The Princess Alexandra Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. We assessed 5 quality assessments.

Staff mostly completed a full patient assessment within six hours of transfer to a ward or unit. Staff completed monthly audits of nursing records and used findings to identify gaps, support learning and provide targeted training.

Patients received care that was based on evidence and good practice standards. Staff told us they received specialist training relevant to their ward, such as non-invasive ventilation. Staff followed up-to-date policies and national guidance.

Most staff worked well together to support patient care. They communicated effectively with other services, including social care, therapies, radiology, laboratories and pharmacy. Most staff reported good relationships with colleagues and managers.

The service monitored outcomes using patient feedback, surveys, complaints and compliments. Leaders identified the specific areas of concern and took action to improve.

Staff understood how to assess capacity and assumed capacity unless there was reason not to. Staff protected the rights of patients subject to the Mental Health Act and followed the Code of Practice. However, training completion for some modules were not within the trust target for both nursing and medical staff.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them, in a timely manner.

Staff were expected to complete a full patient assessment within 6 hours of patients being transferred to wards or units. We found this was not completed within the required timeframe for a patient with an overnight transfer to a ward. Not completing assessments within required timeframes increases the risk that staff will not recognise patient deterioration or be able to adequately treat arising concerns.

Staff used effective tools for screening malnutrition and dehydration and acted on any indicators of concern. Staff told us that they completed the Malnutrition Universal Screening Tool (MUST) as part of the adult admission nursing assessment. Staff were able to discuss how and when they would complete a dietician referral.

The service had processes in place to ensure that all adults had MUST action and prevention plans following admission and guidance for a wide range of nutrition associated issues. This included care of feeding tubes, enteral and parenteral nutrition (delivery of nutrients through feeding tubes or intravenously) and the reduction of risks associated with these.

Staff completed monthly audits of some nursing records, which prompted a review, if safety concerns were found. Audits results showed records had not always been completed as required. For example, completion rates for venous thromboembolism (VTE) assessments were 89%, under the trust target of 95%. However, this figure had increased by over 20% compared with the previous quarter. The trust had implemented a VTE improvement project to ensure patients receive prophylactic treatment appropriately. Ward staff used audit results to highlight gaps in practice, guide learning and provide targeted training where needed.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff told us that they received training that was specific to the speciality of the ward, such as training in non-invasive ventilation, aligned with good practice to deliver effective care. Specialist nurses supported staff and patients during their admission and ensured care was in line with best practice.

Staff followed up-to-date policies to plan and deliver high quality care according to evidence-based practice and national guidance. We reviewed a variety of policies and guidelines and noted all were up to date. Staff used evidence-based, standardised risk assessment tools to identify the level of patient risk for areas such as pressure ulcers and nutrition level.

Leaders told us care was consistently aligned with national guidance, such as the National Institute for Clinical Excellence (NICE), National Service Frameworks, Royal College guidance or information from National Patient Safety Alerts (NPSA). Where national guidance was not available or applicable, alternative approaches were sought through reviewed literature, specialist society guidance and expert consensus, where shared decision making was used.

The evidence shows some shortfalls. Most staff responsible for delivering care worked together as a team to benefit patients.

Nursing staff told us medical staff were off the ward and they were unable to contact them. We observed there had been medical staff on the ward but nursing staff were not aware of this. However, we saw they supported each other to provide good care and communicated effectively with other agencies, such as social services. Staff worked across health care disciplines to care for patients, including therapies, testing (radiology and laboratory service) and pharmacy services.

Staff said they received allegations of bullying from a staff member when spoken to by a staff member in another department. They had addressed this, although instances reoccurred. However, staff generally told us they had better working relationships with each other including with their direct management teams.

We saw that staff from different teams, such as overnight medical admission and the consultant on call for the day, came together during handovers to ensure correct information about patients was passed on. Staff from different areas within the medical care units attended huddles each day to discuss bed status and understand where there may be delays.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service monitored outcomes for patients mostly through family and friends feedback, national surveys, complaints, compliments, and local feedback. Surveys covered a range of experiences, including dignity and respect, privacy, staff attitude and explanation of care and treatment. Results of the NHS adult inpatient survey for 2024 showed responses to questions were worse than or much worse than expected. Leaders had identified from patient feedback that there was lower satisfaction when staff levels were reduced or when there were higher levels of temporary staff, particularly at night. This affected response times rather than the quality of care.

The service took part in a range of national clinical audits, including those for diabetic foot care and inpatient safety, heart failure and cardiac rhythm management and respiratory programmes. This allowed the service to monitor actions they had taken against NICE guidance, monitor patient outcomes and benchmark against other services reporting through the same audit. Local audits were also undertaken to review areas, such as personal and individualised care, completion of records and documentation, and management of processes to reduce risks to patients.

Leaders identified increased reporting of incidents involving staffing levels during night shifts when there were fewer senior leaders or managerial staff available. Leaders had addressed these findings by increasing staffing levels during periods of high risk, such as evenings and weekends. They had introduced twilight shifts to further support staff. Senior staff and on-call management staff were also scheduled to provide cover and be available at evenings and weekends.

The service monitored outcomes for patients through regular audits, such as those for inpatient records. Data gathered was analysed to identify patterns, risks and opportunities to improve care. Records showed engagement in some therapy sessions was higher during the week when a full multidisciplinary team was available.

The evidence showed some shortfalls. Not all staff had received training on consent. Staff provided patients with alternative ways to understand their choices when needed.

The service had a Mental Capacity policy, which was in date and provided guidance to staff. The service provided training for staff in obtaining consent and assessing mental capacity as part of safeguarding training, although not all medical staff had completed the training. This risks medical staff not fully understanding their obligations to inform and assess patients as part of the consent process.

However, nursing staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They explained that capacity to consent was assumed first. Staff understood their responsibilities in obtaining consent from their patients before any care or treatment. Staff used different communication methods, such as written explanations or translations to another language, to make sure patients were supported to make decisions. We observed staff explaining what they were going to do and waiting until patients had a chance to satisfy themselves with questions before completing any actions.

Staff protected the rights of patients subject to the Mental Health Act and followed the Code of Practice.

Patients told us staff asked if they could assess them before completing any tests, such as blood pressure monitoring.