University 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

People did not experience discrimination and staff worked hard to provide equity in access to care and treatment. However, the demand on the service meant people sometimes had long waits for treatment.

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.

People’s experience

Patients told us they had been involved in discussions about their treatment and staff had explained what would happen next and mostly kept them updated with any changes.

Feedback from staff and leaders

Staff involved patients and their families in making decisions about treatment and future care plans. When patients lacked capacity to consent to non-life-threatening treatment staff involved the relevant individuals to make best interest decisions.

However, staff told us they did not consistently have the time required to provide person centred care for people who required reasonable adjustments. This was because they did not always have time or other resources, for example a quiet waiting area, to provide person-centred care.

Observation

We heard staff introduce themselves by name to patients and tell them what role they were going to have in their care. We saw staff reassure patients who were anxious or confused. We saw staff involve patients in discussions about their treatment plans, and we saw evidence of best interest decision making for non-life-threatening treatment for patients who lacked capacity.

People’s experience

The patients we spoke to told us they had been asked about their communication needs.

Feedback from staff and leaders

Staff understood the diverse health and care needs of people and the local communities. However, staff told us they did not consistently have the time or other resources to meet the needs of all groups of people. For example, they were not always able to make reasonable adjustments for people with a learning disability or people with autism.

Staff told us they had easy access to an interpretation service for patients whose first language was not English.

Feedback from partners

The needs and preferences of different people, including those with protected characteristics under the Equality Act, and those at most risk of poorer experience of care were not consistently prioritised or met.

Healthwatch Coventry visited the urgent and emergency medicine department in February and March 2024, they reported their finding in August 2024. Eleven people told them they had a communication support need and 8 of these said that these needs had not been met. The support needs people identified included not speaking English, autism, hearing impairment, sight loss and dementia.

Processes

Senior leaders told us to provide continuity of care patients who demonstrated violence and aggression against staff or other patients were not prevented from receiving treatment in the department. However, they might have a behaviour contract imposed to ensure they did not pose a future risk to staff and patients. They held restorative justice meetings and encouraged patients to write letters of apology to staff they had been violent or aggressive towards. Senior trust leaders also visited the department as part of a corporate rota to let staff know violence and aggression from patients or other members of the public towards staff should not happened and to demonstrate it was an important issue that mattered to the whole trust.

People’s experience

Most but not all of the patients we spoke to were happy with the level of information they received about their treatment and what would happen next. The patients in the waiting room we spoke with were less happy with the information they received than the patients in majors.

During our second day on site, patients who had been in the waiting room overnight told us they had received very little information from staff overnight about their long waits for treatment. However, they said after a shift change in the morning a member of staff made an announcement to everybody in the waiting room. This was about majors being full, staff being busy with those patients, and no doctors being free to review patients for the next hour or more. They told us they appreciated this update which helped put their long stay in the waiting room into context.

Feedback from staff and leaders

Some staff shared concerns about the information boards in the waiting areas that told patients average waiting times, and the length of time to be seen by a doctor. They said this information was misleading as it related to the wider urgent and emergency medicine directorate and not just the emergency departments. This meant the length of time to see a doctor did not always reflect the time people would be waiting. The result of this was patients telling staff they were unhappy about not being told the more realistic (longer) waiting time.

Senior leaders told us the information boards in waiting areas only related to the waiting times for people in the adult and children’s EDs.

Observation

Patients were provided with information to help with their individual needs. We heard staff talking to patients in majors about their treatment plans and asking if they understood or wanted to ask questions.

Processes

Leaflets about some conditions were available for patients, for example on head injuries or sudden cardiac arrest. Patient information leaflets were also available electronically from the trust website or by scanning a QR code.

People’s experience

Patients in the waiting room told us when they raised their concerns about the time they had waited to be seen staff told them to raise their complaints directly through the patient advice liaison service (PALS). They said this was because staff told them they had already raised this as a concern, but nothing had been done.

In line with trust processes staff sign posted patients to the Patients Advisory Liaison Service (PALS) to highlight their concerns.

Feedback from staff and leaders

Staff told us they listened to patient’s complaints and took them seriously. However, they said when they escalated patients’ concerns, they were not consistently acted upon. For example, they said they had raised their concerns about the length of time patients waited in the waiting room at busy times, especially frail elderly patients, but no changes had been made. Staff could demonstrate how they responded to feedback from patients. For example, when patients had fed back the metal chairs in reception areas were uncomfortable. The metal chairs were removed and cushioned chairs with wipeable covers were purchased to replace them.

