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.

At our last assessment we inspected but did not rate this key question. At this assessment the rating was 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.

Patients cared for in corridors did not always have risk assessments or hydration checks completed, which did not meet National Institute for Health and Care Excellence (NICE) guidance. Trust policy stated that staff must use the hourly ED Patient Safety Checklist to monitor hydration, nutrition and key safety measures such as access to drinks, call bells and skin checks. Staff audited the checklist and results showed poor compliance and inconsistency. In May 2025, fewer than half of first‑hour safety checks were completed (under 50%), and completion dropped further for patients who remained longer in the department. Compliance improved in June and July 2025, with July showing the most consistent performance and the highest proportion of completed checks.

However, this progress was not maintained. Compliance declined again in August 2025 and September 2025, particularly for patients who remained in the department for more than four hours. From May 2025 to September 2025, safety checks were least likely to be completed after the fourth hour, creating ongoing risk for patients with extended waits. Overall, the data demonstrated that while initial checks were more reliable, required safety assessments were not consistently completed over time, especially for patients waiting longest in corridor areas.

Staff carried out monthly audits of nursing documentation and electronic records. Safety concerns identified through these audits triggered immediate review and incident reporting to ensure accountability. Teams used audit results to highlight gaps in practice, guide learning and provide targeted training where needed. Although this led to short‑term improvements, these were not always sustained over time, and repeated audits continued to identify similar issues. This meant that despite regular checking and learning activity, compliance did not consistently remain at the standard required.

Staff developed and circulated a sepsis workflow, uploaded a quick reference guide and delivered targeted training during medical training days. Paediatric clinicians received documentation training in July 2025, and weekly catchups with the Sepsis team were introduced to monitor progress.

Staff caring for mental health patients in majors conducted full assessments, including safeguarding and substance misuse screening, and they worked with other agencies and carers to create holistic care plans.

Teams shared learning in huddles and meetings, and carers were involved in mental health planning. However, opportunities for person‑centred learning were limited because the feedback mechanisms in place did not routinely capture the experiences of patients following safety‑related events or episodes of distress. This reduced the service’s ability to fully understand what mattered to patients and incorporate this into safety improvements.

In majors, staff completed safeguarding and substance misuse assessments and created holistic care plans, involving carers and multi-agency teams to meet both physical and mental health needs.

We scored this quality statement as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff did not consistently follow sepsis care plans. In the most recent reporting period, compliance was recorded at below 10%, meaning that fewer than one in ten required care plan steps were completed as expected. Across a six‑month review period, teams did not collect or report data on neutropenic sepsis or on when patients received their first dose of antibiotics. This meant we could not be assured that patients were receiving timely treatment. Overall, the available data showed that progress was inconsistent and not sustained. Early screening, timely treatment, and care planning all remained below expected standards.

We reviewed six months of sepsis data between April to November 2025. Staff performance in sepsis screening was inconsistent, with periods of improvement followed by decline. In May 2025 and June 2025, sepsis screening rose to 70% after being 36.8% in April 2025. Sepsis Six compliance for confirmed cases improved to 84%. However, by June 2025 to August 2025, screening dropped sharply to 49%. Sepsis Six compliance fell to 68%, with antibiotics given in 84% of cases. From September 2025 to November 2025, screening showed only slight improvement at 52%, and antibiotic compliance for suspected sepsis was 74.3%.

Between June 2024 and August 2025, the Sepsis team reviewed compliance reports and identified a drop in key safety measures. Sepsis screening reduced from 71% to 49%, meaning fewer patients were being checked early for signs of infection. Compliance with the Sepsis Six bundle, a set of six urgent steps that should be completed within one hour for patients with suspected sepsis, fell to 68%. The bundle included giving oxygen if needed, taking blood cultures, giving intravenous fluids, checking lactate levels, monitoring urine output, and, crucially, giving intravenous antibiotics.

Patient’s required early antibiotics, this was because sepsis caused by a severe infection could rapidly worsen. Although staff administered antibiotics in 84% of cases, the overall decline in screening and treatment compliance highlighted the need for earlier recognition, especially at triage when a raised NEWS2 score indicated possible sepsis.

