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Peterborough City Hospital

Overall: Requires improvement read more about inspection ratings

PO Box 404, Bretton Gate, Peterborough, Cambridgeshire, PE3 9GZ (01733) 673758

Provided and run by:
North West Anglia NHS Foundation Trust

All Inspections

04 - 06 April 2023

During an inspection looking at part of the service

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at Peterborough City Hospital.

We inspected the maternity service at Peterborough City Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

Peterborough City Hospital is based in Peterborough and is part of the North West Anglia NHS Foundation Trust. The hospital provides maternity services to women living in the city of Peterborough, North Cambridgeshire, areas of east Northamptonshire and Rutland.

The Peterborough City Hospital maternity unit comprises of a maternity day care unit, antenatal clinic, maternity ward (antenatal and postnatal), transitional care ward, triage unit, delivery suite, maternity led unit, home birth service and a community midwifery service. Additional antenatal and postnatal services are provided at the sister site, Hinchingbrooke Hospital. From March 2022 to February 2023, there were 4,111 deliveries at the trust.

We last carried out a comprehensive inspection of the maternity service in 2019. The service was rated requires improvement for safe, good for effective, caring, and responsive and inadequate for well-led. The service was judged to be requires improvement overall.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out an announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

We did not review the rating of the location therefore our rating of this hospital ​stayed the same​

Peterborough City Hospital is rated Requires improvement.

We also inspected the other maternity service run by North West Anglia NHS Foundation Trust. Our reports are here:

Peterborough City Hospital - https://www.cqc.org.uk/location/RGN80

Hinchingbrooke Hospital - https://www.cqc.org.uk/location/RGN90/

28 February 2022

During an inspection looking at part of the service

North West Anglia NHS Foundation Trust provides acute hospital services across three sites. At the time of our inspection, urgent and emergency care services were being provided across two sites from Peterborough City Hospital and Hinchingbrooke Hospital. The trust employs approximately 7,073 members of staff and is supported by approximately 452 volunteers.

We undertook an unannounced focused inspection of Peterborough City Hospital urgent and emergency care services and medical care services (including older people’s care) on 28 February. We also had an additional focus on the urgent and emergency care pathways across Cambridgeshire and Peterborough and carried out a number of inspections of services across a few weeks. This was to assess how patient risks were being managed across the health and care services during increased and extreme capacity pressures.

As this was a focused inspection at North West Anglia NHS Foundation Trust, we only inspected parts of our five key questions. For both core services, we inspected parts of safe, responsive, caring and well led. We included parts of effective in medical care. We did not inspect effective in urgent and emergency care at this inspection but would have reported any areas of concern.

The emergency department at Peterborough City Hospital was previously rated as requires improvement overall with safe, responsive and well led being rated as requires improvement and effective and caring being rated as good. Medical care was previously rated as good overall with all key questions rated as good.

For this inspection, we considered information and data about performance for the emergency department and medical care. This inspection was partly undertaken due to the concerns this raised over how the trust was responding to patient need and risk in the emergency department and the wider trust in times of high demand and pressure on capacity. We were concerned with waiting times for patients, delays in their onward care, treatment and delayed discharges, as well as delayed and lengthy turnaround times for ambulance crews.

We looked at the experience of patients using urgent and emergency care and medical care services in Peterborough City Hospital. This included the emergency department, medical wards and areas where patients in that pathway were cared for while waiting for treatment or admission. We visited services and departments that patients may encounter or use during their stay. We also went to medical wards where patients from the emergency department were admitted for further care. This was to determine how the flow of patients who started their care and treatment in the emergency department and those cared for on medical wards, was managed by the wider hospital.

System wide summary

A summary of CQC findings on urgent and emergency care services in Cambridgeshire and Peterborough.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for Cambridgeshire and Peterborough below:

Cambridgeshire and Peterborough

Provision of urgent and emergency care in Cambridgeshire and Peterborough was supported by services, stakeholders, commissioners and the local authority.

We spoke with staff in services across primary care, urgent care, acute, mental health, ambulance services and in care homes and domiciliary care agencies (social care). Staff had worked very hard under sustained pressure across health and social care services. Staff reported feeling tired and frustrated due to the sustained pressure and the impact this had on their wellbeing and on the delivery of training.

