Royal Lancaster Infirmary

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

At our last assessment we rated this key question requires improvement. At this assessment the rating has improved to good.

Good. This meant people’s needs were met through good organisation and delivery.

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

The service ensured people are at the centre of their care and treatment. The service understood the diverse health and care needs of people and their local communities. Information was available in a range of formats if required. The service made sure that people could access the care, support and treatment when they needed it. People were supported to plan for important life changes.

However, when patients provided feedback, the service did not always respond in a timely manner.

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.

We make sure people are at the centre of their care and treatment choices and we decide, in partnership with them, how to respond to any relevant changes in their needs.

We scored the service as 3. The evidence showed a good standard. 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.

During the onsite inspection we observed examples of person-centred care. Patients waiting in the department for a bed on a ward were offered pain relief, food and drink and staff took the time to have conversations with them. There was a suitable quiet area available. When this was in use patients who may be distressed had the choice of waiting elsewhere be called in. Staff would alert patients to come back to the department either by calling their mobile phone or offering a buzzer device.

There was a familiar faces service to support people who attended frequently. Staff worked collaboratively with the emergency department, hospital specialist teams, the NHS ambulance trust, G.P.s and community care co-ordinators so patients had a personalised care plan to support them in times of need.

The mental health liaison team, employed by the local Mental Health Community Trust were based in the department. Patients attending with a mental health need or concern could be reviewed by the team.

Due to the space available in the department patients tended to stay on trolleys. We noted that the corridors were not wide enough for two beds. We did see a bed in the children’s bay, one of the mental health annex rooms and a consulting room in SDEC. Pressure relieving mattresses and other equipment were available to people on trolleys.

There was an “Enhanced Observation, Supervision and Person-Centred Care Policy”, however; this was passed the review date of 1 February 2025. This policy was to support staff in caring for patients who may need additional support. It included levels of supervision required dependent on assessed risks to support patient safety. We observed staff observing patients on a one-to-one basis where appropriate.

We understand the diverse health and care needs of people and our local communities, so care is joined-up, flexible and supports choice and continuity.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

All staff could articulate how their local communities had diverse health and care needs. All staff could give examples of patients who had varying level of need and could describe how they would accommodate them. This included patients with reduced mobility, autism and mental health needs.

There were gender specific toilets available for patients including disabled toilets with dementia friendly seats and yellow signs on some of the doors for people with visual impairment.

The main waiting room displayed information for patients on notice boards. These included daily staffing numbers as well as photos of managers and pictures of different uniforms worn in the department.

Staff understood the needs of the local population, both for those that lived their permanently, students and people on holiday. We observed staff signposting people to alternative health support in the community.

The service was collaborated with external stakeholders to improve the health of the local population. Initiatives included the ask three questions campaign.

We provide appropriate, accurate and up-to-date information in formats that we tailor to individual needs.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The information, for patients and those close to them that we saw onsite was only in standard format and English, other languages were available for staff to print off.

The service partially complied with the Accessible Information Standard, however there was no hearing loop in the department for people with a hearing impairment. Staff completed mandatory training in information governance. For medical staff compliance was 77.8% and it was 88.6% for nursing staff.

Staff made notifications to external bodies as needed.

Information governance systems included confidentiality of patient records. Trust staff were issued with personalised key cards to access the electronic systems and locked doors.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on.

Staff ensured carers and families were regularly updated about the patient’s progress.

The trust reported that there has been no data security or confidentiality breaches reported to the information commissioner's office (ICO) in the department in the 12 months prior to the inspection.

Due to issues staff had logging in and out of the electronic patient record system, we did observe staff not always logging out of the system after they had used it. This was escalated to leaders at the time of inspection and staff were reminded of the importance of logging off.

We make it easy for people to share feedback and ideas or raise complaints about their care, treatment and support. We involve them in decisions about their care and tell them what’s changed as a result.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

Patients knew how to complain or raise concerns. There were posters signposting how to feedback to the service. However, complaints were not always responded to within the identified time frame.

Between August 2024 and July 2025 there were 67 complaints for the department of which five were upheld and 39 were partially upheld. Most of the complaints related to poor care and treatment as well as long waiting times in the department.

We requested numbers of complaints that had been referred to the Parliamentary and Health Service Ombudsman (PHSO), however no details were provided.

When patients complained or raised concerns, they received feedback. We reviewed examples of complaints and the responses to the complaints. We found that although they varied in quality, they were generally sympathetic with learning identified and there was signposting to the external ombudsman if dissatisfied with the responses. The complaints that were reviewed were not responded to in a timely manner taking between three and six months for a response. This was outside of the trusts policy of 40 days to respond. The trust had an action plan to improve response times in line with trust policy. A reduction in the time taken to respond to complaints overtime was noted.

