The Princess Alexandra Hospital

Updated 30 July 2026

The Princess Alexandra Hospital provides a range of NHS hospital services.

Date of assessment: 11 and 12 November 2025. We carried out an assessment of urgent and emergency care and surgery.

Date of assessment: 26 and 27 November 2025. We carried out an assessment of medical care (including older people).

The rating of urgent and emergency care, surgery and medical care (including older people) have been combined with the ratings of the other services from the last inspections. See our previous reports to get a full picture of all the other services at The Princess Alexandra Hospital.

The rating of The Princess Alexandra Hospital remains requires improvement.

Updated 22 July 2026

The Princess Alexandra Hospital NHS Trust provides medical care services at The Princess Alexandra Hospital.

We last inspected medical care services at The Princess Alexandra Hospital in July and August 2021. This was a comprehensive inspection looking at safe, effective, caring, responsive and well-led as part of a wider inspection, also looking at urgent and emergency care, surgery and well-led. Medical care was rated as good overall.

We conducted this unannounced comprehensive assessment on 26 and 27 November 2025 as part of our winter pressures inspection programme. We looked at all 5 domains.

We visited the following areas as part of the assessment:

Medical assessment unit, same day emergency care, acute medical (respiratory) ward, older people’s assessment unit, elderly care wards, the discharge lounge and short stay discharge ward. We also looked at discharge planning and flow through the hospital.

We spoke with members of the medical care team including health care assistants, junior doctors, registrars, consultants, band 5, 6 and 7 nurses, specialist nurses, and the assistant chief nurse.

Safe: We looked at medical care services only and rated safe as requires improvement.

Staff understood how to protect adults and children from abuse and knew how to report concerns, but many doctors had not completed the required safeguarding training. Staff involved patients in their care and explained treatments, but some patients said they lacked enough information about what would happen next.

Staffing levels were sometimes insufficient because of increased patient acuity and staff redeployment, which increased pressure, although leaders monitored risks.

The service took safety seriously, encouraged staff to report concerns, supported them after serious incidents, and shared learning. The service had clear processes for raising concerns and being open with patients. The service managed care and records safely, with good use of electronic systems, risk recording and teamwork, but leaders could not fully monitor how well staff used early warning scores after a new system launch.

The service managed infection risks well overall, with clean wards and good compliance. The environment was safe and clean, staff maintained equipment well, and they promptly addressed any issues found during the inspection. The service handled medicines safely in most areas, monitored incidents to reduce risks, and quickly fixed a storage problem when it was identified.

Effective: We looked at medical care services only and rated effective as good. Staff usually completed a full patient assessment within six hours of transfer to a ward or unit. They audited nursing records each month to identify gaps, support learning and deliver targeted training.

Patients received evidence-based care that met good practice standards, and staff had relevant specialist training and followed up-to-date policies and national guidance. Most staff worked well together and communicated effectively with other services, and they reported positive working relationships with colleagues and managers.

The service monitored outcomes using patient feedback, surveys, complaints and compliments, and leaders identified concerns and took action to make improvements. Staff understood how to assess capacity, protected the rights of patients under the Mental Health Act and followed the Code of Practice.

Caring: We looked at medical care services only and rated caring as good. Patients reported kind care from staff, and our observations confirmed that staff treated patients and relatives with dignity and respect, and protected privacy in practice.

The service supported compassionate care through clear policies, mandatory training and equality initiatives. Staff listened to patients, involved them in decisions and met religious, cultural and individual needs.

Staff remained committed to good care despite pressures from staffing shortages and corridor care. They felt supported by leaders, wellbeing services, the Freedom to Speak Up Guardian and appropriate guidance for overseas staff.

Responsive: We looked at medical care services only and rated responsive as good. The service responded well to patients’ needs by understanding individual requirements, including those of people with dementia, learning disabilities or sensory needs, and by providing flexible care through trained and well‑supported staff.

Staff organised discharge planning effectively and worked closely with other services to support safe and timely discharge. Leaders used local health data to improve services and reduce inequalities. The service gave patients clear and accessible information, encouraged feedback, removed barriers to care, and maintained a focus on fairness, listening and responsiveness despite pressures on hospital flow.

Well-led: We looked at medical care services only and rated well led as good. The service shared a clear vision and strategy and took action to improve its culture, working with external partners to develop the service and improve patient access and outcomes.

