Good Hope Hospital

On this page

• 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

We rated responsive as requires improvement. We looked for evidence that the service met people's needs. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people's needs were not always met. The service was in breach of the legal regulations relating to safe care and treatment due to long waits, crowding and lack of flow in the department. However, there were some good areas in this key question including good person-centred care, and learning from complaints.

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.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people's needs. The service took account of patient's individual needs and preferences as much as possible in the circumstances of a busy emergency department. Staff coordinated care with other services to ensure all care needs were provided.

People understood their condition, care and treatment options. Most patients were aware what they were waiting for in emergency department. A few patients were unaware of the next stage of their emergency department journey, particularly patients who were told they were waiting for a bed to become available in the hospital, but they had no idea where or when this would be.

Staff made sure patients living with mental health conditions, learning disabilities and dementia, received the necessary care to meet all their needs. Staff had support from the hospital's vulnerabilities team who supported people with specialist needs. The team attended emergency department when they saw a patient was admitted who had vulnerabilities. They ensured reasonable adjustments were considered such as placing them on the right ward if they were admitted or if neurodiverse ensuring the ward was a quieter ward.

There were only limited services for people with frailties, although a hospital-wide team offered support. The hospital did not have a `same day emergency care' service for people with frailties to be treated more promptly as yet. For patients who needed further support following discharge they were referred to the older persons assessment and liaison team who assessed the patients and provided additional support, packages of care or equipment for discharge; they worked 7 days a week. They could also refer directly to the medical team if appropriate.

Some areas of the emergency department provided mixed sex accommodation overnight such as majors C or the clinical decisions unit. This was permitted and within national guidance on mixed sex rules in emergency care, but it was difficult for staff to always respect the individual's personal, cultural, social and religious needs in these areas.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There were no information leaflets in languages for patients who did not speak English as their first language visible within the department. The service used language line interpreting services when needed.

While the communication tools were not always available, staff took time to communicate and engage people in discussions about their immediate needs. For example, a nursing associate told us they had a patient who communicated using Makaton cards and there were none available in the department. Therefore, they drew some cards themselves to ensure the patient was able to communicate their basic needs with them such as toileting, needing a drink, and pain.

There was a communications box which had tools to enhance patients’ communication, such as amplifiers, hearing aid checks, and a magnifying glass.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Patients, relatives and carers knew how to complain or raise concerns. The service clearly displayed information about how to raise a concern in patient areas. All patients in emergency department were sent a text message to their mobile phone once they were discharged to ask for feedback on the department. Patients in the children's emergency department could also feedback by scanning a QR code.

Staff understood the policy on complaints and knew how to handle them. Managers investigated complaints and identified themes. Senior nurses told us a lack of communication, hard chairs, lack of hot food, crowding and waiting times were frequent complaints. Complaints were used as an opportunity for learning.

The governance team produced a monthly assurance report. This detailed the complaints received and looked at themes found. Complaints were graded and reviewed at a weekly meeting and actions were updated. They were also discussed at governance meetings. At the time of the assessment, the service had 16 formal complaints. Managers told us there was a band 7 who was the lead for complaints, and they always tried to phone patients to resolve the complaint.

Staff knew how to acknowledge complaints and patients received feedback from managers after the investigation into their complaint. We reviewed 3 complaints. They were clear, included apologies and where learning had been identified, the person who complained was told what had been done to make improvements. Managers shared feedback from complaints with staff and learning was used to improve the service.

Where staff were involved in complaints, they wrote reflections to ensure they learned from them. Staff told us patients complained about lack of communication at times. This was due to the increase in demand from patients and meant the pressures within the department were higher and there was less time to communicate well with all the patients. We spoke to patients within the department and most of them said that they were informed about the plan and that there were long waits in the department.

People did not receive prompt care and treatment in line with national performance targets. There were significant system pressures, crowding and a lack of flow which meant there were long waits in the department due to a lack of available beds elsewhere in the hospital. However, patients could access the service when they needed it, but they may be subject to long waits. We acknowledge at the time of our assessment compliance with national standards around waiting times was a significant concern and national issue across most emergency department and had been for many years.

There were systems to manage the flow of patients through the emergency department and to discharge and admit patients to the hospital, but they were not always working effectively. There were long delays in accessing care and national standards around waiting times for emergency department were not met. There were a high number of patients using the services coupled with the failure to be able to move people quickly to a bed in the hospital, resulting in crowding.

