New Royal Liverpool University

On this page

• 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

At our last assessment we rated this key question inadequate. At this assessment the rating is requires improvement.

People experienced long wait times and felt that there was a lack of clarity regarding how long they would wait to help manage their expectations and relieve any uncertainties they had. Patients arriving at the department in an ambulance experienced delays with their care and treatment being handed over to hospital staff. When a decision was made to admit patients, delays were experienced waiting for a bed on a ward. People were involved in decisions about their care. The service provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it. The service was easy to access and worked to eliminate discrimination. People received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback. People participated in planning their care.

This service scored 39 (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 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patients told us they had had an appropriate assessment of their health needs. Patients in temporary escalation areas told us staff met their emotional and health care needs. Patients told us they were consulted about their treatment plan and care in general. Patients were very understanding of the pressures faced by the staff with one patient saying they did not like to ask for help when they were so busy. Patients told us they had their tests completed and treatment plan explained to them, and they were satisfied with the standard of care, referring to staff as “excellent” but acknowledging the wait time saying, “It couldn’t be helped.”

Patients in ambulatory care told us they had received pain relief when required.

Staff considered patients individuals needs and preferences. They undertook risk assessments to identify specific needs such as nutrition, hydration, and pressure ulcers. Patients were provided with food, blankets, pressure relieving equipment and additional pillows. Staff did not use formal documented person-centred care plans, but patients’ needs and preferences were recorded on the daily notes in the electronic patient record.

An advocacy team was available to support those patients with additional needs and requirements.

Staff identified that a significant number of patients presented at the department who were not registered with a GP. As a result of this, a GP who worked with the emergency department outreach team offered care and treatment including vaccinations to those whose circumstances may make them vulnerable such as the homeless community. Staff had also recognised a high incidence of tuberculosis reported from one community and would support these patients if they presented at the department through testing and care advice.

The discharge lounge was available during the day for those patients who could go home and were waiting for transport or medicines.

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 scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was available information on what to expect and the process within the emergency department. There were posters and leaflets written to advise patients. Leaders had written an information sheet to advise those patients were residing in temporary escalation areas to apologise that a room was not available on a ward, why this happened and how patients should expect to be treated.

Digital displays reporting wait times were available to patients who had not yet been treated and regularly updated. In addition, staff regularly walked around the waiting areas to check on patients.

The treating clinician was responsible for providing the discharge advice and ensured it was in an accessible format for the patient. When altering or adding medication, this was written down for the patient as well as communicated to their GP via electronic discharge letter sent straight to the surgery.

During the assessment we noted signage for patients was insufficient and the department was not easy to navigate around. Staff were regularly interrupted and questioned by families and friends of patients whilst lost in the department.

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.

We scored the service as 1. The evidence showed significant shortfalls. The service did not make sure that people could access the care, support and treatment they needed when they needed it.

Most patients we spoke with told us about long wait times they had experienced whilst in the department. Particularly when waiting for admission to a ward. The longest wait at the time of assessment a patient experienced was 47 hours. People and their loved ones told us that more clarity regarding wait times for admission to ward areas would have helped manage expectations and relieve any uncertainties they had.

People could not always access care, treatment, and support in a timely manner due to capacity constraints and patient flow across the hospital. There had been increased attendances during 2024, and the full capacity protocol was used 66 times within the last year.

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 on wards for patients awaiting social care provision were partly responsible for this. Staff we spoke with said patient flow issues had become normalised and that this was demoralising. They told us the temporary escalation area and waiting room areas were not ideal for patients and posed a risk. Lack of beds available to admit patients into impacted on ambulance handover times as additional patients were in the department. Staff followed the streaming pathways 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. 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.

Between 1 April 2024 and 30 November 2024:

• 64,600 people attended the emergency department of which 18,572 (28.6%) were admitted.
• 17.8% of emergency department attendees spent time in a temporary escalation area during their visit.
• 87.7% of patients were triaged within 15 mins.
• 42.7% of patients were seen within 60 minutes. This was better than the regional and national average.
• The trust 4 hr performance figures were at 54.3% between 1 April 2024 and 30 November 2024. This was slightly worse than the regional and national average.
• At the time of the assessment the performance was 35.7% for ambulance handover and releasing ambulance crews within 30–60 mins. This was worse than regional and national figures.
• The time to emergency department clinician review after triage average time was 207 minutes (209 minutes the previous year).

The number of patients admitted, transferred or discharged in line with the four-hour target was low at 29.1% in October, 26.4% in November and 26.6% December. Of those patients requiring admission 43% to 48% waited between 4 to 12 hours between October to December 2024. Patients waiting longer than 12 hours for admission to a ward ranged between 24 to 29.7% for the same period.

Ambulance crews told us that they often waited for lengthy periods to hand over patients and as a result leaders were working closely with the trust to improve ambulance handover times. The average ambulance handover time in October and November 2024 was 56 minutes, for December 2024 this increased to 65 minutes. Handover times were longer in winter than summer months which averaged at 40 minutes.

Ambulance handover delays between 30 and 60 mins were high at:

• 581 during October 2024
• 573 during November 2024
• 571 during December 2024

Ambulance handover delays of more than 60 mins were also high at:

• 477 during October 2024
• 504 during November 2024
• 498 during December 2024

The handover delays were similar to other trusts of comparable size and attendance figures.

Those patients awaiting review by an appropriate mental health clinician within one hour of referral ranged from 88% in September to 64.7% in November 2024.

There were 113, inpatients medically fit for discharge in October, 116 in November and 177 in December 2024; this was impacting on the flow through the hospital and resulting in the escalation spaces being used in the department. The trust was working closely with the local community and mental health trust and local authority to minimise delays for patients medically fit for discharge.

Re-attendance to the emergency department within 7 days of a previous attendance for the period August to October 2024 was 2,893 people. (904 Aug 1036 Sept, 953 Oct).

The clinical leads used the electronic patient record system which provided an overview status of each patient in the department. Clinical leads and shift leaders reviewed every patient at the 2 hourly board rounds. This enabled leaders to staff the different areas in the department based on patient need and also expedite any care and treatment needs.

The bed management team held meetings with leaders throughout the hospital 5 times a day to review resources available to patients and staffing needs.

Staff had 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.

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 accessing the emergency department.

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.