Staff were welcoming, friendly and supportive; they felt valued and supported. Leaders were compassionate, visible and approachable. Medical care had a clear leadership structure, with the divisional triumvirate supported by senior clinical and operational leaders, and effective governance meetings that reviewed quality, safety, risks and performance.

Leaders understood local population needs, including health inequalities, and worked with system partners to improve access and outcomes. The service promoted an open culture where staff felt able to speak up, leaders reviewed and acted on concerns. Leaders ran robust systems for incident management, learning and improvement, used audits and data to monitor safety and quality, and encouraged learning, innovation and research to improve outcomes and patient flow.

Updated 26 September 2025

On the 11 and 12 November 2025 we carried out an assessment of surgical care. This was a responsive assessment due to emerging safety risk for people receiving care at the Princess Alexandra Hospital. We inspected all quality statements across safe, effective, caring, responsive and well-led key questions.

During our inspection we spoke to staff, patients and families using the service. We observed how patients were being cared for and reviewed treatment records of patients.

The service fostered a positive learning culture, with staff encouraged to report incidents and operating theatre teams showing good adherence to safety procedures. However, staff did not consistently complete patient risk assessments. Environmental and equipment risks, such as obstructed fire exits, incorrect oxygen storage, cluttered or dusty storage areas, and the use of corridors for patient care contributed to concerns, as did staffing shortages and delayed call‑bell responses.

Staff delivered treatment aligned with legislation, evidence-based standards, and patients’ individual needs. However, effectiveness was hampered by shortcomings in assessments and documentation. Staff commented that the electronic patient record (EPR) system was difficult to use, affecting handovers and continuity of care. We observed multidisciplinary team (MDT) communication was inconsistent, and daily MDT meetings were not routine, leading to delays in patient care and missed information between professionals. The service promoted healthier living through preoperative optimisation and education. However, clinical audits showed mixed performance, staff did not consistently embed learning from mortality reviews, and compliance with Venous Thromboembolism (VTE) risk assessment remained low. Compliance to World Health Organisation (WHO) standards was observed in theatres.

Staff consistently showed kindness, compassion, and respect. Patients generally felt informed and supported. Staff provided emotional support, used private spaces for sensitive conversations, and made effective adjustments for people with learning disabilities. Frontline teams aimed to respond promptly to immediate needs, high acuity pressures sometimes caused delays, and auditing of nurse rounding was weak. Nurse rounding is a system whereby staff interact with patients to ensure any immediate needs are met. Staff wellbeing was strongly prioritised, contributing to a positive caring culture.

The service had a clear vision, positive culture, and the workforce felt respected and valued. Leaders were visible, knowledgeable, and supportive, though organisational restructuring created uncertainty and some staff questioned senior leadership accessibility. Leaders actively supported equality, diversity and inclusion, with flexible working, development programmes, and secondment opportunities available to staff. The service engaged with partners, implemented improvement initiatives, participated in research, and utilised an accreditation framework to drive continuous improvement, though the impact of some innovations was not yet measurable.

During our assessment, we found concerns which resulted in a breach of regulation.

We found breaches in safe care and treatment, dignity and respect and good governance.

Patients’ care and treatment was not always delivered in a way that met their needs because of incomplete assessments.

We were told patients’ dignity was not always maintained when cared for overnight in the Post Anaesthetic Care Unit (PACU). The unit was mixed sex, had no toilet or bathroom facilities or kitchen.

The trust did not audit the escalation of deteriorating patients to ensure policy was followed.

Staff on the wards we visited told us that they did not always receive a comprehensive patient handover from the Emergency Department (ED). When patients were admitted staff could not access the clinical records for the patient that were recorded in the ED. We were not assured there was a plan in place to rectify this.

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.

Or, if we have requested an action plan, this will be requested upon publication of the final report.

Updated 26 September 2025

The Princess Alexandra Hospital emergency department is based in Harlow and run by The Princess Alexandra Hospital NHS Trust.

We carried out this unannounced assessment of urgent and emergency services on the 11 and 12 November 2025 as part of our winter pressures work.

The service was last inspected in March 2023 where they were rated as overall requires improvement. They were in breach of the legal regulations in relation to staffing, and safe care and treatment. Improvements were found at this assessment.

