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 inspected but did not rate this key question. At this assessment the rating good.

Good: This meant people’s needs were met through good organisation and delivery.

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

This key question has been rated 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.

We scored this quality statement as 2. The evidence showed some shortfalls. The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The CQC Urgent and Emergency Care Survey 2024 showed that patients who visited the department felt reasonably supported in their care. The ‘Care and Treatment’ domain scoring 6.7 out of 10, performed about the same as other trusts nationally. This domain included how involved patients felt in decisions about their care and treatment. Although patients generally felt involved, the results showed there was still room for improvement. Patients said they wanted clearer information, better communication, and more involvement in decisions about their care.

Staff demonstrated some person-centred practices, but gaps limited consistency. Corridor care reviews found no documented risk assessments. Frail patients, including those with dementia were placed in an area excluded by SOP criteria.

Staff used flags in electronic systems and patient passports to identify and support individual needs, prioritising patients with dementia or learning disabilities. However, resources were not always accessible, for example, distraction tools could not be located, reducing the ability to deliver fully person-centred care.

Positive examples of person-centred care included timely assessments in line with national standards, collaborative risk assessments with families, and respectful communication. Mental health patients received comprehensive assessments and care plans developed with patients and carers, supported by timely referrals and multi-agency working.

People 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.

We scored this quality statement as 2. The evidence showed some shortfalls. There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

During busy periods, staff reported delays in streaming, and the Rapid Assessment and Triage process was used because ambulance crews could not offload patients on time. These delays often led staff to use corridor care, which is not supported by national guidance. Staff also recorded that ambulance handover performance improved between November 2024 and June 2025, with handovers over 45 minutes reduced by almost two thirds and continued improvement until August 2025. After August 2025, delays increased again due to wider capacity pressures across the trust, which made it harder for staff to move patients into the hospital.

To address these pressures, the trust’s Urgent Care Improvement Programme was focussed on high‑impact actions to improve patient flow and increase capacity across the whole hospital. This work was essential because longer ambulance handover delays were closely linked to longer waits in the Emergency Department, including 12‑hour waits for some patients.

The Same Day Emergency Care team handled urgent referrals, but NHS 111 and 999 couldn’t contact them directly. This meant the team couldn’t respond as quickly as they might have.

The frailty team engaged early with patients in Rapid Assessment and Triage, working closely with the Older Persons Assessment and Liaison Unit to avoid unnecessary admissions. The team included a doctor, nurse, physiotherapist, and occupational therapist, liaising with social services and discharge teams to arrange care packages and equipment. Staff highlighted strong multidisciplinary working and proactive involvement in patient care.

Emergency department staff followed clear escalation criteria in Rapid Assessment and Triage, triggering actions at 20, 31, and 45 minutes for waits and handovers. Actions included informing the nurse in charge, involving the Hospital Ambulance Liaison Officer team, and decompressing majors or resuscitation areas. During our visit, Rapid Assessment and Triage worked well, no ambulance crews were waiting, and initial assessments met national standards.

The Hospital Ambulance Liaison Officer team collaborated daily with emergency department staff and reported good partnership, though pressures increased when corridors were full. Escalation and patient flow processes appeared effective.

Teams held weekly planning meetings with ambulance staff, emergency department nursing, and management, but clinicians did not attend, limiting clinical input.

We scored this quality statement as 3. 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.

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.

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.

We scored this quality statement as 3. 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.

Staff used a complaints tracker to monitor actions from investigations and ensured improvements were implemented on time. Complaints were discussed in meetings so teams could share lessons learned and agree changes, showing governance and learning from feedback.

Between 1 November 2024 and 31 October 2025, staff managed 59 formal complaints. Overall, 93% of complaints were managed within policy guidelines. As of 1 December 2025, seven complaints remained under review.

Staff took complaints seriously, escalating concerns for deeper investigation where needed. This improved care quality, safety, and patient experience by ensuring lessons were learned and changes made.

Clinical teams acted on recommendations to improve care. The Palliative Care Team and senior Emergency Department staff reviewed end‑of‑life care and planned for situations where no beds were available. The Lead Matron and Head of Nursing took responsibility for implementing these actions. However, patients were not always given easy ways to provide feedback. During our visit, we did not see comment cards or suggestion boxes, and leaders told us these had been removed. Feedback continued to be collected digitally through the Friends and Family Test.

