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

We rated safe as Requires Improvement. We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At our last inspection we rated this key question as Inadequate. At this inspection the rating had improved to 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. We breached the service in the safe domain around Regulation 12 (2) (a) Safe care and treatment and Regulation 15 (1)(c) premises and Equipment.

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 had effective systems to raise concerns both formally and informally. Reports were analysed and urgent actions taken by leaders to manage or remove risks. Staff were confident to report incidents and supported when things went wrong. Staff knew what they should report and when. The trust’s formal reporting system was easy to use. Staff saw incidents as an opportunity to learn and improve. Staff gave examples of incidents they had reported, confirming this. This included patient falls, safeguarding concerns, medicine incidents and patients displaying aggressive behaviour.

All patient safety incident investigations (PSII) were undertaken by the patient safety team with the support of the quality governance team and wider divisions. Incidents were commissioned at the Review Action and Learning from Incidents Group and presented back on completion. Staff reported 253 incidents between January 2025 and February 2026, 111 incidents were in the review stage as of March 2026, and there was a total of 62 overdue incidents requiring a full investigation, the oldest was dated August 2025.

The service looked at patient safety incident investigations in line with the Patient Safety Incident Response Framework. We reviewed examples of after action review reports and found them to be robust with details and action.Serious incident investigations showed multidisciplinary staff involvement and how learning, change and improvement resulted from the investigation.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if things went wrong. We saw evidence that the duty of candour was completed in the Emergency Department (ED). We looked at ED directorate governance meeting minutes and saw duty of candour completion was discussed for each incident. Managers debriefed and supported staff after any serious incident. Staff said local managers were supportive and they would debrief staff after involvement in incidents such as a traumatic resuscitation.

People were confident about raising concerns. These were taken seriously, people were involved in investigations if they wanted to be, and reports of the event were shared with them. People or those who represented them were given an apology and an explanation of the event, and people were given a timely response.

Safety was one of the departments priorities that involved everyone, including staff as well as people using the service. There were avenues for staff to learn from complaints, incidents, and audits. Staff were provided with updates in the form of emails, meetings and newsletters.

Nursing handovers were documented daily and records showed they were well utilised for key messages. During the inspection, we observed the medical and nursing handovers, and they delivered key messages and learning was evidence.

Managers told us they plan and implement safety huddles throughout the shift, and we observed this during our inspection.

The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. However, due to crowding and pressures on the capacity of the emergency department, despite expansion and new elements to the service, they were not always safe transitions for people. This was for majority of patients, but specifically for those with mental health needs, where long waits in an emergency department were known to be detrimental. Patients who had been admitted to the emergency department with both physical health needs, but also mental health needs were being held in the department for too long. During our assessment, 1 patient had been in the department for 92 hours awaiting assessment for mental health care. This was recognised by all staff, and this presented a significant risk to the patient’s safety and effective treatment. This was an ongoing risk in the department as waits for mental health beds, managed by another NHS trust, were scarce in the area and wider region. Staff gave us many examples of delayed mental health support for patients. Staff were doing their best to care for the patients, but some aspects of patients’ poor mental health were outside of the skills and experience of staff. Staff from the mental health service came to assess the patient more formally but were not always treating or managing the mental health concerns alongside any physical health concerns. This was not in accordance with the Royal College of Emergency Medicine mental health toolkit, the Royal College of Psychiatry guidance, or the National Confidential Enquiry into Patient Outcome and Death ‘Treat as One’ report. The delays to ongoing pathways for patients with mental health needs was on the department’s risk register and graded as a medium risk due to some mitigating actions and noted improvements in liaison with the mental health trust.

Where a Mental Health Act assessment was needed, there were processes in place for this to be requested and appropriate staff would attend the department to carry these out and record their assessment and decision. All members of staff we spoke with could describe the pathway for mental health patients, including risk assessment and management. Records for patients with mental health needs were comprehensive and staff were able to access most records from patients’ GPs. Background information or ‘red flags’ which would alert staff to important information were being well used in those records we reviewed. In other records we saw a history of safeguarding information for a patient with a long history of attendance and healthcare needs. Staff including the security team, if necessary, when supporting those patients requiring additional support, were aware of patient’s backgrounds and alert to their needs as early as triage, or records being updated in more detailed discussions with the patient and their family.

