During an assessment of Medical care (Including older people's care)
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.