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 assessment we rated this key question requires improvement. The service was in breach of legal regulation safe care and treatment due to crowding and waits in the emergency department. At this assessment the rating has remained the same. We assessed 3 quality statements

We looked for evidence that the service met patient's needs.

Staff tried to provide equity in access to care and treatment. However consistent with our previous assessment, we found patients who attended the emergency department who needed admitting as an inpatient, experienced long waiting times in the department.

Due to challenges with flow in the hospital patients did not always have access to care and treatment in the emergency department when they needed it.

Patients continued to wait long periods for admission. There were examples of long stays in the department whilst patients waited for an appropriate place of care. This included extended waits in environments that not designed for patient care.

Staff were committed to making reasonable adjustments where required and listened to people's concerns to improve the service. However, this was not always possible due to overcrowding in the department.

However, the service generally delivered person centred care. Patients were involved in decisions about their care. The service provided information people could understand. Patients knew how to give feedback and were confident the service took it seriously and acted on it.

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 majority of patients we spoke with told us that they felt they were at the centre of their care and treatment. Patients felt involved in planning and making shared decisions about their care and treatment. In the UEC Survey 2024, in relation to the question, were you involved as much as you wanted to be in the decisions about your care and treatment', the hospital scored similar to other trusts.

Patients told us they had had an appropriate assessment of their health needs and they were consulted about their treatment plan. Patients were very understanding of the pressures faced by the staff. Patients told us they had their tests completed and treatment plan explained to them, and they were satisfied with the standard of care.

Staff generally considered patients individuals needs and preferences. They did not always complete risk assessments to identify specific needs such as nutrition, hydration, and pressure ulcers. Staff we spoke with were aware of the need to undertake risk assessments, how to undertake them and who to contact for support. However, staff said due to the operational challenges they did not always have time to complete them.

Patients were provided with food, blankets, pressure relieving equipment and additional pillows.

Specific patients' needs were flagged on the electronic systems. For example, there was a specific tag for patients living with dementia. Patients living with dementia were often placed near the nursing station to enable good oversight of their needs.

Staff were committed to trying to make reasonable adjustments to help patients access services. However, due to overcrowding this was not always possible. The department had access to translation services. There was a multi-faith room on-site for staff and patients with a chaplain team available to visit bedside upon request.

We saw positive interactions between staff and patients with complex needs to ensure they remained settled in the department. Staff made sure patients living with mental health problems, learning disabilities and dementia, received the necessary care to try and meet all their needs. Staff told us that resources were available for patients living with dementia including a twiddle sleeve provided by volunteers. There were also link workers available to provide additional support and advice to staff for supporting patients with learning and mental health difficulties.

The department had hearing loops for people with a hearing impairment. A hearing loop delivers the sound from a sound source such as a microphone, direct to a user's hearing aids.

The environment of the Children's ED was child-friendly including a variety of toys available. There was not a dedicated play specialist within the Children's ED. Staff could request support from play specialists from the Children's ward if required. Staff had undergone training in distraction techniques to minimise stress and anxiety in children. Staff working in the Children's ED had access to \"Don't Forget The Bubbles\" (DFTB) an online educational resource for paediatric medicine, particularly emergency medicine. It's a platform created to share knowledge and insights related to caring for children, aiming to improve patient care and support the learning of healthcare professionals.

The trust had Butterfly Companion Volunteers Offering companionship to patients at the end of life. The team was recruited and trained with support from, a national charity.

Patients were encouraged to use a hospital passport which helped inform hospital staff about the needs of the person with a learning disability and how to support them. Staff told us they had used them previously and were familiar with their use.

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 service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was information available on what to expect and the process within the emergency department. There were posters and leaflets written to advise patients. Leaders had written an information sheet to advise those patients were residing in temporary escalation areas to apologise that a room was not available on a ward, why this happened and how patients should expect to be treated.

The service provided real time waiting information for patients arriving in the ED Digital displays reporting wait times were available to patients who had not yet been treated and regularly updated. In addition, the trust's website clearly displayed current wait times at the 10 minor injury units within Cornwall.

Patients could expect information to be tailored to individual needs. This included making reasonable adjustments for disabled people and interpreting and translation.

The trust's IT systems did not link up with system partners such as 111 so information could not be shared easily. However, the emergency department's IT system did link with the minor injury units so information could be shared easily if a patient was redirected to one of the minor injury units.

The Urgent and Emergency Care Survey 2024 showed the trust scored similar to other trusts for questions relating to the time they spent waiting and being involved in their care.

The majority of patients we spoke with considered they had received enough information about their condition, care and next steps.

Patients were informed as to how to access their care records. The patient had Patient secure online portal (secure website) which allowed access to all hospital outpatient appointment information in one place, by using a smartphone, tablet, or computer. Patients could rebook, or cancel hospital appointments online and access supporting information, including appointment letters.

There was a variety of information available in relation to health care, either displayed publicly on walls or screens or as part of leaflets and other materials. Information was provided in different languages and large print if required.

Discharge letters were sent electronically to GPs and other professionals if required (for example community nursing). Patient paper records were stored securely.

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 did not always provide care in a timely way. The whole hospital as well as the emergency department was exceptionally busy as had been the case for many years. Data showed that between January 2025 and March 2025 the average time a patient spent waiting for admission to a ward was 5 hours 36 minutes.Data indicated in the last 12 months the hospital performed consistently worse than the England average for all patients waiting more than 12 hours from arrival to admission. The latest data available (February 2025) indicated 12.6% of all patients waited more than 12 hours in the department.

Leaders and staff acknowledged that people could not always access support and treatment in a timely manner due to patient flow and capacity issues.

The emergency department was worse than the regional and national average for patients waiting less than 4 hours from arrival to admission, discharge or transfer. Data showed between October 2024 and March 2025 on average 46% of patients had a decision to admit, discharge or transfer within 4 hours of arrival. Performance had improved since the rate of 39% in October 2024. Between January 2025 and March 2025, the average time a patient spent in the department was nearly 6 hours against the standard of 4 hours.

Staff told us long delays in these areas were common. During our assessment on the 8 April at 9:15 am there were 58 patients in the department. The longest wait for a patient requiring a ward bed was 18 hours, there were 16 patients who had waited longer than 12 hours for a bed and a total of 29 patients waiting for a bed.

Lack of beds available to admit patients impacted on ambulance handover times as additional patients were in the department. Data showed between January and March 2025 on average ambulance handover took more than 1.5 hours which was more than the national target of 1 hour. The trust and local ambulance provider had implemented Timely Handover Process (THP90) to address this.

The national standard is that patients should have their first initial assessment within 15 minutes of arrival. Data showed variable compliance with this standard. Between January 2025 and March 2025 this standard was met on average 70% of the time.

The service had policies and procedures for escalation and care of patients in temporary escalation areas to mitigate the main risks from crowding. The hospital had processes to monitor performance and quality against national targets and standards.

There was a constant focus by staff on the issues with crowding and capacity pressures in the department. We were told by all those staff we met that the pressure they were under and how this affected their ability to provide safe and quality care was a constant worry. There was recognition and support from the wider health and social care community who understood the pressures and the need to respond as a system. At the time of our assessment the trust was participating in a system wide "Perfect Fortnight" in the run up to Easter which ran between 7 and 17 April 2025. The trust had 5 pledges to reduce pressure on the department when there was an increase in the number of visitors to Cornwall. There was a "wash up" exercise completed for feedback and key learning points followed by a debrief.

The department was fully accessible to patients with disabilities or who used a wheelchair.

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.