There was routine use of corridor care which risked patients’ safety, privacy and dignity and staff’s ability to provide safe care. There was a standard operating procedure for the use of the corridor which detailed the criteria to cohort patients. The exclusion criteria included but was not limited to patients requiring oxygen therapy, patients with early warning scores above 2, or who required continuous cardiac monitoring, and patients at risk of falls.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge; however, there were long-standing local and national issues with access and flow through the whole health and care pathway which resulted in ‘gridlocked’ or full hospitals. These included an increase in demand for services from an aging population living for longer with more conditions, insufficient capacity in adult social care continuing to contribute to delays in discharging medically fit people from hospital, and difficulty for some people getting care from a GP practice having a knock-on effect for emergency departments.

Pathways created to keep the patients safe were adhered to. For example, those patients attending ED with chest pain were seen promptly and a health care assistant working alongside the waiting room nurse was able to carry out bloods and ECG, this meant any patient attending ED with chest pain would receive an ECG within 15 minutes.

ED occupancy was frequently over 150%, which led to delays within the department. Senior ED leaders demonstrated a good understanding of these issues and were working in collaboration with other divisions within the hospital and their system partners to try and improve flow within the wider hospital and the system generally.

Patient flow coordinators we spoke with were working to help identify opportunities to increase flow in the hospital and wider system to create capacity in ED. Several initiatives had been introduced including virtual ward services which were well established within the local health economy. The trust had recently introduced a waiting area nurse who had oversight of the waiting area, managing vital checks for patients and providing pain relief when required in addition to transporting patients to X-rays or other departments within ED. The trust had also commenced a trial called ‘front line consultant’ that provided additional review of patients that may prevent them requiring hospital admission. Since the last inspection, the trust had introduced the streaming nurse to assess patients and stream them to the appropriate area. All the additional initiatives to support their ED services were welcomed by staff and had a positive impact on their wellbeing.

Patients accessed emergency services when needed. However, they did not always receive treatment within agreed timeframes and national targets. Managers monitored waiting times. There were safe systems of triage and oversight of patients, but these were not always operating in a timely way. The triage times in the department were not always meeting the clinical guidance for triage which was to see all walk-in patients within 15 minutes of arrival for both children and adults. Data showed the average time to triage all patients as of March 2026 was on average within 16 minutes, in February 2026 66% of adults’ patient were seen within 15 minutes with 71% of children being seen within 15 minutes against trust target of 80%. When certain thresholds around patient numbers were reached or exceeded, a protocol was enacted to increase the number of nurses to reduce the risk of the delays, which included waiting room nurses to step in and triage patients.

We saw policies and processes about safety were aligned with other key partners who were involved in people’s care journey to enable shared learning. There were referral pathways into the ED, and they worked with the ambulance teams to ensure the correct patients were conveyed to their department. There was a stroke pathway that sometimes worked well. There was a direct line from the ambulance to the stroke team. The stroke team were sometimes responsive with 24 hours cover. Where there were delays due to flow, patients with a suspected stroke still had a scan promptly in line with their pathway, some staff told us they had thrombosed patient in ED if required there and then.

There were 2 handovers a day at the change of each shift. They contained key safety information about the patients who were in the department at the time. The nurse in charge and the emergency consultant in charge had good communications throughout their shifts to highlight any potential safety concerns.

There were systems in place to protect staff. There was security on site who attended the emergency department when staff or patient needed assistance.

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service worked with people to understand what being safe meant to them and the best way to achieve that. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Data showed as of January 2026, 97% of nursing staff were trained to level 3 safeguarding adults and 78% for safeguarding children against trust target of 80%, 89% of medical staff had completed adult safeguarding level 3 and 96% for children’s level 3; this was a significant improvement from our previous inspection where safeguarding training levels were low.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. There were effective systems, processes and practices to make sure people were protected from abuse and neglect. There were a clear safeguarding policy and pathway which was accessible to staff. All staff we spoke with knew how to make a safeguarding referral and who to inform if they had concerns. Staff had access to the trust’s safeguarding lead for advice.

Staff in the department received training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), which senior managers reported supported decision‑making for patients experiencing prolonged stays. The electronic patient record system flagged current and previous safeguarding concerns to support staff awareness and response.

