William Harvey 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 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.

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. We assessed all quality statements.

We found that although the service had worked hard to make improvements there were still areas of concern. We saw patients being cared for in temporary escalation areas that did not adhere to the specific criteria for admission to these areas. During our assessment, we saw patients spending long periods of time being cared for in the emergency department including on corridors. The service did not always make sure that people could access the care, support and treatment they needed when they needed it. However, the service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. Patients were also supported to make decisions to improve their overall health.

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.

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 evidence showed significant shortfalls. The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People’s care and treatment was not always co-ordinated, responsive or delivered in a way that met their assessed needs. We saw patients being cared for in temporary escalation areas that did not adhere to the specific criteria for admission to these areas. For example, there was a patient on corridor C that needed 2 hourly repositioning for pressure area check and care. We also saw 2 patients on the corridors who needed oxygen cylinders. Both of these are exemptions within the Standard Operating Policy for corridor care. Safety measures were in place with additional checks on the patient and checks on the oxygen levels in the containers.

Patients and their families told us their care needs were not being met. Prolonged stays in temporary escalation areas with no privacy and dignity, lack of sleep and noise being the main problems.

We heard from a patient who was in a corridor for more than 24 hours with a suspected spinal injury. Due to delays in treatment and scanning they were unable to get up to use the toilet facilities. The patient was very distressed and felt they were not being communicated to well about the delays and their needs were not being met.

During our assessment patients and their families told us their care needs were not being met. For example, patients waiting for pain medication, and lack of privacy and dignity for those we spoke with in escalation areas. .

Several patients felt that sleep overnight in escalation areas was impossible as the lights were not switched off and there was constant noise, people banging into their trolleys as they passed by and no privacy.

Patients in the temporary escalation areas did not have personal call bells to gain the attention of staff. This posed a risk to patient safety in the event of an emergency. Staff did have access to a central emergency call bell linked to the main unit to gain attention if needed.

We reviewed a range of evidence in relation to concerns raised by families about the environment in the temporary escalation areas. Patients described the corridors as a “terrible experience” with comments about a lack of dignity and “being whacked into by people passing by”. Several concerns raised through the CQC talked of noise, lack of food and drink and patients not being able to rest because of noise and lighting.

Some patients told us they had missed doses of medications as there were delays in prescribing medication. Patients also felt pain medication was not offered in a timely way.

Staff considered patients' individuals needs and preferences. They undertook risk assessments to identify specific needs such as nutrition, hydration, and pressure ulcers. Patients were provided with food, blankets, pressure-relieving equipment and additional pillows.

The service flagged patients who were known to have a learning disability on admission. Details of the specific reasonable adjustments that they may need were recorded. People living with a learning disability were initially assessed using the standard nursing assessment tools.

The patient liaison team spoke with patients to ensure their individual needs were met and could provide books and various items to help alleviate boredom. There were also link workers available to provide additional support and advice to staff for supporting patients with learning and mental health difficulties.

Staff supported patients to make their own decisions about their care and treatment. For example, we heard staff explaining the possibility of attending a scan as an outpatient to allow a patient to go home.

Patients in the Children’s ED had access to sensory toys, books and games. There was also a full time play therapist to engage with children and support procedures if needed.

We witnessed security guards asking staff members to describe patients individual needs to assist them to provide person-centred care. They would interact with people taking into consideration if they were living with dementia, learning disabilities or autism.

The service catered for bariatric (high body mass index) patients with wider chairs in the department and beds which could hold patients up to 220lbs. If a further weight limit was needed, a suitable bed from other areas of the hospital could be requested. We also saw specialist equipment in majors for bariatric use.

There was a Same Day Emergency Care (SDEC) team who supported the ED daily. They reviewed the patient list within the department first thing and transferred appropriate patients up to SDEC.

There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

During our assessment, we saw patients spending long periods of time being nursed in the emergency department including on corridors. Patients were spending several hours on trolleys and waiting room chairs once a decision to admit had been made, due to no beds being available on the wards.

