The Princess Royal Hospital

On this page

• 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

At our last assessment we rated effective as good. At this assessment the rating has remained good.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and 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, where understanding current outcomes and exploring best practice was part of their everyday work.

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 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. The trust kept its database of guidance up to date. Staff used information given regularly in safety briefings and newsletters to implement new guidance or changes to existing procedures. They used effective tools for screening malnutrition and dehydration and acted on any indicators of concern.

The trust’s intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected current practice. It had guidance for staff around collaboration with multi-agency teams and for delegation of clinical tasks to ensure the right people delivered evidence-based care and treatment.

The service participated in clinical audits which enabled them to show care was being provided in line with national recommendations and best practice, with action plans to improve compliance.

Medical staff told us the Royal College of Emergency Medicine was a source of good practice and guidance alongside the National Institute for Health and Care Excellence (NICE). Nursing staff knew their responsibilities and professional standards of care to which they were required to adhere. Staff were aware of legislation and guidance which protected patients' rights and knew how to apply this in practice. This included patients who were subject to mental health and mental capacity legislation or codes of practice, and people's human rights. Staff were also trained to support people with cognitive impairment and advocate for them.

The triage process followed evidence-based practice and patients were graded in accordance with the seriousness of their presenting complaint. There was a colour-coded scale on the computer programme to give a visual appearance of those patients who would need more urgent review. The time patients had been in the department was also colour coded to indicate those waiting longer than the national standard and gave a visual warning to staff about delayed treatment, particularly when both high-risk trigger colours were indicated.

The service had processes in place to ensure there was no discrimination, including on the grounds of protected characteristics under the Equality Act, when making care and treatment decisions. Staff told us they followed the trust’s Equality, Diversity and Inclusion policy when making decisions.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Staff and leaders were encouraged to learn about new and innovative approaches that evidence showed could improve the way their service delivered care. Records were up to date and showed comprehensive assessments undertaken leading to effective ongoing care.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. Staff we spoke with were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers ensured that staff had access to regular team meetings. Managers identified learning needs of staff and provided them with opportunities to develop their skills and knowledge.

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 held regular and effective multidisciplinary meetings. Staff shared information about patients at effective handover meetings within the team. Teams had effective working relationships, including good handovers, with other relevant teams within the organisation, for example care co-ordinators, discharge teams, and specialist teams.

Some staff told us they had to wait for some specialities to review their patients due to acuity and demands of patients presenting to ED, and lack of capacity within the hospital. Patients were not always reviewed within 30 minutes as per interprofessional standards. Doctors from ED chased their colleagues to review but told us they often had pushback from the teams on the wards due to capacity and demands throughout the hospital.

The service had information systems that allowed them to see patients’ GP records to ensure continuity of care. They worked alongside several services such as ambulances, psychiatric liaison team, older persons assessment and liaison team, and clinical specialities. There were electronic alerts used to make staff aware of a patient vulnerability.

Staff had access to the information they needed most of the time to make effective decisions about people's care. This included if the patient was local or on a shared GP NHS record, access to a patient's medical history from their GP or other care providers. This was of specific importance to staff when the patient had mental health needs or there were safeguarding or child protection concerns. Otherwise, the existing or known patients' hospitals records flagged when there were concerns the staff needed to be aware of.

The paediatric team attended the main ED handover. This ensured the staff were aware of risks within both departments and the nurse in charge of ED had a good understanding of the staffing and potential risks in paediatric emergency department (PED). We observed both the nursing and medical handovers and found them to contain relevant patient information. We found staff discussed high risk patients within the department and a snapshot of learning points.

There was a bed meeting 3 times a day. Staff worked together to encourage flow from ED into the hospital amongst a significant shortfall of bed capacity. There were often no beds available which caused the long delays in ED.

There was specialist trained teams and individuals who made themselves available to the emergency department such as the emergency nurse practitioners, that offered staff and patients support. There were also trained safeguarding staff who could give advice and guidance when there were concerns of abuse or neglect. However, as with many patients, due to ward-bed capacity being often full, there were unacceptable waits for onward care for those patients with mental ill-health. As highlighted previously, there was a lack of parallel assessment of patients presenting with both mental and physical health needs.

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 service did not always monitor patient’s care and treatment to continuously improve it. Staff did not always ensure outcomes were positive and consistent, or that they met both clinical expectations and the expectations of patient themselves.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes.

Patients pain relief was monitored in line with local guidance. Staff asked patients about their pain and patients we spoke with told us staff gave them pain relief when asked. The service had an hourly checklist which asked the patients their pain score. We found this generally was completed. Staff met patients’ nutrition and hydration needs. Some patients we spoke with had been offered drinks and food.