Data showed staff had completed learning disability and autism training. As of March 2026, 91% of staff had completed Tier 1 Oliver McGowan training, 19% had completed Tier 2, staff told us they were waiting for next available dates to complete Tier 2.The trust mandated completion of the eLearning element of the Oliver McGowan training, with additional NHSE-funded sessions delivered between November 2025 and March 2026, where 330 Tier 1 and 180 Tier 2 places were fully utilised, resulting in a modest improvement in compliance. A wider programme for 2026/27 was being finalised, including 3,000 training places prioritising patient-facing staff through a one-year agreement, with planned delivery of 92 Tier 2 and 16 Tier 1 sessions and a target of 60% compliance by March 2027, alongside the development of a longer-term sustainable training model.

Staff completed a ‘Mental Capacity Assessment for adults and young people’ form when considering a person’s capacity. This included sections for what the specific decision the assessment was in relation to the person’s ability to understand, retain, and communicate their decision. There was mental health representation at the trust’s safeguarding group.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. For example, when patients had complex social care needs or staff identified potential safeguarding risks at home, they liaised with the safeguarding team and other multidisciplinary colleagues to ensure patients were protected. We saw a completed examples of safeguarding referrals during inspection.

Staff followed safe procedures for children visiting the service. The children’s emergency department had a separate children’s waiting area. The trust had senior clinicians with responsibility for safeguarding of adults and children. They were visible in the department and staff knew how to contact them. Reception staff were trained in safeguarding recognition and checked all patients under the age of 18 to determine if there were any concerns flagged. If so, nursing staff would be alerted and generally come through to the waiting area to get more information. Safeguarding contact details were available in the reception and staff knew who to contact if they had immediate concerns.

Staff told us they would refer to the safeguarding team even if they were not sure whether it was within the scope of their remit. They had no concerns about speaking up for people and this included those who accompanied a patient who gave rise to concerns about themself or others. Staff followed a process when adults, who were parents of unwell children, left the ED without completing their treatment. They would phone the parent and if they had a safeguarding concern, the police would be informed. If their clinical observations were out of normal range, an ambulance may be called to their house. They also completed an audit for patients who did not wait and ensured they were managed in line with policy. Trust conducted a study looking into people leaving without being seen, specifically within children assessment unit (CAU) and children and young person’s unit (CYPU). The study showed a high number of patients were leaving CYPU without being seen which posed a risk to patient safety, many patients were also being referred to CAU for investigations, that caused unnecessary step in the patient journey; Due to known demand versus capacity, the team trialled a revised shift pattern of 12:00pm to 10:00 in CYPU. The shift change was aimed to match peak activity times, reducing the waiting times by service, therefore positively effecting the number of paediatric patients leaving without being seen. The week commencing 3 February and 15 February 2026 study showed, 2%reduction in the number of patients leaving without being seen and a reduction in the number of patients being referred to CAU, with 29 patients seen and 20 avoidable CAU admissions.

Children had their own assessment area pathway within the department. All paediatric patients we saw in the area were accompanied by their parents or carers

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties.

The service used evolving standard operating procedures (SOPs) to help manage risk. This meant that procedures could be changed to manage risk flexibility to take into consideration, for example, changes in demand or in staffing levels. Leaders told us they used an evolving SOP for the escalation corridor due to increased challenges with capacity in the ED. However, they were confident that the current SOP was comprehensive for managing safe patient care.

There were tools to monitor deteriorating patients and risks were being acted on. The electronic patient record system created a national early warning score (NEWS) tool for each patient at triage. Staff updated the initial key metrics to monitor deteriorating patients or those already presenting with potential risks which triggered a more urgent review. NEWS data was more regularly updated than some of the other metrics, and in those records, we looked through, staff sometimes acted on increased scores where this alerted them to possible or emerging risks. Patients coming into ED automatically were scheduled for 2 hours observations, however, this was changed depending on individuals. Some delays were noted and observations were not always done in the 2 hour window. Paediatric Early Warning Scores (PEWS) scores were entered electronically, and the system recognised the child’s age and put the observations onto the appropriate chart. Any out-of-range PEWS scores were flagged to clinicians.

Patient risk was understood and there was a constant focus on patients being held in ambulances due to recognised risks from long waits. Patients arriving by ambulance were seen in the rapid treatment assessment bays to ensure each patient was given an initial assessment. An average of 82.5% of patients received an initial assessment within 15 minutes in February 2026 and 83.5% in March 2026.

Handover delays of patients arriving by ambulance were reducing but had not reached safe levels of 80%. In published data for February 2026 it took on average, 72.9 minutes for Royal Shrewsbury and Princess Royal Hospital (PRH) combined, and for PRH this was 65.7 minutes, against a trajectory of 55 minutes by March 2026Staff were clear that patients on ambulances were their responsibility, although all staff worked together to support patient safety.

The service worked with people to understand and manage risks by thinking holistically. There was a multidisciplinary approach to issues where specialist advice and guidance was required to make sure people’s needs were met. This included supporting people who had needs relating to neurodiversity, such as autism, a learning disability, or dementia. People were given chance to communicate their feelings and what mattered to them. We observed staff allowing people to communicate their specific needs, but also anxiety or distress and did their best to help reduce those. This also happened with those who accompanied patients who themselves were anxious or worried about their loved ones. We observed triage over 2 days, and found staff to be caring, kind and understanding with all patients but also asked patient’s partners or carer if they were okay.

There was an improvement since our last inspection around clinical oversight in the waiting room in the form of a waiting room nurse, streaming nurse and front door clinician. This enabled staff to monitor patients of risk of deteriorating within the waiting room. Waiting room nurses performed regular observation of patients waiting in the waiting area and escalated any concerns to the appropriate clinician. We observed examples of this during our inspection and the patient was transferred to resus immediately.

We observed patients being triaged during our 2 days inspection. We found risks were assessed appropriately, past medical history was ascertained, and pain score was completed, along with observations, current issues and medication.

There was an hourly safety checklist to complete on patients who had been admitted to the department, and we saw this was generally completed within the target timeframe of 1 hour. This checklist included ensuring patients were turned if they were high risk of pressure damage, ensuring they had a drink and asking if they were in pain.

There was a lack of flow within the hospital. During the first day of inspection, we saw at 9am there were 39 patients with a decision to admit, meaning they been reviewed and were waiting a bed within the hospital. There were 23 patients in the department, 49 minutes average waiting to be seen, longest wait 2 hours and 23 minutes. Children ED, 3 patients waiting, 1 hour 4 minutes longest wait, there was 1 patient waiting in the urgent treatment centre. To encourage flow, the trust applied a push model where patients who had been seen and accepted by medical or speciality doctors were transferred into extra escalation bed spaces on wards. During busy times, this happened 3 times a day to free up space in the department. This happened on both days of our inspection. There were inclusion and exclusion criteria to ensure patients were suitable for these bedspaces.

There was good oversight of patients by the senior team in the department. Each computer in the department had access to the patient management system which displayed an overview of the patients. It showed the length of time each patient had been in the department, or on an ambulance, or were waiting for triage, or treatment. Resident doctors told us they discussed every patient with the consultant in charge.

There were alternative areas and processes for sending patients who did not need urgent and emergency care. There was an urgent treatment centre which was staffed by advanced nurse practitioners, nurse practitioners and GPs. Patients could be sent here by the streaming nurse if deemed appropriate, with strict criteria.

Leaders assessed the department regularly throughout the day using the NHS England Operational Pressures Escalation Levels framework. It generated different responses depending on the overall score. It had 4 different levels with level 4 being the highest pressure which meant they were unable to deliver comprehensive care.

The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Staff had access to all the equipment they needed and guidance or instructions for use. Staff used their training in moving and handling to support their safety. The department was made safe by specialist estates staff regularly assessing environmental risks. The environment was managed safely with equipment and facilities well looked after and meeting people’s needs. However, while we saw the environment was visibly clean, it was crowded, and patients were staying in the department for long periods of time. The emergency department was spread out and there were different areas for patients to be seen in, which was an improvement from previous inspection, although the department saw more patients than previous years. Not all facilities and premises were appropriate for the service being delivered. There was not enough space to care for the number of patients in the department, we saw incidents where patients were waiting to go into resus as there was not always space, this highlighted the risk to those patients; This meant patients were cared for in areas which were not designed for longer staying patients. Patients spent long periods of times, often more than 12 hours, in chairs and on trolleys. Despite best efforts to ensure patients who needed hospital beds received them, there were not enough. We saw some patients remained on trolleys over 24 hours.

Most patients were observed to ensure they were safe. There were numerous areas used for patients who were waiting for the next steps in their treatment or transfer. The main patient waiting area was overseen by reception staff who could see most of the room, along with streaming nurse, navigator and the waiting room nurse. Triage nurse and front door clinician also had a presence in the area when collecting patients to assess. Other areas where patients were waiting were in busy places, used constantly by staff and others so patients were not hidden from view. There were co-located services for patients that were adjacent to the main ED area. This included the X-ray department and other scanning facilities. The Same Day Emergency Care (SDEC) facility, was also close by to allow for joined up working.

Resuscitation equipment was available and fit for purpose. It was stored in appropriate trolleys, which were sealed with tamper evident tags. Safety checks were carried out daily and all checks were completed electronically using a quick response code.

The nurse in charge carried out regular rounds within the ED. An emergency call bell was located on the corridor which was normally a public corridor within the department. Although there were no wired call bells in the escalation area as it was normally a public corridor, the area was always supervised by a registered nurse and healthcare assistant. A ‘fit to sit area’ was available and was mostly used for patients waiting for bloods to be taken. A recliner chair area was also available for patients awaiting medical beds and bloods. A nurse and HCA were allocated to all areas within the department. The paediatric ED had a separate area with 2 paediatric triage rooms.

A relative’s room was available for families to have a quiet space or have private conversations with staff. There were several rooms and cubicles used to admit patients with mental health conditions which may be treated alongside any physical health conditions. The mental health assessment room conformed to the guidance from the Royal College of Psychiatrists as it was ligature free, had doors which were not lockable and opened both ways to allow safe access. The furniture was safe from being used as a form of weapon.

Hazardous and clinical waste was responsibly managed. The department’s fire safety and other emergency systems were tested and maintained.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff were noticeably busy and worked under pressure when the department had higher numbers of patients or when people required close supervision. There was a good degree of support and mutual respect among staff working in the department.

Records showed there were enough medical staff to meet the recommendations of the Royal College of Emergency Medicine. When locum doctors were needed, they had training in emergency medicine. Records showed nurses and healthcare assistant staffing mostly achieved planned staffing numbers but were supplemented at times by bank staff. There were enough staff with the right training and qualifications to safely treat children. Managers had stopped using agency nursing staff to cover shortfalls and relied on bank staff to fill gaps. Bank nursing staff received an induction and were familiar with the area. Advanced nurse practitioners, nurse practitioners and GPs staffed the UTC area. This was in line with establishment.

Managers could access locums when they needed additional medical staff. The locums used were regular doctors who had worked in the service for some time. Managers made sure locums had a full induction to the service before they started work. Processes were in place to ensure locums understood the trust’s systems to make sure they could deliver safe, effective and efficient care to patients. The service had a good skill mix of medical staff on each shift and reviewed this regularly. We saw good examples of skill mix on shifts we observed during inspection.

ED Consultants worked clinically in the Emergency Department between the hours of 8.00am and 10.30pm, with a Consultant fulfilling non- resident on call between 10.30pm and 08.00am for each site. Consultants were supported by a team of resident doctors. Middle grade doctors worked on overlapping shifts as did the foundation year doctors in the department. All resident doctors reported that they had enough staff per shift.

As of February 2026, there was overall staffing issues, and we saw during our inspection some shortages due to sickness. The department were over recruited, this was 13% higher than required. There was a 5.44% sickness rate for the department which had decreased by 0.6% in February 2026.There was a 9.5% turnover rate in the 12 months prior to the inspection.

The nurse in charged moved staff depending on the demands of the department to maintain patient safety. If the department was unable to cover any staffing shortfall, staffing across the division on the site was reviewed and staff moved accordingly. We observed a capacity meeting; we found the meeting to be thorough and staffing across all departments and sites were reviewed on regular basis throughout the day. The number of nurses allocated to care for the patients on the corridor was variable and allocated by the NIC depending on skill mix and competence. This could be nurses from ED or those who were redeployed from the ward areas. Staff discussed the identification of staff to support ED and additional escalation areas through their regular capacity meetings.

All new starters underwent an induction and had a supernumerary period. Newly qualified nurses were provided with a competency booklet, and training was supported by the practice education facilitator (PEF) team. They had an in-house new starters week and clinical skills courses to ensure competence. PEF teams were working clinically 100% of the time at the time of inspection until 30 March 2026, to support areas where services had increased demands.

All staff who undertook triage in key areas had completed formalised triage competencies; this was evidenced through the electronic roster system.

We reviewed the department’s 6 monthly mandatory training trajectory and compliance was variable against the trust’s target of 90%. Core skill ln mandatory Training for nursing staff and healthcare assistants was compliant at 88%, and for medical staff at 87%. However, compliance levels for immediate life support, paediatric immediate life support and European Paediatrics Advance Life Support (EPALS) for nursing staff were low. The lowest compliance rate was 13.7% for EPALS. Medical staff’s paediatric basic life support compliance was at 45% and was at 75% for adult basic life support. This included both the urgent and emergency service as well as the acute admissions service. Staff told us that training was paused in October 2025 due to winter and the pressures on the service, management team told us they were on target.