During our visit and from our review of concerns raised through our website we heard that patients sometimes had a delay in receiving pain relief while in the department. One patient told us, ‘I have been waiting for pain relief for two hours’ others reported ‘long delays in getting paracetamol’ and feeling ‘forgotten’.

We also saw delays in access to CT scanning. Staff told us that it could be up to 23 hours delay in non-urgent scans being undertaken. Patients were waiting in the department during these delays. For example, there were 16 patients waiting for a CT scan during our assessment one of which had been waiting 23 hours.

We reviewed self-discharge data audits which showed that 46% of patients who self-discharged stated the wait for specialities as the reason. A further 16% stated they left because of the wait time in ED and 10% because of the wait time for a bed. Audit results also showed that 75% of patients discharged themselves between 8pm and 8am. These findings highlighted the continued impact of overnight operational pressures, reduced service availability, extended waits, and patient flow.

The trust was in partnership with system partners to develop and improve services for people in their local communities. The shared ownership of the urgent treatment centre was an example of how services were working together to ensure patients were seen more efficiently and away from the hospital environment.

All patients attending the department were registered on the Electronic Patient Record (EPR) and staff completed the documentation of hospital handover using an electronic system. External partners, such as GPs, community nurses, and social workers were involved to enable continuity of care and support for discharge. The department had formal agreements with other NHS trusts and tertiary centres to facilitate transfers of care where required.

Staff in the Children’s ED used the nationally recognised Safe Transfer of the Paediatric Patient (STOPP) transfer forms to ensure all relevant information was available during the transfer of children and young people to another service.

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

Patients received information in an accessible way. Additional accessibility needs were identified, recorded, highlighted and shared within the EPR, in accordance with the Accessible Information Standard.

The waiting rooms within each area had a board on which waiting times were displayed and updated regularly. These were also available via a QR code. The treating clinician was responsible for providing the discharge advice and ensured it was in an accessible format for the patient. When altering or adding medication, this was written down for the patient as well as communicated to their GP via electronic discharge letter sent straight to the GP surgery.

We observed appropriate conversations between medical staff, patients and family members about treatment plans and options. We saw there was a room available where staff could take families and carers, when delivering bad news.

Staff told us they had received General Data Protection Regulation training (GDPR) and could explain their duties regarding confidentiality and data sharing.

Staff had access to GDPR and equality and diversity policies on the intranet. Staff could also ask for advice from the trust Caldicott Guardian. A Caldicott Guardian is a senior person responsible for protecting the confidentiality of people's health and care information and making sure it is used properly.

Staff identified patients who would need interpretation services. These could be face to face although if this was not available, telephone interpreter services could be used.

Staff had access to several relevant leaflets available throughout the departments, via a QR code or trust website. Patients could also get information on how to access this in different languages. Staff told us these could be printed off as and when they were needed. Patients could access lots of information via the QR code given to them upon booking in. This included information on how many people were in the department and current wait times.

We reviewed the trust website which included a range of information for patients and links to a various useful information. This included signposting to external support as well as contact details within the trust and how to book appointments.

Staff ensured carers and families were regularly updated about the patient’s progress. We witnessed staff speaking with a patient’s relative on their mobile phone and helping to add additional call minutes to allow them to contact their relative who was in the department.

However, in the CQC Urgent and Emergency Care Survey 2024 in the question about clear explanations about tests received a score of 6.9 out of 10. This was much worse than expected when compared to other hospitals. The department also scored worse than expected in relation to clear explanations about test results and feeling staff explained the results in a way they could understand. They scored 6.8 out of 10.

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

The service made it easy for people to share feedback and ideas. Staff assisted patients to raise concerns and patients, carers and relatives could make complaints directly by visiting the trust’s patient advice and liaison service (PALS) or through the trust’s website by telephone, form or email.

There were 189 complaints received for UEC from February 2025 to January 2026. Of these 24% related to clinical management, 15% to attitude of staff with communication, delays and nursing care being among the top themes.

