Great Western 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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to a good.

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.

The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people's needs.

Staff made sure patients living with mental health problems, learning disabilities and dementia, received the necessary care to meet all their needs. The department had mental health assessment area and sensory rooms for patients with mental health conditions and living with autism.

Patients presenting with mental health needs were appropriately signposted to the liaison team for further assessment. Whilst they waited for this, patients were mostly cared for in the mental health unit, which was often full, therefore there were many mental health patients who were cared for in the unsuitable environment of the ambulatory waiting room. Assessments was also limited between certain hours putting some at a disadvantage and not receiving timely care and treatment.

Patients in the paediatric ED had access to sensory toys, feelings and emotion puzzle cards, books and games. Staff provided patients with dementia with dementia bags of calm which contained a fidget spinner, colouring book and stress relief ball.

Staff supported patients living with dementia and learning disabilities by using, `This is me' documents and `My Health Passport' for autistic patients which contained information about the patients' interests, how they communicated pain and what caused them distress.

The department had access to interpreters and signers when needed. Staff also had access to communication aids to help patients.

We saw positive interactions between staff and patients with complex needs to ensure they remained settled in the department. Staff made sure patients living with mental health problems, learning disabilities and dementia, received the necessary care to meet all their needs.

There were also link workers available to provide additional support and advice to staff for supporting patients with learning and mental health difficulties.

There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Whilst we did not see any evidence of patients needing emergency treatment and not receiving this, there was a risk to patient safety and care for patients who required emergency treatment due to the inability to offload ambulances at the point of arrival which led to untimely treatment and transfer to inpatient departments for ongoing monitoring and management

The provision of specific mental health care was provided by a local mental health trust who undertook assessment, and continued care where relevant, of adult patients within the trust who required specific mental health input. Service provision, following referral from the ED team included an initial assessment by the local liaison team and where indicated, a Mental Health Act assessment. However, there were often significant delays for these assessments. During our inspection, 2 patients with mental illness absconded from the department because they found the delays for specialist treatment to be intolerable. Absconding patients have been associated with poor outcomes, putting both the patient and community at risk through self-harm and harm to others.

Patients requiring on-going care within ED or the observation unit due to their mental health care requirements were supported by a local mental health care trust to manage this aspect of their care. For patients requiring an admission to any mental health care facility from ED or the Observation Unit, whether voluntary or involuntary, the responsibility to locate and arrange the admission lied with the local mental health care trust, or if outside of their region, the relevant local mental health provider.

People's individual needs and preferences were considered, including those with protected characteristics under the Equality Act and those at most risk of a poorer experience of care.

Following a brief discussion with the clinical navigator, patients were tracked to the appropriate area on the electronic patient record (EPR) which included the UTC waiting area.

All patients attending the department were registered on the EPR and staff completed the documentation of hospital handover using an electronic system.

The ED engaged with other healthcare providers both within and external to the hospital to ensure that patients received appropriate follow-up care. However patients referred to speciality teams waited many hours to be reviewed and transferred to appropriate wards.

External partners, such as GPs, community nurses, and social workers were involved to enable continuity of care and support for discharge. The department had formal agreements with other NHS Trusts and tertiary centres to facilitate seamless transfers of care where required.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared within the EPR, in accordance with the Accessible Information Standard.

The waiting rooms within each area had a screen which displayed the waiting times.

The trust had a printable accessible information poster and leaflet within its policy. Patients had access to information leaflets regarding medicine and treatment plans if they required them.

We saw a wide variety of resources including leaflets, and interpreter services were available to ensure the patients understood their care and treatment, if required.

We observed appropriate conversations between medical staff, patients and family members about treatment plans and options. We saw there were private family rooms where staff could take families and carers, when delivering bad news.

Since the relocation to the new integrated front door, the teams had made strides to improve the visibility of important information through enhanced signage and digital displays in ambulatory majors, ensuring patients remain informed throughout their visits.

Staff we spoke with told us they had received General Data Protection Regulation training (GDPR) and could explain their duties regarding confidentiality and data sharing.

Staff had access to GDPR policy and equality and diversity policy on the intranet. Staff could also ask for advice from the trust Caldicott Guardian. A Caldicott Guardian is a senior person responsible for protecting the confidentiality of people's health and care information and making sure it is used properly.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Patients received a text message following their discharge for feedback on care received. Additionally, patients and family members could also fill in a comment card which were displayed at the reception.

