understaffed.

During our inspection the service were understaffed. Their staffing establishment on the days of our inspection on 29 April 2025 were understaffed by 1 registered nurse during the day shift and understaffed by 1 registered nurse and 1 healthcare assistant in the night shift.

There was a bleep holder role within the service covered by a minimum of band 7 nurse during the day and a band 6 nurse during the night. The role was to try and move staff to cover areas experiencing additional pressure such as volume of patients, acuity and/or emergency.

The doctor staffing establishment at the time of our assessment included 13 consultant roles, 8 foundation year 2 doctors, 24 speciality doctors, 15 speciality registrars and 6 trust grade doctor or dentist (Speciality registrar). The service had 14.16% consultant vacancies and 5.38% junior medical vacancies. At the time of our inspection the total nursing and support to nursing staff vacancies were -0.41%.

At the time of our inspection the service had 12.10% registered nurse and support nursing staff turnover. Medical staff turnover had reduced at the time of our inspection and was 1.89%. The highest medical staff turnover rate was in August 2024 at 22.64%.

We saw the service had some staff sickness absence which fluctuated from April 2024 to March 2025. We saw that nursing staff had an overall sickness rate of 1.53%, medical staff had 5.32% and the children’s assessment unit had 2.68%.

Staff told us most nursing and healthcare assistant shifts with gaps were filled with bank nurses, but the staffing levels were, for most of them, their highest worry. Staff told us some of the temporary workers were regularly employed in the department, but the workload of the substantive staff was always increased. Staffing shortages was recognised on the risk register. Leaders recognised there were at times a risk staffing levels would not maintain a safe nurse to patient ratio.

We saw the service had regular use of bank medical and nursing staff from April 2024 to March 2025. The temporary consultant whole time equivalent bank usage was 17% for that period. For the same period temporary junior medical whole time equivalent bank usage was 18.70%. The service had bank nursing staff usage of 21.90%. We saw from the data provided by the service the paediatric nursing staff in the emergency department had used bank staff 19.94% in the last 12 months.

The service had a small usage of agency staff for junior medical staff in April 2024, October 2024, December 2024, January 2025 and February 2025 which totalled 4.4%.

Staff told us there was not always enough staff to safely and effectively manage the capacity and acuity of patients in corridor care. There were 7 reports over the last 12 months highlighting inadequate safe staffing levels across the emergency department.

We saw nursing staff did not meet the service target for adult basic life support level 2 training and paediatric life support level 2 training with both at 68%.

The service did not ensure staff completed their mandatory training. We saw medical staff were compliant with their mandatory training for equality, diversity and human rights (94%) and fire safety training (91%). Other training for example, dementia awareness training, health, safety and welfare training and infection prevention control training was below the service target. We saw nursing staff were compliant with most of their mandatory training however were below the service target for resuscitation level 2 for adults basic life support training (68%) and paediatric basic life support training (68%). We saw for the children’s assessment unit (CAU) staff were compliant with most of their mandatory training however were below the service target for safeguarding children level 3 (86%). The service had an action plan to ensure all medical staff were compliant with mandatory training by the end of June 2025, which was overseen by the mandatory training lead and clinical lead for the ED. The agreed action plan was for the general manager and assistant manager to liaise with the clinical lead and training lead to ensure allocated time is given to complete basic life support training.

The service had consultant presence every day from 8am until midnight.  After midnight there was an on-call consultant until 8am who would attend the hospital where required.

All staff we spoke with told us they received regular review of their work in the form of an appraisal. This gave staff the opportunity to discuss progression, learning and development. The services medical staffing had completed 97% of their appraisals. The services nursing staffing had completed 90% of their appraisals. The children’s assessment unit had completed 100% of their appraisals.

We saw the infection prevention and control mandatory training for medical staff was below the service’s target of 90%. Medical staff had 81% compliance. Nursing staff were compliant with the service target for infection prevention and control level 1 training completion of 100% and infection prevention and control level 2 compliance of 95%.

We saw the environment was visibly clean. We saw domestic staff cleaning the environment during our inspection. We did not see ‘I am clean’ stickers on all equipment that were cleaned. During our assessment we saw two ‘I am clean’ stickers, although these were out of date, dated 9 April 2025.

Cleaning checklists were not completed in all areas of the emergency department. We saw in the children’s emergency department; some cleaning checklists were completed but they were not completed in full. We spoke with domestic staff who told us they knew their duties well and said they were supported to do a good job. They had all the equipment they needed. However domestic staff told us they did not complete any cleaning checklists. We were shown a list of areas the domestic staff were requested to clean but there was no assurance that this was being completed.

Following the assessment, we requested details of the planned cleaning regimen. From the information provided we could not be assured that all areas of the emergency department were being cleaned. We could not see from the information provided whether cleaning was being completed frequently or in which areas.

The service mostly assessed and managed the risk of infection. Any patients who were tested as positive or showing signs of infection, which could be passed to others, were isolated as soon as possible.

Patients were otherwise screened at triage for markers of infection, such as temperature and resistance to certain medications. The department was no longer carrying out mandatory tests for COVID-19 (which was not required by national guidance), but staff could test the patient if there were symptoms. Staff told us when there was an infection breakout, infection screens were used and side rooms were used to isolate infected patients.

We saw staff washing their hands and using personal protective equipment (PPE), such as gloves and aprons. The service completed hand hygiene audits for the emergency department. We saw data from April 2024 to March 2025 which illustrated half of the audits were under the service target of 95%. We were not provided with an action plan for the audits that were under the compliance target. We saw the hand hygiene audits for the children’s emergency department from November 2024 to March 2025 which showed 100% compliance.

We saw all staff were bare below the elbow.

We saw curtains were clean and were in date.

Hazardous and clinical waste was responsibly managed.

The first point of contact for patient attending the emergency department was a nurse or consultant. Patient’s medical history including allergies were checked on first contact with the triage nurse.

The service had systems for appropriate handling of medications to ensure patient were given their medications as prescribed. However, there were some issues with storage. We saw on the ambulatory emergency care unit (AECU) there were medications in an open unlockable trolley. There was a 5-drawer trolley stationed at the entrance to the AECU, a short distance from the patient waiting area. This was accessible to anyone attending the unit. We told staff about this who were responsive and removed the trolley from the unit. We were told any open medications outside of the box was disposed of and we saw the other medications were stored securely in the unit joining the AECU. We saw the communications sent to staff following the removal of the trolley and information about where the medications were now stored.

Medications used for resuscitation were available in tamper-evident trolleys and stored in areas where they could be overseen by staff. The trolleys were checked daily by staff who completed and signed a checklist in full.

Staff told us they had online access to relevant medication policies, procedures and guidelines and this was observed during this visit. The service had a policy for rapid tranquilisation (when an injectable medication was used to help calm a person who was distressed) and when requested, staff were able to show this. There was a sepsis pathway and guideline and all recommended antimicrobials under the guideline were stocked and available for use.

Staff told us the mental health trust staff were not able to administer medication to patients as they were working for a different service. The emergency department staff administered the medication, but they did not always understand mental health treatments. Where patient did not have a physical issue, administering medication was not always seen as urgent. This caused a wait in medication being administered to mental health patients. An agreement to prescribe medication was signed however the agreement for mental health staff to administer medication had been delayed. This impacted patients suffering from mental health concerns by them not receiving medications when required.