The complaints were RAG (red, amber or green) rated to show the length of time and monitored for stages of completion. For example, the report for January 2026 showed 4 complaints were rated red, 9 amber and 9 green. The red rated complaints were overdue, the longest had been open 162 days with the report due by 30 January 2026. Despite the delays in some of the complaint responses, there was a clear system to identify and move them forward. All of the complaints had an initial written response.

There had been no complaints referred to the Ombudsman in last 12 months. Care Group Governance teams were responsible for co-ordinating the investigation of a complaint, for arranging any local resolution meetings for the patient, and for ensuring timescales for complaints were met. Complaints Managers were responsible for day-to-day case management of complaints, this included acknowledging all complaints and updating the database.

The Quality and Safety Committee (QSC) which was a sub-committee of the trust board, ensured the trust board was kept informed monthly via the QSC report.

Patients were involved in their complaints review. Staff always arranged to meet with the complainant wherever possible to discuss their worries in person.

Staff we spoke with said complaints were always taken seriously. We reviewed recent complaints and found they had been responded to in a respectful way. We also heard about recent changes to practice following on from complaints, for example the addition of more plugs, so patients could charge their phones in escalation areas.

Complaints were discussed from across the trust. The service discussed their complaints and shared the learning from them in regular meetings including the divisional quality governance forum.

Duty of Candour (DoC) was required to be completed for any incident that had a harm level graded as moderate or above. The duty of candour is a legal and ethical obligation for health and social care providers to be open, honest, and transparent with patients or their families when a mistake occurs that causes or could lead to significant harm. Staff were required to have a conversation within 10 days of the recognition of duty of candour requirement, with a follow-up letter being produced and sent within 15 days of the same date. The final duty of candour was required to be completed within 10 days of the investigation being completed. We reviewed data which showed good adherence to this with 1 verbal DoC missed , the trust later told us that this was delayed due to difficulties in contacting the patient's next of kin, and 2 final report delays from January to December 2025.

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.

The department had struggled with hospital capacity impacting flow. Although staff felt this had improved recently. The increased demand and poor flow in the department was in part a consequence of beds not being vacated by patients with complex discharges from hospital ward beds. There were also delays for people who were medically fit to go home but had no immediate care provision in the community. This had a significant impact on the performance of the emergency department and the ability to be responsive to patients and meet their needs in a timely way as patients could not be moved through to the appropriate ward.

The inability to review and admit patients in a timely way increased crowding and reduced flow in the department. Data provided for the 3 months leading up to our assessment showed there were 4,501 patients who were in the department for more than 12 hours. Of these 62% were admitted into the hospital and 33% were discharged home. In the same period 58 patients were transferred to a different hospital or healthcare facility.

In the same period, we saw that 905 patients did not wait for treatment. This accounted for 2.2% of patients attending the department. The department audited “did not wait” data which included consideration of whether mental capacity was considered and documented during self-discharge. Follow up of these patients was communicated to the GP for follow up.

Between 1 November 2025 and 31 January 2026, overall compliance with completion of triage assessment within 15 minutes was reported as 84%. However, we observed patients were not always triaged in 15 minutes, meaning patients were at risk of not being identified as higher risk and escalated to the appropriate areas. During our observations on both days of our assessment, we found inconsistent triage and observations. For example, during our observations on day one, during a 2 hour period we saw 8 patients who did not receive a full triage within the 15 minutes recommended. Two patients did not receive a triage for 51 minutes, with a further 2 waiting 41 minutes. In the children’s ED the 15 minute target was met 100% of the time from November 2025 to January 2026.

The department audited 50 patient records a month. Between 1 November 2025 and 31 January 2026, the department reported an overall compliance with completion of NEWS2 observations within 15 minutes of arrival was 90%, meeting the locally agreed target. Early completion of NEWS enables the timely recognition of acute illness, supports appropriate prioritisation and streaming, and informs prompt clinical Between 1 November 2025 and 31 January 2026 overall compliance with NEWS2 observation frequency across the 3 month audit period was 91.7%. This was in line with the trust target of 90% and showed that systems were in place to support the early identification of patient deterioration.