We identified a need for more capacity in primary care to meet people’s needs in Cambridgeshire and Peterborough. We found some concerns in relation to access for patients trying to see or speak to a GP; however, other services proactively reviewed patients’ attendance at emergency departments and took action to reduce avoidable attendances and improve access to appointments.

We visited a primary care unit run by an acute trust; whilst this was working well, we were told it was addressing an issue in access to primary care and was a short-term solution. We were told of a GP liaison service which enabled GPs and Consultants to work together to discuss individual patient needs. This service had successfully supported a significant number of people to stay at home or to access an alternative pathway and avoid going to an Emergency Department.

Access to NHS111 services for people in Cambridgeshire and Peterborough was generally in line with or better than elsewhere in England. Performance was closely monitored and there were plans in place to address staff shortages, particularly for health advisors, and there was a successful on-going recruitment campaign.

System partners in Cambridgeshire and Peterborough had been part of a collaborative project to launch a Virtual Waiting Room within the Cambridge and Peterborough region. The initiative aimed to help patients who call NHS 111 receive the care they need while alleviating the pressure on Emergency Departments (EDs).

Staff working in ambulance services reported a significant volume of calls which were inappropriate for a 999 response and could have been dealt with in primary care or urgent care services. Staff also reported a high number of elderly people seeking support through emergency services because they felt their care packages were insufficient and did not meet their needs.

Ambulance crews also highlighted their frustrations with the variation in pathways at different hospitals across Cambridgeshire and Peterborough and that ambulance crews were not prioritised for accessing alternative pathways. By streamlining pathways and handover arrangements, ambulance crews felt they could be more efficient.

For many complex reasons, including ambulance handover delays and staffing shortages, there were not enough crewed ambulances to respond to 999 calls within national targets. This posed a risk to people in the community waiting for a 999 response.

Staffing shortages in some Emergency Departments impacted on the delivery of safe and effective care. Staff were not all up to date with mandatory training and did not always assess risks appropriately.

We visited a mental health service and found it met the needs of people who presented in the Emergency Department or transferred between acute and mental health services. However, staff within Emergency Departments reported problems in accessing mental health services and were not able to make referrals 24 hours, seven days a week. This impacted on the ability to provide appropriate care and treatment and moving patients to the appropriate service.

Whilst we found some examples of collaborative working focused on developing system wide resilience, we found Emergency Departments remained under significant pressure. Patients experienced significant waiting times in these departments and staff reported the challenges of caring for patients within the department for such long periods of time. Some staff felt too much risk was accepted and held within emergency departments and didn’t always feel supported by system leaders.

Same Day Emergency Care pathways aimed to relieve the pressure from Emergency departments. However, these services also experienced staff shortages, and some were only available during set times. Opportunities were lost to use admission avoidance pathways for the frail and elderly and increasing the risk of patient harm such as falls and skin pressure damage’

Delays in discharge for patients in hospital were significant and impacted on their health and wellbeing. Staffing issues were also impacting on the social care provision in Cambridgeshire and Peterborough; although there were beds available in care homes, there was not always enough staff to enable admissions. The staffing issues were also present in domiciliary care agencies which reduced the availability of care at home.

Staff working across health and social care reported poor discharge processes. Staff working in care homes and domiciliary care services reported that patients were often discharged late at night and with insufficient information to ensure a safe transfer of care.

Staff working in these services also reported significant delays in ambulance responses, however they gave very positive feedback in relation to welfare calls received by GPs or 111 and 999 call handlers.

We found a lack of knowledge across social care services in relation to managing deteriorating patients. By increasing staff awareness, services may be able to meet people’s needs without needing to request emergency services.

We observed some local and system escalation meetings and found there was limited, if any action taken in response to issues and risks escalated.

Summary of North West Anglia NHS Foundation Trust – Peterborough City Hospital

We found:

  • The services provided mandatory training in key skills in relation to patient risk but not everyone had completed it.
  • The design, maintenance and use of facilities and premises in the emergency department did not always keep people safe. Staff did not complete risk assessments for each patient comprehensively to remove or minimise risks or update the assessments. Staff did not always keep detailed records of patient care and treatment. The emergency department did not have systems and processes in place to safely prescribe, administer, record and store medicines.
  • Within the emergency department, staff were not always discreet or attentive when caring for patients.
  • People could not always access the emergency care service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not in line with national standards. Staff described a culture of acceptance given the capacity and lack of movement of patients through and out of the hospital. This led to extended patient waits and patients staying for longer than necessary in the emergency and urgent care environment.
  • Within medical care, shortages of staff meant the service did not always have enough medical, nursing and support staff to keep patients safe from the risk of avoidable harm and to provide the right care and treatment in a timely way. Managers regularly reviewed staffing levels and skill mix and efforts were made to increase staffing levels for each shift.
  • Although people could access the medical care services when they needed it, they did not always receive the right care promptly due to pressures on bed capacity. Arrangements to admit, treat and discharge patients were impacted due to significant numbers of patients that no longer met the criteria to reside in the hospital but were waiting for access to onward care packages. Patients were being moved, sometimes at night, in order to admit them to the right place once a bed became available. Some patients were needing longer stays while they awaited treatment.


  • Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • Within the emergency care service there was enough nursing, medical staff and support staff to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed staffing levels and skill mix. The services managed infection risk well. Staff used personal protective equipment and control measures to protect patients, themselves and others from infection. Equipment and the environment were visibly clean.
  • Within medical care, doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. Key services were available seven days a week to support timely patient care.
  • Within medical care, staff treated patients with compassion and kindness, they respected their privacy and dignity, and took account of their individual needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
  • Care was planned and provided in a way that met the needs of local people and the communities served. The services also worked with others in the wider system and local organisations to plan care.
  • Leaders had the skills and abilities to run the services. Services had a vision for what they wanted to achieve and a strategy to turn it into action. Leaders operated effective governance processes throughout the service.

How we carried out the inspection

During the inspection we observed care, spoke with 37 members of staff and carried off site interviews with the senior leadership team. We spoke with 12 patients and/or their carers. We observed care provided; attended site meetings, reviewed relevant policies and documents and reviewed 22 sets of patient records.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection

21 December 2020

During an inspection looking at part of the service

We carried out an unannounced focused inspection of the emergency department (ED) at Peterborough City Hospital following the ‘Resilience 5 Plus’ process. The ‘Resilience 5 Plus’ process is used to support focused inspections of urgent and emergency care services which may be under pressure due to winter demands or concerns in relation to patient flow and COVID-19.

We did not inspect any other services as this was a focused inspection in relation to urgent and emergency care. We did not enter any areas designated as high risk due to COVID-19. The inspection framework focused on five key lines of enquiry relating to critical care, infection prevention and control, patient flow, workforce and leadership and culture.

We previously inspected the ED at Peterborough City Hospital in July 2019 as part of our comprehensive inspection methodology. We rated it as requires improvement overall. Following that inspection, we issued one requirement notice and told the provider that they must take specific actions to ensure patient safety.

18 May 2015

During an inspection of this service

18 and 19 May 2015

During an inspection looking at part of the service

Peterborough and Stamford Hospitals NHS Foundation Trust was one of the first wave of NHS trusts to be authorised as a foundation trust in April 2004. The trust has approximately 633 beds and over 3,500 staff spread across two sites, Peterborough City Hospital (611 beds) and Stamford Hospital (22 beds). Peterborough City Hospital is a new building funded under the private finance initiative (PFI); it became fully operational only in December 2010, combining services previously supported on three separate sites. It provides acute health services to patients in Peterborough, Cambridgeshire and Lincolnshire.

In addition, the trust provides a range of community services including community midwifery and Macmillan nursing as well as domiciliary visits undertaken by consultants. The trust provides rheumatology and neurology services at the City Care Centre and services in support of Sue Ryder in Peterborough, at HMP Peterborough and in local GP practices. We did not inspect these services during this inspection.

This was a follow up inspection to the comprehensive inspection of March 2014. This inspection was focused and specifically considered  the core services of urgent care and medicine and looked at all key questions and considered the responsiveness of children’s services as well as the effectiveness in end of life services. The inspection took place on the 18th and 19th May 2015.

Overall we found a trust that is improving and had addressed most of the issues we noted during our inspection in March 2014.

