William Harvey Hospital

On this page

• 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

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 requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. We assessed all quality statements.

The service delivered good outcomes, with effective assessments, evidence-based care, and strong multidisciplinary teamwork. Patients’ needs were well documented and integrated, and national guidelines were embedded in practice. Staff worked closely with mental health teams and other specialists, ensuring coordinated care and smooth transitions. People were supported to live healthier lives, and outcomes were monitored through audits and surveys. Consent processes were robust, and patients were involved in decisions about their care. However, the department still had escalation and flow challenges which could impact on outcomes. Pain relief was not always offered in a timely way and information on chaperones was not available to patients; when this was raised during the inspection the Trust took immediate steps to install chaperone posters in the department.

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.

The evidence showed some shortfalls. However, the service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

We reviewed 21 patient care records; 3 were of patients attending with a mental health illness. Although we saw good documentation of patient’s needs, we found that patients were not always offered pain relief and patients in temporary escalation areas had unmet needs. Pain relief was offered to patients at triage. However, 2 patients told us they had not received pain medication while wating to be seen by a clinician. One of the patients had been waiting 45 minutes and was quite distressed.

The service took part in the urgent and emergency care survey 2024, a patient experience survey conducted by the Care Quality Commission (CQC) in England. Its aim was to assess patient experiences in emergency departments (ED) including wait times, communication, and overall quality of care. Results showed that the trust scored 5.3 out of 10 for pain control and feeling that hospital staff did all they could to help control their pain if they were in pain. This was somewhat worse than expected meaning the trust performed somewhat worse for that particular question compared to most other trusts that took part in the survey.

Concerns had been raised by patients that food and drink had not been readily available to them during their time in the UEC. Patients in the temporary escalation areas did not have side tables to keep water jugs on. We saw that patient trolleys added to the space restrictions within the corridors.

We saw data that showed poor compliance with VTE risk assessments. Compliance for 2024 to 2025 averaged at only 77%. Patients were risk assessed within 12 hours 10% of the time and within 24 hours 50% of the time. The department had identified key workstreams and these had been incorporated into the existing improvement work and a new project has been created for 2026.

Patients in temporary escalation areas were offered hot meals. We saw staff assisting a patient to eat their meal as they had limited mobility. We saw staff offering drinking water and refreshments to patients waiting in the triage and waiting rooms. A water fountain and vending machines were available and a coffee shop was located within hospital grounds.

Staff completed care plans that met the needs identified during assessment. The patient care plans were in depth and allowed staff to see quickly what the needs of the patient were. Staff could add flags to patient records to identify patients with additional needs or who might require additional support. This included alert flags for patients with allergies, mental health needs, people with learning disability, autism or living with dementia.

People who used the service told us that staff discussed their needs with them, and they were involved in how care and treatment was planned. The department had a patient liaison team who visited patients particularly those in temporary escalation areas. Their role was to provide a point of communication for patients and their families or carers; explain why it was necessary for corridor care and give patients a contact point if they needed anything to make their stay more comfortable.

Care plans were personalised and updated when needed. Staff used recognised tools to assess pain for patients and those who were unable to communicate verbally. They could also record Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms, which created a personalised recommendation for clinical care in emergency situations, where patients were not able to make decisions or express their wishes. We saw evidence of this on patient records during the assessment.

We reviewed a recent mental health risk assessment audit. This was a retrospective review of 20 randomly selected adult patients per month, all referred to liaison psychiatry between November 2025 and January 2026. The results showed good compliance with mental health (MH) risk assessment standards. For example, identification of patients requiring a MH risk assessment achieved 100% compliance in November and January, with a slight reduction to 95% in December. This indicated good recognition of risk and appropriate initiation of assessment processes. Patient description documentation was completed 100% of the time in November, decreasing to 95% in December and 90% in January. Escalation processes and formal Mental Health capacity assessments (where required) were completed in 100% of applicable cases across all 3 months showing good, embedded compliance with MH needs.

