The Princess Royal Hospital

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• 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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

This key question has been rated as Requires Improvement This meant people’s needs were not always met.

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 evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The department had access to designated specialty leads, for example, for frailty, and trauma. The service was further supported by in-reach services to support person-centred care, for example, for cardiology, tissue viability and learning disabilities. The PED service was funded for a Play Practitioner 7 days but this was limited on the day of the inspection, due to a vacancy. They typically supported the department to help children with additional needs or challenging behaviour.

Staff were aware of Recommended Summary Plans for Emergency Care and Treatment (ReSPECT) forms and their role in supporting patients requests in terms of their care. We saw ReSPECT forms were available in some of the patients notes we checked.

Staff tried to ensure patients with a long length of stay in the department were moved onto a hospital bed with a pressure relieving mattress, where needed. We were told there often were not enough beds to do this for all patients who needed it. We saw some patients received regular skin integrity checks

Staff made sure most patients living with mental health conditions, learning disabilities and dementia, received the necessary care to meet all their needs. Communication ‘flags’ were present on the patient information system which highlighted if a patient required further support or required reasonable adjustments. The triage nurse or HCA would be alerted to any of these needs prior to calling the patients for review. This ensured any patient with specific needs could be managed in an appropriate way that considers their needs from a communication perspective.

A frailty team provided daily support to the emergency department 7 days a week, running from 7.30am to 7.30pm Monday to Friday, and 9.00am to 5.30pm Saturday and Sunday.

They reviewed the patient list within the department first thing and transferred appropriate patients up to their ward. Staff told us every morning a few patients were moved to the frailty unit and the team were helpful. They attended the department twice a day minimum to identify appropriate patients.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The main waiting room had automated up to date information regarding waiting times that was relevant to them displayed on a large screen.

Information governance systems included confidentiality of patient records. The service supplied appropriate, accurate and up-to-date information in formats tailored to individual needs. Patient information was held securely.

Most information given to patients or their relatives in the emergency department was verbal. There were several leaflets available, particularly in the minor injuries category, for people to take away. Staff said there were various ways in which they could provide information in a way people could understand. This included being able to provide interpretation for people who did not speak English as a first language. They were also able to obtain support for people who were deaf and used British Sign Language.

All patients who were discharged from the ED had a letter sent to their GP which showed the care received and any updated medication on it. Patients were verbally told this information and could request a copy of the discharge letter if required.

The PED had information posters displayed, all with a QR code so it could be viewed on a mobile phone.

Information about patient care was shared between shifts and departments. ED staff completed situation, background, assessment, recommendation (SBAR) handovers when moving a patient to a ward area. This ensured good continuity of care. There was a handover between staff in the department at the beginning and end of each shift. This included highlighting patient risks and any safety aspects of care. Throughout the day staff could approach the nurse in charge and the consultant in charge to discuss any patients they needed support with.

Information gathered about patients or others was held in secure systems which met data protection legislation requirements. Access to computerised patient records was password protected with a secure login.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Staff recognised how complaints were opportunities for learning and making things better for patients. The themes from complaints or concerns raised with staff directly or indirectly were mostly about the delays faced by patients.

People could give feedback about their experiences of care and support including raising any concerns or issues. We saw information in the waiting rooms about how to complain about the care. The trust’s website provided clear information about how to make an online, written, or verbal complaint and how quickly people could expect a response.

All formal complaints were graded and discussed in clinical governance meetings, and we saw completed action plans for formal complaints. The total number of formal complaints in January 2026 for the medicine and emergency division was 54. In December 2025, 33% of responses were sent by the Division to the Complaints Team by the requested date. There were currently 203 open complaints in the Division. Of these, 94 was overdue responses from the division. In January 2026, no complaints from the Division were referred to the Parliamentary Health Service Ombudsmen and no cases were closed. In January 2026, there were 145 Patient Advice and Liaison Service (PALS) contacts relating to the Medicine and Emergency Division. There were 32 compliments logged for the Division in January 2026.

Managers investigated complaints and identified themes. The themes were shared with staff for learning. If a complaint theme was continuous, it would then be raised as a risk. The governance team produced a monthly assurance report. This detailed the complaints received and looked at themes found. We saw lessons learned were created for complaints.

The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Crowding and delays to ambulance handovers led, at times, to patients being placed in a corridor or staying for long periods in chairs in waiting areas. People also stayed for many hours and sometimes days in beds in busy areas. In patient records we selected for review at random, most of the patients had been in the department for more than 24 hours awaiting either review or onward care.

People also remained on the back of the ambulance that brought them for many hours with the crew unable to handover the patient and return to the needs of the community. Staff said there were frequently times when patients were held in the rapid assessment and triage area, in the minor injuries’ unit, or in waiting areas, which increased the risk of harm to the patient.

Staff in triage had the appropriate training to ensure they could recognise critically ill patients. These patients were prioritised according to acuity using a recognised triaging system. Staff worked hard to remove any barriers to access for patients. There was a strong culture to prevent discrimination and inequalities supported by training and guidance.

The increased demand and poor flow in the department was a consequence from beds not being vacated by patients with complex discharges from hospital wards, delays for people who were medically fit to go home but had no immediate care provision in the community. This had a significant impact on the performance of the emergency department and the ability to be responsive to patients and meet their needs in a timely way.

The trust operated a same-day emergency care (SDEC) acute frailty service, along with medical and surgical same day emergency care. The trust followed the NHS England long-term plan that recommended that all hospitals with a 24-hour emergency department should provide an acute frailty service operating for 70 hours a week. NHS England described this as having significant benefits for patients not least from avoiding unplanned and longer stays in hospital. This would equally reduce the risk of infection and patients suffering hospital-acquired deconditioning, that is mental and or physical decline from periods of inactivity or long-stays in a hospital bed or chair.

Demand for emergency services was increasing. NHS priorities and operational planning guidance set a revised and temporary standard that 78% of patients should be admitted, transferred, or discharged within 4 hours of arrival in the emergency department. This was temporarily reduced from the 95% NHS constitutional standard. Although showing signs of beginning to improve, far too many patients were spending too long in the department.

The service streamed lower acuity patients to their urgent treatment centre or SDEC based on a set criteria. The SDEC saw a high volume of patients which helped with capacity constraints for the ED.

Patients were not always seen within 30 minutes of referral to specialist teams. There were agreed internal professional standards, but these were not always adhered to.

The trust had a frailty service, and other initiatives that aimed to keep people out of the ED and therefore reduced demand on the service, but this was not always the case due to high volumes of patients.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.