The Princess Royal Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of regulation for mandatory training, including safeguarding training and staffing.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. We scored the service

Staff knew how to report incidents through the electronic reporting system and could give examples of incidents they had reported or would report. Across both trust sites, 5602 clinical incidents and 1017 non-clinical incidents had been reported in the 12 months before the inspection. There was 1 reported serious incident for Medical care services within the last 12 months.

We viewed a sample of after-action reviews of clinical incidents including an unsafe discharge due to a patient’s package of care not being reinstated, and a missed referral to haematology outpatients after an inpatient episode. We saw that leaders thoroughly investigated incidents, involving participants from outside of the organisation where appropriate. Action plans were produced and updated. Staff and leaders discussed incidents weekly at Medicine Safety Huddle meetings, including highlighting incidents which were overdue.

Staff said they received shared learning from incidents during team handovers and huddles. Staff we asked understood the meaning of Duty of Candour; that is being open, transparent and giving patients and loved ones an explanation if things go wrong. We saw that Duty of Candour had been documented in a patient’s record.

The evidence showed some shortfalls. The service had safe systems of care established; however, staff did not always adhere to them to manage or monitor people’s safety.

Patients were generally admitted from the emergency department to an acute medical ward before transfer to a general/specialist medical ward or discharge. In the sample of records viewed, patients received timely medical reviews on admission, and throughout their time in hospital. This included patients who were specialty outliers. Nursing staff largely completed adult inpatient admission booklets, although they were not always complete in a sample of patient records inspected on ward 9, a ward for the care of the elderly.

There were clear admission and exclusion criteria for several areas including frailty same day emergency care (SDEC) and discharge lounge. Staff we spoke with said that criteria were rarely overridden during times of increased pressure, but if they were, staff submitted an incident report. There was also a standard operating procedure (SOP) to support the use of escalation bedspaces, that is additional bedspaces on wards to support patient flow when the emergency department was too full. However, on one of our inspection days a patient in an escalation bedspace on ward 9 did not meet the criteria as they had a history of falls, including a recent fall on the ward. The patient did not have a call bell in their bed space. Inspectors fed this back to senior leaders.

Areas such as frailty SDEC which were not open 24/7 had processes and a close working relationship with wards to ensure patients who needed to be admitted overnight could be accommodated. Patients could stay overnight in SDEC which was staffed at times of extreme pressure.

Staff completed staffing handovers and ‘board rounds’ to share information and plan for patients in their care. We observed a nursing handover on ward 36 where 3 teams handed over to each other and while we saw one team also carry out a bedside handover, we did not observe all teams doing so.

The evidence showed some shortfalls. Staff did not always complete mandatory safeguarding training. However, staff were aware of how to raise concerns to protect people’s right to live in safety free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Staff knew how to make a safeguarding alert and did so when appropriate. However, certain staff groups did not have up to date training. For example, 50% of doctors in acute medicine had up to date safeguarding adults level 3 training, and 57% were compliant with safeguarding children level 3 training, against a target level of 90%. Furthermore, 40% of doctors in nephrology had completed level 3 safeguarding adults training. However, staff we spoke with could give examples of safeguarding concerns they had or would raise and felt confident to seek support from trust safeguarding leads. All the patients we asked felt safe in hospital and able to raise any concerns without fear of negative consequences.

The evidence showed some shortfalls. The service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service had validated tools to assess and mitigate potential risks to patients; however, staff did not always complete or adhere to them. For example, we saw in a patient record that the required neurological observations and Glasgow Coma Scale scoring were not fully completed for a patient on acute medical unit after a fall. The Glasgow Coma Scale is a standardised tool used assess consciousness level in patients. Furthermore, the patient was documented as requiring 1:1 staff supervision due to their high falls risk but on entering the ward the following inspection day, inspectors found the patient moving around their bedspace and no staff in their bay. This was escalated to the nurse in charge and senior leaders to mitigate the risk to this patient.

Leaders undertook a nursing quality assurance audit. Pressure ulcer risk assessments were not always updated weekly on the same wards. Bed rails assessments and moving and handling assessments were more consistently completed across wards. Risk assessment for venous thrombus embolism had improved significantly between January and March 2026, from 69% completion within 14 hours to 82%.

