University Hospital

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Patients told us they were treated with kindness, empathy and compassion. However, patients in the waiting room did not consistently have their privacy and dignity respected. Staff understood the reasonable adjustments they needed to make to treat people as individuals, but they did not always have the time or other resources to do this.

We have not awarded this service a score for Caring.

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

People’s experience

Patients told us that staff were kind and compassionate. They said they understood staff were busy and this was the cause of delays in being reviewed by a doctor and long waits in either the waiting room or in majors.

However, patients in the waiting room did not have privacy or dignity. People were visible to each other at all times and conversations with staff could be overheard by other patients.

Most patients situated in majors had private cubicles or were in a spacious bay. They told us their privacy and dignity was respected and upheld at all times. However, patients in the fit to sit area were not afforded any privacy or dignity. The area was a cubicle that had been repurposed to hold 8 chairs. The chairs were close together because of limited space and this meant patient conversations with staff could be overheard and patients were visible to each other at all times.

Healthwatch Coventry visited the emergency department in February and March 2024, they reported their finding in August 2024. They found “The small waiting area made it difficult to maintain people’s dignity and privacy. We observed people in pain and being sick into bowls, holding onto drips, taking medication; with some sitting in nightwear they had arrived in whilst surrounded by other people who were able to view this.” Healthwatch were an organisation established to ensure people’s experience of health and social care were used to improve those services.

Feedback from staff and leaders

There was a culture of kindness and respect between colleagues which extended to colleagues from other organisations.

Staff collaborated with other experienced colleagues to provide support for people with additional needs when they could. For example, they could quickly get support for adult patients with mental ill health from an externally provided service. However, staff told us they were not consistently able to get support for patients with a learning disability from the externally provided team and there was not a team to support patients with autism. Staff also said there could be long waits for support for children and young people presenting with a mental health crisis. Again, the team that supported this cohort of patients was from an externally provided service.

Following our assessment the trust gave us details about the ‘purple card system’. This system provides patients with an opportunity to ask to have a private conversation with staff in a separate room.

Feedback from partners

The hospital ambulance liaison officer said they were treated with kindness and respect at all times by the emergency department staff.

Observation

Staff were not consistently able to maintain the privacy and dignity of patients in the waiting room.

We visited in September 2024 and found there had not been any improvements in staff being able to maintain patient’s privacy and dignity since the visit by Healthwatch in February and March. We saw patients who were visibly and audibly in pain, and others who were being sick into bowls. We saw staff holding conversations with patients in doorways because of a lack of appropriate space to talk with them with confidentiality.

Staff contacted family or friends when requested. However, there was some confusion about which staff could access information about next of kin and so this was not consistently being done in a timely way.

Staff locked patient records when they moved away from computer screens to maintain confidentiality.

People’s experience

Staff treated people as individuals, considering any relevant protected equality characteristics. Patients told us their social and religious needs were understood and met, for example through the provision of food that met these needs.

Feedback from staff and leaders

Staff told us they had received training about making reasonable adjustments for people that needed them. Part of the training had been delivered by people with lived experience about how the department could work for them. However, staff told us the training did not match what it was possible for them to provide. There were limited resources available for people to use apart from ear plugs, and fidget toys. Staff also felt due to pressure from demand and crowding in the department the environment was not helpful for people who needed quiet and calm.

Staff had been involved in a project to support patients with mental health problems who had long stays in the department. Long stays for these patients were sometimes inevitable as a suitable bed at a mental health location could not always be quickly found. The aim of the project was to keep patients calm and comfortable in the emergency department. There was an element of training involved for staff so they understood how difficult it might be for somebody with a mental health problem to be in the department for a long time, and what resources could help patients have a better stay. They also involved people who had previously been a patient in the project to get their input about what would have helped them. The outcome enabled staff to put together packs containing items to promote good sleep, including sleep masks and earplugs, and toiletries so people could meet their personal hygiene needs. Things to alleviate boredom were also included for example, playing cards, puzzle books, pens, and fidget kits. Fidget kits were designed to give people something to do with their hands to help them take their mind off a situation which in turn can reduce anxiety.

As part of the trust’s wider objective to provide person centred care, plans for discharge to a ward considered people’s individual needs, ongoing care arrangements and expected outcomes. Although this could have meant slightly longer delays for some patients, staff were determined that patients should be in the right place in the hospital. For example, patients requiring a surgical bed would only be transferred to a surgical ward, and gender was considered to ensure patients of the same gender were always cohorted together when they were moved to a ward.

Observation

When they were able, staff supported patients on a one-to-one basis because the patient had additional needs. This included patients with dementia who were confused or agitated and required support to keep them calm and to stay in the department. Patients who had mental ill health were supported to keep themselves safe and those around them.

Processes

The department provided training to enable staff to treat people as individuals, including a range of equality characteristics. For example, staff received training to help them support patients with a learning disability and autistic people. We saw evidence that showed 89% of staff had completed this training.

There was a system of adding flags to the electronic patient records to alert staff of additional needs that some patients may have, for example, because they required isolation due to illness or had an allergy.

The needs of patients were not always highlighted through electronic records. Most staff did not have the ability to create a digital flag for patients with a learning disability, with autism, or with dementia.

There was a care pathway for autistic people and for patients with a learning disability. This was a flow chart that explained to staff they may need to make reasonable adjustments to accommodate peoples’ support needs, and how to assess what reasonable adjustments might need to be made. It also included information to ensure people's additional needs were communicated to other teams if the patient was going to be admitted to a ward.