In recent months, the percentage of the trust’s patients that left ED before being seen for treatment was higher than England and regional percentages from November 2023 to April 2024, before decreasing to 6.5% from May 2024 to May 2025. From June 2025 to September 2025, the percentage increased above the England and regional percentage again. In September 2025, the trust figure was 7.6%, compared to the England average of 4.8% and regional average of 5.3%. We saw on display in the department figures for 16 February 2026, showed that 23 adults and 1 child left without being seen. On February 16, 2026, the average time in the department was 253 minutes for non-admitted patients and 823 minutes for those patients being admitted. There were 1,169 patients that arrived as ‘walk in’ patients with 389 arriving with ambulance.

The trust’s percentage of patients that reattended ED within 7 days of a previous attendance was lower than the England and regional reattendance rates from October 2023 to April 2024, and June 2025 to September 2025.

The service participated in the Royal College of Emergency Medicine (RCEM) quality improvement programme (QIP). The QIP had clear projects outlined for improving patient safety and experience in emergency department in line with RCEM standards. This included projects around care of older people and time critical medicines.

The service participated in the Getting It Right First Time program for emergency medicine. Monthly patient outcome data showed areas to be addressed which was updated and compared to local trusts. There was an associated action plan to improve outcomes for patients in the department which was updated monthly.

The average time to initial assessment ranged between 15 to 46 minutes and fluctuated across the months. The trust’s median time from arrival to initial assessment was consistently shorter than the England average from November 2023 to September 2025. There was a decrease from 13 minutes in October 2023 to 8 minutes in September 2025, which was greater than the decrease in the England median over the same period.

The service was significantly worse than national average for ambulance handovers taking over 60 minutes. The service monitored the ambulance handover times. We reviewed data from January 2026, and 32% of ambulance handovers took over 60 minutes.

Patients’ median total time in ED at the trust was consistently longer than the England average from October 2023 to September 2025. However, there was a considerable decrease from 4 hours 10 minutes in April 2025, to 3 hours 47 minutes in September 2025. In September 2025, the England average was 2 hours 45 minutes. Furthermore, the trust consistently reported a longer 95th percentile total time in ED compared to the England average from October 2023 to September 2025, peaking in January 2025 at 42 hours and 8 minutes, compared to the England average of 17 hours and 58 minutes.

The trust’s percentage of patients admitted, transferred or discharged within 4 hours of arrival for type 1 attendances showed little variation over the most recent 12 months, but consistently remained above the regional and England percentages. Type 1 attendance is an unplanned, first attendance at a Type 1 emergency department for a new clinical condition or a deterioration of a chronic condition. The percentage was 40.8% in January 2024, and 43.8% in December 2025. There was also little variation in the regional and England percentages over the same period. The percentage of type 1 in ED attendances spending less than 4 hours in the department for the trust remained consistently below the standard of 78%, and the England percentages. The trust’s percentage of patients waiting more than 4 hours from the decision to admit to admission increased considerably from 33% in September 2024 to 51.1% in December 2025. This was much greater than the England and regional figures in January 2025 of 34% and 41.9%, respectively. There was also a considerable increase in the number of patients at the trust who were waiting for more than 12 hours from the decision to admit to admission, from 957 in January 2024, to 1,429 in December 2025.

Managers and staff used the results to improve patients' outcomes. Action plans to improve performance were in place and were updated and discussed regularly within the clinical teams. Junior doctors participated in improvements and this formed part of their clinical education. Band 7 nurses led small teams of staff to focus on specific improvements including sepsis management, complaints and tissue viability. Managers and staff carried out a comprehensive programme of repeated audits to check improvement overtime. Regular local quality audits were undertaken in the emergency department (ED), and results were fed back into the trust’s internal quality assurance systems. Externally reported audits were completed as required. Managers used information from the audits to improve care and treatment.

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. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Staff knew how people who did not have the mental capacity at the time to give valid consent should be treated. Most staff knew consent could not be provided by another person unless they had a lasting power of attorney for the patient. In those cases where the patient did not have capacity or an attorney, staff knew they needed a multidisciplinary approach to treating the patient where a decision was taken in the patient’s best interests. In these circumstances, staff knew they had a duty to endeavour to involve the patient’s relatives or friends, or an advocate for the patient, if possible, in any decision taken. We saw an example of this during our inspection. We observed staff gaining consent from patients in line with legislation and guidance in relation to care and treatment and saw this was documented in all records we looked at.

Staff supported children and their families in decision making about their care and treatment. Staff understood the process to assess whether a child had the maturity and competence to make their own decisions and give consent to any care or treatment.