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

At our last assessment we rated this key question good. At this assessment the rating has remained good.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

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.

We scored this quality statement as 2. 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.

Staff received training on how to use the electronic patient record system (EPR) and had used this for 12 months. Staff we spoke to said that the system was not easy to use and it was often time-consuming to find information recorded about patient needs and previously completed risk assessments.

We reviewed 14 sets of electronic patient records and were unable to locate up to date risk assessments in 11 of these. As such we were not assured risk assessments led to effective care plans to ensure patient needs were met. Ward leaders acknowledged that improvements were required regarding the EPR system.

Falls risk assessments and associated care plans were not in place to prevent potential patient harm. We requested the last three months of falls risk assessment audit data for the surgical wards and this showed that not all patients had an accurate falls risk assessment.

Staff did not always make sure patients nutrition needs were assessed and met in line with current guidance. Not all patients on the surgical wards had a MUST assessment completed or a care plan to meet their nutritional needs. The menu offered to inpatients included patient choice with a range of diets and textures.

Patient handover notes were not printed from the EPR system between each shift. A paper handover form was used to collate the information from the EPR system. Staff told us this was time consuming and information was sometimes missed. We reviewed the last three months incident reports and none were submitted to record concerns with patient handover.

Information on individual patient needs were displayed on ward whiteboards to alert staff to those patients who required assistance with repositioning and nutrition and hydration. Given the nutrition audit results provided by the trust we were not assured this was effective at reducing risk.

However, staff were aware of how to monitor skin for pressure ulcers and use body maps when repositioning and recording skin integrity.

We scored this quality statement as 3. 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.

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

Staff gave patients clear information about their care and treatment needed to support both their physical and mental health. People felt their expectations and needs were considered during decision making.

Staff we spoke to told us they could access a range of specialists, if required, to meet the needs of patients such as physiotherapists, dietitians and pharmacists. Staff told us these reviews happened in a timely way when requested.

On the wards we visited, staff champions were identified for a wide range of specialist areas including infection control, tissue viability and sepsis. Staff told us that these champions received training in specific areas and were then able to share knowledge with the wider team to ensure evidence based patient care was delivered.

We observed 2 patient theatre lists and saw effective systems in place to promote and protect the safety of patients. The service followed National Safety Standards for invasive procedures and World Health Organisation (WHO) surgical safety checklists. We also saw ‘Stop before you block’ posters and guidance attached to equipment such as ultrasound machines. We reviewed clear consent processes and allergy checks as part of the preoperative checklists.

We scored this quality statement service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between

When patients received care and treatment from members of the multidisciplinary team (MDT) it was not always coordinated. On the wards we visited there were no daily MDT meetings attended by consultants, ward nurses and allied health professionals. Information was communicated to each team via the electronic patient record and staff told us this caused delays and on occasion information was missed.

Staff on the wards we visited told us that they did not always receive a comprehensive patient handover from the Emergency Department (ED). We were told when patients were admitted there may be a short delay before ward staff could access the clinical records for the patient that were recorded in the ED.

Staff told us that they were able to request assistance from specialist teams and access support in instances where patients’ condition deteriorated via the trust’s electronic communication system. This was observed during our inspection and followed the escalation policy provided by the trust.

We scored this quality statement as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service triaged preoperative patients to ensure those that would benefit from preoperative optimisation would be afforded the right amount of time and attention.

The service delivered preoperative information sessions for patients due to undergo joint replacement surgery, sessions provided dietary, physical, and psychological advice to support health promotion prior to surgery. People’s health was assessed at pre-assessment and staff could make referrals relevant to the patients' needs e.g. smoking cessation at any point in the pathway.

We observed staff effectively communicating with patients about treatment options and care plans, including one example where staff explained expected recovery timescales post-surgery.

We saw a range of health promotion and advise posters in public areas and within the wards, including signposting to support groups within the wider community.

We scored this quality statement as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The trust showed inconsistent performance within clinical audits. While they seemed to perform better within the National Joint Registry (NJR) data, the National Emergency Laparotomy Audit (NELA) data showed 3 metrics below expectation. The National Hip Fracture Database (NHFD) data also showed inconsistent patterns, and the trust did not take part in the Fracture Liaison Service (FLS-DB) Audit. These clinical areas could therefore represent areas of improvement for patient experience and outcomes. We are unaware of action plans for these areas.

VTE risk assessment compliance for the previous quarter was reported to be 68.1%, below the trust target of 95%. The trust advised this was in part due to the implementation of the EPR system and they have a trust wide VTE improvement project.

The trust had an appropriate Learning from Deaths Policy, due for review in August 2026 and completed Structured Judgement Reviews (SJR) where appropriate. We reviewed the last three months Learning from Deaths Reports and were not assured learning had been embedded given key learning themes remained the same for September and October 2025.

We scored this quality statement as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

People told us staff explained care and treatment options in a way they understood and gained verbal consent before carrying out procedures.

Consultants would gain written consent before any surgical procedure. Consent forms were completed electronically and reviewed in theatre as part of the checklist. The trust monitored this against the World Health Organisations (WHO) checklist and audit data indicated 100% compliance in the previous 6 months.

People's capacity and ability to consent was considered, and they, or a person lawfully acting on their behalf, were involved in planning, managing, and reviewing their care and treatment. The trust had a mental capacity policy that was ratified, in date and accessible to all staff that was next due for review in February 2028. Staff generally showed understanding of when and how to assess whether a patient had the capacity to make decisions about their care, and the Mental Capacity Act (MCA) 2005. Trust audit data between April 2025 and September 2025 showed improvements had been made in the standard of Mental Capacity Assessments completed. This was due to recommendations that were made by the Safeguarding Steering Group.

Staff followed the trust policy and procedures when a patient could not give consent. We reviewed the consent policy, which was ratified, in date and accessible to all staff and next due for a review in June 2028.