The Princess Alexandra Hospital

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• 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

This means we looked for evidence that the service met people’s needs. At our last assessment we rated this key question good. We assessed 7 quality assessments.

Overall, the service responded well to patients’ needs. Staff took time to understand what each patient needed, including people with dementia, learning disabilities or sensory needs, and adjusted care to fit their routines and preferences. Patients could see a range of trained staff, who were supported through good supervision and specialist training.

Discharge planning was well organised, with staff working closely with other services to help patients leave hospital safely and as early as possible, although some delays still happened for more complex discharges. Leaders used local health information to improve services and reduce inequalities, including setting up specialist units and new care pathways to help patients get the right care sooner.

Patients were given information in ways they could understand, had opportunities to give feedback, and staff worked hard to remove barriers to care. Despite pressures on hospital flow, the service showed a clear focus on treating people fairly, listening to them and responding to their needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s needs were met through good organisation and delivery.

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 evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff used flags in electronic systems and patient passports to identify and support individual needs, prioritising patients with dementia or learning disabilities. We saw staff ask patients’ questions to determine how their pre-existing illnesses affected them specifically. They made sure to record patients’ preferences if they had specific routines to follow.

Patients had access to a wide range of professionals, and staff were qualified and well-trained. Managers supported person-centred care through supervision, appraisals, and specialist training, ensuring staff could respond to changing needs. One staff member told how dementia care training provided them with scenarios for different presentations of dementia and how they could best approach managing patients’ specific needs. Patients with mental health needs received assessments and care plans developed with them, and supported by timely referrals and multi-agency working. 

The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The trust had a discharge planning team to oversee more complex patient discharges and had a good understanding of the discharge areas that affected flow through the hospital. Leaders made changes to access discharge venues, referrals to local authorities, and internal systems to improve focus on discharges and delays experienced.

Staff were able to discharge patients to a community hospital if the patient was waiting to be assessed for social care services. They had arranged and encourage the use of an underused community assessment triage unit for specific patients to avoid inpatient admission. Staff were able to complete one form for all referrals to the different local authorities. Ward board rounds had been restructured to prioritise early discussion of discharges, ensuring timely decision-making and prompt arrangement of onward care. Staff had multiple meetings each day to discuss discharges, both with local authority staff and hospital staff, to facilitate discharge arrangements.

However, there remained blocks in patient flow through the hospital, particularly for specialist rehabilitation and 48-hour fast track discharges. The trust had taken some actions to improve this, such as providing hospice at home service until social care services could start.

The service considered external sources, including local authority health profiles to support their understanding of the needs of the local community. These identified health inequalities from which senior leaders could better understand the demands on their service. In response to this senior leaders developed pathways for common cardiovascular issues so that patients had quicker and easier access to treatment and support. Leaders implemented systems to improve access to services, including technology, transport and education, for people with conditions such as diabetes. Although numbers for the trust were in line with national and regional figures, contributing factors were higher and leaders acknowledged the potential for undiagnosed disease.

Staff had developed information boards, which were found on the wards with key information such as dietary requirements, manual handling requirements and mobility status to ensure continuity of care.

Patients who required specialist therapy services, such as speech and language therapy and occupational therapy, were either referred by ward staff or therapy staff identified during board rounds. Therapy staff told us that patients referred were triaged and seen in priority order to ensure adequate care provision.

The service had developed specific ward areas, such as the frailty assessment unit and same day emergency care (SDEC) unit, to assess and manage the care and treatment needs for patients meeting particular criteria. This took some pressure from the emergency department and acute wards and helped to provide patients with dedicated staff for their needs.

Staff referred patients to external providers, where this was appropriate. While they were not able to influence when patients were transferred to other providers, they kept patients up to date with actions and discussions they had.

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

Staff made notifications to external bodies when required, for example notifying the Care Quality Commission for notifiable incidents and the Nursing and Midwifery Council for concerns about staff conduct. 

The service’s information governance systems ensured confidentiality of patient records. The service complied with the Accessible Information Standard, so patients with disabilities, impairments, or sensory loss received information in a format they needed.

Ward staff provided information leaflets to explain common medical conditions, their symptoms and treatments. This information was detailed but was not always located in areas of the wards that all patients may access.

