Royal Albert Edward Infirmary

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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.

At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant people were supported and treated with dignity and respect and involved as partners in their care.

Most patients, relatives, partners and stakeholders described staff as kind, caring and respectful. Patients felt listened to, involved in their care and treated with dignity. Staff treated patients as individuals, making reasonable adjustments for communication, culture, religion, disability and personal preferences.

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 the service as 3. The evidence showed a good standard. The service treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Patients described staff as kind, considerate and caring. Many spoke positively about the compassion shown to them, using terms such as “wonderful,” and “amazing.” One patient said staff “worked so hard, you can see they are so busy, but they are always kind and helpful,” while another told us that nurses were “thoughtful” and that they felt emotionally supported throughout their stay.

Patients told us that staff maintained their privacy and dignity, including during personal care and sensitive conversations. They said they felt comfortable raising concerns with doctors and nurses. Examples of good practice were recorded, including positive feedback for a staff member who spent time with a patient who was suffering with anxiety.

Patients also described how staff supported them emotionally. Some patients had been referred to the Admiral Team, who provided specialist dementia support and offered advice and guidance to patients living with dementia, their families and carers, and supported ward staff to deliver person-centred care.

One family member commented, “they [The Admiral Team] care not just for the patients but their family members too, they bring hope.” Another stated, “I cannot thank them all enough… they have made a very stressful stay more manageable. They have all gone above and beyond. They truly are a very special and dedicated team of people,” which demonstrated that emotional needs were considered alongside clinical care.

Families were often included in discussions and care planning. One family member said, “staff showed immense patience giving us lengthy, detailed explanations regarding mum’s medical condition.”

We spoke with a patient living with dementia and their relative, who both spoke positively about the caring nature of staff. The relative said, “I’m really impressed with all the staff. They have no problem with me coming to visit and check to see how I am managing too.”

We observed staff encourage and support a patient with cognitive impairment to mobilise safely around the ward. Another relative said, “the staff are nice and caring, they know my brother, he feels safe and we feel reassured, supported and updated.”

However, communication with relatives was not always consistent. Some patients reported variable updates from staff, including a relative who told us that information provided by ward staff was often “disjointed and incomplete” and stated, “I never get told what the plan is.”

A review of minutes from the ‘Patient Experience and Engagement Group’ showed that inpatient feedback had consistently highlighted 5 key areas for improvement: staff attitude, the care environment, quality of care, waiting times, and aspects of treatment. Additional recurring themes included communication, staffing levels, the admissions process, and patients’ mood and wellbeing. Leaders demonstrated awareness of these findings and patient experience data, including complaint themes, was routinely reviewed within leadership meetings. Action plans had been developed and monitored to address recurring issues and drive improvements in patient experience.

Despite these concerns, patient feedback data for the medical division between May 2025 and May 2026, which included responses from 11,516 patients, showed that 91% of patients rated their overall experience as ’very good’ or ’good’.

During our assessment, we used a Short Observational Framework for Inspection (SOFI) to observe patient mood, engagement, and the quality of staff interactions. Overall, interactions between patients and staff were positive. We observed staff providing reassurance, explaining care and assessments, and seeking consent before interventions.

Patients were supported with their mobility, comfort and dignity needs. Staff were observed assisting patients to sit in chairs and return to bed, and privacy and dignity were generally maintained throughout care interactions. However, a privacy and dignity concern was observed within a temporary escalation space (TES) when a patient's clothing had become displaced, leaving the patient partially uncovered. The concern was escalated immediately to staff, who responded without delay and took appropriate action to maintain the patient's privacy and dignity. This demonstrated a responsive approach to addressing concerns and minimising the impact on the patient.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met their needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Patients were positive about the service supporting relatives and carers to visit at times that suited them, including overnight stays. One patient told us that staff had allowed her mother to stay as the patient was very anxious, which had provided reassurance and comfort.

Staff made a range of adjustments to support individual patient needs. For example, we observed communication tools being used for patients living with dementia, experiencing delirium, and other communication difficulties. Staff demonstrated an understanding of the emotional and social impact that a person’s care, treatment, or condition had on their wellbeing and on those close to them.

Staff and patients had access to interpretation and language translation services, including support for translating documents. British Sign Language interpreters were available on request. Patients were also able to access hearing loops in certain areas to support communication and understanding. In addition, braille and easy-read formats of patient leaflets were available to support patients who needed them.

Staff shared information with patients about their treatments, local services, and their rights. Information on how to raise concerns or make a complaint was clearly displayed on all wards we visited.

