New Royal Liverpool University

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. At this assessment the rating is good.

Staff understood the diverse health and care needs of people and the local communities. Appropriate, accurate and up-to-date information was provided in formats tailored to individual needs. The service actively sought out and listened to information about people who were most likely to experience inequality in experience or outcomes. Care, support and treatment was tailored in response to this. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People did sometime experience delays waiting for a bed on a ward, particularly during busy periods.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People's experience

Most service users understood their care options and felt it had been conveyed to them in a way they understood. The majority told us they had had the opportunity to ask questions about their care. The 2023 CQC National Inpatient Survey reported LUHFT scored 10th out of 120 acute trusts for overall patient experience, and 21st out of all 131 trusts including specialist trusts.

Feedback from staff and leaders

Staff understood the importance of person-centred care and how to deliver it. Staff told us their workload had improved from when they worked on the old site, but when they did not have additional staff for one to one care it was harder to manage.

Staff could describe how they used patient passports and 'This is me' documents to get to know patients and their individual preferences.

For Liverpool Quality Assessment (LQA) end of life and person centred audits for 17 medical wards, none were graded as red (79% or below), 1 was graded as silver (80-90%), and 16 were graded as gold (90-100%).

Observation

We observed staff utilising personalised care plans on all wards. We observed rooms with information indicating the patients’ preferences and any special diets. Where required, staff used coloured trays to differentiate nutritional needs. Staff, including the ward clerks, assisted with mealtime and stopped any other non-critical tasks they were doing.

Patients were risk assessed on entry to the ward, including those who were waiting for a bed. We did not observe more than one patient waiting for a bed on a ward at any time. All patients were reviewed in the patient safety meeting to share learning across the ward environment.

Patients waiting for a bed were provided with privacy screens at the end of a zone and most had access to an accessible toilet. Manual bells were given to patients as no integral call buzzers were in situ. The trust confirmed they had a schedule to enhance these spaces with integral call buzzers.

Care plans and risk assessments were observed to be up to date and patients had the equipment they needed (for example, falls mats).

People's experience

Patients we spoke with told us their care needs were met and they were reviewed daily by a doctor. Therapy staff were based on the ward, which was beneficial as they were available to speak with if they had any queries. Staff worked together as a team and provided patients with information relevant to their condition.

Feedback from staff and leaders

Staff could describe the support and referral systems in place for patients experiencing other conditions such as poor mental health, those with a learning disability or living with dementia. Staff had good links with the trust's re-ablement service and community re-ablement services and planning for continuity of care started on admission. Staff were aware of health inequalities, local deprivation levels and how this impacted on people's health. Particularly long-term health conditions related to breathing and cardiac problems.

Staff took on link roles with specialist services to share best practice when caring for people with complex needs. This included learning disability, dementia, diabetes and a range of other conditions.

Staff and leaders were aware of the challenges across the health and care system in the local area and worked with community stakeholders and commissioners to continually review services. An example of an improvement made was discharge co-ordinators liaised directly with care providers, if the patient had a short stay in hospital, to ensure care packages continued on discharge.

Observation

Discharge planning meetings took place and staff had good knowledge of local support services as well as those further afield. We saw how complex discharge plans were made for people who took ill visiting the city of Liverpool, liaising with families and travel services to get them home. Staff had good relationships with local social care services and care staff visited the wards regularly to assess patients who were ready to be discharged into residential or nursing care.

Social workers were available to support with complex discharge planning, however they sometimes were not able to attend the daily discharge meetings due to availability. Staff told us this had been fed back to leaders and it was under review.

Observation

There was available information on what to expect and the process within each of the ward departments and units across medicine. There were posters and leaflets written to advise patients. Leaders had written an information sheet to advise those patients were 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.

All the bed tables in the medical assessment unit had a wipeable informative sticker advising patients of visiting times, the unit telephone numbers, description of staff uniforms, what to expect and discharge information. Patients reported this was really helpful as the information was to hand, particularly if they were speaking with relatives on the telephone.

Digital displays outside of each patient’s room recorded dietary preferences, mobility aids required and other information that was regularly updated as the patient's requirements changed.

Discharge co-ordinators worked with clinical and medical staff co-ordinating patient’s discharge. We observed how they kept the patient up to date with developments and provided written information for the patient to take home in a format that was accessible to them. 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.

During the assessment we noted signage for patients was available in braille and some signs were being replaced to be more accessible to all.

