New Royal Liverpool University

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated this key question good. At this assessment the rating has remained good.

People were treated with kindness and compassion. Staff made every effort to protect the privacy and dignity of patients. They treated them as individuals and supported their preferences. People had choice in their care and were encouraged to maintain relationships with family and friends. The service proactively supported staff wellbeing.

This service scored 70 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

We noted patients receiving care in the temporary escalation area were near to another busy and noisy area. There was a room available for staff to support patients with their personal care. However, there was one room for up to 20 patients which meant personal care and examinations were regularly performed with screens around the patient. The screens used on the temporary escalation area to provide privacy were observed not to be completely effective. Some patients were also being treated in communal seating areas. In the waiting room, triage cubicles were separated by sound-proof privacy panels and there were individual assessment rooms. It was reported that all sensitive conversations happened in a private room. Patients expressed concern regarding the lack of dignity and privacy these conditions afforded.

Lack of washing and sleeping facilities for patients in the mental health hub was observed. At the time of the assessment some patients had been in the hub for more than 3 days. Staff explained the area was designed as an assessment area rather than a ward. Staff regularly contacted the community mental health trust to would try to secure a bedspace for anyone waiting in the Hub. There was a joint approach to patients with both physical and mental health needs from the emergency department staff and the hub. Staff in the hub used interpretation services to meet the needs of patients.

Patients said that staff listened and communicated with them appropriately, and in a way they could understand. All patients spoken with described compassionate and caring care given to them by staff. Patients described being as involved in their care as they wanted, and up to date with all plans. Patients were grateful for food and drink offered to them whilst waiting in the emergency department. Patients experienced a quick response to any medical needs they may have, for example, pain or nausea.

The trust provided patients with a ‘friends and family test’ (FFT) to rate their experience of the service. In November 2024, 62.91% reported a good experience in the emergency department. However, it was noted that this was not the final figure due to IT technical errors at the time of the assessment, and an increase to these results was expected. FFT satisfaction scores for the emergency department in July 2024 were 78.40%, and 80.84% in August 2024. The target for assurance is 75%.

Although privacy and dignity were difficult to maintain for patients receiving care and treatment in the temporary escalation area, the patients we spoke with did not voice any concerns and acknowledged the difficult circumstances staff were working in. A local survey completed by the trust asking patients if ‘they felt they were treated with privacy and dignity’ showed that in September 2024 100% of those responding said they were happy with the privacy and dignity afforded to them. In October and November 2024 outcomes showed a slight decline of 88.89% and 84.62% respectively.

Staff and leaders acknowledged the difficulties in ensuring that dignified care was always upheld for patients in temporary escalation areas and acknowledged the time other patients waited for treatment. Staff gave examples of how they understood and respected the individual needs of each patient. Particularly how personal, cultural, social, and religious needs of patients and how these may relate to care needs. Staff told us that working relationships within the department were positive.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People’s individual needs and preferences were understood, and these were reflected in their care, treatment, and support. The trust devised the Liverpool Quality Assessment and Accreditation (LQA), and each clinical area was scored. The LQA framework was developed to take into consideration the CQC fundamental standards of care and was also aligned to the CQC Single Assessment Framework. It included the key clinical indicators that were designed to provide assurance of the quality of clinical care that was being delivered across the trust. It assisted clinical leaders to understand how they delivered care; identify what worked well and where further improvements were needed. Fortnightly training sessions were held to support staff with topic areas such as person-centred care and communication needs or patients.

The accreditation was scheme focused on person centred care, ensuring that privacy and dignity were maintained such as the appropriate use of curtains, screens, and appropriate clothing. It also aimed to ensure that patients were aware of the name of the nurse looking after them every shift, that call bell systems were within reach, that individual reasonable adjustments were recorded and shared at handover, that patients were called by their preferred name, and that overall patients and relatives had a positive experience receiving care and treatment.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

People were supported to understand their rights, care and treatment by using different ways to communicate. The department had access to interpretation and communication services to facilitate contact with patients. There was a patient communication resource box available which contained aids for communication such as hearing amplifiers, list of accessible digital applications for blind or partially sighted patients, dyslexia overlays, British sign language guide, ABC / QWERTY keyboard sheet, deaf / blind information sheets, interpreter sheet, hearing aid repairs, easy reader glasses and Makaton sign guides.

