Royal Albert Edward Infirmary

Ratings - Urgent and emergency services

• Overall

  Requires improvement

• Safe

  Requires improvement

• Effective

  Good

• Caring

  Requires improvement

• Responsive

  Requires improvement

• Well-led

  Requires improvement

Our view of the service

We carried out a comprehensive assessment of urgent and emergency services at the 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.

Urgent and emergency services at the location primarily comprises the Emergency Department (ED). Patients access the ED through either an initial triage process as walk-in patients or through the Initial Senior Assessment Triage (ISAT) area when attending by ambulance. Patients can be seen and treated in various areas dependant on their need, which include a Clinical Decisions Ward (CDW) for patients who can remain seated, a Majors area and a resuscitation area. When capacity demands, adult escalation spaces in adjoining corridors are used to hold and treat patients on trolleys.

The ED also has a Paediatric Emergency Care Centre (PECC), which has a separate children’s triage and waiting area. Adjacent to the main ED site is an Urgent Treatment Centre (UTC), which sees patients streamed from the ED and has its own waiting area, clinic rooms and treatment areas. As part of this assessment, we also inspected the Same Day Emergency Care (SDEC) and the Frailty SDEC areas, which are located at the same location but are further from the main ED site, being managed and staffed by different teams.

During the assessment, we inspected the above areas and looked at 39 patient records, spoke with 38 patients or their families/carers, and 51 members of staff. We also spoke with 5 staff who were not employed by the service but worked in partnership with them.

We rated urgent and emergency services as requires improvement.

At this assessment, regulatory breaches were identified in relation to safe care and treatment, premises and equipment, staffing levels, and governance. An action plan will be requested upon publication of the final report.

We found that the service did not have sufficient facilities or processes to manage all patients including children with mental health needs. The main waiting room also contained patients with various clinical and individual needs in close proximity and was prone to uncomfortable levels of overcrowding.

Excessively long waits for specialty beds caused issues in flow throughout the main ED. Cases of potential sepsis were not always responded to in a sufficiently timely way, and the number of consultant medical staff employed by the service were well below what national guidelines indicated.

We also found that key risks were not always acted upon, and business continuity plans were not reviewed regularly enough to reflect the current context.

However, recent transformation plans and changes demonstrated early signs of improvement in various metrics, such as average waiting times and flow across the service. The Urgent Treatment Centre (UTC) and Same-Day Emergency Care (SDEC) services were effective in supporting the work of the main ED. Admissions avoidance schemes and the Access to Community Services (ACST) Team worked well to enhance the discharge process to prevent readmissions, so that the right people could access the ED at the right time. Staff in all areas were broadly optimistic about the future and direction of the service.

People's experience of this service

During the assessment we spoke with patients who provided feedback to us about the service. We also reviewed patient survey responses that the service had compiled itself.

Feedback demonstrated that people’s experiences of care were often negatively affected by system pressures and the environment. Most patients we spoke with were critical of arrangements in the main waiting room, finding it cold, overcrowded and uncomfortable to wait in for prolonged periods. We found communication with patients and families about care plans, waiting times, delays and discharge was inconsistent, especially for patients who remained in the main waiting room.

However, patients and families generally received care from staff that was kind, compassionate and understanding. We heard from patients who said for example that staff were “always good when I come here” and “have been lovely to me all day”. Most children and young people were supported effectively, and families were involved in decision making, with 1 parent saying for example that paediatric staff “are always kind and caring, which I really appreciate”. Staff in all areas were familiar with common issues that patients experienced and made efforts to address these.

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