Our key findings were as follows:

  • There had been a recent improvement in the performance of the emergency department against the four hour wait and treatment target.
  • A new medical admissions unit had improved patient access and flow through the emergency department and the rest of the hospital whilst also reducing the numbers of outliers.
  • Safeguarding procedures in the emergency department were more robust with appropriate checks made by staff regarding children’s attendance in the department.
  • Medical and nursing staffing had improved across the clinical areas we inspected since our last inspection in 2014 but there remained shortfalls in some areas and there had been an acuity review during this period with an uplift in staff in some areas.
  • There were some concerns about storage of medicines in medical wards, specifically the monitoring of temperatures.
  • Whilst there was evidence of a learning culture, this was not embedded across the whole of the medical directorate.
  • Leadership was visible at trust and directorate level. Most staff felt valued and supported by their managers.
  • The majority of staff were caring and compassionate when providing care and treatment but we observed a small number of interactions that were not caring.
  • The service had made significant improvements in relation to the provision of same sex accommodation and services for adolescents. The service had engaged adolescents in service development and improvement. We saw a number of patient feedback stories from adolescents giving their opinions on the service, one of these had even been presented to the trust board.
  • The Amber Care Bundle had been successfully rolled out to all areas and there was a more consistent approach to managing pain relief in end of life care patients.

We saw several areas of outstanding practice including:

  • The trust had thoughtfully engaged with children and young people in the service development and improvement of children’s services.
  • A new transition projected had been agreed and was being supported by a CQUIN target for this year called “Ready Steady Go”. This project aimed to build confidence and the understanding of children, younger people and their families’ when transitioning into adult services.
  • The trust was now meeting face to face increasing numbers of patients to discuss concerns or complaints.
  • The Quality Assurance Committee was open to some external stakeholders including Healthwatch.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure records are accurate and updated to reflect the needs of patients and that care is given in line with records.

In addition the trust should:

  • Ensure that learning from incidents is disseminated consistently across the medical directorate.
  • Ensure that patients are adequately supported with nutritional needs on medical wards.
  • Ensure that medicines are stored correctly in all areas.
  • Ensure that call bells are answered in a timely way.
    • The trust should ensure that there are appropriate measures in place to further reduce falls and pressure ulcers.
    • The trust should ensure effective admission to the stroke unit for patients requiring specialist care.

Professor Sir Mike Richards

Chief Inspector of Hospitals

4-5 March and 10 March 2014

During a routine inspection

Peterborough City Hospital has 611 beds and is a new building funded under the private finance initiative. It became fully operational only from December 2010, combining services previously supported on three separate sites. It is managed by and is the main site for Peterborough and Stamford Hospitals NHS Foundation Trust. It provides acute health services to patients from Peterborough, Cambridgeshire South Lincolnshire, North-East Northamptonshire and Rutland.

We found that the services at the Peterborough City Hospital site met the needs of most of the patients attending. The accident and emergency (A&E) department was a busy unit as road links to the hospital were good and patients from surrounding counties used this unit. The hospital had good links with its five surrounding local authorities and patients were sent to the most appropriate hospital for treatment if this could not be provided by Peterborough City Hospital. The hospital provided medical and surgical services to the expanding population of Peterborough and the surrounding area. The increases in house building meant that the population was expanding and at times of increased demand the hospital struggled to cope with these pressures.


The hospital was in the process of reviewing the number of staff on every ward and was using the Safer Nursing Tool recommended by the NHS Institute for Innovation and Improvement. The initial review found that most wards were already functioning at the required level of staffing but a few wards needed further assessment of patient acuity. At our announced inspection we found that most wards were appropriately staffed but we heard that night times were a particular problem with regard to reduced staffing. We returned for our unannounced inspection during the late evening and found that the staffing was appropriate to meet the needs of the patients on all but one of the medical wards, where a member of staff had called in unwell. This was mitigated as a student nurse was on duty. While this meant that staff were busy, patients remained safe during this night visit.

Cleanliness and infection control.

The hospital was found to be clean and infection was prevented and controlled through good use of cleaning schedules and monitoring systems. Each ward and department had audits displayed of the numbers of infections that had occurred and staff were aware of the need for good hand hygiene in preventing the spread of infections. However, we found that a number of hand gel dispensers were empty and that on occasion people had to walk through several sets of doors to find a dispenser that had antibacterial hand gel in it.

4, 8, 20 February 2013

During an inspection looking at part of the service

Patients' existing care needs were not always assessed and care was not always adequately planned to make sure they received the care they needed. Information about the need of people who could not communicate easily was not available and this meant that ward staff did not always know the best way to take care of patients.

Patients were provided with a choice of meals and staff members assisted them appropriately with eating and drinking if this was required.

There were enough staff members available to care for people properly.

There were systems in place to regularly check and monitor the way the service was run. However, this did not identify that existing care needs information was not available and actions put into place was not fast enough to reduce risk to patients.