Staff audited children’s care records over the past 12 months and identified variable compliance with documentation standards. Overall compliance for the period November 2024 to November 2025 was 76%. There were examples of good practice where records fully met required standards, however inconsistencies remained. These gaps meant that records did not consistently demonstrate a clear and comprehensive account of care delivered to patients in the Children’s Emergency Department.

Staff monitored how well they were using early warning scores, such as the Paediatric Early Warning Score (PEWS) and the National Early Warning Score (NEWS2). These scores identified when patients were becoming unwell and needed escalation. When results showed that staff were not using these tools consistently, leaders introduced an action plan, moved to the national PEWS system, and provided further training. This demonstrated a commitment to improving patient safety.

Patients had access to a range of professionals, and new staff received structured induction and supervision. Appraisal compliance was 84%. Leaders shared that one appraisal was outstanding due to staff sickness, and another had an agreed extension.

Staff contributed to quality improvement projects, such as reducing unnecessary intravenous paracetamol use.

We scored this quality statement as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular multidisciplinary meetings and shared patient information effectively during handovers. Teams worked well with care coordinators, discharge teams, and specialist services to ensure continuity of care.

The Rapid Assessment and Treatment area operated 24/7 with clear roles: a registrar as senior decision-maker, a Band 7 nurse, and a Health Care Assistant. We saw completed assessments including National Early Warning Score, observations, electrocardiogram, and blood glucose, supported by point-of-care testing, ensuring timely decisions.

Resuscitation bays displayed clear treatment guides for life support, sepsis, and trauma care. The service was not a specialist unit for major incidents or strokes, staff safely transferred patients when needed. Leaders ensured that staffing levels were appropriate, and nurses held advanced life support skills. Although audits reflected room for improvement in the wider areas, we saw that patients in the resus bays received timely assessments and medication, and staff kept them informed.

The mental health lead collaborated with local hospitals and national networks, supervised the hospital team, and coordinated complex risk meetings. They delivered training on self-harm and mental health conditions. The mental health lead told us that training uptake was low, which had prompted plans for a hospital-wide training needs analysis.

Staff risk assessed patients at triage. If staff identified mental health concerns they made a referral through the Electronic Health Record system. Staff then followed this with a direct phone call to the 24/7 Psychiatric Liaison team. This ensured review and continuity of care. The liaison team had full access to the hospital’s electronic records. Enhanced care needs were assessed at triage. Leaders planned each shift with a dedicated Enhanced Care Health Care Assistant to support patients. Registered Mental Health Nurses could be booked when additional expertise was required.

If there were delays in assessment or bed allocation, the issue is escalated directly to the Integrated Care Board through the operational team. Concerns were also raised in the three daily internal bed meetings and on the daily system calls attended by the hospital’s Head of Site Operations.

The wider hospital infrastructure provided additional mental health capacity, which helped support patient flow and created a calmer environment for individuals awaiting specialist mental health beds.

Leaders demonstrated preparedness for major incidents through training and clear triage processes. Leaders told us during a recent fire alarm, staff managed evacuation effectively, showing strong teamwork and responsiveness.

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.

Staff supported patients to live healthier lives, for example, through participation in smoking cessation schemes, healthy eating advice and screening for cancer.

The trust actively promoted healthier lives by supporting people to quit smoking and created a smoke‑free environment. We saw a strict no‑smoking policy across the hospital. There were stop‑smoking advice and referrals posters for patients who wanted help to quit.

The wider work associated with Princess Alexandra (the royal patron) also included long‑standing support for major health charities, including Cancer Research UK.

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.

Staff continued corridor care without completing consistent risk assessments, contrary to national guidance. Delays in ambulance handovers and mental health patients waiting in unsecured areas posed safety risks.

Audits carried out by the ED team in November 2025 showed that staff continued to provide timely care for the sickest patients. Over 70% of people in the resuscitation area were treated within 60 minutes, which met national standards. Nurses and clinicians at the front door consistently carried out triage, rapid assessment, and early diagnostic tests on time, ensuring that patients were assessed quickly and moved safely into the right part of the department.