Staff had consistently calculated National Early Warning Scores in the sample of records viewed, however the latest deteriorating patient audit showed that observation compliance was significantly below the 90% target for inpatients at 54%, and there was an action plan to improve this metric. Escalation compliance was much higher at 97%, with patient review compliance and timeliness around 90%. Nursing staff we asked felt confident to escalate concerns about deteriorating patients. At the time of inspection, initiatives related to Martha’s Rule were not in place but due to be implemented. A wellness questionnaire piloted on selected wards on the trust’s sister hospital site was due to be rolled out across both sites imminently, and staff were working to implement a ‘call for concern’ telephone service by May 2026. At the time of inspection there was not 24/7 critical care outreach team cover at this site, but plans were in place for 24/7 cover by the end of summer 2026.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties. Most of the patients and relatives we spoke with said that staff kept them updated with plans for their treatment, although 1 patient felt that communication between staff could be better, as there had been confusion about their discharge from hospital. Staff enabled patients to give feedback on the service they received. We observed posters publicising the Friends and Family Test on wards, and viewed a booklet produced by a staff member on discharge lounge which included information on giving feedback and signposting for patient advice and liaison services. Staff enabled patients to make advance decisions when appropriate, completing and updating ReSPECT forms in the patient records viewed.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Wards environments were generally tidy and clutter-free, and all the patients we spoke with felt that facilities and equipment were suitable for their needs. Some, but not all wards were secured with swipe card or intercom access. A sample of medical devices checked had been serviced on time, and non-medical electrical devices had gone through portable appliance testing. Staff carried out daily checks of emergency equipment through a quick response code, and emergency trolleys were securely tagged. A sample of trolleys inspected contained the required equipment which was in date. Cleaning products were stored and risk assessed in line with Control of Substances Hazardous to Health guidance. A biohazard spill kit on AMU had expired on 28 February 2026, this was highlighted to staff to replace.

Sharps boxes were correctly assembled, labelled and not overfilled. Staff segregated clinical and domestic waste. The clinical waste skip located in the unlocked dirty utility room on acute medical unit (AMU) was not correctly secured on the day of inspection, but this was rectified.

Around the time of the inspection, enforcement had been carried out by the local fire service regarding fire safety on the hospital site. Some staff raised concerns with inspectors that escalation bedspaces blocked fire exits. However, the Hospital Full Protocol specified where escalation bedspaces could not co-exist on wards so that fire exits were maintained. We did not see evidence of non-adherence to this on our inspection.

The evidence showed significant shortfalls. The service did not make sure there were enough qualified, skilled and experienced staff. Staff did always keep up to date with mandatory training. However, staff generally received effective support, supervision and development.

Staffing levels was the concern most raised by staff to inspectors. There were 45 vacancies in the service as of February 2026. The service calculated the number and skill mix of nursing staff required, however on the days of our inspections, actual staffing did not meet planned staffing requirements in some areas. For example, on 3 March 2026, same day emergency care (SDEC) was 2 registered nurses short, and the SDEC lead was working clinically to help fill staffing gaps. Ward managers were able to request cover from bank staff. One ward manager told us that they were only able to request bank 24 hours ahead of the shift which limited take up due to short notice, however leaders told us that there was flexibility around this depending on the needs of the ward. Bank staff used were generally staff substantive to that area and so were familiar. The service did not use agency staff. At the time of the inspection, ward managers were rostered to be working clinically 40% of their working time to help cover staff shortages, although leaders told us this was flexed depending on the needs of the ward. There was frailty in Consultant staffing in Cardiology. There were 4.8 substantive and 4.9 locum whole time equivalent (WTE) Consultants in post versus the 14 WTE recommended by Getting It Right First Time. This was a ‘red’ extreme rated risk on the service’s risk register. There was also frailty in staffing of Care of the Elderly Consultants which was rated extreme.

In February 2026, turnover of registered nursing staff was 10%, and the rolling sickness absence for the previous 12 months was 5.4%. Turnover was the same for non-registered nursing staff, however sickness was higher at 8.4% in the previous 12 months. Turnover for medical staff was also 10%, but sickness was lower at 2.5%.

Staff did not always keep up to date with appropriate mandatory training. There were staff groups where compliance fell significantly below the target level of 90%. For example, at the time of inspection 57% of doctors in acute medicine at the Princess Royal Hospital had completed infection prevention and control training, and only 21% had completed mandatory training in Information Governance and Data Security Awareness. Furthermore, 50% of doctors in acute medicine, 50% of cardiology specialist nurses and 48% of nursing staff on ward 9 had up to date basic life support training. The online element of the Oliver McGowan Mandatory Training on learning disability and autism was mandatory for staff. At the time of inspection, 84% of staff had completed this, however, there were staff groups where compliance fell significantly below target. For example, 0% of gastroenterology medical staff, 0% of the respiratory advanced clinical practitioners and 7% of acute medical staff had completed the online training. Tier 1 and 2 training was not mandatory. Due to funding challenges, availability of tier 1 and 2 training was limited, and 5% and 17% of staff had completed tier 1 and 2, respectively. A plan had been developed by the Trust for 2026/27 to deliver 3,000 training places through a service level agreement with a third-party provider with the aim of increasing compliance for both tiers to 60% by March 2027. Staff had access to additional training on mental health.

