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 requires improvement. At this assessment the rating has remained/changed to requires improvement.

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.
The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it. Pressure and demand on the service and the wider hospital, meant at times people would have extended length of stay in the department waiting for discharges or inpatient beds.
Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

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.

People we spoke to told us nursing staff treated them as individuals, took time to listen to their needs and were kind and caring. Some people commented they did not always feel their concerns and needs were being fully considered by some medical staff.

Reception staff told us they would do their best to accommodate patient and relative’s needs whilst booking in. However, they did not have access to language-line or alternative communication aids. They told us there had been several occasions recently where English was not the patients first language and they became very frustrated with the staff when booking in. Staff felt they would benefit from some additional training and access to language line.

As part of our assessment, we carried out a short observation framework for inspection (SOFI) within the public waiting room. SOFI is a tool used by our inspectors to capture the experiences of people who use services who may not be able to express this for themselves. Our SOFI observations noted some positive staff and patient interactions and people being offered food and drink. It was also noted there was a lack of privacy when patients booked themselves in at reception where personal details overheard on multiple occasions. There was also a lack of things to do in the waiting room, with lack of working screens at time of assessment.

The service did not always make sure people were at the centre of their care and treatment choices. They did not always ensure informed decision-making with patients and relatives were documented. We reviewed 14 adult patient records for evidence of documentation of consent to care and treatment and Mental Capacity Assessments (MCAs). The completion of MCAs was inconsistent and none of the records documented evidence of discussions with patients and relatives. We were not assured people were being given information and the ability to make informed consent about their care and treatment, this was not in line with national guidance or best practice. We were not assured that UEC staff fully understood their roles and responsibilities in relation to these legal frameworks. Leaders acknowledged and had identified this gap in learning prior to our assessment. A training programme was being implemented.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People we spoke to told us staff were knowledgeable and available. They told us when waiting in the public waiting room there was limited information displayed about what to expect while in the department. Most people we spoke to told us they were not kept informed about wait times and any possible delays to care. We were told the department normally had a screen displaying estimated wait times, but this was not turned on. Both days of our assessment this screen was not working.

Leaders we spoke to acknowledged improvements with communication around wait times was needed. Reception staff told us it was helpful to have the HCA within the waiting room as a point of contact for patients and relatives and they often get frustrated with the long wait times. They also told us it would be helpful to have information leaflets in different languages as they often had to use their own mobile phones to help translate for patients when booking in.

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Within the minor’s department there was leaflets available for patients to take home. These leaflets contained details about their injury, guidance on management and worsening advise. Within the leaflets was a telephone number and quick response (QR) codes for additional information from NHS websites.

We requested evidence of the services accessible information policy or guidance. We were provided with the trust Learning Disability and Autism Policy. This policy was learning disability focused and did not give guidance on how communication needs to be adapted for other communication needs, for sight impaired, alternative languages or formats. This was not in line with best practice or the Accessible Information Standard.

The trust did have an accessibility statement and were actively attempting to achieve accessibility regulation compliance under the Public Sector Bodies (website and Mobile Application) (No.2) Accessibility Regulations 2018. The trust was aware their public website was not fully accessible but other formats were available on request for example, accessible html, large print, easy read, audio recording or braille.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Since moving into the new department, a year ago there had been some improvements to both the public main entrance triage process and the rapid ambulance triage (RAT) area. However, demand on the service continued to be high and at times people would have longs waits to be seen and extended length of stay in the department.
At time of assessment people told us they were seen promptly at the front door triage and staff carried out initial clinical observations including blood pressure and electrocardiogram (ECG). During the second day of our assessment the department was busier. We did observe 6 people waiting 15 to 20 minutes at the reception to be booked in.

The service also supported NHS My Health Passport scheme. This passport was completed and held and could be utilised by people needing support and reasonable adjustments whilst attending UEC. We requested evidence on how the service monitor people attending with Health Passports, this was not an audit the service carried out.

People being brought in by ambulance to UEC also experienced delays in care and treatment. Staff we spoke to within RAT told us they had 4 cubicles available to accept ambulance patients and 1 of those was used for quick assessment during busy times. Staff shared that the area could become very busy and at times have no space. This meant after initial assessment patients might go back onto the ambulance and wait for a bed (reverse boarding). During our assessment we did see evidence of reverse boarding.

We requested data around ambulance off load delays. There has been an improving trend of handovers within 45 minutes since June 2025. Data in August 2025 showed 2312 people were brought into UEC by ambulance. Out of those people 94% were handed over within 45 minutes to hospital staff. However, data provided did not detail how many patients were reverse boarded onto ambulances and the length of time people remained on ambulance vehicles whilst awaiting a bed.