Staff used the Situation, Background, Assessment and Recommendation (SBAR) tool to communicate important information about a patient's condition to their colleagues.

The evidence showed a good standard. 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.

The triage process followed evidence-based practice and patients were graded in accordance with the seriousness of their presenting complaint.

Clinical guidelines and policies used in the department were developed and reviewed in line with National Institute for Health and Care Excellence (NICE), the Royal College of Emergency Medicine (RCEM) and other relevant bodies. Policies and protocols were accessible on the hospital’s intranet. We reviewed 10 policies, standard operating procedures and clinical pathways and saw they were up to date and indicated when the next review date was.

There was an action log of upcoming review dates on policies, and a spreadsheet that highlighted any changes to national guidance and assigned for review by appropriate team members. There were 22 pieces of guidance in need of review at time of inspection. For example, the recent changes to the guidance for urinary tract infections in adults to include new guidance on antimicrobial prescribing for urinary tract infection and the use of more inclusive language.

Consultants were allocated guidelines to be reviewed and updated; leaders monitored progress.

The service had governance processes to ensure national legislation, evidence-based best practice and required standards were reviewed and were registered to participate in national clinical audit programmes.

New practices were updated and communicated, with training, to the emergency department staff. For example, the department recently changed the type of mask used with ventilators. Staff received training to ensure they were competent before they were used in the department.

The service reviewed Getting It Right First Time (GIRFT) reports, which provided clear actions and best practice recommendations to improve patient outcomes.

The department had access to the full range of specialists required to meet the needs of patients. This included pharmacists, speech and language therapists, play therapists and dieticians.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of patients. New starters followed the emergency department nursing education framework which followed the Royal College of Nursing (RCN) competency framework and was bespoke to the UEC environment. New starters had supervision for 6 weeks if newly qualified and 12 weeks if they were internationally educated nurses. Staff told us that this could be flexed depending on individual needs.

Staff spoke highly of the practice development team. We were given examples of staff members who had requested specific training which had been approved and staff felt able to request further training if needed. Team away days were organised on a rolling monthly basis between the 3 UEC teams. These incorporated learning topics and staff could also suggest training and run information/refresher sessions on these days. Staff described the away days as “valuable” and “a chance to work together.”

Staff had regular appraisals and reported they were valuable and identified learning and training opportunities. At the time of assessment 81% of nursing and additional clinical services staff had received an appraisal within the past year.

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

We attended board rounds and huddles which showed staff held regular and effective multidisciplinary meetings. Staff shared information about patients appropriately.

Teams had effective working relationships, including good handovers, with other relevant teams within the organisation. For example, we saw proactive team working with the palliative care team during our assessment.

Staff completed a care plan for patients entering the emergency department which included information on mobility, skin assessment, falls assessment, nutritional risk assessment and medicines.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment and support. The trust used an electronic patient record (EPR) throughout the hospital. Different teams completed the same record for each patient. This meant patient information was accessible for all, easy to find and helped facilitate better communication between healthcare professionals. Staff said this had led to a more coordinated and patient-centred approach to care. In addition, other system partners used the same IT system making information sharing more efficient and effective. Feedback from staff was extremely positive regarding the EPR system.

The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

There were information leaflets in patient areas, and these addressed appropriate topics including cancer, mental health needs, nutrition, alcohol misuse and how to access services other than UEC.

Patients could access support from the alcohol and substance misuse team via referral or the trust website.

Nicotine Replacement Therapy (NRT) was available in hospital and for patients to take home on discharge, if appropriate.

The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent. However, the trust have told us they had implemented a number of improvement initiatives to address these issues and the outcome of these may been seen at future inspections.

The department had escalation and flow challenges which could impact on outcomes. The service participated in Getting it Right First Time (GIRFT) a national initiative by NHS England to help emergency departments (ED) in England improve their performance. Since September 2025 the department has had a GIRFT UEC team to provide onsite, clinically led improvement support. The GIRFT team had weekly meetings with the chief operating officer, managing director, medical director and nurse director to discuss progress, concerns, future work and any support needed.

