Royal Albert Edward Infirmary

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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

Staff were aware of how they could make reasonable adjustments for patients. Leaders and staff were alert to discrimination and inequality that could disadvantage certain groups of people. People with extended wait times were routinely monitored by staff to ensure their personal and health care needs were being met. Staff did not have formal documented person centred care plans, but peoples’ needs and preferences were recorded in their care records. However, during the inspection we identified one regulatory breach relating to the key question for responsive, where we have told the service it needs to make improvements. People did not always receive timely care and treatment. Waiting times and arrangements to admit, treat and discharge patients were worse than national standards across most indicators.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients told us they'd had an appropriate assessment of their health needs. Patients on the corridor told us their personal, emotional and health care needs were being met by staff.

Staff told us they took in to account patients individuals needs and preferences. They told us they undertook risk assessments to identify specific needs such as nutrition, hydration, and pressure sores. Staff told us they provided corridor patients with hot meals, blankets, pressure relieving equipment, additional pillows, and eye masks to minimise the impact of patient experience due to delayed waiting times. Staff did not have formal documented person centred care plans, but patients’ needs and preferences were recorded on the daily notes in the electronic patient record.

Patients with extended wait times were routinely monitored by staff to ensure their personal and health care needs were being met. We saw that staff provided corridor patients with routine refreshments, hot meals, blankets, pressure relieving equipment, additional pillows, and eye masks to minimise the impact of patient experience due to delayed waiting times. We saw that patients who required personal care were transferred to dedicated areas to maintain their privacy and dignity.

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.

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

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Most patients we spoke with told us about long waiting times they had experienced whilst in the department. During the inspection the longest waiting time for a bed or admission was 62 hours. People and their loved ones told us that more clarity regarding timescales would have helped manage expectations and relieve any uncertainties they had. People who used the service, including disabled people, said it was easily accessible. Patients we spoke with did not experience any physical or digital barriers when using the service. The patient led assessment of the care environment in 2023 ranked the trust 4th (of 131 trusts) for care for people with dementia, and 1st (of 131 trusts) for people with a disability.

Leaders and staff acknowledged that people could not always access support and treatment in a timely manner due to patient flow and capacity issues. Delayed discharges for patients awaiting social care provision, and the outdated estate in the emergency department added to this impact. Leaders told us the emergency department was designed for 210 patients per day and there were now 275-300 patients per day. Staff we spoke with said patient flow issues had become normalised and that this was demoralising. They told us the corridor and waiting room areas were risks and how difficulties with discharging ward patients was impacting on ambulance handover targets. Staff followed the streaming pathways to SDEC and the UTC to manage patient flow pressures. They understood the full capacity protocol and worked to admit patients in a timely manner where possible. Staff were aware of how they could make reasonable adjustments for patients and had access to language and British sign language interpreters. Although the emergency department did not have a designated quiet room for people, staff said they would look to accommodate a private space if required. Leaders and staff were alert to discrimination and inequality that could disadvantage certain groups of people. Leaders were knowledgeable about the impacts of socio-economic deprivation which affected the local area.

People couldn’t always access care, treatment, and support in a timely manner due to capacity constraints and patient flow across the hospital. On inspection the full capacity protocol was active with16 escalation spaces on the corridor. The full capacity protocol was used 66 times within the last year. There had been increased attendances during 2023 due to winter pressures. From December 2023 and February 2024, there were 1684 corridor patients. Of these, 57% spent under 12 hours on the corridor, 13% spent between 12 and 24 hours on the corridor and 30% spent over 24 hours on the corridor. From March 2023 to February 2024, the number of patients waiting more than 4 hours from the decision to admit was worse than the England average and among the worst performing departments regionally. The hospital performed worse than the England average and all hospitals regionally for patients waiting 12 or more hours in the emergency department. There was a significant increase in the number of patients waiting more than 12 hours from the decision to admit to admission between August and December 2023, indicating a worsening trend. Bed occupancy rates and delayed patient discharges across the hospital were higher than the England and regional averages during 2023-2024. Bed management meetings took place 3 times a day in which resources and capacity were reviewed. Increased bed capacity and patients with no criteria to reside impacted on access and flow in the urgent and emergency department. The clinical decisions unit was reconfigured to allow more capacity for patients who were awaiting treatment. The service had processes support vulnerable groups such as a ‘frequent attenders’ and military veterans. Staff completed equality and diversity training. The service had clear pathways for patients with dementia, mental health difficulties, autism and learning difficulties and made reasonable adjustments for patients when required.

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.