We assessed this service using our single assessment framework and looked at all key questions and 24 quality statements.

We visited the following areas as part of this assessment:

• The Princess Alexandra Hospital Emergency Department

We spoke with staff across all disciplines, patients and their relatives, and reviewed care records to inform our judgements and rating for the service.

We found that the service did not always provide safe care and treatment, and patients were not always treated with dignity and respect. The emergency department faced challenges in managing patient flow to the wider hospital. As a result, some patients received patient privacy and dignity was affected.

We rated the service as requires improvement overall.

Updated 31 July 2019

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff received training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Although staff understood how to protect patients from abuse, not all staff had received safeguarding training in line with national guidance.
• A nurse trained in advanced paediatric life support (APLS) or European paediatric advanced life support (EPALS) was not available on every shift. This was not in line with standards set by the Royal College of Nursing.
• Access to allied health professionals was limited, particularly on the Neonatal Intensive Care Unit.
• Discharge summaries were not consistently sent to GPs within 72 hours of discharge.
• Transition arrangements had improved since our last inspection but there was still more work to be done. Transitional pathways for children with epilepsy and children with complex allergies were under development.
• There was currently no formal strategy specifically for the service. Service leads had a plan to develop a strategy with involvement from staff, patients, and key groups representing the local community.

Updated 21 March 2018

Our rating of this service improved. We rated it as good.

Updated 31 July 2019

Our rating of this service stayed the same. We rated it as good because:

• All nursing staff in the end of life care team had completed their mandatory training.
• The maintenance and use of equipment kept patients safe, syringe drivers were maintained and used appropriately.
• Records were well maintained and kept securely.
• There were systems and processes in place to report incidents and staff told us they were encouraged to do so.
• Patient’s needs were assessed, and care and treatment delivered in line with evidence-based guidance to achieve effective outcomes.
• Pain was assessed and managed and there were assessment processes in place for patients who have difficulty communicating.
• The service ensured that staff had the skills, knowledge, and experience to deliver effective care, support, and treatment.
• The service ensured that patients were treated with kindness, respect, and compassion, and that they were given emotional support when needed.
• Patients were supported to be actively involved in making decisions about their care.
• Patients at the end of life were generally nursed in side rooms and there were facilities available for relatives to stay overnight.
• The special palliative care team would generally visit the patient on the day of referral.
• Leaders were visible and approachable. They had the skills needed and understood the challenges to quality and sustainability for end of life care services.
• Staff felt positive and proud of the quality of end of life care delivered and there was a strong culture of quality end of life care throughout that included both specialist and generalist staff.
• Risk registers included identified risks in relation to end of life care and these were regularly reviewed and actioned.

Updated 17 November 2021

Updated 19 October 2016

Outpatient and diagnostic imaging services at The Princess Alexandra Hospital have been rated as good overall. Safe, caring and well-led have been rated as good with responsiveness requiring improvement. We do not rate effective in outpatient and diagnostic services due to there being an inconsistent data set for services of these types.

During this inspection we followed up on a number of areas which we found to be inadequate or requiring improvement during our last inspection in July 2015. The previous issues related mainly to patients having to wait unsafe amounts of time before being offered an appointment. We found that the service had taken action and improvements were seen.

We rated this service as good because:

Staff were aware of how to report incidents and when this should be done. There was a clear escalation pathway for safeguarding concerns and medication was stored appropriately, in line with manufacturer’s guidance. Mandatory training compliance was good and staff were competent in their roles. However, the main outpatient department was dated and in need of repair and refurbishment, and 10 out of the 11 patient records we reviewed did not contain up to date patient information.

Policies and procedures were developed using relevant national best practice guidance and patient outcomes were monitored via national audit arrangements. However, the local audit plan was limited in content meaning that there was limited opportunity to improve patient outcomes locally.

Staff provided compassionate and respectful care to patients. We observed that staff were understanding and maintained patient dignity. The majority of patient feedback that we received during our inspection was positive, and the latest Friends and Family Test (FFT) results demonstrated 96% of patients would recommend the service.

Outpatient and diagnostic imaging services were well-led. There was a cohesive leadership team and staff felt managers were approachable and that there was a strong open culture. Patients and staff were engaged in the running of the service and staff were enabled to be innovative. Since our previous inspection, governance systems had been reviewed and a clear structure had been put in place.