Royal Cornwall Hospital

Updated 29 August 2025

Date of assessment: 8 to 9 April 2025. Royal Cornwall Hospital provides a range of NHS hospital services. The assessment looked at medical care services and urgent and emergency care services as part of the System Pathway Pressures programme. We rated medical care services and urgent and emergency care services as requires improvement. The rating for medical care services and urgent and emergency care services has been combined with ratings of the other services from the last inspections. See our previous reports to get a full picture of all other services at Royal Cornwall Hospital. The rating of Royal Cornwall Hospital remains requires improvement. 

In our assessment of medical care services we found the service did not always have a positive and proactive safety culture where events were investigated. The service did not always work well with patients and health system partners to maintain safe systems and continuity of care. There was not always enough staff to meet patients' needs. Staff were not always able to provide care and treatment in line with evidence-based practice that delivered good outcomes. Staff were kind, caring and compassionate. The service did not always respond to people's immediate needs. People were not always able to access care in a timely manner due to flow challenges across the hospital. The department and staff were led by capable service-level leaders. However, governance and risk management structures were not robust and did not always support the delivery of high-quality care.

In our assessment of urgent and emergency care services we found consultant cover was not in line with national guidance. There was crowding in the department due to flow challenges across the hospital. Staff worked in a strong culture of evidence-based practice. Staff treated patients kindly and with compassion. Medicines were not always managed and stored safely. Governance systems were in place but were not always effective. The leaders were capable and driven, however there was concern for the wellbeing of leadership due to the pace of change.

Updated 19 February 2025

We carried out an assessment of medical care services (including older people's care) provided at Royal Cornwall Hospital on 8 and 9 April 2025, as part of our system pathway pressures programme.

We inspected 24 quality statements across the key questions Safe, Effective, Caring, Responsive and Well-led and have combined the score for each of these areas to give the rating.

During the inspection, we visited 12 wards. We reviewed the environment, staffing levels and looked at care records and prescription records. We spoke with patients and family members and staff of different grades, including; nurses, doctors, ward leaders and senior leaders responsible for medical services. We reviewed performance information about the trust. We observed how care and treatment was provided.

Royal Cornwall Hospitals NHS Trust (RCHT) is the main provider of acute hospital and specialist services for most of the population of Cornwall and the Isles of Scilly. The trust delivers care from three main sites: Royal Cornwall Hospital in Truro, St Michael's Hospital in Hayle and West Cornwall Hospital in Penzance

Medical care (including older people's care) services provided at Royal Cornwall Hospital are managed by 2 care groups: Acute Emergency Medicine (AEM) and Specialist Services and Surgery (SSS) Care Group.

The trust had faced significant operational pressures over the last year, which was intensified during peak holiday season where the visiting tourist population significantly increased demand for services. Although the trust had made changes to combat these pressures, including working with others in the local integrated care system, we found issues with the quality and safety of care delivered.

The service did not always have a positive and proactive safety culture where events were investigated, and learning was embedded to promote good practice. The service did not always work well with patients and health system partners to establish and maintain safe systems and continuity of care. They did not always involve people to manage risks. There was not always enough staff to meet patient's needs. The service did not always control potential risks to the environment, and they did not always manage medicines safely and effectively. Risks of infection were assessed and managed well.

Staff were not always able to provide care and treatment in line with evidenced-based practice that delivered good outcomes. Staff did not always work together well in the hospital to share information, however they worked well with external partners.

Staff were kind, caring and compassionate. Patients told us they felt supported by staff. The service did not always respond to people's immediate needs and patients lacked mechanisms to alert staff. Staff felt supported by their immediate team, however they did not feel engaged with leadership or the organisation.

The physical and mental needs of patients were considered when developing care plans, however patients did not always feel listened to by staff. The service mostly supplied up to date information for patients in accessible formats. People were not always able to access care in a timely manner due to flow challenges across the hospital.

The department and staff were led by capable service-level leaders who had a vision and strategy to make improvements. Staff worked well with partners and there were joint working arrangements, including learning across the system, which was encouraged and linked to improving experiences and outcomes for patients. However, governance and risk management structures were not robust and did not always support the delivery of high-quality care and there were gaps in governance lead roles. Staff did not always feel able to speak up or be involved in decision making and reported a lack of a sense of belonging. There was improved governance and risk management, and a positive culture.

The trust took part in a `perfect week' over Easter 2025 where providers in the system were testing and learning new ways of dealing with the increased demand seen at peak holiday times from tourists. Learning points were identified and allocated to each relevant provider to action, and the hospital took part in the process. Areas included in the work were community issues, risks, and care pathways. There was a log of key learning points to be actioned.