People's experience

Patients and their families told us they felt listened too. One patient had made a complaint directly to the ward manager and they had received a satisfactory verbal response.

Patients spoke positively about their experience in the trust and the inpatient satisfaction score from the NHS Friends and Family test for January 2025 reflected this at 93.8% being satisfied.

Feedback from staff and leaders

Staff could describe the complaints policy and their role in reporting and escalating them. Leaders told us the main complaint themes were waiting times to be admitted to the ward and communication. The trust was working with the valuing patient time collaborative to improve patient communications and using technology to update people with general information. Leaders told us by using patient stories in meetings they were able to share patient experiences and put the patient at the heart of everything. They reported it was a good exercise to promote reflective practice amongst staff and leaders.

Information boards on wards displayed appropriate learning and positive feedback so staff and patients could read it.

Leaders reported they spoke with patients daily and reviewed emerging complaints, incidents, themes or concerns. It was common practice that ward managers deal with complaints, but leaders were on hand to support. Staff told us there was a culture of shared learning not blame.

Processes

For Liverpool Quality Assessment (LQA) communication audits for 17 medical wards: 0 were graded as red (79% or below), 2 were graded as silver (80-90%), and 15 were graded as gold (90-100%).

The division had a complaints procedure which was displayed on noticeboards on the wards. There was a patient advice and liaison team at the site and contact information was on display, including in the most commonly spoken languages.

Learning from complaints and incidents was shared with staff in a number of ways including email, noticeboards, training and face to face daily briefings.

Staff could provide examples where feedback from patients had been received that led to a change in the ward environment. For example, the provision of sensory communication aids to assist communication in an accessible manner.

People's experience

Patients who were waiting for a bed on a ward told us they had experienced long delays waiting in the assessment unit or on the ward. Whilst they felt cared for and looked after, they described the situation as not being ideal.

Some patients told us they were admitted directly to the ward from accident and emergency, particularly those with a cardiac condition, which meant they were admitted for in a timely way to the right specialism.

Feedback from staff and leaders

Staff described how they worked to improve patient experience. Their job was aided by good support from managers and access to interpretive services.

Staff reported that generally patients waited for short periods for a bed but acknowledged longer waits during busy times. Staff described having an additional patient on a ward was manageable, but sometimes they felt concerned for the patient's privacy and dignity. Leaders reported they were taking steps to improve privacy and dignity in these spaces.

Processes

Patients were generally able to access the care they needed when they needed it, however patient need was prioritised and sometimes others would experience a wait. At times of high acuity the continuous flow model meant some patients were boarded. There was a clear inclusion and exclusion criteria to identify which patients who could wait for a bed on a ward. We saw how areas on wards had been adapted to suit patient needs.

The Continuous Flow Model was implemented in February 2024. It stated temporary boarding spaces should only be used when all other options were exhausted. The locations of boarding spaces were selected to allow staff the ability to provide safe care. The spaces were equipped with resources to maintain privacy and dignity, access to maintain personal hygiene needs and call bells were being installed There were power supplies to ensure equipment could be plugged in and charged.

Leaders told us they worked with safeguarding and support teams to transition patients safely home. Staff gave examples of transitional packages of care that patients were discharged with which ensured patients and family or staff at care homes know what time to expect them and their needs. Patients could be referred to the homelessness team and drug and alcohol outreach teams. However, these services were not always available during the out of hours period.

The trust reported they were working towards the revised national planning targets to eliminate patients waiting more than 65 weeks and reported a month on month reduction; in September 2024 there were 131 patients reduced from 228. Despite making progress towards this target, the trust has yet to meet them.

At the Royal site there were 8,440 patients waiting on the referral to treatment (RTT) waiting list at the end of September 2024. The waiting list growth specifically related to Hepatology, Endocrine, Gastroenterology, Respiratory and Cardiology. The waiting list was monitored at weekly divisional performance meetings and patients continued to be booked in based on clinical priority.

RTT Performance for the Division of Medicine at the Royal was 67.26% for people waiting less than 52 weeks for treatment in September 2024 which was better than the trust overall (Trust reported 52.29%).

The trust report patients waiting 52 weeks or less had reduced steadily since January 2024 showing a statistical improvement 8 months consecutively.

Data demonstrated that 96% of discharge medication was dispensed within 2 hours and there had been improvement in the administration of time critical medications such as for Parkinson's disease with audits achieving 99.1% compliance in July 2024, demonstrating a steady increase from December 2023 where compliance dipped to 96.69%.

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.