However, the leadership team’s wider monitoring identified several pressures affecting overall patient experience. Although the number of people attending remained steady, managers noted a 10% rise in the number of patients still in the department at midnight.

Real‑time tracking by the ED coordinators showed growing delays later in the patient journey. Some patients waited more than 10 hours for their first clinical review. Specialty teams were taking longer to respond to referrals, and the site management team struggled to provide inpatient beds promptly. Because of this, 19% of patients ended up staying more than 12 hours in the ED. More patients were left waiting for senior review or for the next stage of their care. These were signs of exit block.

Real‑time tracking by the ED coordinators showed growing delays later in the patient journey. Some patients waited more than 10 hours for their first clinical review. Specialty teams were taking longer to respond to referrals, and the site management team struggled to provide inpatient beds promptly. As a result, 19% of patients waited more than 12 hours in the ED, and increasing numbers were left waiting for senior review or the next stage of care. These were indicators of exit block.

Crowding increased over the month, and mental health nurses reported that the assessment space for mental health patients was often full. Data showed that the number of patients with a decision to admit remained consistently high on most days during the period reviewed.

The ambulance handover team also recorded spikes in delays, even though there were quieter periods in between. These findings showed that although ED staff managed the front‑door workload well, wider hospital pressures were slowing the flow of patients through the system. This created a higher risk of delayed or less effective care for patients.

The team used a wide range of real‑time information to monitor performance. When performance showed signs of pressure, senior ED leaders worked with specialty teams and the site management team to speed up responses from on‑call specialties. Staff told us this helped make sure patients were reviewed by senior clinicians sooner.

The site team focused on improving patient flow through the hospital. This meant fewer people were left waiting in the ED after a decision to admit. These actions aimed to reduce the number of patients “boarded” and improved movement through the rest of the hospital. This support was essential to help the ED maintain safe and timely assessment and treatment, especially when the department became crowded.

Managers introduced a new Surge Plan and held frequent patient placement meetings to address capacity, corridor care, and ambulance flow. Technology supported faster care, such as prompt access to blood test results. Despite these measures, the 12-hour waiting time standard remained a challenge, reflecting hospital-wide pressures on discharge and flow.

Staff used a range of recognised tools to detect and respond to patients who were becoming more unwell, helping to keep people safe and improve outcomes. Nurses and clinicians completed regular observations using NEWS2 for adults and PEWS for children, and they escalated any concerns promptly to senior staff. Staff used safety checklists, clinical risk prompts, and findings from monthly audits to make sure that deteriorating patients were identified and reviewed without delay. These checks formed part of the department’s routine safety huddles and were monitored by the nurse‑in‑charge throughout each shift.

Leaders monitored patient flow using a dedicated calculator and colour-coded escalation process. This structured approach aligned with NHS England guidance and reduced delays during busy periods.

We scored the service 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.

Staff understood their responsibilities under the Mental Capacity Act (MCA) and used MCA assessments to support decision‑making for patients who lacked capacity in the Emergency Department. DoLS authorisations were not routinely completed in ED, which was appropriate given the legal framework and the short‑term, non‑admitted nature of emergency care.

Leaders told us that recent trust‑wide audits had identified variability in MCA practice across services and that actions were planned to strengthen consistency and documentation. While this audit was not specific to the ED, leaders recognised the importance of ensuring robust MCA processes and planned improvements across the organisation.

Where mental capacity was impaired, staff assessed and recorded capacity appropriately. In every case reviewed, Mental Capacity Act (MCA) and Best Interests documentation was completed. Audits showed decisions were clear in 87% of MCA and Best Interests forms, but only 33% of Best Interests forms had all sections completed, highlighting a gap in thoroughness.

Staff took practical steps to enable patients to make their own decisions. Audit data showed that in 100% of cases, staff considered whether patients could decide for themselves, demonstrating commitment to patient autonomy.