The Princess Alexandra Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

Staffing levels were sometimes insufficient because of sickness, vacancies and redeployment, which increased pressure, although leaders monitored risks. Staffing levels were sometimes not high enough to keep patients as safe as they should be. Sickness, vacancies and redeployment occasionally left wards short staffed, which increased pressure on staff. Leaders monitored this closely, and staff worked well together to continue providing care. Most staff had completed mandatory training, but not all nurses had received an annual appraisal.

The service took safety seriously and encouraged staff to report concerns and incidents. Most staff knew how to report issues and felt supported to speak up. However, some nurses did not report near misses if no harm had occurred, which meant opportunities to prevent future problems were sometimes missed. Managers supported staff after serious incidents, and lessons learned were shared with teams through meetings and handovers.

The service had clear policies to help staff raise concerns and be open with patients. Leaders reviewed complaints to spot common problems and made changes to improve care, especially in the rheumatology service where delays were affecting patients. Although responses to complaints explained what happened and included apologies, they did not always show what the service had learned or what it had changed to stop the issue happening again.

The service used safe systems to manage care and patient records. Staff could easily access electronic records and used national tools to spot patients who were becoming unwell. Risks were clearly recorded and acted on. Staff worked well together in multidisciplinary teams and shared important information during structured handovers. However, leaders could not fully check how well staff were using early warning scores after introducing a new electronic system.

Staff understood how to keep adults and children safe from abuse and knew how to report concerns. Most staff had completed safeguarding training, but many doctors had not met the required training levels. Staff knew how to assess mental capacity and had access to specialist safeguarding support when needed.

Staff involved patients in decisions about their care and usually explained treatment options. However, some patients said they were not always given enough information and were left unsure about what would happen next. Staff worked well together and used support such as interpreters when needed.

The environment was generally safe, clean and well maintained. Staff checked equipment regularly, although a small number of checks were missed. Any issues identified during the inspection were dealt with quickly.

The service managed infection risks well overall. Most staff followed infection control procedures, and wards were clean. Audits highlighted some areas for improvement, and the service had action plans in place to address these.

Medicines were mostly stored, prescribed and given safely. Staff monitored medicine-related incidents and took action to reduce risks. In one area, medicine storage was not ideal, but staff corrected this as soon as it was pointed out.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. We assessed 8 quality statements.

We have not awarded this service a score for Safe.

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

The evidence showed some shortfalls. The service had a proactive and positive culture of safety, although not all staff recognised risks or near misses. Lessons were learnt to continually identify and embed good practice, although recording of actions were not always included in complaint responses.

Staff we spoke with knew what incidents to report, how to report them, through a variety of avenues, including freedom to speak up guardian (FTSUG), and felt encouraged doing so. However, we spoke with 2 nurses who were reluctant to report when staff were not available to monitor patients as they felt no harm had occurred. They did not recognise the potential for unexpected or unwanted events or follow the trust’s incident management policy in relation to reporting near misses. Staff told us managers debriefed and supported staff after any serious incident as part of the after actions review (AAR).

Incidents were reviewed daily, weekly and monthly by senior nurses and other senior staff, where learning was identified and fed back to staff directly where that was appropriate. Identified learning was looked at during a twice monthly meeting to ensure actions were followed through.

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.

However, lessons were learned from reported safety incidents and complaints, resulting in changes that improved care for others. Staff told us they received feedback from incidents reported, by email and shared with the wider team in meetings, handovers and safety huddles. We observed learning from incidents, being discussed at handovers and huddles.

The service had policies in place for staff to raise concerns, which ensured members of staff were aware of their duty of candour, openness, and transparency, and the process to raise concerns at work. Staff were also supported by policies on incident and complaints management, which provided information about responsibilities and the route taking to resolution or improvement.

Leaders completed a report into all the complaints received between March 2025 and November 2025 to identify trends and themes, and develop actions to improve the service. This showed which department in the service generated the most complaints, an analysis of the complaints and actions taken to reduce the risk of reoccurrence. This resulted in a deep dive for the rheumatology department between November 2024 and October 2025, which had the highest number of complaints and the highest number for the same theme. Themes included delays, appointments and medicines. Limited outpatient slots reduced infusion delivery and timely patient reviews. Mitigating actions to improve patients’ experiences included recruiting additional staff, increasing the number of appointments available and the implementation of a new software programme to improve clinic allocation and eliminate duplication.

The evidence showed a good standard. The service worked to establish and maintain safe systems of care. They made sure care was provided in line with guidance.

Staff used an electronic patient record (EPR) system for inpatient records, which all relevant staff had access to. This meant there were no delays in staff accessing patient records when they moved to a new team or area.

Staff used a nationally recognised early warning tools to identify patients at risk of deterioration. One staff member showed us how entering adverse observations onto the electronic system automatically brought up other risk assessments for staff to complete. We reviewed care records for 8 patients. There was evidence of evaluation of risk through their care journey, with clear documentation of risk that was acted upon. High scoring entries were either repeated or escalated as appropriate.

