Castle Hill 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

At our last inspection we rated this key question as requires improvement and remained the same at this assessment.

We found new breaches of Regulation relating to complaints, Duty of Candour, and good governance, reflecting concerns about the timeliness and quality of complaint handling, and how effectively waiting times and access to care were overseen.

However, staff within medical care core service (the service) continued to provide person centred care, respond to individual needs, and work collaboratively across teams, and patients were generally positive about the support they received once admitted. These strengths demonstrated that, despite the regulatory shortfalls, frontline staff remained committed to delivering compassionate and responsive care.

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 ensured patients were at the centre of their care and treatment decisions, working in partnership with patients and their families to respond to changes in individual needs and preferences.

Staff understood what mattered to people and provided care that met physical, emotional, and social needs. We observed staff consistently delivering person centred care and meeting fundamental care needs.

Staff provided clear examples of reasonable adjustments, including flexible visiting and access to meaningful activities on the infectious diseases ward, choice of dining location on the frailty ward, support for carers to remain with patients on cardiology ward C26, and adapted environments and visiting arrangements for a patient with a learning disability on the complex rehabilitation ward.

On the frailty ward, staff used a wellness questionnaire and decision matrix to support patients to express how they felt each day and ensure care remained responsive to changes in wellbeing.

Specialist nursing teams, including TB and HIV services, visited patients on wards to provide tailored clinical advice, emotional support and care coordination, supporting personalised care.

Patient records were individualised and holistic, with clear recording of nutritional requirements on charts and bed boards. Menus met national dietary guidance and catered for medical, cultural and lifestyle needs, including diabetic and halal diets. Food and fluid intake was accurately monitored, and patients gave positive feedback about food availability and staff support.

The 2024 adult inpatient survey showed strong performance above the national average for meeting individual nutritional needs, access to food outside mealtimes, and support with eating, drinking and personal care.

Compliance with commencing VTE prophylaxis at 14 and 24 hours was variable and below the 95% target, with lower compliance in the community, frailty and therapies care group. Overall performance was generally good, and this did not detract from the person‑centred approach to care.

The service did not always understand 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.

There were areas where the service did not consistently ensure continuity and oversight of care, particularly when responsibility transferred to external providers. A gap was identified in the referral process for patients requiring community care who lived outside the hospital’s catchment area, due to a lack of shared oversight of referrals sent and received. This created a risk of delays in follow‑up care. Actions were being taken to improve referral tracking and assurance.

Despite this the service demonstrated an understanding of diverse health and care needs, with examples of joined‑up and flexible care. Physiotherapists provided intensive discharge support, and staff within specialist cancer and support services worked closely with voluntary organisations, including the Macmillan Living With and Beyond Cancer team and the Macmillan Information Centre at the Queen’s Centre.

The service ensured that patients and staff had access to clear, accurate and current information provided in formats that met individual needs

Staff made sure patients understood what had been discussed. The trust’s 2024 inpatient survey scored 9.1/10 for patients receiving information about their condition and treatment.

Safety boards displayed key information, and posters with QR codes at bedsides provided access to condition‑specific, treatment and self‑care information in multiple languages. Leaflets supported health education, risk awareness such as falls prevention, and signposted local and national support services.

Specialist nurses supported patients and staff, with teams such as tissue viability producing targeted leaflets and posters to promote best practice. Staff had access to clinical guidance and standard operating procedures to support safe and consistent care delivery.

We observed dementia friendly information, including a large noticeboard on the infectious diseases ward displaying patient feedback and staff information.

However, site signposting was limited, with medical wards spread across multiple buildings. This sometimes required staff to travel long distances and, in some cases, patients to be transferred by ambulance. Portering services supported these transfers to help maintain safety and continuity of care.

The service did not always keep people informed or involved when they raised complaints, and they were not consistently updated about any actions or changes made as a result. However, we did make it easy for people to raise complaints.

As of October 2025, there were 186 open complaints, including 46 overdue, and only 18% were closed within the 60‑day target, resulting in a continued breach of Regulation 16 (Receiving and Acting on Complaints). Leaders acknowledged that improvement was required and reported that delays often occurred during internal quality‑assurance processes. Several key documents, including the complaints policy and guidance for managing correspondence, remained in draft, and a training needs analysis was underway.

Despite these shortfalls, the service made it easy for people to share feedback and raise concerns. Patients and relatives told us they knew how to raise concerns, and the trust’s 2024 inpatient survey scored 8.2/10 for patients feeling able to talk to staff about worries and fears.

Posters explained how to contact the trust’s Patient Advice and Liaison Service (PALS) and feedback was encouraged through the Friends and Family Test (FFT) using QR codes. FFT performance was monitored, with some wards achieving strong results, although performance varied across services.

Patients could provide feedback through multiple routes, including paper, SMS, voicemail and online, although availability was not consistent across all wards. Feedback results were shared at governance meetings, and leaders planned improvements through targeted communication training, co‑produced action plans and real‑time feedback mechanisms.

Family involvement was documented in care records, and wards shared positive examples of learning from complaints, supported by ward‑level action plans and quality‑improvement workstreams.

Waiting times from referral to treatment, and arrangements to admit, treat and discharge patients, were not consistently in line with national standards and showed limited improvement. However, once admitted, patients generally received appropriate care.

