The Ipswich Hospital

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• 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

This means we looked for evidence that the service met people’s needs. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

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.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We reviewed 21 care records in relation to completion of Treatment of Escalation Plan (TEP) and Recommended Summary Plan for Emergency Care and Treatment (ReSPECT). We found 12 of these records did not have clear documentation to evidence the decision had been made in discussion with the individual or their family. This was not in line with 3.4 of trust ReSPECT policy and did not follow best practice guidance by British Resuscitation Council UK.

Patients were moved to outlier areas or the Heart Centre to manage bed capacity at times of high demands. We did not see any documentation within care records to demonstrate this decision had been discussed with the patient to ensure they were consulted or given a choice.

The service utilised the ‘Health Passport’ held by patients and ‘This is me’ document to better the individual needs of each patient. This helped staff deliver care that was tailored to the person's needs. However, we were not always assured staff were using this effectively. We saw learning from patient safety incident investigation relating to staff not referring to a patient’s hospital passport when transferred to Washbrook ward. This resulted in a lack of supervision during meals times which put them at risk of aspiration.

‘This is me’ quarterly audit data showed a compliance of 16% April to June 2025 rising to 44% July to September 2025 at Ipswich Hospital. Completion of reasonable adjustment tool was 95% April to June 2025 decreasing to 87% July to September 2025 at Ipswich Hospital. We were not assured that care was always person centred to support individuals at risk. However, there was an IT solution to automatically produce accessible information standard compliant appointment letters.

Although patients we spoke to during our assessment were positive about the care they received, Healthwatch had received feedback with a recurring theme of not feeling fully involved in care.

Patients were offered a choice of meals and supported to make choices depending on their dietary requirement. For example, we saw a catering hostess give a choice of soft foods to a patient that was on a modified diet.
Patients we spoke to reported that they were supported to make decisions regarding their care and treatment. Patients were supported by specialist teams to facilitate decisions and what treatment pathway they preferred. For example, renal patients met with specialist nurses to discuss the options of a transplant, dialysis or treatment based on their renal function. This meant that plans were in place and patients were able to respond to changes in their health as needed.

Within Endoscopy, procedures were explained to patients at pre assessment. This meant they understood the risks and had choice around their preferred procedure. Where patients were living with dementia or learning difficulties, they were encouraged to bring a family member or healthcare professional to support them. A patient reported to Healthwatch ‘“I had a little sedation, but just the right amount so I could talk and understand everything that was going on. No pain, two procedures, one after the other, and it was absolutely fine. What a lovely, caring department.”
Staff told us that they were able to access interpreter services to translate where there was a language barrier to ensure that patients were informed and understood treatments offered to them.

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.

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, pressure ulcer risk assessments were not always completed to identify and mitigate risk, discharge summaries were not always completed in a timely manner and doctors were not always able to attend to patients in a timely manner out of hours when required.

When patients moved between wards and departments, we observed a verbal handover given from the nurse. However, this was not always effective. For example, we saw an incident reported in relation to investigation for chest pain not being reviewed and repeated following transfer to a ward. Staff we spoke to told us that at times discharges were delayed due to medications and discharge summaries not being completed in advance. We observed morning handover on wards which was not consistent between wards. Leaders informed us this was because some wards are medically led and some wards were nurse led. On some wards there was a strong focus on discharge dates, on other wards this was not consistently discussed for all patients.

Handover time was not protected and we observed consistent interruptions to handover on Waldringfield ward. Following the onsite visit we were told that a Board Round Standard Operating Procedure (SOP) were being developed to establish a consistent and safe hospital-wide approach for board rounds and therefore effective management of inpatients. The primary aim was to reduce delays in a patient’s journey, expedite appropriate decision making and facilitate a safe discharge.

Leaders recognised the need to address factors leading to increased length of stay. They started to run ‘Time to Care’ events where there was a focused improvement initiative designed to ensure that every patient in Ipswich Hospital received, safe, timely, and high-quality care and support staff to work efficiently and effectively. The aim was to improve working together across teams, specialties, and partner organisations to make the best use of both staff and patient time. Leaders planned on auditing the effectiveness of these events to evidence its impact on flow.
Medical staff we spoke to told us that the out of hours staffing was inadequate to meet the demand of administrative and clinical tasks for patients. For example, they told us that at times they were required to amend drug charts for patients and called to review deteriorating patients and could not manage the workload due to there being a reduction in clinical support workers. The trust were implementing a new electronic system that would allow for administrative tasks to be completed remotely and were hopeful that this would reduce the stress on doctors and improve continuity of care.