There were bed-capacity issues in the rest of the hospital, and this resulted in a lack of flow within emergency department. For example, on 24 February at 8.40pm, there were 9 ambulances outside waiting to offload patients, 136 patients in the department, 50 were waiting to be seen and a patient had been waiting 7 hours 30 minutes to be seen by a doctor. The longest patient in the department had been there 1 day, 20 hours. Patients waiting above 1 day in the emergency department were a daily occurrence.

Pressures increased throughout the day when ward beds did not become available, and patients were not able be admitted for specialist care. During our assessment, there were patients waiting on ambulances up to 5 hours while they were waiting for a trolley space to become available. However, these patients were monitored regularly by the nurses for signs of deterioration and harm reviews were undertaken when patients remained on ambulances for 3 hours or more.

Patients recognised there were long waits and crowding. Comments from patients in the feedback survey in 2025 included comments such as "waiting is a problem but it is to be expected with the very trying conditions the staff have to work under and yet they remain totally professional, polite and caring", "from the moment I got there I was treated with courtesy and help although we have to wait a long time, it is not the staff's fault. Keep up the great work, you are very much needed" and "all looked after me well considering they were understaffed".

Some patients were cared for in spaces which were not fully safe or responsive to people's needs. There were long waiting times in the waiting areas and patients were being cared for in areas such as the corridors. The service had a criteria for patients who were cared for on the corridor; there was a maximum capacity of 6 patients. Where staffing allowed, they had a nurse who was assigned to care for the corridor patients. However, this was often not filled and nurses had to care for more patients than planned for in their establishment.

The hospital was using a model developed at a hospital in Bristol to help to relieve pressure on the emergency department, and to share the risk across specialities. The hospital had started a "push model" where patients were sent up from emergency department to the wards before a bed was available. The patient had to be low risk and a low national early warning score. We saw patients moved at 5.30am to release the pressure in the emergency department using the push model.

Leaders were aware of the responsiveness of the department. Senior managers could view the length of time each patient was in the department, and what they were waiting for. The system displayed the number of patients arriving at emergency department from ambulances and the waiting area. The data was discussed at bed meetings 4 times a day.

Some measures in the department were better than the national average. For example, the average time to initial assessment for patients was consistently higher than the national average. Data from 20 January 2025 showed 52% of patients were treated within 60 minutes of arrival; this was better than the national average of 25%.

However, the department had experienced a steady increase in the percentage of ambulance handovers taking over 60 minutes since August 2023. In December 2024, it was 42% compared to the West Midlands average of 35%. Patients on the ambulances were considered as patients of the hospital, and they had a rapid assessment promptly on arrival. Staff worked alongside the hospital ambulance liaison officer to ensure ambulance patients were safely admitted and triaged in line with their clinical priority.

The inability to review and admit patients in a timely way increased crowding and reduced flow in the department. NHS priorities and operational planning guidance set a revised and temporary standard that 78% of type 1 patients should be admitted, transferred or discharged within 4 hours of arrival in the emergency department. This was temporarily reduced from the 95% NHS constitutional standard. Data showed the hospital had improved from 58% in December 2024 to 69% in February 2025 for type 1 patients. However, they were still below the national standard of 78% and national average of 75% in February 2025. Paediatric emergency department compliance with the 4-hour standard was 84.2%% for February 2025; the target was 90%.

Data showed 6.3% of patients in February 2025 waited over 12 hours from the decision to admit them to being admitted to a ward. This was better than the national average for February 2025 which was 13%.

Staff told us there could be delays in clinical specialists (such as surgery, gynaecology, older people's medical care) reviewing their patients in emergency department. The Inter-Speciality Professional Standards document required specialities to review their patients in emergency department within 30 minutes of receiving the referral. However, data showed for the 2 weeks before our assessment this could be achieved. The average for all specialities to assess patients was below 30 minutes; on average across all specialities it took 13 minutes to review a patient once referred. The department had 1 flow coordinator who helped to chase these referrals and had submitted a request to increase this to 2.

There were a few pathways which helped reduce the crowding in emergency department. For example, there was a gynaecology assessment pathway for patients who attended who were pregnant; a surgical assessment pathway for reattendance and failed discharge within 7 days; and the medical assessment pathway where patients attended within 7 days of discharge and GP referrals.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.