University Hospital Aintree

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 inadequate. At this assessment the rating has improved to requires improvement.

People experienced long wait times and felt that there was a lack of clarity regarding how long they would wait to help manage their expectations and relieve any uncertainties they had. Patients arriving at the department in an ambulance experienced delays with their care and treatment being handed over to hospital staff. When a decision was made to admit patients, delays were experienced waiting for a bed on a ward. However, people were involved in decisions about their care. The service provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it. The service was easy to access and worked to eliminate discrimination. People received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback. People participated in planning their care.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

Patients told us they had an appropriate assessment of their health needs. Patients in temporary escalation areas told us staff met their emotional and health care needs. Patients told us they were consulted about their treatment plan and care in general. Patients told us they had their tests completed and treatment plan explained to them, and they were satisfied with the standard of care, referring to staff as “excellent” but acknowledging the wait time saying, “It couldn’t be helped.”

Staff considered patients' individuals needs and preferences. They undertook risk assessments to identify specific needs such as nutrition, hydration, and pressure ulcers. Patients were provided with food, blankets, pressure-relieving equipment and additional pillows. All staff were able to articulate Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) and patients’ needs and preferences were recorded on the daily notes in the electronic patient record.

An advocacy team was available to support those patients with additional needs and requirements.

The discharge lounge was available during the day for those patients who could go home and were waiting for transport or medicines.

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.

There was available information 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 WHO 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.

Staff regularly walked around the waiting areas to check on patients. In addition, we observed staff engaging with patients to give them regular updates such as expected wait times.

The treating clinician was responsible for providing the discharge advice and ensured it was in an accessible format for the patient. When altering or adding medication, this was written down for the patient as well as communicated to their GP via electronic discharge letter sent straight to the surgery.

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.

Most patients we spoke with told us about long wait times they had experienced whilst in the emergency department. Patients waited long periods of time in the department after the decision to admit had been made; in excess of 40 hours. People and their loved ones told us that more clarity regarding wait times for admission to ward areas would have helped manage expectations and relieve any uncertainties they had.

People could not always access care, treatment, and support in a timely manner due to capacity constraints and patient flow across the hospital. There had been increased attendances during 2024, and the full capacity protocol was used 99 times within the last year.

Leaders and staff acknowledged that people could not always access support and treatment in a timely manner due to patient flow and capacity issues. Delayed discharges on wards for patients awaiting social care provision were partly responsible for this. Staff we spoke with said patient flow issues had become normalised and that this was demoralising. They told us the temporary escalation area and waiting room areas were not ideal for patients and posed a risk. Lack of beds available to admit patients into impacted on ambulance handover times as additional patients were in the department. Staff followed the streaming pathways to manage patient flow pressures. They understood the full capacity protocol and worked to admit patients in a timely manner where possible. Staff were aware of how they could make reasonable adjustments for patients and had access to language and British sign language interpreters. Leaders and staff were alert to discrimination and inequality that could disadvantage certain groups of people. Leaders were knowledgeable about the impacts of socio-economic deprivation which affected the local area.

The number of patients admitted, transferred or discharged in line with the four-hour target was low at 28.1% in October, 25.4% in November and 25.9% December. Of those patients requiring admission 35% to 45% waited between 4 to 12 hours between October to December 2024. Patients waiting longer than 12 hours for admission to a ward ranged between 16% to 20% for the same period.

Ambulance crews told us that they often waited for lengthy periods to hand over patients and as a result leaders were working closely with the trust to improve ambulance handover times. The average ambulance handover time in October and November 2024 was 81 minutes, for December 2024 this increased to 87 minutes. Handover times were longer in winter than summer months which averaged at 47 minutes.

Ambulance handover delays between 30 and 60 minutes were high at:

• 512 during October 2024
• 519 during November 2024
• 445 during December 2024

Ambulance handover delays of more than 60 minutes were also high at:

• 634 during October 2024
• 838 during November 2024
• 741 during December 2024

The handover delays were above regional and England averages.

Those patients awaiting review by an appropriate mental health clinician within one hour of referral ranged from 69.6% in September to 61.9% in November 2024.

There were 187 identified as having no criteria to reside in hospital in October, 200 in November and 196 in December 2024; this was impacting on the flow through the hospital and resulting in the escalation spaces being used in the emergency department. The trust was working closely with the local community and mental health trust and local authority to minimise delays for patients medically fit for discharge.

Re-attendance to the emergency department within 7 days of a previous attendance for the period August 2024 to November 2024 was 2,750 people. Between October 2023 and September 2024, the most recent available data, the percentage of unplanned reattendances ranged from 8.7% and 9.8%. which was a higher percentage of unplanned reattendances compared to the regional and national average, with the exception of October 2023 and July 2024 where the percentage of reattendances were in line with regional and national figures.

For the same time period, around 8% of patients left the emergency department before being seen.

The clinical leads used the electronic patient record system which provided an overview status of each patient in the emergency department. Clinical leads and shift leaders reviewed every patient at the 2 hourly board rounds. This enabled leaders to staff the different areas in the emergency department based on patient need and also expedite any care and treatment needs.

The bed management team held meetings with leaders throughout the hospital 5 times a day to review resources available to patients and staffing needs.

Staff had completed equality and diversity training. Mandatory training compliance for Equality, Diversity and Human Rights was 92% for medical staff and 97% for nursing staff. The service had clear pathways for patients with dementia, mental health difficulties, autism and learning difficulties and made reasonable adjustments for patients when required.

People who used the service, including people with disabilities, said it was easily accessible. Patients we spoke with did not experience any physical or digital barriers when accessing the emergency department.

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.