Information boards were found above patient bed space with key information such as dietary requirements, manual handling requirements and mobility status to ensure continuity of care. However, these were often not completed on medical wards to accurately reflect the patients’ needs.

Low staffing was impacting the services delivering patient centred care. For example, therapy staff told us they made recommendations for patients to mobilise to the toilet with assistance of 2 staff and for patients to wash and dress with support. However, due to staffing issues this was not always carried out.

Specialist teams such as renal, palliative, respiratory and diabetes supported patients and staff, 7 days a week. Multidisciplinary team meetings were held on a weekly and monthly basis to discuss care and support required on discharge to ensure continuity. Teams worked closely with the integrated care board and linked in with charities and volunteers to support patients and their families.

Information was shared between primary services and the hospital to ensure care was joined up and flexible to support choice. For example, staff had access to computer systems to read patient notes, send information to patients GP in a timely manner to prevent delay in care when transitioning to the community. However, teams told us that staffing shortages and lack of funding for posts resulted in care being delayed for patients. The introduction of the new electronic patient record system, meant that some specialist services were no longer using an integrated electronic system with community services. Staff felt this would negatively impact on continuity of care. However, due to the change being implemented after the onsite assessment, there was no evidence of the changes having a negative impact on continuity of care.

There were delays in patient flow through the hospital, staff reported these were mainly caused by social care and medication delays. Senior staff had oversight of these via the Red Day Tracker system, which logged all patients on wards for more than 7 days. This enabled managers and leaders to monitor and identify delays in the patient journey. We requested the number of medically fit patients within medical care during our 2 day assessment. We found there was a total of 33 patients of which 12 were experiencing local authority delay in sourcing packages of care, the second highest delay was due to sourcing a rehabilitation bed.

Where there were delays or cancellations of endoscopy procedures or diagnostic testing a clinician and operation manager reviewed the list of patients to ensure that those cancelled are suitable and rebooked. The senior nurse would complete an incident form for all patients cancelled. These were discussed at the Endoscopy Governance meetings. The bookings team ensured that patients were informed and rebooked.

We saw evidence of an activity distraction trolley on Woodbridge ward which offered a variety of sensory and cognitive activities such as puzzles, tactile items, music, or familiar objects that can be used to calm and redirect patients during moments of distress or restlessness.

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

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

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. We saw evidence of a family having a face to face complaint meeting with a ward sister and specialist nurse which resulted in closure for a family that was grieving.

Patient feedback was collected using a QR code on discharge. The service used this information to make changes and improve experience and care. The trust responded to a published report by Healthwatch Suffolk and Healthwatch Essex on patient experience of waiting for elective care. The trust had a plan to improve experience by addressing key themes around communication, proactive protection from impacts on waiting called ‘waiting well’ and offering choice by better informing patients about waiting times at the point of referral. These actions were all in progress during the assessment.

The diabetic team had introduced a pilot for self-administration and management of insulin on the wards following feedback from patients. This meant that patients were given the option to be able to have control of administering their own time critical medications, whilst being inpatient.

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. Ward managers we spoke to said that this increased visibility on the ward and allowed them an opportunity to resolve issues before it became a formal complaint and feedback to staff members where applicable.

Staff we spoke to understood how to escalate complaints and direct patients and their families to the Patient Advice and Liaison Service (PALS) should they wish to raise a formal complaint. Themes drawn from PALS complaints were used to improve services. For example, 4 toilets in entrance 6 made more accessible for wheelchair users following complaints made in August and September 2024. Complaint themes were around communication within discharge summaries and keeping patients and their families updated on investigations and plans. This was also supported by Healthwatch who reviewed feedback for the hospital relating to medical care. Actions taken included reflection for individual staff members and updating teams at morning huddles.

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.

Patients were not always placed on wards most appropriate to their needs due to bed capacity. We reviewed some care records for patients and found that daily reviews were not always documented. There was also delays in transferring patients to more appropriate wards to ensure care was optimised. Staff were moved to cover some of these areas which meant that care may not be by individuals that have the specific training to manage the patient’s condition. We asked for the number of medical outliers and were told there were 21 on the 23 September 2025. To mitigate risk an outlier medical consultant was assigned on every shift to review these patients.