Some of the staff we spoke with said that they completed online training in their own time, though others used quieter times at work to do so.

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Ward areas and equipment inspected were visibly clean. We saw ‘I am clean’ stickers on equipment with the day’s date on. Staff adhered to uniform policy and were bare below the elbow. We observed staff undertaking hand hygiene before and after touching patients, including before and after helping them to eat. Staff also provided patients with wipes to sanitise their hands before eating.

Staff undertook cleanliness audits, combining scores from estates, cleaning and nursing teams. In the latest audit from February 2026, most wards scored above the 95% target level aside from acute medical unit, ward 9 and ward 10. The infection prevention and control (IPC) team carried out quarterly IPC Quality Ward Walks which covered areas such as hand hygiene, uniform, cleanliness and equipment, and the results of walks were combined with monthly assessments by Matrons. We received scoring from 8 wards where the walks were carried out. Four of the wards achieved a ‘green’ score, above the target level of 90%, in February 2026, a decline from January 2026 and December 2025 where 6 wards were above target. Leaders told us that ward managers and matrons devised action plans, scores and discussed as part of Nursing Quality meetings, and IPC reported non-compliance at their governance meeting.

The evidence showed some shortfalls. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

Medicines storage was locked and secure with access only to authorised staff. Medicine room and refrigerator temperatures were monitored with records available of maximum and minimum temperatures to ensure the medicines were stored safely. Medicines storage seen was neat and tidy. There was audit data for the safe and secure handling of medicines for 2025-26 which ensured there was adequate oversight of safe medicine storage.

Controlled drugs (CDs), which are medicines requiring more control due to their potential for abuse, were stored safely and securely with access restricted to authorised staff. Checks were undertaken and recorded by 2 staff twice a day. Pharmacy undertook CD audits every 3 months to check for safe CD compliance. The most recent audits in November 2025 identified minor issues which had been addressed at the time of the inspection.

Resuscitation medicines required in an emergency followed Resuscitation Council (UK) guidance. Daily checks were made by staff to ensure they were safe to use, and records of expiry dates of medicines and equipment were all within date.

Nursing staff told us there was a visible pharmacy presence on wards who supported them with managing medicine processes including ordering and receiving medicines if needed. We looked at prescribed time critical medicines and found they were administered on time or within 30 minutes of the prescribed time. Reminders of the times were also written on an information board above the patient’s bed. However, we found that although processes were in place to ensure people received their medicines as prescribed this did not always happen. Patients did not always receive their medicines as prescribed. We saw that some patients had missed doses of medicines because they had either not been ordered from pharmacy or nurses had not obtained an emergency supply from another ward following policy. Trust data showed that 46.7% of all omitted doses across medical wards were due to stock unavailability. The reason for missed doses was not always clearly documented. We also found unclear documentation on medicine administration record charts where dose changes had occurred, and it was difficult to determine when the change had been made as it was not recorded. This increased the risk of medicine errors.

Weights of patients were recorded on all medicine administration records seen which is important for calculating weight-based medicines prescribing. Allergy status of patients was routinely recorded on all medicine records seen. This meant that allergies were highlighted, and medicines could be prescribed safely.

Clinical pharmacist reviews and decisions to make changes to patient’s medicines were recorded in patients notes. The ward pharmacy team undertook the process of medicine reconciliation, the process of gathering a complete list of people’s prescribed medicines. The national target was 100% of patients admitted receiving medicine reconciliation within 24 hours of admission. We found that a detailed medicine history was taken by pharmacy which also included, where possible, talking with patients which helped to ensure that medicine reconciliation was accurate.

When patients were prescribed antimicrobials, we saw that these were prescribed and reviewed following antimicrobial guidelines.

There was a clear discharge process for medicines. Medicines for discharge were screened and checked for accuracy by clinical pharmacists.

Medicines incidents were reported and discussed in clinical governance meetings. These were investigated and themes identified by the medication safety officer. Information was then cascaded to staff.