Cheltenham General Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating remains good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff and leaders understood the current legislation, national standards and evidence-based good practice guidance relevant to their service.

The trust performed well in providing people with treatment quickly upon arrival in the ED. The median time, defined as the mid-point between the shortest and longest times, to initial treatment for the trust from August 2023 to August 2025 was 69 minutes which was mostly below regional and national statistics.

There was a sepsis quality improvement project. This included the use of a sepsis trolley (a computer on wheels with with medicines, supporting timely treatment of sepsis) in the rapid assessment treatment (RAT) area.

We saw a “You said/We did” board which showed responses to feedback including information about where to obtain food while waiting in the ED.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us there was a good team culture and a strong nursing team. Staff worked collaboratively across the service to support each other and patients. The ED nursing team also worked collaboratively across the Gloucester trust sites. The team was recently nominated for the 2025 Achievement Award for Team of the Year. This was because of staff’s cross-site working arrangements between the 2 EDs and there was a positive collaborative team culture.

There were signs in staff rooms with information to contact mental health liaison teams including self-harm, older age adults and alcohol liaison. Also signs with contact details for community admission avoidance services including single point of clinical access, community rapid response, and community intravenous therapy teams.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There were systems to support patients and escalate concerns. Staff triaged patients effectively and provided appropriate care. The primary escalation plan for patients who became significantly unwell was to transfer to Gloucester ED.

The trust had processes to monitor outcomes of people using the service. Staff had timely access to test results and diagnostic imaging results. However, some patients told us they were given pain medication but were in pain again while waiting for test results and reviews.

Electronic systems recorded patient information, results and monitoring of patients. There was an escalation process if a patient showed signs of deterioration.

There was an ongoing quality improvement project for the management of patients presenting with or developing sepsis in the ED.

There was also an ongoing improvement plan of the clinical vision of flow for patients who presented via triage and ambulatory patients who attended via ambulance and were categorised as very urgent.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service maintained up to date policies and processes regarding the Mental Capacity Act (MCA) 2005 and restrictive practice, including rapid tranquilisation. Staff could access up-to-date policies at any time on the trust’s intranet.

Consent to care and treatment was obtained in line with legislation and guidance, including the MCA and the Children’s Acts 1989 and 2004. People were supported to make decisions and, where appropriate, their mental capacity was assessed and recorded. When people lacked the mental capacity to make decisions, “best interests” decisions were made in accordance with legislation. The use of restraint was understood and monitored, and less restrictive options were used where possible.

Staff knew the process for referral to emergency mental health support, including the mental health liaison team.

Translation services were available to facilitate discussions around consent for patients and clinical staff. Consent was documented in notes and on consent forms.

Staff asked for consent from patients prior to care and we witnessed a doctor asking a patient for consent prior to conducting an examination.

There was a chaperone policy for adults and children and, as part of the consent process, patients had access to this if needed.