CQC again rates The Princess Alexandra Hospital as Requires Improvement

The Care Quality Commission (CQC) has again rated The Princess Alexandra Hospital as Requires Improvement following inspections of its medical care, surgery, and urgent and emergency services carried out in November.

The hospital is run by The Princess Alexandra Hospital NHS Trust. The inspection did not affect the trust’s overall rating, and CQC said findings from a separate inspection of the trust’s leadership will be published at a later date.

The inspection formed part of CQC’s routine monitoring programme and also responded to concerns raised about the quality and safety of services.

Medical care showed the strongest improvement, with its overall rating increasing from Requires Improvement to Good. The service also improved to Good for Effective and Well-led, while retaining Good ratings for Caring and Responsive. Its Safe rating remains Requires Improvement.

Urgent and emergency services remain rated Requires Improvement overall. Inspectors raised the Responsive rating to Good, while Safe and Well-led remain Requires Improvement. The Caring rating was downgraded from Good to Requires Improvement, while Effective remains Good.

Surgery services were downgraded from Good to Requires Improvement overall. Inspectors found the service remained Requires Improvement for Safe, while Well-led also fell to Requires Improvement. Ratings for Effective, Caring, and Responsive remained Good.

Taking these findings together, CQC has again rated the hospital Requires Improvement overall. The hospital continues to be rated Requires Improvement for Safe, Responsive, and Well-led, while Caring remains Good. The Effective rating has improved from Requires Improvement to Good.

CQC has requested action plans from the trust to address the issues identified, with the regulator noting that the trust took immediate action after concerns were raised during the inspection.

Inspectors found patient safety concerns across all three services. While leaders had recognised many of the issues themselves, progress in addressing them varied between departments. Medical wards were found to be making steady improvements, whereas surgery and emergency services had not consistently embedded the changes needed.

Within surgery services, inspectors found staff were not always completing risk assessments consistently and some patient handovers lacked important information, increasing the risk of communication failures affecting patient care.

The emergency department continued to experience significant operational pressures due to high demand, poor patient flow and ongoing refurbishment work. Inspectors found this contributed to long waiting times and overcrowding, affecting patients’ privacy and overall experience. People waiting for mental health support were particularly affected, with limited facilities and specialist mental health staff available to meet their needs.

Inspectors also identified concerns around medicines management, including expired or missing emergency medicines in the emergency department and medicines being stored on the floor in medical wards. Patients in temporary care areas within the emergency department were not always monitored closely enough to identify deterioration in their condition.

Although most clinical areas were clean, inspectors found infection prevention procedures were not always followed consistently. Environmental safety issues were also identified, including blocked fire exits and incorrectly stored oxygen cylinders on surgical wards.

The inspection found staffing levels did not always meet demand, although leaders sought to reduce risks by redeploying staff where required. Inspectors also noted that while the trust encouraged general feedback from patients and staff, people attending the emergency department did not always have opportunities to raise concerns about their care while receiving treatment.

Alongside these concerns, CQC highlighted several areas of good practice. Staff were found to treat people with dignity and respect, involve patients in decisions about their care, and provide treatment based on recognised evidence and good clinical practice. Inspectors also praised the strong teamwork on medical wards, where staff worked effectively with colleagues and partner services to meet patients’ needs and support timely discharge from hospital.

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