We were told the current priority areas of improvement were reduction in corridor care, embedding of the acute assessment area and medical SDEC and improving discharge and long length of stay processes.

Figures showed in December 2025 out of all the patient attendances the percentage waiting over 12 hours was 14.4%. For patients attending with type 1 and 2 attendances this slightly higher at 21.4% staying over 12 hours. Both figures were worse than the England average, which was 7.4 and 10.5, respectively.

Type 1 is a consultant led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients. Type 2 is a consultant led single specialty accident and emergency service (e.g. ophthalmology, dental) with designated accommodation for the reception of patients. Type 3 may be doctor led or nurse led. It may be co-located with a major Emergency Department or sited in the community.

Figures showed in December 2025 the percentage of type 1 and 2 attendances admitted, transferred or discharged within 4 Hours was 48.2%, this was worse that the England average of 60%. Figures for percentage of paediatric attendances admitted, transferred or discharged within 4 Hours were better. With 71% compliance with type 1 and 2 and 96.1% for type 3.

The trust recorded any unplanned reattendance within 7 days which included any readmissions within 7 days. The re-attendance rates from July 2025 to January 2026 averaged 11.3%.

The trust provided us with audit data from October to December 2025 and an additional notes audit for January 2026 as the trust had had an IT error with data being incomplete for December 2025. The audit showed poor compliance with patients being assessed within 15 minutes for sepsis. With 74% in October and 84% in November 2025.

The audit represented compliance with sepsis screening for patients who scored 5 or above on their NEWS2 score and/or 3 in a single parameter. As an interim measure the trust did an additional audit of 10 randomly selected patients who have triggered a sepsis screening. Fifteen-minute initial assessment compliance was reported as 80%. The trust said this was due to delays in documentation and staff not backdating the triage time when documentation is completed retrospectively.

Average length of time in the department was only provided for time in the clinical decisions unit (CDU). Results showed a low of 4 hours in November 2025; figures had been increasing with figures in February 2026 showing the average length of time reported as 9 hours.

The department took part in several national and local audits. The WHH submitted data to the National Major Trauma Registry (NMTR) audit. Reports were published 3 times a year and were discussed at the trauma group where actions were managed. One staff member was responsible for this data submission currently; however, high numbers of trauma work meant the trust should have 2 further staff to facilitate this. The trust told us there was a business case submitted for the past 2 years but so far this has been unsuccessful. As a result, the department has only achieved 80% compliance for this audit.

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

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They supported patients who lacked capacity to make their own decisions or when experiencing mental ill health. Staff had completed living with dementia training, with an overall compliance of 94%.

The service had effective systems to ensure staff assessed the mental capacity of patients and recorded decisions made in service users’ best interest when applying to deprive the service user of their liberty. We saw this was documented clearly in the patient records we reviewed. We witnessed staff explaining procedures and the associated risks of accepting the treatment or not. Staff obtained and recorded verbal consent where appropriate and were supported by the safeguarding team if needed, for example, with any guidance around consent, mental capacity and best interest decisions making processes.

Staff had access to mental health/deprivation of liberty safeguards (DoLS) guidelines on the trust intranet. Staff were able to talk about DoLS and how this would impact patients. Staff were aware of their responsibilities under the Mental Capacity Act 2005.

However, patients could not clearly see how to request a chaperone or if this service was available to them. The trust were made aware of this during our assessment and have since told us they have placed information posters in patient areas.

In the CQC Urgent and Emergency Care Survey 2024 the trust scored worse than expected for the question about involvement in decisions. The trust scored 6.7 out of 10 for being involved as much as they wanted to be in decisions about their care and treatment. The trust did not perform as well for that particular question compared to most other trusts that took part in the survey