People’s experience

Due to the pressure in the department from demand and crowding, people were not always supported to have choice or control over their care and make decisions for their wellbeing. Patients in the waiting room told us relatives and carers had been requested to leave during the night. This was because there was not enough room for all the patients to sit down even though additional chairs had been brought in. This meant not all patients could be supported by the people they chose to have with them.

However, patients in majors were able to have their relatives or carers with them throughout their stay in the department.

Feedback from staff and leaders

Staff told us they tried to find chairs for relatives and carers of patients in majors, so they were comfortable while they were waiting with their loved ones.

Staff told us they did not presume patients always needed assistance and would ask what assistance they needed to promote independence. For example, they would ask patients if they required help to sit up in bed rather than helping without asking.

People’s experience

Patient’s needs, views, wishes and comfort was not always the priority of staff. They tried to anticipate when someone may experience discomfort, concern or distress, but did not consistently achieve this. There were too many patients in the waiting room for staff to prioritise them all. However, most patients in majors told us they had a more positive experience, and staff were very responsive to their needs.

Patients told us they had been asked about any additional needs, such as communication needs, during the triage process.

Feedback from staff and leaders

Staff told us there was a focus on identifying risks to patient’s health and wellbeing early in their admission to majors in both adult and children’s departments. There were patient checklists to ensure risk assessments and intentional nurse rounding was completed with patients. Intentional nurse rounding was a process in which nurses regularly checked in with patients to identify and meet their needs. This helped to promote patients' psychological safety and maintain their physical wellbeing by meeting their nutrition and hydration needs, reducing falls and pressure ulcers.

There was proactive action and support provided to prevent avoidable deterioration to people’s health and well-being in majors. For example, staff knew about and understood deconditioning, especially the risks to elderly frail patients. Physical and psychological deconditioning can occur when patients have prolonged periods of bed rest, poor nutrition, sleep disruption, and exposure to frightening sounds. To help prevent this staff worked hard to reassure patients, offer a range of food and drinks, reposition patients or encourage them to move. Some staff told us they were concerned frail elderly patients who spent the night in the waiting room deconditioned. This was because they were spending many hours sitting, may not be offered regular refreshments, and who may be experiencing psychological distress because of the noise, and the behaviours of some of the other people waiting.

However, although people’s needs were a priority for staff, some arrangements had made it hard to meet them as they wished. Staff were truly dedicated to trying to do the right thing for patients with a learning disability and patients with autism and carried moral injury at not being in a position to meet their needs through a lack of time and other resources.

Staff told us the use of pillows had been stopped which they felt did not meet the comfort needs of patients some of whom were receiving end of life care or were in the department for up to 24 hours. However, senior leaders told us pillows were always available for patients.

Staff also told us beakers were no longer available for patients who found it difficult to use cups. If patients did not have their own beaker with them, they might experience difficulty drinking any fluids offered without the correct mouth attachment. However, senior leaders told us beakers were always available for patients who needed them.

Observation

The children’s department shared a room with the paediatric ward for when staff needed to break bad news to relatives or that patients and families could use during the final hours of a child’s life. The room was tastefully decorated and contained comfortable furniture. There was a fold out bed that could be used by family members. Staff told us there were resources in the room that could be used to refer parents and family members to bereavement counselling services.

The family rooms in the adult department were sparsely decorated but contained suitable seating for breaking bad news or for grieving families. There was a viewing room so family members could view their deceased relative.

Feedback from staff and leaders

Staff told us they had access to wellbeing resources through the trust intranet. They said the trust held wellbeing days throughout the year, but they typically could not attend these due to pressures of work.

Staff also told us they did not always feel listened to. For example, some had raised their concerns about the number of people in the waiting room especially overnight and felt nothing had been done to reduce the risk overcrowding posed. They had also raised concerns about the display in the waiting areas that informed patients how long they might wait to see a doctor, and the average length of wait to see a doctor. They were concerned that this information was misleading because patients no longer in the waiting room were included in the calculation for the average length of wait to see a doctor. Therefore, this information was not representative of length of waits for patients in the waiting rooms. They said the confusion this created for patients and their family members increased the likelihood of aggression from patients towards staff.

To help prevent violence and aggression from patients towards staff, some staff had body-worn cameras. Staff told us when they advised patients they were going to turn their camera on, this was often enough to stop the violence and aggression towards them.

Processes

There was an annual staff survey, and all staff were encouraged to take part so their responses could be used to improve staff satisfaction. The most recent staff survey results from 2023 for the emergency medicine clinical group scored worse than overall trust results for all categories (we are compassionate and inclusive, we are recognised and rewarded, we each have a voice that counts, we are safe and healthy, we are always learning, we work flexibly, we are a team, staff engagement, and moral). The biggest difference was for ‘we are safe and healthy.’

The trust provided a range of wellbeing resources for staff which could be accessed through the intranet. This included a face-to-face counselling service, wellbeing webinars, a money matters scheme, menopause support and a support cafe. The support café offered staff the opportunity to be reminded of the trust wellbeing offer as well as to talk about anything that was on their mind. Within the emergency medicine department there were 11 ‘people supporters’. People supporters were volunteers who championed staff wellbeing and cascaded key wellbeing messages to staff through notice boards and encouraged engagement in wellbeing activities, for example, laughtercise classes.

Monthly ‘time for tea’ sessions were held for the emergency medicine clinical group. At these sessions staff could have a drink and a chat with the leadership team to share their thoughts and ideas.