The Princess Royal 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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The service was in breach of regulation for audit performance of the stroke pathway, and completion of risk assessment and patient observations.

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 did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them.

There was an evidence-based pathway to support sepsis identification and treatment, however staff did not always follow the pathway. In the deteriorating patient audit from February 2026, sepsis assessment was not consistently completed on both the acute stroke unit and stroke unit and ward 36, with ‘red’ scores between 71 and 75%. Wards 9, 17 and 11 were also below target. Furthermore, several wards had ‘red’ scores for both recording of escalation and medical review. None of the patients audited on acute stroke unit who had high risk indicators for sepsis in the presence of suspected infection received IV antibiotics within 60minutes of the trigger concern. Recent projects to try to improve compliance included implementation of a digital observation dashboard to help timely recognition of the deteriorating patient, and a staff training programme which was due to be rolled out by August 2026.

Staff did not always assess patients’ needs around food and drink. The latest nursing quality assurance audit showed shortfalls in the completion of malnutrition universal screening tools (MUST) both in the 6 hours after admission and reassessment weekly or after a change in patient condition. In February 2026, ward 17 (respiratory ward), and ward 36 both scored ‘red’ for completion of MUST, with 71% and 20% completion within 6 hours and 68% and 25% reassessment, respectively. However, inspectors found that fluid balance and food charts were completed in the records viewed. We observed a breakfast service on ward 9 and found that patients with an “alert” around food and drink were served on a red tray. If the alert was an allergy, an additional sheet describing the allergy accompanied the tray. Inspectors viewed the bedspace of a patient on a pureed diet, and feeding instructions provided by speech and language therapy were clearly indicated on a yellow sign. Staff feeding the patient breakfast followed the instructions. Patients we spoke with were happy with the food choices on offer and felt they meet their needs.

As of February 2026, 83.5% of medicine and emergency care staff across both trust sites had received an annual appraisal, with 92% of medical staff receiving appraisal. We spoke with a nurse who had been in post for 6 weeks who felt that they there was “strong training for new starters”, and that her team and manager encouraged her professional development. At the time of inspection, practice education facilitators (PEFs) in the directorate were working clinically to help cover staff shortages. However, leaders said that staff noted on the rostering system when PEFs were required for onboarding new staff or essential staff training so that they could be released.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff shared information about patients at effective handover meetings within the team. Inspectors observed a ‘board round’ on ward 9 and saw a thorough discussion of patients involving a multidisciplinary team including doctors, nurses, physiotherapists, occupational therapists and a member of the patient flow team. It was noted that an occupational therapist raised a discussion about the mental state of a patient, and a referral to the mental health liaison team was planned as a result. Discharge pathways were discussed for all patients. We noted input from specialist teams in patient records, including a thorough and responsive review by the palliative care team.

Staff had 7 day access to diagnostic imaging services. A member of the cardiology team mentioned that the inpatient echocardiography service was “excellent”. However, there was no capacity for patients suffering a suspected transient ischaemic attack to receive a carotid ultrasound over the weekend, meaning that the target for scanning within 24 hours was not always met. This was a high risk on the service’s risk register. Staff referred patients requiring thrombectomy to another trust who they described having an excellent relationship with.

There was a specialist complex discharge nurse team who worked with ward teams to ensure discharge assessments were accurate for patients requiring packages of care or discharge to another facility, as well as liaising with patients’ families. There was a separate team to work with patients requiring a complex discharge across the Welsh border.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed significant shortfalls. The service monitored people’s care and treatment, however, outcomes were not always positive and consistent, meeting both clinical expectations and the expectations of people themselves.

Staff participated in national and local clinical audit and benchmarking but outcomes were mixed. In the latest Sentinel Stroke National Audit from July-September 2025, multiple areas of audit scored ‘E’, very poor, across hyperacute assessment, specialist pathway, and multidisciplinary team assessment. There were also ‘D’, poor, ratings for therapy intensity and therapy frequency. We viewed the service’s action plan and spoke with staff about challenges to meeting the targets. Staff told us that the number of ringfenced beds on the stroke ward for emergency admission stroke patients had reduced over time, and that at times decisions were made to admit non-stroke patients into the 2 ringfenced beds which affected admittance to the stroke unit within 4 hours. ‘Door to scan’ time was highlighted as an area of concern in the audit, and staff reflected this target was difficult to reach due to radiology location and capacity, and a process which meant that computed tomography angiography (CTA) referrals had to be approved by a radiologist before taking place. Out of hours, CTAs also required an on-call radiographer to attend from home to perform the scan. ‘Door to needle’ time, that is the time between patient arrival and the administration of clot-busting medication, thrombolysis, was being monitored as an area for improvement. Staff told us they were administering thrombolysis in the emergency department where possible. Physiotherapy and occupational therapy (OT) were generally available 7 days a week, with some variability around OT. However, speech and language therapy was a 5 day service and there were no specialist psychology services.

A local audit on peak flow measurement in patients admitted with asthma exacerbation showed significant non-compliance with 3 out the 4 standards audited. As a result, further education was delivered to staff, and peak flow charts were distributed across the trust.

However, the service scored above average in all areas of the latest National Audit of Dementia Care where sufficient information was returned. The trust was also above audit average in all elements of the 2026 National Audit of Inpatient Falls.

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.

Patients we spoke with said that staff asked for their consent before carrying out care and treatment, and staff explained treatments in a way they could understand.