Staff attended a daily MDT handover where all patients care and treatment was discussed. They also attended cross department huddles to identify where there were staffing shortfalls, patient deterioration or other risks. These occurred twice a day to consider known issues and potential issues across the service. Staff took part in meetings that were proactive in identifying when patients were to be discharged. The discharge team worked proactively with local authority social services to identify social care needs and arrange for these to be met when people were discharged.

Staff used a Situation, Background, Assessment and Recommendation (SBAR) format to provide updates during staff handover and when transferring patients to other areas and shifts.

The service had developed guidance for staff when patients were transferred to non-designated areas to provide clinical care. This guided staff to only place patients in these areas who met specific criteria and were suitable for the reduced facilities. Staff completed a risk assessment to assess this criteria and reported when this was not met.

The evidence showed some shortfalls. Staff knew how to apply guidance on safeguarding patients, although not all staff had received training on how to recognise and report abuse. The service worked well with other agencies to do so. The correct actions were taken to assess patients’ mental capacity and when staff deprived patients of their liberty.

The service provided training on how to recognise and report abuse. The service provided nursing and medical staff with level 3 safeguarding training for children and adults. However, at the time of inspection, nursing staff compliance was 85% and medical staff was 51%, both below the trust target of 90%.

There was an adults safeguarding policy, which was available when staff needed guidance. The policy was in date and version controlled.

Staff reported that they knew how to make a safeguarding referral and who to inform if they had concerns. Staff gave examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act 2010. Staff also knew how to identify patients at risk, or suffering, significant harm and knew where to document and access this information. Staff reported that the safeguarding team was very visible and could identify the safeguarding lead in their area.

Staff told us they followed a process if they had concerns about a patient’s ability to make decisions about their care or treatment. They told us information was available in the electronic patient record system to support completion of a mental capacity assessment and a deprivation of liberty safeguards application if necessary. This also provided guidance regarding the lowest level of restriction staff could take to make sure patients were safe. The electronic system automatically notified the safeguarding team for staff members when they entered information. The service completed Deprivation of Liberty Safeguards applications when patients had been assessed to be without capacity to make decisions about staying in hospital and required constant monitoring.

The evidence showed some shortfalls. Staff provided care to meet people’s needs. However, staff did not always communicate everything that would happen.

Staff completed audits to monitor use of nationally recognised tools for deteriorating patients such as venous thromboembolism (VTE). This is a standardised system used to detect and respond to clinical deterioration in patients.

Leaders told us they had been unable to audit National Early Warning Score 2 (NEWS2) compliance with completion and escalation since using the EPR. However, they had looked at other systems to monitor levels of patient referrals to escalation teams to ensure these were not increasing. There had been no increase in the number of patients referred to these services since the implementation of the EPR.

Staff communicated with patients so that they could understand their care and treatment. Patients told us explanations were given to them, although these were not always detailed and patients were left with additional questions that were not always answered. One patient told us they had been advised they were eligible for discharge with medical or nursing staff visiting them at home to give intravenous (IV) medicines. However, the mechanism of administration had not been explained and the patient did not know if they would have an IV all day or when they would be discharged for this to start.

We observed good multidisciplinary working. Staff held handovers and safety huddles involving all relevant members of the multidisciplinary team. They were structured and were held in an area with minimal disruptions. Shift changes and handovers included all key information to keep patients safe.

During our assessment some patients told us that staff explained treatment options to them and their relatives and gave them time to ask questions before making a decision. Discussions with patients were recorded in patients notes and conversations included the use of translation services and hearing loops.

The evidence showed some shortfalls. The design, maintenance and use of facilities, premises and equipment kept people safe. However, there were times when patients were cared for in areas that were not designed for patient care. Staff were trained to use them. Staff managed clinical waste well.

Staff cared for patients in corridors or escalation areas when required and reported when there were issues that involved these patients. Leaders told us this occurred as infrequently as possible and we saw no patients in these areas during our visit. However, use of escalation areas puts patients’ safety, privacy and dignity, and staff members ability to provide safe care at risk. The highest number of reports for one theme was in relation to unsafe or inappropriate clinical environment, which accounted for 25 out of 105 reports (24%), in the 12 months before our assessment. Just over 15% of these 25 reports resulted in minor harm or treatment. Staff provided patients with a portable call bell which alerted staff with a doorbell sound. Call bells were accessible to patients if they needed support. Staff responded quickly when call bells were used; we saw call bell had been placed within patients reach.

The service designed the environment in specialist areas, such as the respiratory ward and same day emergency care, to follow national guidance.

Staff completed safety checks of specialist and emergency equipment and we saw adult resuscitation equipment was mostly checked daily. Records showed staff had not completed checks on 2 dates on one resuscitation trolley.

Most portable electronic equipment had been portable appliance tested, although we saw some computer equipment did not have stickers to demonstrate this. This was rectified immediately when we spoke with senior staff. The service tested the fire safety equipment within the last 12 months. We saw all equipment had last servicing dates and next due dates on.

The evidence showed some shortfalls. The service did not have enough qualified and experienced staff to keep patients safe. However, staff worked together to provide care.