Staff identified and recorded individual needs, flagged them on patient records, and shared them with other providers for continuity of care. Patients could access alternative formats such as large print, braille, audio, easy-read, email, and British Sign Language, as well as interpreters or communication aids during appointments.

Patients could request adjustments by contacting the patient experience team, ensuring equal access to healthcare information and services. Staff ensured patients could obtain information on treatments, local services, patients’ rights, and complaints processes, which were also available on the trust’s website.

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

The service sought feedback from patients through a variety of sources, such as a complaints, compliments and surveys. Information was available on the trust’s website signposting patients and members of the public on how to complain to the service. Patients could write, email or telephone to make a complaint.

The service had a policy for complaints and compliments that provided staff with guidance regarding their role and subject definition and timescales for completing complaint investigations. Following the onsite visit, the service provided data that showed over the last 12 months, medical care had received 113 complaints. The trust had received higher numbers of complaints in the last year compared with previous years, which represented a 146% increase. Complaints were broken down into broad categories and one area raised more than any others; appointments in rheumatology. A deep dive showed top themes and actions staff were taking to improve patients’ experiences, including increasing the number of outpatient clinics in the area where most complaints related to.

We looked at 3 complaints, which had all been responded to with explanations for each concern raised and included apologies for patients’ experiences. Responses did not, however, always include whether the service took any action to reduce the risk of a reoccurrence, or whether any lessons were learned.

Patients and their relatives had varying views on how well staff listened to them. One patient told us, “Some [staff] are great, others not so much.” Other patients told us staff were “fantastic” and listened to their preferences.

The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Patients were assessed, investigated, diagnosed and treated promptly. Patient told us they had, “Constant monitoring,” staff were, “Quick to pick up on anything,” and they, “Felt everything did happen as it should.” Patients said they did not feel that things could have been done differently and that, “All the steps to get to the ward were needed.”

Staff worked hard to remove any barriers to access for patients. There was a strong culture to prevent discrimination and inequalities. The service worked closely with external organisations to identify barriers to patient experience and discuss improvements. Staff listened to people who had concerns or complaints and sought ways to improve the service.

Patients who were placed in other areas to their responsible consultant were allocated to a specific medical outliers team to reduce the risk of not being reviewed. Staff followed a referral process for these patients to ensure they received medical reviews of their care, including out of hours access to the medical on call team. Information provided showed 2 referrals had been made to the outlier team on the second day of our visit.

Staff told us that the ward rounds followed the ‘sick, home, other, plan’ (SHOP) principles to identify priority reviews of patients based on their clinical need. Staff told us that ward rounds occurred at scheduled times, which resulted in timely decision making. However, we observed medical staff arriving late in one round.

The evidence showed a good standard. Staff and leaders 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 service undertook equality impact assessments of their policies and procedures to ensure they did not place patients with protected characteristics at a disadvantage. Adjustments were made to ensure patients had the correct support when they attended appointments. The clinical harm review process assessed for possible harm and disproportionate impact on those patients waiting longer than expected for treatment.

Staff showed their understanding of the need to identify patients who may require additional support and the need for staff members to make reasonable adjustments to remove barriers to care. Staff completed mandatory equality, diversity and inclusion (EDI) training, which included human rights principles. Overall compliance was 88%, just under the trust target of 90%. This was part of the core statutory and mandatory training and was refreshed every three years to ensure compliance and awareness. 

Patients were able to access a 7-day service from most therapies staff, radiology (x-ray and scanning), phlebotomy (blood testing), pharmacy and social services. Information about staff availability was circulated to senior service staff to ensure changes and impacts to access were known.

The service had policies to guide staff when considering completion of do not attempt cardio-pulmonary resuscitation forms and when patients needed palliative or end of life care. Staff used the Recommended Summary Plan for Emergency Care and Treatment forms (ReSPECT) and Do Not Attempt Resuscitation forms, although we did not see any completed forms in the patient notes we reviewed.

The trust had included auditing of ReSPECT forms in their care of the elderly wards as part of their clinical audit programme to highlight the need for completion and improve the quality of detail entered into the form.