The Princess Alexandra Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

We looked for evidence that people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

At our last assessment we did not inspect this key question. At this assessment the rating is requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service requires improvement in caring for people. While staff demonstrated kindness and person-centred care for mental health patients and understood cultural and spiritual needs, privacy and dignity were not consistently maintained. Patients were cared for in open corridors without screens, and personal care was sometimes delivered without privacy, contrary to national guidance. Therapeutic spaces for mental health patients were limited, and resources to support comfort were not always available. Although many interactions were positive, gaps in planning for privacy and inconsistent responsiveness meant the service did not always minimise discomfort, worry, or distress.

We have not awarded this service a score for Caring.

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

We scored this quality statement as 2. The evidence showed some shortfalls. Service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

Patients were nursed for long periods in corridor areas without screens, which exposed them to constant foot traffic and compromised privacy and dignity. We observed staff carrying out observations in open spaces without privacy, and on more than one occasion patients used cardboard urinals without appropriate screening in place.

Staff told us this environment made it difficult to provide personal care discreetly. On one occasion we saw a substantive nurse intervene promptly to provide privacy and escalate the issue to senior staff, but the lack of suitable space and screening meant that maintaining dignity was not always possible. These practices fell below the standard of privacy and dignity expected.

Leaders recognised that privacy screens were available but not consistently used to maintain patient dignity. During our visit, we observed a semi‑conscious patient who was unable to reposition himself, which was causing visible distress to his family. Family members shared their concerns with us, and we raised the issue with staff, who attempted to reposition the patient but were unsuccessful. The family continued to express their concerns to staff.

We observed members of the public walking through narrow corridor areas where unwell patients were positioned on trolleys and clinical activities were taking place. This meant patients were exposed without adequate privacy, and their dignity was not protected.

Paediatric areas had limited space, which sometimes compromised privacy when managing unwell or vulnerable children. We were told of an incident in which an unwell child, who was not receiving active resuscitation, was brought through the main entrance due to a temporary obstruction. Although privacy screens were put in place before the child entered the department, this demonstrated how the layout could occasionally create risks to dignity when standard pathways were not accessible.

Leaders explained that established standard operating procedures directed ambulance‑arriving children to enter and exit via designated side or rear entrances, and that simulation exercises had reinforced these pathways. We also found that individuals brought in under police escort were managed in the waiting room without a clear or formal process for ensuring enhanced privacy. This did not fully align with NHS and Royal College of Emergency Medicine guidance.

However, mental health patients were treated with kindness and staff demonstrated person-centred care. Records showed holistic planning, involvement of carers, and immediate escalation of safeguarding concerns. Patients had access to chaplaincy services for spiritual and cultural needs, and staff said they could raise concerns about disrespectful behaviour without fear.

We scored this quality statement as 2. The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Leaders told us that the trust had begun implementing the Oliver McGowan Mandatory Training programme in January 2025, following receipt of national funding. At the time of our inspection, compliance with Tier 2 training was 45.6%, equating to over 1,300 staff. The trust was delivering the training in a phased way to ensure staff could be released safely from clinical duties, with an internal trajectory to exceed 90% compliance by the end of 2026. Although progress had been made, the trust was still in an early stage of implementation, and full compliance had not yet been achieved. Leaders recognised this and had plans in place to increase uptake over the coming year.

Children’s comfort and reduced anxiety continued to be prioritised, even while the children’s ED operated from a temporary space. Staff made use of neurodiversity‑friendly adjustments such as calming décor and fidget toys. Staff worked hard to treat each child as an individual. However, some staff felt that the limitations of the temporary environment did not always fully support this approach. Patients were still supported to access information on treatments, rights, complaints procedures, and local services.

Staff identified individuals needing extra support and made reasonable adjustments under the Equality Act 2010. When a mental health patient’s disability was missed, staff escalated and adapted plans promptly, showing responsiveness.

Personalised care was supported through hospital passports, health passports, and purple folders.

We scored this quality statement as 3. This is the default scoring from the previous inspection.

We did not look at Independence, choice and control during this assessment.

We scored this quality statement as 2. The evidence showed some shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Staff showed concern for people’s wellbeing in a caring and meaningful way. However, high levels of demand meant staff were not always able to respond to people’s needs quickly enough to prevent avoidable discomfort, concern, or distress. Some patients waited more than 12 hours in the department.

One patient told us they did not have access to washing facilities to allow them to freshen up during a prolonged stay. At the time of our visit, washroom facilities in the majors area were unavailable due to refurbishment. Leaders told us that staff supported patients to access alternative bathroom facilities in other areas of the department and that this was not usual practice outside of the refurbishment period, which was completed on 19 November 2025.

Volunteer services and housekeeping staff were in place to support patients with refreshments. Leaders told us that hydration and nutrition rounds took place regularly throughout the day, with drinking water and disposable cups available in waiting areas and other parts of the emergency department, including for patients cared for in corridors. However, some patients told us they did not experience continuous access to water or hot drinks during their stay.

Mental health patients were not always cared for in environments that fully supported their therapeutic needs. Although the emergency department had one designated mental health suite, this was not sufficient to meet demand at the time of our visit, and some patients waited over six hours in non‑therapeutic spaces, which reduced their comfort and dignity.

Leaders told us that estate and infrastructure limitations meant it was not feasible for all cubicles to mirror the design of the mental health suite and acknowledged that this was a system‑wide challenge common to district general hospitals. However, during our visit the department was caring for a high number of mental health patients, and staff told us they were concerned about their ability to manage patients safely and therapeutically in the available environment, despite providing compassionate and supportive care.

Staff did not always answer call bells in a timely manner. Many patients in the major’s temporary escalation areas did not have a call bell to gain the attention of staff. This posed a risk to patient safety in the event of an emergency.

During delays in offloading, ambulance crews and emergency department staff provided patients with food, drinks, and access to toilet facilities, and patients continued to receive care while remaining on ambulances. Leaders told us that these patients were included in nutrition and hydration rounds, received ongoing treatment and diagnostics, and were monitored by both ambulance crews and emergency department staff, with escalation processes in place where concerns were identified.

However, ambulance crews told us that care delivered during prolonged ambulance waits was not equivalent to care within the emergency department. They described challenges in meeting patients’ needs while remaining on vehicles for extended periods, despite close monitoring and efforts to minimise risk.

Patients receiving corridor care did not get the same level of care. None of the six corridor care records we reviewed had risk assessments. We saw evidence of dementia patients placed in Corridor 2, despite policy stating confused or high-risk patients should not be there. To help improve care, the trust updated their Surge and Capacity Plan policy and Temporary Escalation Spaces SOP.

Staff used an electronic system to flag patients with dementia, learning disabilities, autism, or mental health needs and prioritised quieter spaces. They also used patient passports, but resources like distraction tools were not always available. While patients generally reported positive interactions, these gaps meant the service did not consistently reduce discomfort, worry, or distress.

We scored this quality statement as 2. The evidence showed some shortfalls. The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff were committed to delivering good care, but gaps in processes and resources, such as corridor care without risk assessments, created stress and pressure.

Some staff did not always feel valued, and organisational changes created uncertainty. In response, leaders provided regular updates, engagement sessions, and access to wellbeing resources. Leaders reinforced their commitment to an inclusive culture and continued career-focused appraisals to help staff feel secure and supported.

The provider supported wellbeing through occupational health services and celebrated achievements with staff awards. Appraisals included career development discussions, reinforcing professional growth. Sickness and absence rates were like the provider average, indicating workforce stability.