Patients shared a mixed experience of their care in the department. In November 2024 after gathering feedback from 411 people, patients explained that their arrival at A&E generally went well and felt like what people reported at other hospitals. They gave the hospital a score of 7 out of 10 for this part of their experience, and the CQC rated the trust as performing “about the same” as others nationally.

When patients talked about waiting, many said they waited far longer than they thought they should. Feedback from the Friends and Family Test reflected this, with a low waiting score of 4.5 out of 10. We compared this with other hospitals and found the trust performed worse than expected in this area. This matched separate performance data showing that fewer than 3 in 5 patients were seen within four hours, reinforcing what patients told us about delays.

Patients were more positive when they spoke about privacy during their visit. They rated this aspect with a score of 7 out of 10. This placed the trust in the “about the same” category compared with other A&E departments across the country. This suggested that, even with pressures on the department, staff were still able to maintain a reasonable level of dignity and confidentiality for those receiving care.

Overall, patients described an emergency department where the first stages of care felt reassuring and respectful. Long waits affected the overall experience.

We scored this quality statement as 3. 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 had equal access to care and treatment. The service considered the needs of people with different protected characteristics and made reasonable adjustments, such as providing a quiet room for those with sensory concerns and addressing communication barriers. The premises were accessible for people with physical disabilities, but space for mental health needs in the emergency department was limited, and patients in the care of justice services did not have planned adjusted spaces.

Doctors provided adequate medical cover day and night and attended wards quickly in emergencies. Emergency department staff triaged walk-in patients and mainly received major patients via ambulance. Same Day Emergency Care operated as a specialty service with bespoke inclusion and exclusion criteria, removing patients from the four-hour clock, which did not align with Fit to Sit ambulatory majors.

Managers monitored capacity and flow using an online platform that pulled data from the electronic health record system and displayed the trust’s Operational Pressures Emergency Level status. The clinical site team led bed meetings three times daily, attended by senior clinicians, and agreed actions using surge plan cards. An additional evening meeting included senior emergency department staff and on-call managers. After each meeting, the clinical site team issued a Patient Flow Report confirming status and actions. Huddles led by the emergency department nurse in charge and the emergency department consultant reviewed status and escalated issues.

Senior leaders managed long-term plans to improve urgent care across the Trust. The main Majors 1 area had 15 spaces, including one for mental health, and most spaces had equipment to send patient data remotely (telemetry). The temporary Majors 2 area had seven beds and three chairs but didn’t have this remote monitoring.

Staff managed two corridor areas for patient care, which created space constraints. Four resuscitation spaces were generally protected for critically ill patients, though exceptions occurred, indicating inconsistent application of national guidance.

We scored this quality statement as 3. The evidence showed a good standard. Staff and leaders actively 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.

Staff had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

All staff completed mandatory Equality, Diversity and Inclusion (EDI) training, which included human rights principles. This was part of the core statutory and mandatory training and was refreshed every three years to ensure compliance and awareness.

Staff demonstrated understanding of the need to identify individuals who may require additional support and make reasonable adjustments under the Equality Act 2010 to remove barriers to care. During the inspection, one mental health patient had a disability that had not initially been identified. When this was highlighted, staff promptly escalated the issue and adapted care plans to meet the patient’s needs, ensuring equitable access to services.

Delays in transferring patients from Emergency Department trolleys to beds were linked to bed shortages and environmental constraints, such as narrow corridors. These issues impacted patient flow and timely access to appropriate care.

We scored this quality statement as 2. The evidence showed some shortfalls. People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff used Recommended Summary Plan for Emergency Care and Treatment forms and Do Not Attempt Resuscitation forms, but we did not find any completed forms in the emergency department. A trust‑wide audit in September 2025 told clinical staff they needed to complete the Recommended Summary Plan for Emergency Care and Treatment training module. However, staff had not created an action plan to respond to this.

A volunteer‑led space was available for visitors and families of people nearing the end of life. Volunteers also provided bedside companionship and short breaks for visitors.