The hospital had a multi-faith chaplaincy service and a bereavement service, which staff accessed to support patients and their relatives. Staff told us that faith leaders could attend the patient’s bedside if requested. They also provided examples of how they had supported patients to meet their cultural and religious needs, such as facilitating access to faith leaders, accommodating dietary requirements, supporting patients with prayer and worship, and respecting cultural preferences relating to personal care and end-of-life wishes.

We saw evidence that patients were offered choices of food and drink that met their cultural and religious requirements, including kosher and halal options. We reviewed the ordering system and found that it provided appropriate menu choices to support this. Staff gave an example of a patient who had arrived on the ward late and required vegetarian food; housekeeping staff contacted the kitchen to ensure a suitable meal was provided.

We spoke with 10 patients who each told us there were a wide range of food options available to them.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Staff shared examples of how they had identified and addressed individual needs prior to procedures. Reasonable adjustments included enabling patients to choose to have family members remain with them on the ward before and after procedures to help reduce anxiety. Other adjustments included providing books and magazines to support patient comfort and wellbeing.

Staff described how they adapted activities to reflect individual preferences, rather than expecting patients to conform to a fixed routine. For example, staff had observed what was meaningful to a patient living with dementia and supported them to choose how they spent their time. They reported that this approach had helped to reduce agitation and improved the patient’s comfort and engagement when undertaking activities they enjoyed.

Staff also gave examples of using dementia ‘This is Me’ documents to gather important personal information about patients, such as their likes and dislikes. They used this information to engage patients in conversations about familiar topics, which helped to reduce anxiety and improve engagement.

Staff described how they had supported a patient during discharge by providing a familiar therapeutic comfort aid, such as a ‘dementia doll,’ to help ease the transition to a care home.

We spoke with a patient living with dementia and their relative, who was the patient’s main carer at home. They provided positive feedback about the care provided, stating that staff had asked about how best to communicate with the patient and understand their preferences, which they found helpful.

Partners and stakeholders reported that carers had been appropriately involved in care discussions, which supported patient choice and contributed to safer transitions from hospital to home.

We scored the service as 2. The evidence showed some shortfalls. While some patients experienced timely and attentive care, the service did not provide consistently prompt or clinically responsive care across all wards.

Some medical and nursing staff told us it was difficult to arrange timely reviews for patients who were medical outliers. Medical outliers are patients receiving care on wards outside their usual specialty area due to bed capacity and patient flow pressures. Staff reported that this could result in delays to clinical decision-making, including reviews of deteriorating patients, medication changes and discharge planning. They also told us that caring for patients outside the appropriate specialty environment could affect continuity of care, as staff may be less familiar with the patient's condition, care pathway and specific needs. This increased the risk of delayed treatment, poorer coordination of care and a less positive patient experience.

We also found that a relatives' room on one ward was being used for storage and as a workspace for medical staff. Relatives told us the environment was not suitable for sensitive discussions and did not provide an appropriate private space to receive updates or discuss distressing news. This reduced the privacy, comfort and emotional support available to patients and their families at times when they may have needed it most.

Although call bell audit data from March to May 2026 showed all medical wards achieved green ratings for patient access to call bells and response times, some patients told us that requests for assistance with toileting and pain relief during the night had not always been met despite them using the call bell multiple times. Delays in responding to these needs could affect patient comfort, dignity and experience, and may increase the risk of avoidable harm, particularly for patients at risk of falls or those experiencing unmanaged pain.

However, many patients told us staff were attentive and responded promptly when they needed help. One patient said, "if I need anything, they come straight away," reflecting a responsive approach across several areas of the service. During our assessment, we did not observe any delays in staff responding to call bells.

We saw staff proactively check on patients for pain relief, hydration and repositioning rather than waiting to be asked. Patients described feeling reassured, particularly during periods of anxiety or confusion, and told us staff communicated calmly and clearly to help them understand changes in their condition or treatment.

Staff adapted their approach to meet the needs of patients with communication difficulties or more complex needs. They used simple language and involved family members where appropriate, helping patients to feel understood, supported and involved in their care and treatment.

We scored the service as 2. The evidence showed some shortfalls. Although leaders had implemented measures to support staff wellbeing, staff did not always feel adequately supported, which had the potential to impact their wellbeing and ability to consistently deliver person-centred care.

Information provided by the trust, including staff wellbeing and Freedom to Speak Up (FTSU) data, identified ongoing concerns relating to high workloads, staffing shortages, limited support following sickness absence, and the emotional impact of sustained operational pressures. Staff also raised concerns about recruitment challenges, rota management, and inconsistencies in working arrangements.

