Royal Cornwall Hospital

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• 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 good. At this assessment the rating has remained good. We assessed 3 quality statements.

We looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

We observed staff offering compassionate care to patients. Most patients we spoke with told us they were treated with kindness and respect when receiving care. Patients told us they felt reassured by their care. Staff reported the workload still negatively impacted their wellbeing. Staff worked in a highly pressured environment. However, workforce wellbeing was recognised by the leadership team who were trying to develop initiatives to support the staff.

Most staff felt supported by their managers and colleagues due to a strong team culture. However, staff did not feel engaged or involved in operational decision making. Leaders were sighted on the risks to the workforce and the support required.

Maintaining patients’ privacy and dignity in the department was challenging. The crowded nature of the department meant that escalation areas were in use. The use of the temporary escalation areas did compromise privacy and dignity. However, we did not observe incidents of privacy and dignity not being maintained.

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.

The department was crowded, patients were being held and looked after in one of the corridors of the department. We observed patients in the corridor being treated with compassion and kindness although it was difficult to be able to maintain privacy in conversations due to this being an open area. There were portable screens which could be used, and we observed staff taking patients to a private area for any tests or procedures to maintain their dignity.

Although privacy and dignity were difficult to maintain for patients receiving care and treatment in the corridor, the patients we spoke with did not voice any concerns and acknowledged the difficult circumstances staff were working in.

Staff and leaders acknowledged the difficulties in ensuring that dignified care was always upheld for patients in temporary escalation areas and acknowledged the time other patients waited for treatment.

Friends and family survey results from April 2024 indicated 85% had a very good or good experience and 9% had a poor or very poor experience. Performance was slightly better than at our last assessment.

Staff at all levels sought to accommodate patients' needs despite the challenges with over crowding. The IT systems allowed for transparency in patient needs and cultural preferences.

Staff were able to access interpretation services to communicate with patients.

Chaplaincy staff and facilities were available to support patients, carers, and staff in response to cultural, religious, or unexpected needs such as a death. There was a room available for private conversations.

The hospital had a rehabilitation and sensory garden for critically-ill patients. The Critical Care Healing Garden was located immediately below the Critical Care Unit. It has been filled with sensory plants, two outdoor hospital bed spaces, a rehabilitation bridge, and peaceful seating areas for families, carers and staff.

Patients said that staff listened and communicated with them appropriately, and in a way they could understand. Patients told us that they received kind and compassionate care. Patients described being as involved in their care as they wanted, and up to date with all plans.

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.

There were delays in responding to people's individual needs. Data showed long waits in the department. Patients were offered meals three times a day. Hot food could be ordered from the main kitchen within the hospital. Staff offered hot drinks to patients and carers during the day. However, data showed in March 2025 only 76% of patients had been offered a drink within 2 hours of arrival which was the departments target.

The trust scored better than expected for the question on patients being told why they had to wait with the ambulance crew. However, scores for patients being told how long they would wait to be examined or treated, and updated on how long their wait would be, were particularly low for the trust, as well as for England. The trust scored better than expected for patients saying they were told who to contact if they were worried about their condition after they left department.

The department had effective processes and tools for assessing patients when they first presented to the department. Staff used a nationally recognised tool to triage patients.Staff we spoke with knew the process for referral to emergency support, including mental health crisis teams.

Staff provided emotional support to patients, families, and carers to minimise their distress. They understood patients' personal, cultural, and religious needs. Staff gave patients and those close to them help, emotional support and advice when they needed it. The service undertook audits which monitored compliance with staff informing the patient’s next of kin that they were in hospital. For example, the latest data available for March 2025 showed 93% compliance.

Patients and their families could give feedback on the service and their treatment and staff supported them to do this. Patient feedback posters and actions taken by the trust to act upon concerns were displayed in the department and waiting areas.

Staff supported and involved patients, families, and carers to understand their condition and make decisions about their care and treatment. Staff talked to patients in a way they could understand, using communication aids where necessary.

Staff introduced themselves and established a good rapport with patients. Staff across all professions demonstrated caring and attentive attitudes towards patients.

Staff told us they were unable to influence change and contribute to decision-making in the department which impacted them. There was a disconnect between the clinical teams and operational corporate decision making and staff felt a loss of autonomy and influence. Frontline staff delivering the service did not feel empowered to drive initiatives to improve quality and safety. Staff described the pressure they felt in the morning to move patients out of the department, and this had a negative impact on their wellbeing. Staff felt their voice was often unheard. This was reflected in the 2024 NHS staff survey results. Only 46% of Acute and Emergency Medicine (including ED) staff either agreed or strongly agreed that they were involved in deciding on changes introduced that affect their work area. This was worse than the trust average (50%).

The majority of staff told us that they felt supported and valued by their immediate line managers. However, in the 2024 NHS staff survey only 34% of Acute and Emergency Medicine (including ED) staff were either satisfied or very satisfied in relation to the extent of which the organisation valued their work. This was worse than the trust average (40%).

Leaders tried to foster a culture of promoting of equality, diversity and human rights to prioritiorise safe, high quality compassionate care. However, there was mixed results in the Workforce NHS Workforce Race Equality Standard (WRES) Survey 2024. For example, 56% of white staff (working in ED) believed that there are equal opportunities for career progression / promotion compared to 45% of ethnic minority groups. Twelve percentage of white staff in the last 12 months personally experienced discrimination from any of the following: Manager / team leader or other colleagues compared to 30% of ethnic minority groups.

Senior leaders voiced concerns relating to their wellbeing and having no time protected time. For example, meetings ran until late in the evening. Senior leaders told us that they were worried the current pace of change was not sustainable for staff wellbeing. Senior leaders worked hard to provide wellbeing support to staff. For example, they arranged a summer ball for staff.

Staff we spoke to valued the yearly session with their team members to undertake required training and attending the governance meeting in the afternoon.

The service supported staff with an induction programme when they joined the department including a period of supernumerary status and time to gain experience in different parts of the department. There were opportunities to undertake training relevant to the emergency department as well as simulation training. There was a "train to retain" staff culture by supporting staff to develop. New staff were assigned a mentor for support and guidance. There were initiative ideas to support staff in training, wellbeing and development. For example, "Turbo Tuesday" which was a quick 10 minute teaching session open to all staff and Thursday Learning Club (TLC). Training sessions focused on relevant areas. For example, acute illness management, mental health and non invasive ventilation.

There was an inclusive organisational culture which enabled staff to have a sense of belonging. This was reflected in the Trust Strategy 2023-2032, which included "We Are Royal Cornwall Health Trust" Operational Development programme for 2024/25 as a key pillar. The review of Year 2 and next steps paper which was recently presented at sub board committees outlined progress to date. For example, the initial targets in leadership and values-based training had been met. However, phases focused on Equality, Diversity & Inclusion and Wellbeing have been delayed due to staff capacity challenges.

There were support mechanisms in place to support staff in the event of catastrophic events including a Trauma Risk Management (TRiM) debrief and the chaplaincy team. Sixty six clinical staff trust wide had completed TRiM training staff were encouraged to complete a TRiM referral for any potentially traumatic event. TRiM is a trauma-focused peer support system

Leaders were aware of the demands of the department and staff wellbeing. The majority of staff told us that although they were very busy, they could take their breaks.