For example, a patient attended the emergency department and upon arrival checked in with the receptionist and was asked if they would like a BSL (British Sign Language) Interpreter. This was the first time they had been asked whilst attending an emergency department. The interpreter arrived 2 hours later and stayed for the duration of the patient’s attendance in the department. The patient reported it was great to be able to express their concern/problem from the very start of the process and as a result felt their health concerns were dealt with a lot quicker. The patient was then moved to a ward, after a wait for a bed, interpreters were provided for the ward rounds. The patient felt their needs were met from start to finish and they were able to fully understand the diagnosis. The trust was working on improving treatment options and literature available for trans and non-binary people on hormone treatment which affected their bloods.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff provided emotional support to patients, families, and carers to minimise their distress. They understood patients' personal, cultural, and religious needs. Staff gave patients and those close to them help, emotional support and advice when they needed it. All contact between staff and patients was conducted professionally, sensitively and in a way which respected confidentiality and the emotional wellbeing of both patients and their relatives and carers.

Patient experience of triage had continued to report highly with 100% reporting a good experience in July, August, and September 2024. Patients were given hot and cold food choices and beverages whilst in the emergency department.

Staff we spoke with understood the emotional and social impact that a person’s care, treatment, or condition had on their wellbeing and on those close to them. Staff supported and involved patients, families, and carers to understand their condition and make decisions about their care and treatment. Staff talked to patients in a way they could understand, using communication aids where necessary.

Staff always introduced themselves and established a good rapport with their patients. Staff at all levels of seniority across all professions demonstrated caring and attentive attitudes towards patients.

There was a consultant lead for complaints who had dedicated time to investigate and respond to complaints. All staff felt able to raise concerns where appropriate. For example, resident doctors raised patient safety concerns regarding a particular patient who they felt was inappropriately being cared for on the temporary escalation area. The senior team listened and responded to the concern swiftly.

Patients and their families could give feedback on the service and their treatment and staff supported them to do this. Patient feedback posters and actions taken by the trust to act upon concerns were displayed in the department and waiting areas.

Staff followed the trust ‘Care After Death’ standard operating procedure (SOP) which adhered to both regional / national guidelines and National Institute for Health and Care Excellence (NICE) guidelines. The SOP provided guidance which included religious / cultural variation requirements, medical and legal processes, death certification and mortuary requirements, the SWAN model of care, and provided detailed information for families.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Regular teaching sessions for nursing and medical staff incorporated recent events within the department to facilitate learning and incident debriefing.

We heard examples how staff new to the department were supported to develop their knowledge and skills and gain additional experience. Most staff spoken with in the department described the working environment as supportive, inclusive, and positive. There were many examples of staff members either working in the department for lengthy periods of time or returning to work there after periods of work elsewhere. There was a sense of collegiality which provided peer-to-peer support. Resident doctors described supportive peers and cited this as a reason to recommend the department as a place of work.

There was a strong emphasis on the safety and wellbeing of staff. Staff felt supported, respected, and valued. There were various initiatives to support staff wellbeing. There were cooperative and appreciative relationships amongst staff. Staff were able to self-roster and flexible working contracts were available to those requesting them. Leaders had recently taken steps to alter working hours by reducing the working day for nurses following feedback from staff about how tiring their long shifts were.

There was a wellbeing hub for staff and access to a variety of wellbeing services such as physical wellbeing support with a physiotherapy service, occupational therapy, weight management, stopping smoking, keeping fit. There were mental health wellbeing service providing stress management, staff psychology service, counselling, wellbeing hubs, access to NHS digital applications and national support services. Financial wellbeing services were available to staff with instant pay options, cost of living advice, money saving tips, support accessing food banks, NHS discounts, salary sacrifice, and opportunities to access financial support. Flexible working, access to Freedom to Speak Up Guardians, a pension scheme and advice service, retirement scheme and advice, pastoral and multi-faith support, coaching, mentoring, and mediation were also available.