Staff told us staffing levels sometimes dropped when there was short term sickness or when staff were redeployed to other areas. This often made the ward environment busy and staff had competing priorities. On one ward we saw 2 patients with cardiac monitoring but no nursing staff in the bay to oversee this, as the nurse had also been allocated another bay of patients to care for. Information provided following this assessment showed in November 2025 there were 70 red flag reports where staff were unable to provide enhanced care. This information also showed 7 incidents where staff were delayed in providing pain relief and one patient receiving end of life care who had delayed administration of medicines through a syringe driver (slow administration under the skin).

The service had a good skill mix of staff on each shift and reviewed this regularly. However, during the assessment the numbers of nurses, health care support workers (HCSW) and medical staff did not always match the planned numbers in all areas. Information provided following this assessment showed there were 301 HCSW and 299 nurse unfilled shifts for the period 17 November 2025 to 17 December 2025. Almost a quarter of the requests to bank and agency for the unfilled shifts were due to sickness, with19% due existing vacancies and 17% due to additional staffing need for one to one care.

The trust provided mandatory training that was comprehensive and met the needs of patients, which included nationally required and trust required training. Overall compliance for mandatory training was 88%, below the trust target of 90%. Staff said their managers prompted them to look at the electronic staff record for required training and the practice development nurse kept them up to date with changes for such things as tissue viability.

The service’s staffing was assessed as part of the ‘SafeCare’ census, a NHS platform to help organisations match staff levels with patient acuity and dependency. The vacancy rate for nursing staff (7%) was below the trust target of 9%, although the rate for health care support workers (HCSW) was higher at 13%. The overall voluntary turnover was also below the trust target of 12%. However, sickness rate for medical care staff was over the trust target of 4.5%, at 5.5% in November 2025, although long term sickness rates were reducing. Medical staff sickness rates and overall voluntary turnover were within the trust target. However, medical staff vacancy rates were higher than the trust average at 11%, which meant a high number (10%) of locum medical staff were used.

However, patients told us there were enough staff, who responded to call bells quickly.

Staff took part in a safety huddle twice a day, which covered staffing, acuity levels, safeguarding, concerns in each area, discharges and learning from previous incidents or complaints. We observed evidence of good multidisciplinary working.

The service reported that they used regular bank and agency staff who were familiar with the service and made sure all bank, agency and locum staff had a full induction and understood the service.

Managers supported staff to develop through yearly, constructive appraisals of their work. Data from the service showed overall there was 71% compliance with appraisals for nursing staff, it is unclear what the trust target is for appraisals. Compliance rates for medical staff was 100%.

The evidence showed some shortfalls. The service controlled infection risk well. Most staff used equipment and control measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean, although audits identified areas requiring improvement.

We saw some staff not washing their hands between patients. Gloves were used before staff provided care for patients, although not all staff washed their hands between putting gloves on. Other staff members were seen wearing jewellery with a stone on their hand, wearing their hair down below the shoulders and wearing a wrist watch. These practices increase the risk of harbouring and cross infection.

However, most staff followed infection prevention and control principles such as, bare below the elbows. We observed staff put on and remove aprons and gloves before and after entering side rooms that isolated infectious patients. The service provided hand gel was for staff and visitors within ward areas. We also saw staff adhering to policy for patients with potentially infectious illnesses by using single rooms for isolation, which were clearly signposted to staff and other patients.

The infection prevention and control committee meeting reviewed audits results, such as the number of MRSA infections and hand gel compliance between May and October 2025. The committee highlighted areas of concern, including isolation practice and staff awareness, documentation of IV insertion and dressing compliance, and commode cleanliness. We saw green RAG ratings for performance against most other audited areas, such as equipment cleanliness, environmental areas, commode and dirty utility cleanliness, in the last 6 months, indicating compliance against most trust targets.

The service maintained all ward and department areas, which were visibly clean with suitable furnishings. Staff kept cleaning records up-to-date, which demonstrated that all areas were cleaned regularly.

The service displayed cleaning scores in ward areas, they showed most areas consistently performed well for cleanliness. Where there were exceptions, the service implemented a cleaning action plan to address identified concerns.

The evidence showed some shortfalls. The service used systems and processes to safely prescribe, administer, record medicines, although storage was not always ideal.

Staff stored and managed all medicines and prescribing documents safely. The clinical room where the medicines were stored was locked and could only be accessed by authorised staff. Medicines were in date and stored at the correct temperature. However, in one ward we saw medicines that were not stored safely and had been put onto the floor. This increased the risk of contamination, temperature fluctuations, safety and trip hazards, and accidental damage and misplacement. We discussed this with staff and the issue was immediately rectified. Staff monitored and recorded fridge temperatures and knew to act if there was variation. Staff checked controlled drug stocks.

The service monitored records for medicines incidents to determine any trends and themes. Actions were identified, together with prompts and teaching aids for staff, and consideration for alternative medicines if appropriate.

Staff followed systems and processes to prescribe and administer medicines safely. Patients had prescription charts for medicines that needed to be administered during their stay. We reviewed prescription charts and found staff had completed them accurately and kept them up to date.

Staff followed national practice to check patients had the correct medicines when they were admitted, or when they moved between services.