Royal Albert Edward Infirmary

Ratings - Medical care (Including older people's care)

• Overall

  Requires improvement

• Safe

  Requires improvement

• Effective

  Good

• Caring

  Good

• Responsive

  Requires improvement

• Well-led

  Requires improvement

Our view of the service

We carried out a comprehensive assessment of medical care services (including care of older people) at Royal Albert Edward Infirmary (RAEI). The assessment included an unannounced on-site visit on 12 to 14 May 2026. To support our findings, we also spoke with partners, staff and leaders remotely in the weeks following the assessment visit.

Medical care services provide diagnosis, care and treatment for a wide range of conditions, including general medicine, cardiology, respiratory medicine and gastroenterology. As part of the assessment, we visited the Medical Assessment Unit (MAU), Community Assessment Unit (CAU), Medical Receiving Unit (MRU), Ince, Winstanley, Lowton, Pemberton, Shevington, Orrell, Astley and Standish wards, the Coronary Care Unit (CCU), Acute Stroke Unit (ASU), Discharge Lounge, Endoscopy Unit and the Pharmacy Department. We also visited surgical wards where medical patients were being cared for and spoke with staff about their management.

We reviewed patients’ clinical records. We spoke with patients and their relatives, as well as members of staff across a range of roles, including nurses, doctors, ward managers, matrons, ward clerks, allied health professionals (including physiotherapists and occupational therapists), and senior managers.

We also reviewed feedback from people who contacted us about their experiences and considered performance information provided by the trust. We observed care and treatment delivery in a range of clinical areas and attended several meetings, including safety huddles, nurse handovers, ward rounds and board rounds.

During the assessment, we inspected the above areas and looked at 43 patient records, spoke with 28 patients or their families/carers, and 41 members of staff. We also spoke with 4 staff who were not employed by the service but worked in partnership with them.

We rated medical care (including older people’s care) as requires improvement.

At this assessment, regulatory breaches were identified in relation to safe care and treatment, staffing, infection prevention and control and governance. An action plan will be requested following publication of the final report.

The service was experiencing several challenges that affected the consistency of care delivery, including staffing shortages and gaps in mandatory training compliance. Pressures on patient flow resulted in some patients waiting for extended periods in environments that were not always suitable for their needs.

The service did not consistently take timely or effective action to address inequalities in access and outcomes. The use of escalation beds reduced access to regular medical reviews for some patients and negatively impacted their experience of care.

While governance and quality improvement processes were in place, they were not consistently embedded across the service. Governance arrangements were not always effective, with examples of outdated policies, incomplete audit action plans, and a lack of clear accountability. Further work was required to strengthen oversight, improve consistency, and ensure compliance with regulatory requirements. Some staff also reported limited visibility and support from senior leaders, and additional efforts were needed to ensure all staff felt confident to raise concerns and speak up.

Despite these findings, patients were generally positive about the care they received and told us they felt respected, supported, and involved in decisions about their care. Staff worked collaboratively, demonstrated compassion, and contributed to a positive learning culture. Systems were in place to support patient safety, learning from incidents and complaints, and the delivery of evidence-based care. We also observed several examples of good practice across the service.

People's experience of this service

Most patients and relatives described staff as kind, compassionate and respectful. They said staff were friendly, approachable and took time to listen, helping them feel supported, involved in decisions and treated with dignity. We saw staff maintained privacy during personal care and conversations were handled sensitively.

Most patients and families spoke positively about the caring approach of staff and their understanding of individual needs and preferences. One relative of a patient living with dementia told us staff were attentive, knew the patient well and supported them to remain calm and comfortable. One patient described care as “brilliant” and said staff were “first class.”

To support our understanding of people's experiences, we also completed a Short Observational Framework for Inspection (SOFI). This enabled us to observe interactions between staff and patients, particularly where people may have found it difficult to communicate their experiences directly. Observations indicated that staff treated patients with kindness, respect and dignity and responded appropriately to their needs.

Some relatives told us staff supported them as well as patients, which included offering food and enabling flexible visiting to support family involvement. Families felt most staff understood the emotional impact of illness and provided reassurance.

However, some patients reported delays in receiving assistance, particularly overnight, which included help with toileting and pain relief. Some patients told us they had been moved multiple times throughout their hospital stay, sometimes feeling isolated and lacking timely clinical review. This meant their immediate needs were not always met promptly.

We did not identify any inequalities in people’s experiences as a result of their protected characteristics at this assessment.