Conquest 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

We looked for evidence people and communities had the best possible outcomes because their needs were being assessed appropriately. We reviewed whether people’s care, support and treatment reflected their needs including 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 ensuring that an understanding of current outcomes and exploring best practice was part of their everyday work.

We assessed all quality statements in this key question.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service did not always provide effective care. Monitoring of risks and patient outcomes did not always lead to improvements and there was inconsistent multidisciplinary working to ensure the smooth running of the service.

However, staff and volunteers worked hard to try and meet the needs of patients where they could. The department had access to teams that helped support people once whilst in the department and when at home. 

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 scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The service did not provide timely care following patients’ initial assessment. Records showed delays after their initial assessment, including significant waits for reviews by surgical and medical specialties and delays in senior nurse reviews.

Staff did not always document care plans in sufficient detail. Although staff updated care plans when required, records were often brief and did not consistently demonstrate ongoing assessment, monitoring or the reasons patients remained in the emergency department while awaiting an inpatient bed. As a result, records did not always show that staff had fully reviewed and responded to patients' changing needs during prolonged waits. In the context of poor patient flow and extended delays, incomplete documentation increased the risk that deterioration, unmet needs or delays in escalation may not be recognised or communicated effectively and could affect continuity of care.

However, staff generally completed core clinical documentation. Most records we reviewed contained timely NEWS2 observations and risk assessments, including sepsis and falls assessments. Staff also used electronic alerts to highlight additional patient needs and risks, including dementia, safeguarding concerns and infection risks.

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 4.8 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 worse than expected meaning the trust performed worse for that particular question compared to most other trusts that took part in the survey.  

We observed a patient with back pain and multiple comorbidities who had been referred to the medical team overnight but was still waiting for an inpatient bed at 16:00 the following day. During this period, the patient received only intravenous paracetamol and intravenous fluids despite reporting high pain scores. The prolonged wait and limited pain management increased the risk that the patient's symptoms and overall condition were not adequately managed while awaiting definitive care. The patient's family expressed distress about the lack of communication and their perception of the care provided, demonstrating the negative impact that delays and poor flow could have on patient and family experience.

The service did not always use the rapid assessment and treatment area as intended. This area was designed to support the prompt assessment and treatment of patients.  Patients were often cared for there while awaiting admission to inpatient beds. As a result, the area was not consistently available for its intended purpose, which reduced the service’s capacity to assess and treat patients promptly. This impacted patient flow through the department and increased the risk of delays in care.

Monthly mental health audit data showed that staff routinely completed mental health risk assessments for both adult and paediatric patients attending the department. This practice aligned with recognised mental health risk assessment standards. We reviewed 12 months of audit data, which showed sustained improvement in compliance over time. Adult risk assessment compliance was lowest in February 2025 at 66% and showed steady improvement from June 2025 to January 2026, with an average compliance rate of 90%.

Staff and volunteers, including housekeeping staff, were observed offering patients food and drinks throughout the day. Patients were provided with sandwiches and hot drinks, and vending machines offering a range of food and drink options were available in the main waiting area. However, we saw access to hot food for patients was inconsistent and generally dependent on length of stay, and in temporary escalation areas tables were not always available to support the safe serving of food and water.

We scored the service as 3. 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.

Staff used the trust's systems to follow the latest guidance and evidence-based practice. They used information shared through regular safety briefings and newsletters to implement new guidance and changes to existing procedures.

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

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

The service used a combination of paper and electronic documentation. Most risk assessments we reviewed were complete and updated when required. Adult, children and young people with mental health needs had timely triage and mental health risk assessments documented. The average time to be assessed by triage was 15 minutes. This had improved since January 2026 and was in line with national targets.

The service participated in the Royal College of Emergency Medicine (RCEM) Quality Improvement Programme. This demonstrated leaders' commitment to continuous improvement and enabled the service to benchmark its performance against national standards and implement improvements where required.

The service did not always provide timely access to specialist mental health input, and some patients experienced delays in being seen by psychiatric liaison practitioners provided by an external service. This meant patients did not always receive assessment and care from appropriately skilled mental health professionals in a timely way, in line with evidence-based practice.

