- NHS hospital
Royal Cornwall Hospital
Assessment report published 29 August 2025
Contents
Ratings - Urgent and emergency services
Our view of the service
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.
People's experience of this service
Most patients, families and carers we spoke with were positive about the staff, who treated them with warmth and kindness. The majority of patients said communication with them was good and they were kept informed of their care and treatment. Patients said they were seen quickly when they arrived and were asked appropriate questions to find out more about why they had attended the ED. Records we reviewed showed they were given the tests they needed usually promptly. Although care was being delivered in temporary escalation areas, we observed staff interacting with patients in these areas and staff apologised to patients for delays.
There were really good examples of the ED team using MDT working to treat patients' comprehensive needs which included using the learning disability team and the homeless patient advisor to obtain the background history of a patient history. There were examples of joined up care within the trust, however the discharge process and discharge planning was lacking especially for 1 out of 5 of the patients we spoke to.