The evidence showed some shortfalls. The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Managers audited compliance with infection prevention control (IPC) practices including hand hygiene, care quality assurance and cleaning. Audits results varied and hand hygiene results were 74% against a trust target of 80 %, In ED the environmental audit results for January 2026 were 94.5%. Staff received training on IPC and hand hygiene training during their initial induction and annual mandatory training. Training data showed that IPC Level 1 was 98.77% compliant, completed in November, and 97.53% in December 2025. IPC Level 2 was 88.50% in November, and in December 2025 88.62% of staff had completed IPC training. We found there were no hand washing facilities close to those staff caring for patients on the corridor, staff had to walk away from the corridor to be able to wash their hands.

Most staff adhered to infection control principles, including handwashing. However, during our observations, we saw some staff did not always wash their hands between patients and did not always clean the blood pressure machine between patients. There were clear roles and responsibilities around infection prevention and control (IPC). The infection prevention and control team supported the department. There was enough personal protective equipment available for staff.

The service mostly assessed and managed the risk of infection. Any patients who were tested as positive or showing signs of infection which could be passed to others were isolated as soon as possible. However, we did not see signage on doors to alert or prompt staff to take precaution before entering the room due to infection.

Improvements had been made in the overall compliance of MRSA screening, which had increased from 45% In November to 82% in December 2025. Processes were reviewed on how screening was captured and this supported the improvements made.

All areas appeared clean, had required furnishings and were well-maintained. Staff maintained equipment well and kept it visibly clean. ’Clean’ stickers were visible and in date. Domestic staff knew their duties well and said they were supported to do a good job. They had all the equipment they needed and had been trained well at induction, and training was regularly updated.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involve people in planning, including when changes happen.

Staff followed good practice in medicines management in line with national guidance. Medicines storage was locked and secure with access only to authorised staff. Medicines were electronically dispensed with access only through staff scanning their identification card. All medicines were monitored through an electronic system, each staff member that took out medications was recorded for audit and incident purposes.

Emergency medicines were stored in tamper-evident boxes which followed Resuscitation Council (UK) guidance. Staff recorded safety checks on emergency medicines and equipment to ensure they were safe to use.

Medicines were delivered from pharmacy which ensured medicines were available, and pharmacy were able to review stock levels electronically. If there were any medicine shortages or non-availability pharmacy provided advice regarding alternatives. Staff knew the routes to obtain medicines out of hours. There was a locked cabinet in the medicine room containing controlled medicine (which are medicines requiring more control due to their potential for abuse) keys that were only accessible to senior staff.

Staff recorded allergy status in all medicine records seen. This meant that allergies were highlighted so medicines could be prescribed safely. Doctors undertook medicine history reviews. this ensured patients’ medicine records were up to date before they were admitted or moved between services. Antibiotics were prescribed following the trust antimicrobial guidelines including details of their indication for use, length of treatment and review dates.

The sepsis screening tool was completed and antibiotics for treating sepsis prescribed when appropriate. Based on data from January 2026, improvements were seen from the last inspection. The main areas of improvement were review within recommended time frame, which was at 89.8% compliance, assessment at point of presentation was 87.3%, escalation 93%, and reviewed by an appropriate grade of clinician was 89.8%. An area that required improvement was around patients receiving antibiotics within 60 minutes which had declined to 70% from December 2025 figures of 88.5%. Leaders stated that a potential cause of decline was increased ambulance holds, this was discussed on capacity meeting daily and was part of the trust overall improvement plan.

The service had systems to ensure staff knew about safety alerts and incidents. Medicine incidents were reported onto the incident reporting system and learning from incidents was shared across the trust.

There were patient group directions (PGDs) used in certain areas of the ED. All band 6 and 7 paediatric nurses and emergency nurse practitioners in fit to sit could administer against PGDs for pain relief and inhaler medication. This meant they could be given without a prescription and review from a doctor.

There was a risk assessment for the use of oxygen cylinders where patients did not have access to medical gas pipeline systems, for example, patients receiving corridor care. This provided guidance around the hazard, current and additional risk control measures staff should take in all areas.

Staff had protocols for administering rapid tranquilisation.