The service also did not have pharmacy in‑reach within the department, which meant patients did not always receive their regular or usual medicines in a timely way.

We scored the service as 1. The evidence showed significant shortfalls.  The service did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services.

Leaders did not ensure staff, teams and services always worked effectively together to provide coordinated care. Poor coordination between specialties contributed to delays in patient assessment, decision-making and treatment, particularly for patients requiring specialist review and admission. 

We observed delays in patients with mental ill health receiving assessments following referral to the appropriate teams. This issue was evidenced through service audit findings. During the waiting period, patients often lacked access to a suitable therapeutic environment in which to remain while awaiting assessment.

Care was not consistently coordinated across teams and specialty services. Although some specialties provided on-call support to the emergency department, patients did not always receive timely specialist assessment because of capacity pressures and competing demands elsewhere in the hospital.

During the inspection, we observed delays in specialty teams accepting referrals from the emergency department. Staff described, and we observed, disagreements between specialties regarding clinical ownership and responsibility for patients. In 1 example, medical teams disputed which specialty should review a patient, which delayed clinical decision-making, admission and transfer to an appropriate ward. Staff told us that disagreements between specialties and clinical pathways about where patients should be managed sometimes delayed care and treatment.

These delays meant patients remained in the emergency department longer than necessary while awaiting specialist review and definitive treatment. This increased the risk of deterioration, prolonged pain and discomfort, and delayed access to appropriate inpatient care. Leaders had not implemented effective systems to ensure timely specialty review, escalation and admission. As a result, patients did not always receive coordinated care without avoidable delay.

The service used multiple electronic and paper-based systems to access patient information, review investigation results and document clinical care. Medical teams recorded notes on paper, which staff later uploaded to electronic systems. Staff told us the complexity of navigating multiple systems increased the risk of errors and created barriers to effective information sharing. Staff could not always easily identify whether a patient had already been reviewed by another team and often had to access several systems to obtain a complete clinical picture. This increased the risk that important clinical information could be overlooked and reduced continuity of care between teams.

The service did not collect or monitor data relating to time-to-specialty review. As a result, leaders could not effectively identify, monitor or address delays experienced by patients waiting for specialist assessment. This limited leaders' oversight of patient flow through the emergency department and reduced assurance that patients received timely access to specialist input. Leaders told us the emergency department planned to move to a fully digital system in September 2026, which would enable this data to be monitored.

During our observation of the morning board round, discussions lacked a clear structure and did not consistently involve the wider multidisciplinary team. Staff did not always share key patient information, which reduced opportunities for comprehensive multidisciplinary review and coordinated care planning. This increased the risk that important aspects of patients' care and discharge planning may not have been considered promptly.

Despite these concerns, staff described a supportive culture and positive working relationships across teams. We observed examples of effective day-to-day collaboration, and staff spoke positively about their relationships with colleagues across the trust. The urgent treatment centre utilised emergency nurse practitioners and GPs to support alternative patient pathways and reduce pressure on the emergency department. Leaders also used the safer nursing care tool to assess staffing requirements against patient acuity.

Each shift had an Emergency Physician in Charge (EPIC) who provided senior clinical oversight of the department and supported operational decision-making.

The department had also implemented a cardiac arrest huddle, which enabled specialty teams to coordinate roles and responsibilities during in-hospital cardiac arrests. Staff told us the process was well established and worked effectively in practice.

Security and emergency department staff described positive working relationships, and security staff responded promptly when called for assistance.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service had several established in‑reach teams that supported patients’ wellbeing, promoted independence and reduced future care needs.

The service had access to a hospital intervention team (HIT), which included nurses, physiotherapists and occupational therapists. The team completed holistic assessments, supported mobility, and carried out proactive falls assessments before helping patients to return home or move to an appropriate care pathway. Staff told us they focused on preventing avoidable admission and deterioration. The team operated 7 days a week from 8am to 8pm, with slightly reduced hours on bank holidays.