Whilst most staff described a supportive wellbeing culture and said they felt able to raise concerns about workload or stress, workforce pressures continued to affect staff experience. Staff told us that direct managers were generally approachable and that systems were in place to monitor wellbeing. However, most staff we spoke with were unable to clearly identify who their managers would escalate concerns to beyond their immediate line management structure. Staff indicated that escalation pathways were not consistently understood and they had limited confidence in organisational oversight and governance arrangements. Staff described this uncertainty within the context of an ongoing organisational transformation programme, which had resulted in changes to leadership and governance arrangements and may have affected staff understanding of escalation routes.

The concerns raised regarding workloads, staffing levels, morale and operational pressures indicated that the trust had not yet consistently ensured staff wellbeing and enablement across services. The NHS Staff Survey 2025 showed that 55% of staff would recommend the organisation as a place to work. This represented a decrease from 59% in 2024 and was below the national average of 58%.

We also spoke with some staff who expressed frustration that administrative requirements associated with multiple documentation systems reduced the time available for direct patient care. Many described bedside paperwork as burdensome and told us they had escalated these concerns.

Despite these concerns, most staff spoke positively about the support they had received from their line managers. For example, we spoke with a staff member who described feeling well supported during their return to work following a period of ill health, which they said had a positive impact on their mental wellbeing. Another staff member reported receiving good support and clear communication throughout their period of maternity leave, which had enabled a successful return to work.

Feedback from staff highlighted a consistent commitment to delivering safe and compassionate care, as well as strong loyalty to their teams and patients. Staff survey scores reflected these positive experiences and attitudes. Lower scores relating to recognition, learning opportunities and staff morale demonstrated that workforce pressures continued to negatively impact staff wellbeing.

However, staff reported usually being able to take breaks and having access to rest facilities, and flexible working arrangements were supported where possible to help manage personal commitments alongside work responsibilities.

The trust had developed a ‘Resident Doctors Board Assurance Framework’ aligned to NHS England's ‘10 Point Plan to Improve the Working Lives of Resident Doctors’ guidance. The framework outlined how the organisation monitored and assured itself regarding the experiences and working conditions of resident doctors.

Data within the framework showed that general medicine remained the specialty reporting the highest number of concerns throughout the year and accounted for the largest proportion of concerns within the trust. Key themes included persistent staffing shortages and rota gaps, extensive ward coverage, high workload intensity and acutely unwell patients requiring prolonged review. Additional concerns related to delayed handovers, missed breaks and missed teaching opportunities. The framework also highlighted that resident doctors were frequently managing complex workloads without sufficient staffing.

The framework included a target of achieving doctor satisfaction levels of 80% or above. However, we found that the trust did not have a fully established process to measure doctor satisfaction consistently and was therefore unable to demonstrate compliance with this standard at the time of our assessment. The trust had identified the development of a formal process to measure and monitor doctor satisfaction as an area for improvement, with a target implementation date of September 2026.

In response to workforce and wellbeing challenges, the trust had a range of wellbeing initiatives and support mechanisms in place. Staff had access to rest areas, including a ‘Wellness at Work Lounge.’ The ‘Steps4Wellness’ (S4W) team promoted wellbeing initiatives, encouraging staff to take breaks and maintain adequate nutrition and hydration during shifts. Information was disseminated through S4W champions and the S4W toolkit.

Staff were able to provide feedback through a variety of mechanisms, including the National Staff Survey, pulse surveys, ‘Listening into Action’ walkabouts, exit interviews and topic-specific wellbeing surveys. The trust had also established staff networks, including the Disability and Wellbeing Network (DaWN), ‘Faith and Minority Ethnics’ (FAME) and True Colours (LGBTQIA+), which provided opportunities for peer support and engagement. A new ‘Wellbeing and Attendance Support Policy’ had been introduced, alongside individual wellness at work plans intended to support staff wellbeing and reasonable workplace adjustments.

Additional wellbeing resources were available through the S4W toolkit, the trust’s wellbeing adjustment advisor role, and access to internal and external support services. These included the ‘Mindful Living’ programme, ‘Trauma Risk Management’ (TRiM), talking therapies, the Greater Manchester Critical Incident and Trauma Service, ‘Work Well,’ the trust’s employee assistance programme and ‘Access to Work’ scheme.

Most nursing students we spoke with told us they felt supported and had access to learning opportunities during their placements. Some said they would consider applying for substantive roles on the wards where they had completed their placements once qualified.