The service worked with system partners to coordinate discharges with appropriate community support. This included discharge from the hospital and from the virtual ward. The wards utilised discharge coordinators to facilitate appropriate transfer of care.

We found 5 breaches of the legal regulations in relation to safe delivery of care and treatment, premises and equipment, staffing, dignity and respect, and good governance.

Service users were not always treated with dignity and respect.

Staff did not always provide the safe delivery of care and treatment and assess risks to people's health and safety or mitigate them where identified.

Staff did not always ensure the proper and safe management of medicines and that premises and equipment were secure. The environmental layout of the building did not always keep people safe.

The service did not always ensure that persons providing care or treatment to service users had the competence, skill and experience to do so safely.

Governance systems did not always ensure risks relating to the health safety and welfare of service users were mitigated and that service users' records were accurate, complete and kept secure.

We have asked the provider for an action plan in response to the concerns found during this assessment.

Updated 19 February 2025

On Tuesday 8 and Wednesday 9 April 2025 CQC carried out an assessment at Royal Cornwall Hospital. This assessment was part of our System Pressures Programme where we inspected Medical Care and Urgent and Emergency Care (UEC) services. We last inspected UEC in May 2024 when we rated UEC as Requires Improvement. At this assessment the ratings stayed the same. At this site visit, there had been some improvement against the areas of concern found at the previous inspection.

We assessed 24 quality statements across the safe, effective, caring, responsive and well-led key questions. We have combined the scores for these areas with scores from the last assessment to give the rating.

We found three breaches of regulation where care and treatment was not always provided in a safe and timely way in line with clinical guidance. Patients were not always admitted from the emergency department to a ward bed in a timely manner. Consultant cover was not in line with national guidance. Mandatory and specialist training compliance was below the trust target. There were not effective processes for the management of risks within the department. However, appraisal compliance for staff and ambulance handover delays had improved.

There was crowding in the department with patients staying for extended periods in the department awaiting a ward placement. This included extended periods in environments that were not intended for patient care. This was due to the emergency department being full and patients who needed admission or specialty review being managed in waiting rooms and temporary escalation areas.

The trust and local ambulance provider had implemented Timely Handover Process (THP90) which was in operation between 08:00am and 6:00pm. The ambulance staff stayed with the patients during this time and were released at 90 minutes. However, staff told us that this had been poorly implemented.

There were concerns with the safe management and storage of medicines in the department. The crowded nature of the department meant that escalation areas were in use. The use of escalation areas, did not offer privacy and dignity. Governance systems were in place but not always effective.

However, staff followed infection, prevention and control procedures when carrying out their work. The service carried out regular audits, including monitoring against the emergency care standards. Staff worked in a strong culture of evidence-based practice. We observed staff offering compassionate care to patients and patients we spoke with were positive about the care they received. Most staff were positive about where they worked, and leaders were sighted on the risks to the workforce and the support required. However, we were concerned about the wellbeing of leaders delivering multiple changes at pace.

We spoke with 17 patients and 2 relatives/carers. We reviewed 8 adult patient records and 5 records of children and young people. We spoke with more than 40 staff which included: consultants, resident doctors, nurses, senior leaders, healthcare assistants, administration staff, pharmacists, housekeeping staff, occupational therapist and a student nurse.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Updated 14 December 2018

Our rating of this service stayed the same. We rated it as good because:

• Staff adhered to infection prevention and control policies and protocols.
• The units were clean, organised and suitable for children and young people.
• Incidents were reported and acted upon with feedback and learning provided to staff.
• Treatment and care were effective and delivered in accordance with best practice and recognised national guidelines.
• There was good multidisciplinary team working within the service and with other agencies.
• Children and young people were at the centre of the service and the priority for staff.
• Children, young people and their families were respected and valued as individuals.
• Care was delivered in a compassionate manner. Parents spoke highly of the approach and commitment of the staff who provided a service to their children.
• Children received excellent care from dedicated, caring and well-trained staff who were skilled in working and communicating with children, young people and their families.
• Staff understood the individual needs of children, young people and their families and designed and delivered services to meet them.
• There were clear lines of local management in place and structures for managing governance and measuring quality. The leadership and culture of the service drove improvement and the delivery of high-quality individual care.
• All staff were committed to children, young people and their families and to their colleagues. There were high levels of staff satisfaction with staff saying they were proud of the units as a place to work. They spoke highly of the culture and levels of engagement from managers.
• Innovation, high performance and the high quality of care were encouraged and acknowledged.