8 August 2012

During an inspection looking at part of the service

This inspection was completed to check improvements following a targeted review of the regulated activity of 'termination of pregnancies'. The focus of our visit was to assess the use of the forms that are used to certify the grounds under which a termination of pregnancy may lawfully take place.

21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

6 October 2011

During a routine inspection

We were told that staff were polite, courteous and respectful and one person commented, 'Staff are kind, gentle and move at my pace'. People were involved in decisions about their care and treatment and felt they were listened to by staff. They said staff members were good at explaining what they were going to do and told us that the results of tests were explained in a way that people understood. Tests and scans were carried out and results were provided quickly.

All of the people we spoke with who had suffered pain confirmed that they had received pain relief quickly and that staff monitored whether people were in pain. One person had pain relief that they could control and staff listened to what they wanted. Referrals were made to specialist teams for pain management and different types of pain relief were tried.

People had positive comments regarding meals and one person said that, 'The food is very good indeed and a marvellous choice, better than home'.

People were seen quickly by the triage nurse but that they did not know how long they would have to wait following this.

Staff members washed their hands before and after attending to people and any used utensils and equipment were cleared away and not left in patient use areas.

Most people were able to find the emergency department easily, although they had difficulty finding disabled parking and in understanding where to park.

Most people we spoke with said staff responded quickly to their call bells and acknowledged them if they were not able to attend to the person straight away. All but one of the people we spoke with on different wards through the hospital said they felt there were enough staff available.

All of the people we spoke with regarding complaints confirmed that they had no concerns about their care and treatment. They stated they knew who to speak to if they were not happy with any aspect of their care but that they had not needed to do this.

31 August 2011

During a routine inspection

All of the patients we spoke with during our visit to the Maternity Unit told us they had always been shown respect by the staff caring for them. Staff were polite, caring and attentive and they said that they were treated with respect and dignity. They also told us their partners and husbands were treated with respect and welcomed into the unit. One patient told us, "All the staff have been very nice, they're all helpful. They spend time explaining things".

The care provided was of a good standard and one woman said, "Staff have all been really nice, supportive and have had the time to talk". Most patients said they received care and treatment quickly and did not have to wait. They told us that there were usually enough staff and that they had received one to one care from a midwife while in labour.

30 March 2011

During a themed inspection looking at Dignity and Nutrition

Most people said their privacy and dignity was respected and they had not been embarrassed or made to feel uncomfortable in any way. Comments some patients made include staff being described as, 'Very impressed, they really care', 'staff are lovely' and 'very polite'. One patient commented when asked if they were happy with the care and treatment, 'Yes very ' 10/10!'

Most patients said they are involved in decisions about their care, although about half of the people we spoke with said they had not received enough information, especially about the hospital facilities. One patient said that the doctors were very good at explaining. However, a patient's relative told us, 'We ask for information, Mum is moved between wards, we are not informed'.

Patients told us that staff are caring towards them, most staff members ask them how they want to be addressed and treated, and explain what the staff member is going to do. However, some patients said they had to wait quite a long time to receive the care they required and staff members were always very busy.

Most people we spoke with were complimentary about meals provided at the hospital. They commented that there is enough to eat, often saying the amount was too much and most patients said they liked the food. One patient commented that there was a lot of choice and another patient said about meals, 'I like my food hot and it always is'.

Patients said staff help them with their meals, but that sometimes they don't get enough help with opening packets or obtaining drinks. Patients are not always helped to wash their hands before eating.

21 December 2010

During an inspection in response to concerns

During our visit to the emergency department on 21 December 2010, we spoke with a large number of people who were using the service and also spoke with their relatives.

People told us that overall they felt that the facilities were better than those offered at the previous A&E department located at Peterborough District Hospital. However, a number of people felt that the parking arrangements were not adequate and that the emergency department's waiting room was very cold.

The majority of people spoke highly of clinical staff and the treatment they received. People told us that they had been given specific information regarding their condition and details of discharge arrangements. People told us that their nutritional needs were met where applicable and that they were offered timely pain relief.

Although the emergency department was not excessively busy on the day of our visit, a number of people who had attended on previous days had experienced very long waits for treatment.

People told us that they found the booking in and triage arrangements confusing, and that signage in and around the department was not sufficient. People we spoke with also told us that they had been required to discuss private information in a public area.