- NHS hospital
Royal Cornwall Hospital
Assessment report published 29 August 2025
Contents
Ratings - Medical care (Including older people's care)
Our view of the service
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.
People's experience of this service
We reviewed 46 records across 10 wards. We spoke with 72 staff and patients. Patients told us there was multidisciplinary team working and patients felt listened to by staff. Patients found staff caring and responsive and praised the care they received. Carers for one patient stated that staff had been "fantastic." There was clear person-centred care provided. When reviewing records, patients and their next of kin (NOK) were involved at all stages of planning and the patient's needs were considered at all steps. There was mixed feedback from patients regarding whether they had been provided information. One patient stated they were given constant updates and reassurances. Another patient stated they had been told different things by different members of the multi-disciplinary team (MDT) and was unsure what she was waiting for.