Senior leaders told us they, or the patient safety team, met with people who raised complaints about the department. They involved people in the investigation process and not just in the outcome. They said this was to demonstrate to patients they cared and wanted to improve patient experiences based on their feedback.

Processes

Patients were encouraged to provide feedback on the service through QR codes on posters and leaflets. The trust website contained details of how to give feedback on care and making a complaint.

People’s experience

Due to the pressures on the departments from demand and crowding, there was not always access to care or support when needed. Some patients in the waiting room told us they were waiting for up to 18 hours to be admitted to a ward. Due to high demand for limited available beds, some patients in majors said they waited for up to 24 hours to be transferred to a ward.

Some patients told us they had travelled a long way to get treatment. They said they were unhappy with the length of their walk from the car park to the ED, and also with the car parking charges.

Once patients had been reviewed by a senior clinician and a decision to refer them to a speciality team had been made there was significant variation in the responsiveness of the speciality team to review the patient. This was outside the control of the emergency departments. In September 2024, adult patients being referred to acute medicine services could expect an average wait of just over 2 hours. However, a referral to gastroenterology in the same month saw some patients wait much longer for a specialist review. Waits for specialist review impacted the amount of time patients stayed in the department which was recognised was detrimental to their health and wellbeing. It also subsequently could affect access to urgent and emergency care for other patients.

Patients told us there was no lift access to the emergency department and this meant some people had difficulty accessing the department if they found they could only get access using the external staircase or going into the main hospital building and walking from a lift and outside across the parking area. This was a concern that had been highlighted by Healthwatch Coventry when they visited the emergency department in February and March 2024, they reported their finding in August 2024.

In response to Healthwatch’s findings the trust took action to improve access to the ED.

Feedback from staff and leaders

Staff told us they worked hard to generate flow in the department to improve access to care and treatment for emergency patients. The main practice was by navigating patients not needing emergency care to the right service for them and diverting them to alternative care and treatment facilities. However, not all these facilities were open 24 hours a day.

There was a flow coordinator based in the adult emergency department 24 hours a day, all year round. This role was introduced to ensure the process of transferring patients to their onward ward or department took place as efficiently as possible, and to ensure other opportunities to provide space and generate flow were not overlooked.

Processes

People could access the service when they needed although they might have a long wait to see a doctor. The department was open 24 hours a day 365 days a year. Adults and children were cared for including those seeking treatment for mental ill health. The service worked with other healthcare professionals to provide a service for different healthcare needs and serious conditions needing specialist input.

Due to pressure within the system and subsequent demand on the hospital, some patients remained within the department for significant periods of time. This was due to a lack of available beds for patients to be transferred. As a result, not all patients could be discharged from the department and transferred to wards at the point they were fit enough for transfer. On our inspection, for example, there were patients waiting in the adult’s department for admission to a ward for over 24 hours. On 25 September 2024 at 2.15pm the 5 patients who had been in the department the longest were there between 20 and 21 hours. All of these patients were awaiting transfer to ward. The next day at 2pm the 5 patients who had the longest lengths of stay in the department had been there between 21 and 25 hours. Four of these patients were waiting for transfer to a ward. However, to mitigate risks to patients, any treatment which could be started in the ED was commenced as soon as possible.

Data from the trust for July 2024 showed more than 22% of patients spent 12 hours in the department, and 52% of patients waiting to be admitted to a ward spent over 12 hours in the department. From July to September 2024 only 50% of ED patients were treated and discharged in less than 4 hours (July 50.3%, August 48.3% and Sept 50.4%) against the national urgent and emergency care recovery target of 78% and the national standard of 95% of patients to be treated and discharged in 4 hours.

Trust level data for July to September 2024 which included treatment provided by the urgent treatment centre and minor injuries unit as well as the emergency department had a national average of treatment and discharge in less than 4 hours of 66.1%. This was worse than the England average of 75% of patients being seen within 4 hours.

The amount of time ambulances waited to handover patients was captured and showed most patients (80%) in August 2024 were handed over to the ED within 30 minutes or less, which was slightly better than the England average which was just above 30 minutes. Patients brought in by ambulance requiring urgent lifesaving care were taken straight into the ED.

As well as the adult and children’s emergency service, the emergency medicine group had other services for minor injuries and illnesses and other speciality treatments, such as an eye casualty. Although not all other services were open overnight, these alternatives provided valued diversion for patients needing specialist care or could be treated more quickly (same-day emergency care). However, when these services became full, as they did in times of severe pressure, patients would end up in 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.

Feedback from staff and leaders

Staff told us people who may be approaching the end of their life were identified and this information was shared with next of kin, other services involved with the person, and staff. Staff endeavoured to ensure the environment was as peaceful as possible.