The alcohol care team (ACT), in place since 2023, worked closely with the department to streamline care pathways and ensure rapid identification, assessment and intervention for alcohol‑related presentations. Since the team’s introduction, the service reported fewer avoidable alcohol‑related admissions. Data from 2025 showed a 42% reduction in total bed days linked to alcohol rehabilitation admissions.

The department benefited from frailty team input, including a daily frailty consultant. The team supported, completed comprehensive geriatric assessments, considered patients’ holistic needs and supported informed decision‑making. Staff and leaders consistently gave positive feedback about the frailty team’s impact.

The service also had access to other specialist teams such as an acute oncology team, a learning disability team, and a dementia team. However, the dementia team told us their involvement with the emergency department was limited. Staff we spoke with in the department confirmed this. 

We scored the service as 2. 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, or that they met both clinical expectations and the expectations of people themselves. 

The service did not consistently achieve positive outcomes. Data from the Royal College of Emergency Medicine (RCEM) Mental Health Self‑Harm Quality Improvement Programme (2023–2024) showed the service failed to meet several recommended standards outlined in the Quality Improvement Programme (QIP) report, despite an action deadline of December 2025. Of the 5 recommendations, the service performed above the national average in only 1. 

Staff completed monthly sepsis audits in the emergency department for both adult and paediatric patients. Compliance across both audits remained consistently poor. In February 2026, audit data showed that the department achieved only 58% compliance with the "All Sepsis 6" audit. Review of the data identified a recurring issue with inadequate monitoring of urine output in patients undergoing sepsis screening. This placed patients at risk of harm, as urine output monitoring is a critical indicator of kidney function and deterioration in patients with sepsis.

Leaders told us that sepsis management appeared on the risk register. However, the risk register provided only included risks relating to paediatric sepsis management, which had remained on the register since 2018. Although mitigating actions were documented, evidence demonstrated that these controls had not been effective in improving compliance or reducing risk. Leaders told us that sepsis outcomes were in line with national benchmarks and showed no performance outside expected variation. Updated trust sepsis guidelines were out for consultation at the time of the assessment.

These issues had persisted despite a previous poor outcome at another emergency department within the trust where missed opportunities in the recognition and management of sepsis had been identified. Leaders told us that learning from incidents was routinely shared across all sites. However, this incident occurred before the audit period reviewed and yet sepsis audit results remained poor, with limited evidence that learning had been effectively embedded into practice. This raised concerns about the effectiveness of organisational learning, the pace of improvement, and leaders' ability to ensure known risks were consistently addressed across services.

Audit data from October 2025 to February 2026 showed persistent delays in completing routine observations and late responses to high NEWS2 scores. This audit identified the majors area as having the greatest delays, with 50% of observations completed more than 60 minutes late. 

However, during the assessment we observed staff completing patients’ observations in line with national and local guidance.

The service also participated in Getting It Right First Time (GIRFT), a national NHS England initiative to support emergency departments in improving performance.

We scored the service as 3. 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 took all practical steps to enable patients to make their own decisions. Staff made best interest decisions when patients lacked capacity. They recognised the importance of respecting the person’s wishes, feelings, culture and history.

Patients understood their rights around consent to the care and treatment they were offered. Patients received information about care and treatment in a way they understood and had the appropriate support and time to make decisions.

Staff had access to the trust consent policy and understood the relevant consent and decision-making requirements of legislation and guidance. Staff knew who to contact for advice.

The service respected advanced care plans when available. Staff kept family members and advocates updated about care. We observed staff gain consent from patients for their care and treatment in line with legislation and best practice guidance.

Training compliance for the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLs) was consistently high across the required staff groups. The average compliance for MCA training in March 2026 was 95% and 91% for DoLs. 

Staff understood the specific requirements of taking consent from children, including the Gillick competence. The Gillick competence is when children under 16 can consent to their own treatment if they have enough intelligence, competence and understanding to fully appreciate what is involved in their treatment.

Staff had 24-hour access to mental health support through the psychiatric liaison service provided by the partnership NHS mental health trust. Staff told us they felt the service was supportive. However, they reported that there were often delays after referral before attendance.

In the CQC Urgent and emergency care survey 2024, the trust scored about the same as other trusts for the question about involvement in decisions.