However:

• There was poor compliance with mandatory training levels.
• Safeguarding training compliance remained a challenge and required continued improvement. We were not assured there was a consistency of understanding of processes and policies at the named lead doctor level.
• The location of the high dependency unit and the nursing observation arrangements remained a risk to children who were not visible to the main nursing station.
• Some staff had little training in mental health beyond their mandatory training. There was no further formal training to manage children and young people with complex mental health conditions who were in a crisis. Some staff said they did not feel adequately equipped to deal with these patients.
• Risk assessment and decision-making processes for children and young people with mental health needs were not always documented and some staff did not understand the requirements.
• There was a lack of coordination between patient record systems and this hampered delivery of effective care and treatment.

Updated 14 December 2018

Our rating of this service stayed the same. We rated it as good because:

• Staff followed best practice with regards to the prevention and control of infection. In general, there were good systems for staff to keep people safe and safeguarded from abuse. Most risks to patients were assessed and their safety was monitored. Staff had all the information they needed to deliver safe care and treatment. Staffing levels for nurses and doctors were provided at safe levels. Staff managed medicines safely. The service had a good track record on safety. When things went wrong, the team shared learning from investigations and made improvements.
• In general, the team provided care based on the best available evidence. The service monitored care and treatment using data from internal and external audits. Patient outcomes were mostly good compared to other services. Staff had the skills, knowledge and experience to deliver effective care. They were competent and had good opportunities for development. Staff worked well together and involved other services and organisations to deliver effective care and treatment.
• Staff were consistently caring and treated patients with kindness, dignity, respect and compassion. Patients were given the emotional support they needed. Patients and relatives felt involved in treatment decisions.
• In general, patients received personalised care responsive to their needs. Patients could usually access treatment in a timely way. Staff ensured the individual needs of complex patients were met. Consent to care and treatment was always sought in line with legislation and guidance. Patients complaints and concerns were listened to and used to improve quality of care.
• The local leadership team had the capacity and capability to deliver high quality sustainable care. Leaders understood the challenges to care and there was a strategy for improvement. There were clear roles, responsibilities and systems of accountability to support good governance and management. The culture of the unit was focussed on patient safety. Staff worked together to deliver good quality care.

However:

• Some safety systems were not well monitored, such as mandatory training compliance. Not all risks to patient safety were assessed and well managed, such as the routine maintenance of medical equipment and the use of bed rails for patients.
• Not all necessary staff were involved in assessing, planning and delivering care and treatment. There were gaps in the multidisciplinary team which reduced patients’ access to rehabilitation and specialist nutritional advice.
• Not all care was responsive to patients’ needs. Patients sometimes were not admitted to the unit or discharged at the right time due to the demand for beds on the unit and the wider hospital. Complaints were not always handled in a timely way.

Updated 14 December 2018

We previously inspected diagnostic imaging jointly with outpatients, so we cannot compare our new ratings directly with previous ratings.

We rated this service as outstanding because:

• People’s needs were met through the way services were organised and delivered. Patients could access the service when it suited them, and staff ensured the individual needs of complex patients were met. Consent to care and treatment was always sought in line with legislation and guidance. Patients’ complaints and concerns were listened to and used to improve quality of care.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. Risk was understood and managed and there was a proactive and collaborative approach to reviewing and improving quality and safety.
• People were protected by a strong comprehensive safety system, and a focus on openness, transparency and learning when things go wrong. There were safe levels of staff who were trained to provide safe care. Patient records, infection control practices, systems, and staff recognition and management of risks to patients assured us of a safe service.
• The team provided care based on the best available evidence. The service monitored care using data from internal audits. Staff had the skills, knowledge and experience to deliver an effective service. They were competent and had good opportunities for development. Staff worked well together and involved other services to support them in providing effective care.
• Staff were consistently caring and treated patients with kindness, dignity, respect and compassion. Staff made every effort to minimise any distress for patients.

However:

• Some parts of the estate were not suitable for patient care and needed updating.

Updated 26 February 2020

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and acted on them and managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service. Staff were working towards keeping good care records using a process of audit and improvement programmes.
• We saw staff provided care and treatment which was suitable for patients at the end of their life. Staff gave patients enough to eat and drink and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
• Staff had the skills, knowledge and experience to lead the service. Leaders ran services well, were developing information systems and supported staff to develop their skills. Specialist end of life staff understood the service’s vision and values, and how to apply them in their work. Most staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Documentation did not always provide assurances that suitable, individualised care was provided for patients at the end of their life.

