Royal Cornwall Hospital

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment, we rated this key question as good. At this assessment the rating has stayed good. We assessed three quality statements: kindness, compassion and dignity, responding to people’s immediate needs, and workforce wellbeing and enablement.

The provider was in breach of legal regulations in relation to dignity and respect.

People were treated kindly and felt safe and supported However, patient dignity was not always protected across wards.

The service did not always respond to people’s immediate needs.

Staff felt supported by immediate managers, but did not feel engaged with the organisation and staffing issues negatively affected some staff member’s physical health.

This service scored 65 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Several patients told us nursing staff were compassionate and advocated for patients. Patients described staff in Roskear ward as “amazing” and staff in Same Day Medical Assessment unit (SDMA) as “fantastic.” From the most recent Friends and Family Test, between 1 January and 31 March 2025, 98.6% of the 733 respondents rated their care as very good or good.

There was compassionate support for end-of-life patients. The service used the “butterfly scheme” in wards: specially trained volunteers offered comfort and companionship to dying patients. The chaplaincy service also supported the wards and liaised with the palliative care team to provide support for patients with a terminal diagnosis. The service worked with the patient and the patient’s family to transfer the patient to their preferred location of death, ensuring all care needs were met throughout the process. There was a reserved courtyard in the hospital with a garden for patients to spend their final moments. Staff members treated this reserved courtyard with respect and solemnity.

However, dignity was inconsistently protected across wards. In Tintagel ward, staff told us it was difficult to provide good care and preserve patients’ dignity in escalation spaces as there were no curtains. In AMU, there were no curtains for patients in boarding beds. In the 2024 Patient-Led Assessments of the Care Environment (PLACE) Area Scores, patients rated the privacy in AMU2 at 76.4%. However, in Wellington ward, staff had access to portable screens to protect patient privacy if needed. Across the Acute and Emergency Medicine wards overall, the average privacy rating was 71.6%. During our inspection we did not observe any incidents of patients’ dignity not being maintained.

There was evidence the service did not protect the privacy of service users. The trust reported 27 mixed sex breaches from October 2024 – March 2025. 24 mixed sex breaches were in the Coronary Care Unit, 1 in the Same Day Medical Assessment Unit (SDMA) and 2 were in Wellington ward. However, there had been no mixed sex breaches in SDMA and Wellington ward since December 2024. Staff told us mixed sex breaches occurred in the discharge lounge when a patient on a trolley or a bariatric (a patient with a high body mass index) patient was brought down to the discharge lounge. Staff were aware of mechanisms to report same sex breaches. RCHT had a Same Sex Policy, reviewed in February 2024, which outlined the organisation’s commitment to maintaining patients’ privacy and dignity. There were robust reporting arrangements and monitoring mechanisms. There was clear decision-making guidance for staff and justification of breaches. The same sex policy had not been reviewed recently.

There was record of one incident demonstrating patient information was not treated as confidential: a patient was sent home with another patient’s notes and medical directives. However, we were assured this was an isolated incident and the trust investigated with steps taken to learn.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Independence, choice and control during this assessment. The score for this quality statement is based on the previous rating for Caring.

Patients in SDMA had to travel the full length of a public corridor to AMU to use shower facilities due to the lack of shower in SDMA, delaying immediate needs.

There was a lack of appropriate safety equipment across the wards. There were multiple incidents where admitted patients did not have access to call bells. For example, additional beds had been placed in bays on AMU to increase ward capacity. These beds were not in a designated bedspace. There were no call bells for patients to request help from staff. One patient told us, \"I just wave at the staff if I need anything\". In Pheonix ward, there was a chair placed in the temporary escalation space (TES), however the space did not have a call bell or curtains. The chair also blocked an exit.

Records did not reflect that immediate needs were consistently addressed. Staff responded to people's immediate needs when in pain, however, there were inconsistent records of pain medication given across patients' paper and electronic records. Additionally, patient records in AMU showed inconsistency in completing nursing assessments. Staff aimed to complete initial nursing assessments within 24 hours, however following the first 24 hours, nursing assessments were not consistently completed across wards and care planning was incomplete. For example, a medical patient's record in St Mawes ward reflected they had only been reviewed for VTE once, and there had been no further assessment in the following 5 days. In Pheonix Ward, we reviewed a patient's records and found gaps in the written record with the Malnutrition Universal Screening Tool (MUST) and National Early Warning Score (NEWS2) score outstanding. The MUST tool is used to identify a patient's nutritional status and the NEWS2 score is a standardised system to assess the patient's risk of deterioration.