The trust was in the lowest performing national segment (Segment 4) for Tier 1 cancer delivery. Only 54% of urgent cancer referrals received a definitive diagnosis within 28 days, ranking the trust 118 out of 118 providers.

Seventy‑four percent of patients received first treatment within 31 days, and only 51% within 62 days, ranking the trust 116 out of 118. None of the cancer standards met the 75% target, and performance continued to deteriorate. NHS England undertook a national support visit to review cancer pathways, including diagnostics and endoscopy capacity.

The trust continued to fall short of the national Referral to Treatment (RTT) standard of 92%, with only 57% of patients treated within 18 weeks, ranking 106 out of 131 trusts. Four percent of patients waited more than 52 weeks, ranking 118th nationally. Performance declined across both measures, and the trust ranked 107th for the gap between planned and actual 18‑week delivery. The service had completed sprint programmes to support waiting list validation.

This constituted a breach of regulatory requirements, as further work was needed to achieve consistent, equitable and timely access to care.

The trust’s six‑week diagnostic performance was 26% in June 2025, remaining well below the national standard.

Bed occupancy data from September 2025 showed consistently high occupancy, with increased numbers of patients staying over 7, 14 and 21 days. This reflected sustained flow constraints, significant cohort of long‑stay patients, reducing the availability of beds for new admissions and contributing to inequitable access to timely care.

The endoscopy unit and ward 100 at HRI operated as a single service, with no 24/7 provision at this site. The service ran at full capacity Monday to Friday, with additional evening, weekend and waiting list initiative activity. Weekly capacity meetings ensured available slots were used, with unused capacity offered to bowel screening. Plans were in place to expand capacity from five to eight rooms.

A GIRFT cardiology optimisation review identified barriers to equitable access, including underutilised cath lab capacity and rising regional demand. Staff reported patients could wait up to three weeks for procedures. Further constraints included rota delays, inconsistent scheduling and long waits for echocardiography, Holter monitoring and ECG review. These issues contributed to extended inpatient stays and increased risk of breaching RTT and diagnostic standards. In response, the trust began implementing GIRFT priority actions, including criteria‑led discharge, expanding ANP, ACP and specialist nurse roles, and improving training and accreditation for timely echocardiography reporting.

The 30‑day readmission rate to medical wards was 12%. The trust reported work with the GIRFT team across five flow workstreams, including one focused on understanding readmission reasons and identifying improvements. While this work was ongoing, care groups were progressing actions through the wider trust flow programme to improve patient flow, reduce delays and support timely, equitable access to care.

The community frailty and therapy care group reported taking a whole‑system approach due to limited community capacity and worked with partners to reduce avoidable admissions. The cardiovascular care group described work to improve early community intervention for patients with chronic cardiac and vascular disease to reduce avoidable readmissions.

Staff and leaders actively listened to feedback and information from people at risk of inequality and tailored care and support accordingly.

The clinical strategy recognised that a significant proportion of the local population lived in areas of high deprivation, with poorer health outcomes and barriers to accessing care. These included rural and coastal geography, digital poverty, low health literacy, and increasing acuity and complexity. Leaders demonstrated a clear understanding of how these factors contributed to health inequity.

The strategy set out a whole system, equity focussed approach, aligned with national policy, with a focus on early intervention, prevention, self-management and delivering more care closer to home to improve population health and reduce avoidable admissions.

Future plans focused on expanding community and home based care, developing new models of delivery and supporting effective delivery of “Neighbourhood Health provisions”. Leaders recognised and responded to barriers such as digital exclusion, low literacy, and social isolation, ensuring care was accessible, personalised and compassionate.

Compliance with equality, diversity, inclusion, and human rights training met the 85% target with the exception of the community, frailty, and therapy care group, which reported lower compliance. Overall, this demonstrated a strong organisational commitment to promoting inclusive and equitable care.

The service supported patients to plan for important life changes, so they have time, information and support to make informed decisions, including at end of life.

Staff recognised the importance of early discussions about care preferences, including at admission and ensured these were clearly recorded and shared so care was delivered in line with individual wishes.

Relevant healthcare professionals and partner services were actively involved in care planning, particularly for patients with complex needs. Palliative care and discharge liaison teams supported personalised planning, and staff reported easy access to specialist support, including Macmillan nurses, cancer support workers and specialist palliative care teams. Oncology teams were described as providing particularly strong end‑of‑life planning, with effective support also available in the community.

Staff had access to bereavement packs, and chaplaincy services provided spiritual, pastoral, and emotional support to patients, families, and staff. Cardiology staff shared examples of compassionate, person centred end of life care, including supporting patients and families during significant life events.

End of life care was delivered sensitively and with dignity, with access to private rooms and practical support such as refreshments for families. On oncology ward 29, staff used sunflower symbols on doors to discreetly indicate patients nearing end of life, supporting clear and sensitive communication.

Compliance with Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) training was strong, with most staff exceeding the 85% target. However, locally mandated ReSPECT training had not been offered to some nursing staff in the community, frailty, and therapy care group or in major trauma.

Leaders explained local context and confirmed they would review the need to extend training to these staff groups.