Updated 27 February 2023

Updated 26 February 2020

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse and managed safety well. Staff assessed risks to patients and acted on them. Staff completed comprehensive records and managed medicines well. Staff kept themselves and patient equipment clean. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness. Staff listened to patients and their carers and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. Some patients could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Not all records in cardiology were stored securely. Staff were not always aware of learning from incidents in other clinics. There was a risk of cross infection because staff did not follow trust policy for cleaning the play equipment in outpatient clinics. Staff did not always complete safety checks on emergency equipment. Essential fire safety equipment was not available or was out of date.
• Not all key services were available seven days a week.
• Not all staff took care to maintain patient privacy and dignity in outpatient clinics.
• There were delays for treatment in some specialties. Patients waited longer than expected for their complaints to be investigated and resolved.

Updated 12 May 2016

We judged sexual health services as good overall because:

• Patients were protected from avoidable harm. Openness and transparency about safety was encouraged. Staff understood their responsibilities and were encouraged to report incidents and near misses.

• Safeguarding vulnerable adults, children and young people was managed proactively and effectively by staff trained to recognise early signs of abuse.

• Staff were employed in sufficient numbers to run the service effectively. A daily briefing ensured all staff were aware of any potential risks or concerns regarding the operation of the clinics.

• Patients’ care and treatment was planned and delivered in line with current national recommendations and legislation.

• The service participated in local and national audits and used the outcomes to inform,develop and improve care pathways and patients’ care and treatment.

• Staff worked well together as part of a multidisciplinary team to coordinate and deliver patients’ care and treatment effectively.

• Patients were provided with sufficient information regarding their care and treatment needs to be able to give consent prior to procedures or treatments being carried out.

• The sexual health service provided a caring service to patients.

• The privacy, dignity and confidentiality of patients’ was protected and they were treated respectfully by the staff.

• Patients we spoke with provided us with positive feedback regarding their experience of using the sexual health service.

• The service was planned and delivered in various locations and at different times of day times, in order to meet the needs of the local population.

• The facilities and premises we visited were fit for purpose.

• The booking system for appointments was easy to use and supported patients to attend an appropriate clinic to meet their care and treatment needs.

• Patients were advised on how to make a complaint, were listened and responded to and action was taken in response to complaints and suggestions received.

• Staff were aware of a clear vision and strategy for the service in that the aim was to become a fully integrated sexual health service. However, this was dependent on future commissioning arrangements which lay with an external organisation.

• There were effective governance systems within the service and the wider trust. The service was able to identify current and future risks and the actions required to address these issues.

Updated 26 February 2020

• The service did not have enough staff to care for patients and keep them safe. Nursing staffing in the surgical division remained a challenge and had been for some time. The service provided mandatory training in key skills, however, we were not assured all staff were fully compliant with their training, particularly medical staff. Staff were working towards keeping good care records using a process of audit and improvement programmes.
• The management of medicines could be improved to ensure best practice. Not all controlled drug records were completed in accordance with trust policy.
• The service did not always have suitable premises. On Trauma 1 ward, we found a room which was used for both storage of equipment and as a patient waiting area, because of a lack of storage area. There was not enough space in the St Mawes lounge, we observed three patients having their observations taken in the waiting area, with one patient standing up to have their observations done as no chair was available. However, the surgical admissions lounge was used as an escalation area and not adequately staffed with appropriately trained nurses. Surgical nurses were not trained to look after the acutely unwell medical patients on the surgical admissions lounge.
• The service did not always plan care to meet the needs of local people or take account of patients’ individual needs. Medical outliers were regularly in the surgical bed space and this impacted on patient flow throughout the hospital. At the time of our inspection there were 44 medical outliers on surgical wards including the surgical admission lounge and Wheal Coates. On one day of the inspection we saw 16 medical outliers (out of a total of 18 surgical inpatient beds and four day-case beds).
• Not all staff understood the service’s vision and values, and how to apply them in their work. In some areas we found that this had a negative effect on morale and on staff retention.

However:

• Staff understood how to protect patients from abuse. Staff we spoke with understood the trust’s safeguarding policy and processes and were clear about their responsibilities. Staff had access to a safeguarding lead nurse and told us they gave good support.  
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.  Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week. 
• ​Leaders ran services well using reliable information systems and supported staff to develop their skills. The leadership team felt supported by the executive team to drive progress and make improvements. They had a good awareness of risks and the challenges to the service. We found the leaders highly energised and enthusiastic about shaping the future of surgical services in Cornwall, focusing on patient experience.