The trust monitored compliments. In the 12 months prior to the inspection visit there were 71 compliments for the emergency department and 113 for SDEC.

The CQC urgent and emergency care survey for the period of April 2024 and July 2024 showed the department scored worse than expected for patients having enough time to discuss their condition and treatment with staff, were given enough privacy when being examined or treated and being involved in their care and treatment. A plan was in place to improve these results which was currently in progress.

We make sure that everyone can access the care, support and treatment they need when they need it.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Between July 2024 and June 2025 44,229 patients attended the emergency department.

• 37,944 adults received care for acute physical concerns
• 1,668 received care for acute mental health concerns
• 6,617 children attended of which, 181 received care for acute mental health concern.
• On average 39% of all patients seen were admitted which was higher than the national average of 27%.

There was a requirement from 1 August 2025 was to hand over from ambulances within 45 minutes; staff considered this achievable as usually able to offload. The departments 1% campaign was to reduce ambulance handovers by 1% each week prior to this deadline.

74% of ambulance patients were handed over to hospital staff within 30 minutes, and 85% of the remaining patients were handed over within 60 minutes.

All patients had an initial assessment within 7 minutes of arrival to department, compared to the England average of 8 to 10 minutes. An average of 63% of all patients were seen, received the required treatment and were discharged within four hours. This was generally higher than the England average overall but had decreased from 70% in April 2024, For those patient’s awaiting admission the trust had introduced ‘forward wait’. This meant that patients could wait on a ward, for up to two hours, whilst waiting for a discharged patient bed to be available. However, we did note there was lack of specialist review for patients in the emergency department whereby the decision to admit had been made. They remained under the care of emergency department staff whilst waiting in the department that staff reported increased the acuity of patients care needs in the department.

We did note that 10% of patients left the department without being seen, which was higher than the national average of 5%.

We actively seek out and listen to information about people who are most likely to experience inequality in experience or outcomes. We tailor the care, support and treatment in response to this.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. All policies and procedures we reviewed included equality impact statements. There was an “Equality Impact Assessment Procedure.

Staff were trained in equality, diversity, inclusion and human rights as part of their mandatory training requirements. Medical staff compliance was 94.4% and nursing staff was 87.5%.

Feedback from patients included an example of where a patient was praising staff for accommodating their child’s individual needs, described as “above and beyond.” Staff wore rainbow lanyards that patients could identify with. Patient’s described staff as being supportive and making the patient’s attendance at the department as stress free as possible.

The trust monitored the demographics of patients who attended the service. This included local communities as well as those transient and visiting the local areas. Between July 2024 and June 2025, of those who declared their nationality, patients attending the service were predominantly British with most recording as white. There were similar numbers of males and female patients who presented, however; other genders were not classified. There were more adults who attended aged between 40 and 64 the lowest number of attendances was for 16 to 17 year olds.

The trust supported John’s Campaign and dementia forget-me-knot passports for patients attending with dementia symptoms. There were dementia friendly items although these were being refreshed at the time of inspection. Admiral nurses could be contacted to support if needed.

The frailty intervention team were a multidisciplinary team consisting of advanced nurse practitioners (ANP), clinicians, occupational therapists and physiotherapists. We did not see any therapists in the department during the inspection, however; patients were streamed to the frailty unit for referral to an allied health professional.

The trust supported those patients identified and recorded on the electronic record system with a learning disability. An automated referral could be sent to the learning disability matron for specialist support. Patients attending had the option to wait outside of the department (in their car if they choose), if a designated quiet area was not available. They were given a buzzer or could be alerted by phone when staff were ready to see them.

Paediatric patients with chronic health issues were given ‘open access’ meaning they could attend the paediatric ward rather than the emergency department.

We support people to plan for important life changes, so they can have enough time to make informed decisions about their future, including at the end of their life.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We saw examples of staff supporting patients to make decisions about their care and treatment and their future. We saw the use of treatment escalation plans which were completed with patients.

Staff were able to articulate how they would care for people who are nearing the end of their life and how they would ensure that it is managed and communicated in a sensitive and dignified way, this included advanced care planning and respecting patient’s do not attempt resuscitation decisions.

Staff ensured all relevant healthcare professionals and other relevant bodies are involved in planning the care and treatment of people with complex needs. We observed patients being referred to appropriate specialties.