Across wards, there were different structured clinical models that allowed staff to work across multi-disciplinary teams to meet patients' immediate needs. There were clear lines of escalation in the service. Staff we spoke with knew the process for contacting the critical care outreach team and other departments when a patient became critically unwell.

However, there was concern that staff treating medical outliers would not be able to respond to people's immediate needs. Due to the presence of medical outliers on non-medical wards, staff in St Mawes ward (surgical) told us they felt "out of their depth" treating medical patients.

There were initiatives to upskill staff to increase staff availability to respond to people's immediate needs. For example, specialist stroke nurses conducted swallow assessments and were trained to insert nasogastric (NG) tubes to increase the response time of providing medications, fluids, and nutrition for patients suffering from a stroke.

It was clear that patients' wishes were considered in conversations. We found several examples in records of clinicians speaking with the patient and their family to discuss the patient's wishes and plan the immediate next steps. Four out of 5 patients we spoke with told us their wishes were considered.

Patients told us they were consistently provided food and drink. Lunch was served from a hot trolley, and we saw staff check each patient had food. We received mixed feedback from patients on the quality of the food, however the Patient-Led Assessments of the Care Environment (PLACE) scores of the inpatient food were 88.95%, demonstrating patient satisfaction with the food and drink provided.

The environment in the wards was mostly equipped to meet the immediate needs of patients living with dementia and with a learning disability. The PLACE scores for the inpatient wards for people with disabilities was 76% and for people with dementia was 80.6%. `This is Me' booklets were used to support communication and medical plans with patients with dementia.

Staffing shortages and organisational challenges affected staff wellbeing and team morale. In Karensa Ward, staff positively encourage each other to take lunch breaks and offer coverage. However, in the Medical Day Unit (MDU), staff told us they were frequently unable to take breaks and would take lunch around 5pm. Staffing issues affected workload and stress across teams. Staff told us their physical health suffered because of short staffing. In the March 2025 staff pulse survey, only 74% of staff reported that they feel a strong personal attachment to their team, below the trust target of 90%. Although overall staff sickness absence was 4.6%, the lowest since May 2024, staff stress-related absence rates had increased by over 2% from 25.9% in February 2025 to 28% in March 2025. The trust attributed increased staff stress to the increase in communication to staff regarding the trust’s financial challenges.

However, staff told us they felt valued by their teams, their matron, and head of nursing. Staff felt comfortable escalating concerns and initiatives for improvement to their manager. Staff told us that the ward leaders were strong advocates for staff.

The trust had a dedicated wellbeing team currently focused on changing the wellbeing strategy to improve working conditions for staff. The trust sought to create a positive working environment through building emotional resilience and addressing current challenges. In February 2025, the trust received the Gold Defence Employer Recognition Scheme for the organisation’s role in promoting and supporting their employees in the Armed Forces.

Although managers and leaders tried to foster a culture of psychological safety and equality when delivering compassionate care, there were mixed results in the Workforce Race Equality Standard (WRES) Survey 2024.[AH1]For example, in AEM (excluding Emergency Department), 53% of white staff believed that there were equal opportunities for career progression / promotion compared to 48% of staff from ethnic minority groups. In SSS, 52% of white staff believed there were equal opportunities for career progression / promotion compared to 58% of staff from ethnic minority groups. Twelve percent of white staff in AEM (excluding Emergency Department) and 8% of white staff in SSS in the last 12 months personally experienced discrimination from any of the following: manager / team leader or other colleagues. However, 30% of staff from ethnic minority groups in AEM (excluding Emergency Department) and 23% of staff from ethnic minority groups in SSS reported experiencing discrimination from manager, team leader or colleagues.

As part of the wellbeing strategy, emotional wellbeing and resilience training was provided to management staff and leadership. Additionally, Trauma Risk Management (TRiM) training was available for staff to support their emotional wellbeing when dealing with traumatic events. Across the Trust, there were 82 TRiM practitioners with plans to increase the volume through additional training. There was a dedicated inbox for colleagues to request support from TRiM practitioners.

There was clear support for staff professional development from service leadership. Staff told us they had appraisals every 6 months. However, in the March 2025 staff survey, only 77.6% of eligible staff had completed their appraisal, below the trust target of 90%.

The chaplaincy service provided emotional support to staff when needed, offering spiritual comfort and a physical space. There were mechanisms for staff to contact a chaplain for staff support. Staff spoke positively of the chaplaincy providing support to wards after a member of staff had passed away.