Staff planned for patients’ discharge, including good liaison with care co-ordinators. The re-attendance rates from July 2025 to January 2026 averaged 11.3%.

There were often delays in specialist teams admitting patients. Where a response was recorded, the proportion of reviews recorded within 60 minutes was around 23%. We also saw data that showed over a 6 month period, on average, it took 27.6 hours for patients to be admitted to an acute medical ward, 24.6 hours to general medicine and 28.6 hours to be admitted to respiratory medicine. With the exception of ear, nose and throat and paediatrics all specialties reported an average over 6 months of between 10 and 28 hours.

NHS England’s UEC Care Plan 2025/26 sets a maximum of 45 minutes for ambulance handovers to Emergency Departments. Recent audits showed that ambulance handover occurred within 15 minutes 65% of the time and 95% of patients were handed over within 30 minutes. This showed gradual and consistent improvement over the past 12 months. There was a safe, validated, reliable and audited system to identify critically ill patients when accessing the department by ambulance. Staff had good systems and processes to identify the severity and urgency of a patient's condition to prioritise care and inform staffing decisions.

Patients admitted as an emergency must receive a thorough, face-to-face review by a suitable consultant within 14 hours of hospital arrival. On average this was achieved 95.8% from November 2025 to January 2026.

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 had access to the Equality, Diversity and Inclusion (EDI) Policy for Patients, Carers, and Families alongside the EDI workforce policy.

The provider had undertaken an equality impact assessment (EIA) on policies used by the service. An EIA is a tool designed to improve equality analysis, practice and outcomes. The trust’s equalities and human rights impact assessment guided staff for the collection of data to ensure risks for complying with their responsibilities for groups with protected characteristics were addressed. The equality, diversity and inclusion policy endeavoured to create a fair, diverse and inclusive workplace and healthcare service

All staff received equality, diversity and human rights training as part of their mandatory training. In January 2026 compliance was 94.6%, with a trust target of 90%.

There were processes to support staff to deliver care and treatment and not put patients with protected characteristics at a disadvantage. Staff said there were measures to support people living with mental health problems, learning disabilities, autism and dementia, to receive the necessary care to meet their needs. Staff could access support and guidance from specialist nursing teams, such as learning disability nurses, dementia nurses and the psychiatric liaison team.

Staff had access to a restraints policy, this guided staff about the use of restraint and restriction to ensure they were not used inappropriately and included the legal frameworks for restraint. There was a pharmacological policy for the use of rapid tranquilisation and restrictive interventions, to ensure staff understood the legal framework and guidance for patient safety. Between 1 November 2025 and 31 January 2026, there were 3 recorded instances of rapid tranquilisation administered within the UEC department. These were reported via the trust’s incident reporting system. During the same period, the department recorded 899 presentations of patients with presented with mental health needs. The use of rapid tranquilisation therefore represented a small proportion of overall mental health presentations (approximately 0.33%). Each incident was reviewed through governance processes to ensure that clinical justification, documentation, monitoring and escalation were appropriate, and to identify any learning.

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.

Patients were supported to make decisions to improve their overall health. This included stopping smoking and making healthy eating choices.

Patients we spoke with felt that their future needs had been considered. The service had a proactive patient liaison team to support patients witing the department.

Staff supported patients to make decisions about their care and treatment and their future, for example Do Not Attempt Cardiopulmonary Resuscitation (DNACPR). A DNACPR is a medical order indicating that if a person's heart or breathing stops, healthcare teams should not attempt to restart it.

Staff created personalised care plans to account for the patient’s needs, wishes and feelings. Patients were given safety advice and leaflets to ensure a safe discharge. This included information on how to use crutches, reducing the risk of blood clots, and preventing back injury.

Care for people who were nearing the end of their life was managed and communicated in a sensitive and dignified way. The trust’s palliative care team were available, and specialist teams supported patients who were at the end of their lives that presented in the department.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs.