The Princess Alexandra Hospital NHS Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Requires improvement

Our view of the service

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.

People's experience of this service

The Adult Inpatient Survey (2024) highlighted that the Trust was the only one to benchmark as ‘much worse than expected’ when the responses to all benchmarked questions were analysed together. This was the fourth year in a row they had benchmarked overall as ‘worse’ or ‘much worse’. This suggests that patients continue to experience poor care and that the trust had done little in the way of learning or improving from previous surveys. These results are now a year old and while they are the most up to date outcomes, they would not reflect any improvements that the trust has since made.

The October 2025 board paper noted that the CQC and inpatient survey 2024 was published in September 2025 was carried out in November 2024. This coincided with the first month of the electronic health record, which caused cancellations and delays that affected patient experience.

During our inspection of urgent and emergency care, surgical care and medical care we spoke with over 16 patients and relatives. They told us their privacy and dignity were sometimes compromised, especially when care was delivered in non-designated clinical areas. We observed Mental Health patients stayed for long periods in unsuitable environments. Despite this, patients and families consistently praised staff for doing their best in challenging circumstances, reporting that staff communicated well, listened to them and treated them with respect. People stated they did not always receive timely care and treatment, but they said they felt safe and knew how to raise concerns or make complaints. Most patients said they understood their treatment plans and felt staff explained information in a way they could follow.

The trust gathered feedback from people who used their service using the Friend and Family Test (FFT). The data from 2024/2025 showed that 79% of patients (13,336 patients) rated the service as good or very good compared to 76% in 2023/2024.