Royal Cornwall Hospital

On this page

• 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

At our last inspection we rated this key question requires improvement. At this inspection the rating remained the same.

We looked for evidence that the service met people’s needs.

We assessed 3 quality statements on equity in access. Flow challenges and staffing issues meant people did not always receive timely access to care. People did not always feel listened to and they received conflicting information. The trust had awareness of their populations needs and worked with partners to address health inequalities, and patients with dementia and learning disabilities had access to support and resources.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The physical and mental needs of patients were not always considered when developing care plans. Four out of 5 patients’ records we reviewed had clearly documented patient and family involvement at all sets with the patients’ needs considered. However, patients told us they did not always feel listened to by staff. Nursing staff advocated for patients and complaints from Acute and Emergency Medicine (AEM) and Specialist Services and Surgery (SSS) patients highlighted that patients similarly did not always feel listened to by staff members when they raised concerns.

The service had resources to support the care needs of patients with dementia and learning disabilities and worked towards ensuring that its workforce had the right skills and knowledge to provide safe, compassionate, and informed care to autistic people and people with a learning disability. The service commenced its roll-out of the required Oliver McGowan Mandatory Training on Learning Disability and Autism (Tier 2) in March 2023, and demonstrated commitment by recruiting and training its own experts and facilitating trainers to build their Oliver McGowan team. At the time of our inspection, 21.3% of all staff had completed this training. NHS England has recognised that it may take up to 3 years for large employers to fully roll out this programme.

The service provided support boxes to patients living with dementia and learning disabilities to alleviate the stress of the experience. “This is Me” booklets were available for patients living with dementia and hospital passports were available for patients with a learning disability. Although it was unclear that these communication booklets were used to inform care decisions. For example, there was a “This is Me” booklet within a medical patient’s record in St Mawes ward. However, it was placed at the back and staff felt it was not used to influence communication with the patient.

Protected characteristics under the Equality Act were identified and considered in patient records. Appropriate steps were taken for patients with MCA and DoLs. DoLs applications were present, and the patient’s support network was involved in discussing the patient’s best interests in the care plan.

Following the Healthwatch April 2024 report and the Family and Friends Test results, the service worked to provide tailored mental health support for armed forces members and veterans.

Staff and the trust supported patients and their families when experiencing a distressing diagnosis. The service ensured there were care plans and volunteers were available to support family members.

Staff used online translation services and the trust’s language line when communicating with patients who did not speak English. For example, a patient living with dementia who did not speak English was unsettled and refused to eat or drink. Staff used online translation services to help the patient feel comfortable.

The service was mindful to minimise unnecessary patient transfers and used visual mechanisms to discourage transfers. If a patient had been moved 3 times or more, the patient’s identifier would be purple in the ward.

The service tailored the patient discharge to each patient. Discharge coordinators worked with each patient to explore all applicable resources such as the homelessness team or the virtual ward to coordinate a safe discharge.

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.

The trust used online translation and language line to communicate with patients who do not speak English including British Sign Language.

The trust’s website provided clear and accessible information for patients and their families on what to expect throughout the patient journey in the medical care service. There was information about visiting hours and important information to know for each ward, including ward telephone number and matron name, on the trust’s website.

There was clear information on the trust’s website on expected waiting times for first outpatient appointment, diagnostic waiting times, and referral to treatment waiting times. Each wait time list was broken down by specialty and showed how frequently the page was last reviewed by the trust, providing transparent and up-to-date information for patients.

There was clear signage for patients in the medical ward on how to provide feedback to the service. The signage included information about the steps the service takes after receiving feedback.

Discharge letters were sent electronically to GPs and other specialists if needed.

However, there was mixed evidence that the service supplied up to date information for people using the medical care services. We spoke with one patient who stated staff had updated them on test results in an accessible and timely manner. However, another patient’s relatives told us that they had not been updated on their care. Another patient stated that they had been told differing information by different members of their MDT. A total of 76 complaints were received between October 2024 and March 2025 for medical services. Lack of communication and conflicting information were among the top complaint topics.

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 was aware of the population’s health inequalities and worked with partners to address the population needs. The trust’s quality assurance committee met with the Cornwall Partnership NHS Foundation Trust and reviewed information from partners, including Healthwatch, to shape the trust’s health inequalities agenda.

There were accessible toilets in the main corridor of the medical care services. These toilets had automated voice recordings to provide directions on the layout for patients with visual impairments.

There were processes to move patients to their appropriately allocated wards. However, because of flow challenges across the hospital, patients were not able to access services in a timely way. For example, There were high rates of delayed discharges due to a high volume of medical outliers in wards, short staffing of specialty doctors on weekends, and short staffing of occupational therapists and physiotherapists in the Early Supported Discharge (ESD) team. The high rate of delayed discharges had a knock-on effect, directly impacting ED admission rates.

Short staffing impeded discharge flow and patient care progress. Staff told us it was difficult to find a specialty doctor to review a patient on the weekend and to make an agreement to discharge medical outlier patients at the weekend. Additionally, the staffing levels of Occupational Therapists, Physiotherapists, and social workers on the ESD team for stroke patients were below operational need due to the volume of referrals in Cornwall and the Isles of Scilly. The trust was completing a capacity and demand exercise to inform a case for further expansion of this team.

To address these discharge challenges, the trust employed discharge coordinators. The discharge coordinator attended board rounds and liaised with transportation and community services to ensure patients were appropriately supported during discharge.

The trust collected patient feedback to improve the patient pathway. The AMU used two iPads to collect patient and family feedback prior to discharge to improve the patient experience. Responses were reviewed and discussed at ward meetings.

The trust had also made significant improvements to waiting lists for trust-wide services and the cancer treatment pathway. Patients waiting over 65 weeks for access to services trust wide improved from 1,603 in January 2023 to 16 in March 2025.

The trust’s March 2025 IPR report showed that the trust’s combined 28 day performance and combined 62-day performance in cancer diagnosis and treatment exceeded the national targets. The trust’s combined 31-day performance of 89.8% sat just below the England average of 91.8%. The trust was developing an improvement plan to address these rates as part of the 2025/26 operational planning.

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 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.