Patients and families were supported to raise their concerns with the department. In the first instance this was to escalate to staff and leadership team. If they were unable to provide a resolution, patients were signposted to Patient Advice Liaison Service (PALS).

Child friendly feedback forms were also now in place within children’s emergency unit (CEU) to support patients and their families to feedback and share their experience.

The department provided us with an example of when changes were made in response to patient feedback. A patient who was registered deaf contacted the PALS to highlight how they felt there was a lack of awareness and tools on how to best work with deaf people. Following this feedback, training was provided to ED and urgent treatment centre (UTC) teams around communication cards and tools such as sign live that were available. In addition to this, memos were also sent out to staff via email to raise awareness of communication cards.

Staff understood the policy on complaints and knew how to handle them. Managers investigated complaints and identified themes.

The trust observed a continued improvement in the emergency department Friends and Family Test (FFT) data in the third quarter and a noted decline in performance during December which was 75%, despite a positive upward trend in November's results of just over 80%.

We reviewed the meeting minutes for Patient Quality Subcommittee meeting for the month of February 2025. These showed that the department had received 33 complaints across ED and UTC, with 10 still open and out of expected time frame. Leaders told us the department were actively engaged in addressing these complaints and concerns, ensuring timely and appropriate responses.

Following the results of the urgent and emergency care CQC patient survey of ED and UTC in February this year the key themes related to attitude and behaviour, extended waiting times, uncertainty about the reasons behind these delays, and insufficient communication regarding the patient’s care relation to test results and investigations. To address these issues, the department had conducted regular team meetings focused on reviewing feedback and were in the process of progressing with an improvement plan to focus on compassionate care and opportunities for patients to voice and discuss their concerns. Additionally, the ED and UTC team were working on a framework designed to promote and inform patient-centred care, particularly for individuals who were visually impaired, have dementia or had a learning disability need.

People could access the service when they needed it, however, they did not always receive care promptly. For example, whilst patients had been seen by the ED clinical staff, we saw patients who had waited more than 12 hours to be seen by a medical specialty doctor regarding ongoing treatment.

The department was not meeting the standard 4-hour performance target which meant patients could not always access emergency services when needed or receive treatment within agreed timeframes and national targets. The department had oversight of these through their Quality Sub Committee Meetings where they focused on the key quality indicators and discussed improvement being taken to address these concerns.

Based on the ambulance data from February until March 2025, the trust had the second highest average handover time. This meant ambulance staff had to stay with the patient until they could be handed over to the department, preventing them from being dispatched to other jobs.

The trust reported the highest 12-hour decision to admit breaches when compared to other trusts. On average, patients coming to trust were waiting the longest for admission (13.2 hrs). This was over 2 hours longer than the average wait when compared to other trusts.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The department sought out views of patients, local people and communities across Swindon and Wiltshire about their experiences of using our health and care services and to help shape improvements and outcomes. This involved working with potentially disadvantaged groups to ensure equity of access, care and treatment. For example the interiors, furnishing and environment for the new ED was designed from feedback as part of wider engagement program.

The trust had an involvement and engagement tracker which recorded the level of activity and demonstrated how it had informed and influenced decision-making across the organisation. Some of these included engagement workshops with patients with learning difficulties and ASD and through feedback received from the deaf community.

Staff worked hard to remove any barriers to access for patients. There was a strong inclusive culture which prevented discrimination and inequalities, supported by training and guidance. Staff listened to people who had concerns or complaints and sought ways to improve the service.

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 were supported to make informed choices about their care and plan their future care while they had the capacity to do so.

Any patients being discharged without onward support for care needs had a discharge planning document completed as part of the admission documentation which completed by the nurse undertaking their admission assessment.

The front door therapy team (FDT) provided physiotherapy, occupational therapy and discharge planning to the ED and ED Observation unit 7 days a week. The role of the FDT was to assess patients who required therapy input or discharge planning and to facilitate safe discharges as soon as possible. For patients who were not medically fit to leave hospital, the aim was to prevent deconditioning and start early rehabilitation and discharge plans.

Staff had access to the trust wide resuscitation policy and demonstrated a clear understanding of the trust do not attempt cardiopulmonary resuscitation (DNACPR) policy and ReSPECT documentation. The ReSPECT process created personalised recommendations for a person's clinical care and treatment in a future emergency in which they are unable to make or express choices. These recommendations were created through conversations between a person, their families, and their health and care professionals to understand what mattered to them and what was realistic in terms of their care and treatment.