Staff voiced concerns over who was accountable and responsible for patients’ care when they were returned to ambulance to await a bed. Staff gave an example of a patient waiting 4 hours in an ambulance who was in pain and required a UEC staff member to administer strong intravenous (IV) pain relief whilst still outside. Staff told us there was not always clear guidance for staff to follow when it came to treatment decisions while patients were still outside on ambulances. On review of incidents in the last 12 months there were 1 incident documented of ambulance handover delay which caused delay in treatment.

Ambulances arriving with very unwell patients would pre-alert the hospital so they could prepare and make ready the appropriate nursing and medical teams. We requested ambulance pre-alert audit data; however, this audit was not part of the trusts audit activity. We also observed that the ambulance pre-alert proforma did not include vital NEWS2 scoring information. We were not assured pre-alert information was being competed correctly, reviewed and appropriate action taken by UEC staff following the alert call.

Leaders acknowledged that demand on the service was at times high and capacity and flow within the department had been on the trusts risk register since 2021. Leaders we spoke with had a clear focus on patient experience and wished for people to be given the right care, in the right place at the right time. They had been working closely with the integrated care board (ICB), NHS England and other UEC departments to learn and develop best practice models for safe UEC access.

Leaders did acknowledge this flow and capacity issue and understood the potential impact on patient safety and care. Ambulance offload delays had been on the services risk register since 2022. Leaders told us they had taken steps to ease the number of ambulances attended the department and there had been a decrease in handover delays since July 2025. Leaders had worked closely with local ambulance service leaders to establish the best care pathways for patients. Virtual wards were being used to manage and monitor patients remotely to reduce physical bed demand and improve patient experience. Virtual wards (also known as hospital at home) allow patients to get the care they need at home safely and conveniently, rather than being in hospital.

People we spoke to during our assessment mostly said they were treated equitably. They told us staff were kind, caring and supportive during their time in the department. We observed patient being offered hot drinks and assisted to use facilities by staff. There was a vending machine within the public waiting area and during daytime hours in the hospital there was a canteen and shops open. During assessment we observed staff supporting vulnerable patients. For example, we saw an occasion where a member of staff assisted a patient with their hearing aids installing new batteries for them.

Staff we spoke to said in paediatric urgent and emergency care (UEC) told us they had breakfast bags and refreshments available for children and their families. In majors we observed patients being given refreshments this included those waiting in corridor beds. However, it was not always clear which patients were nil by mouth either from the patients notes or information on the departments white board.

During our assessment in all areas of UEC staff were observed caring for patients and relatives with kindness and respect. We saw good patient interactions considering peoples communication needs. During initial triage processes a patients frailty score were calculated and clearly documented. A frailty score is a scoring system to identify people, aged 65 and over, who are living with moderate and severe frailty. This can help target key interventions to help avoid any potential risks due to frailty. During assessment we reviewed 14 adult patient care records. Pressure sore risk assessment were completed for all those patients who were at risk.

We requested evidence on how the service support potentially vulnerable patients, such as those with additional needs and disabilities during their care. The service had a current Learning Disability and Autism policy and gave data around associated training such as staffs Oliver McGowan training. The Oliver McGowan Mandatory Training on Learning Disability and Autism is named after Oliver McGowan, whose death shone a light on the need for health and social care staff to have better training. The Health and Care Act 2022 introduced a statutory requirement that CQC-registered providers must ensure their staff receive learning disability and autism training appropriate to their role. On review of the services mandatory training, it showed 92% of nursing staff had completed training compared to 58% of medical staff. Medical staff training levels was not in line with the trust target of 90% compliance.

During assessment we observed gaps in risk assessment and documentation of patients’ potential risks and vulnerabilities. For example, those at risk of falls were not always clearly identified, patients at risk of venous thromboembolism (VTE) were not receiving timely assessment and patients at risk of deteriorating did not always have a treatment escalation plan in place. We requested audits to demonstrate how these processes were monitored for compliance. This was not provided. Therefore we were not assured leaders had clear oversight of all vulnerable patients within the department and that care received gave a consistent and expected outcome.

We also requested evidence of how the service respond to patient and families feedback following their care experience. Poor or lack of communication was a common concern raised by patients and their families. The service provided copies of corridor care information leaflets and UEC staff uniform posters that were displayed in patient areas.

Leaders acknowledged the need to improve communication particularly around wait times and reasons for delays. They said that patient safety and overall care experience was a key priority. UEC teams meet with divisional leadership monthly to discuss department concerns and that they had a reflective forum for staff and patient stories to be discussed.

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