Updated 26 August 2026
The Princess Alexandra Hospital NHS Trust (PAHT) provides care for a local population of 350,000 people, with an extended population of 500,000 people. Providing services to Harlow, Epping, Bishops Stortford, Hoddesdon, Cheshunt and Broxbourne local authorities. They employ approximately 4000 staff who work across 3 locations. The trust reported an adjusted financial performance deficit of £1.1 million for the financial year 2024/2025.
The trust provides a full range of general acute, outpatients and diagnostic services. Services are provided at The Princess Alexandra Hospital, Herts and Essex Hospital and St Margarets Hospital.
PAHT is part of the NHS Essex Integrated Care Systems (ICS), formed in April 2026 following the merger of Mid and South Essex, West Essex and North East Essex ICS.
PAHT are in segment 3 of the NHS National Oversight Framework (NOF). Segment 3 indicates a provider needs increased NHSE oversight and targeted improvement support, with closer monitoring of performance and potential intervention in areas of concern. In quarter 1, 2026/2027 league table for NHS performance, PAHT was ranked 85 out of 134 acute trusts in England.
We had previously inspected PAHT in July 2021. At that time, we had rated the trust overall as requires improvement and well-led as requires improvement.
The CQC monitor patient safety incidents and wanted to understand how the trust was addressing and learning from these incidents.
We undertook a trust level (well-led) assessment which included onsite visits on 26, 27, and 28 January 2026. We also held 14 staff focus groups, interviews and observed board and committee meetings between November 2025 and February 2026. We assessed all 8 of the quality statements in the well-led key question in this assessment.
Our previous inspection made some recommendations for improvements and the CQC wanted to see if these had been implemented.
Prior to the well-led review, the CQC has inspected 3 Assessment Service Groups (ASGs): urgent and emergency care, surgical care and medical care. These were rated Requires Improvement for Surgery and UEC and Good for Medical Care.
CQC notified the trust that we were considering enforcement action for breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations, following concerns identified in the Urgent and emergency care assessment. The trust subsequently submitted a comprehensive action plan to address these concerns. We followed up themes from these inspections during the well led assessment.
We assess all eight of the quality statements in the well-led key question when assessing an NHS trust using our current framework.
Our positive findings from the well led review included:
- A very enthusiastic, proactive, and engaged patient panel who was representative of the patient's voice.
- The visibility and skill set of the senior leadership team.
We also identified areas for improvement which included:
- The poor estate in maternity and infection control risk.
- The way the change management process was carried out and the impact it had on staff morale at all levels, coupled with staff expressing concern about the rapid pace of change.
- Staff networks were in their infancy, and the senior leadership team oversight and assurance of Equality Diversity Inclusion objectives is an area for improvement.
The trust’s leadership has been rated requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.