Staff planned for patients discharge, however, expected discharge dates were not consistently reviewed at morning board round. Therapy staff told us that staff were not always able to support rehabilitation goals on the ward due to low staffing. This meant that necessary arrangements to support a timely and safe discharge were not always made.
During our assessment we asked for the top 3 delayed transfer of care patients within medical care. The longest 2 delays were 195 days and 181 days due to requirement for rehabilitation that could not be commissioned as there was no bariatric rehabilitation placement within the area. They remained in hospital whilst receiving therapy to meet their goals. This meant they were receiving suboptimal care compared to a specialist service with subject matter expertise due to the lack of external provider beds.

Information leaflets were available for a range of conditions for patients and families such as the butterfly service, pressure ulcer prevention and specialist advise such as dialysis. These were on display but staff were not aware if these could be made available in other formats such as larger font or different languages.

The discharge lounge was used to facilitate flow within the hospital. Patients were transferred there whilst awaiting medications, discharge summaries or transport. Staff told us that there had been times where patients have not been discharged due to delays in care services commencing. Therefore, patients were moved to the Heart Centre overnight and moved back to the discharge lounge the following morning to await discharge. Although patients had access to sandwiches and fruit at meal times whilst sat in the discharge lounge they did not have access to a hot meal.

The stroke rehabilitation gym area was being used as an escalation area and staff told us that this had been used for 3 weeks. This meant that gym equipment and rehabilitation of patients was within the main corridor of the ward entrance which did not maintain dignity for patients. Due to the limited space and lack of privacy of the area it limited access to patients. This was on the risk register and there were plans to have a new stroke gym by May 2026.
There was a robust system in place to review consultant to treatment times (RTT). We spoke with senior leaders who told us that their largest RTT wait times were in relation to neurology. Any patients exceeding 18 weeks and 52 weeks were reviewed on a weekly basis. The trust were taking action to address the waits within specialities. For example, endoscopy patients were being offered appointments at Colchester General Hospital or another site commissioned by the ICB depending on their complexity and ability to travel. Patients were given the choice and wait times for alternative places so that patients could make an informed decision.

Staff felt that the medical staffing cover was inadequate at night for the medical care wards . Ward staff had experienced delays in a doctor reviewing patients when they had concerns. Medical doctors told us that they were conflicted at times on who to review when there were multiple requests across differing wards. This meant that patients did not have timely reviews in line with trust policy. Ward staff would escalate to the site matron who would contact the doctor requesting an urgent review.

Staff made reasonable adjustments for patients, for example, people with mobility issues were provided with walking aids. Specialist teams were available to support care when patients needed it. For example, there were Dementia Nurse Specialists to support dementia patients on medical wards.

Staff were able to order specialist equipment such as air mattresses and bariatric equipment as required. All staff we spoke to knew how to access equipment if needed to support the care and treatment of patients.

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.

We scored the service as 2. The evidence showed some shortfalls. 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 10 care records in relation to completion of Treatment Escalation Plan (TEP) and Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms. We found 9 of these records were not completed in line with trust policy and did not follow best practice guidance by British Resuscitation Council UK. 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.

During the assessment we reviewed 21 ReSPECT forms for completion in line with trust ReSPECT policy version 1.0. We found 16 of these records were not completed in line with trust policy and did not follow best practice guidance by British Resuscitation Council UK. For example, there was lack of consultant review, completion of clinical recommendations of emergency care and treatment and/or forms reviewed on admission.

We requested to review the division’s last audit for completion of ReSPECT and TEP forms and found poor compliance with regards to capacity assessments, details on what matter to patients and clear documentation of realistic interventions. Senior leaders stated that the audit shows compliance with completion and was not a measure of quality. Foundation doctors had initiated a quality improvement project at Colchester General Hospital to improve compliance. Learning had been shared with Ipswich hospital and included posters and information on the wards promoting capacity assessment completion. The effectiveness of this project was yet to be measured.

The palliative care team supported wards, patients and their families to plan for end of life care. This service was provided 7 days a week, except for consultant cover which was supported by consultants at Colchester General Hospital or hospice out of hours. The service supported with training for wards or making plans when patients were nearing end of life to support their wishes. For example, a patient had expressed their preferred place of death to be home and this was arranged and supported by the palliative care team.

Advanced 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. These documents were held within yellow folders for staff to refer to on admission. There was a plan for this to change to an electronic database in November to ensure details were held centrally and accessible in emergencies by all healthcare professionals.