Inspector wants improvements at Royal Cornwall Hospital
CQC has concerns about urgent and emergency services and medical care
Royal Cornwall Hospital's urgent and emergency services and medical care have been rated "needs improvement" by the Care Quality commission after its latest inspection.
The CQC visited in April and has today published its report into what it found.
Breaches in regulations relating to dignity and respect, safe care and treatment, safe premises, staffing and management processes were discovered and they've asked bosses to show how they're responding to that.
Catherine Campbell, CQC’s deputy director of operations in Cornwall, said: "During our inspection of Royal Cornwall Hospital, we continued to find ongoing challenges that affected people’s care. In both medical and emergency services, staffing shortages and reliance on temporary staff disrupted continuity of care. Flow and capacity pressures also had a direct impact: transfers to escalation areas, long waits for ward beds, and crowding in emergency departments meant people waited longer than necessary, sometimes in environments that didn’t meet their needs or support their privacy and dignity.
"We also found risks in how staff managed medicines, including expired stock, poor labelling, and incomplete medicine records which created the potential for errors, putting people at risk of unsafe treatment. Leaders’ oversight and risk management processes didn’t always work well, with delays in investigations and incomplete reviews.
"However, alongside these challenges, we also saw some positive practice. Staff worked in strong partnership with others. In medical care, their links with community teams, discharge coordinators, and the integrated care system supported people to leave hospital more safely and without unnecessary delay. In emergency care, specialist teams such as learning disability services, homeless advisors, and mental health liaison were well integrated, helping people receive joined-up care that met their wider needs.
"We also saw a culture of learning and safety. Staff in medical care shared learning at safety briefings and team events, while in emergency care, proactive reporting of incidents and complaints led to improvements. This meant people benefited from staff who were constantly adapting and learning from past events to improve care.
"Despite pressures, staff remained committed to treating people with compassion, dignity, and respect. They communicated clearly with people and their carers, involving them in decisions even in busy and challenging environments. Senior leaders were aware of the issues and supported their teams to prioritise safety. The trust recognises where it must improve, and we will continue to work with them and return to check progress.
More details from the CQC report
CQC has re-rated Royal Cornwall Hospital as requires improvement. Well-led has dropped from good to requires improvement. Effective and caring are rated as good. Safe and responsive remain rated as requires improvement.
In medical care, well-led and effective have declined from good to requires improvement. Caring is rated as good. Safe and responsive are rated as requires improvement.
CQC has changed the rating for how safe and well-led urgent and emergency care from good to requires improvement. Caring has again been rated as good. Responsive has been rated as requires improvement while effective has been upgraded from requires improvement to good.
The overall rating for Royal Cornwall Hospitals NHS Trust remains requires improvement.
In medical care inspection, inspectors found:
Staff found it difficult to move people’s beds in some areas due to poor environmental design and clutter, although they maintained most areas well.
Wards lacked appropriate safety equipment. Staff placed extra beds without call bells, leaving people to wave for attention. On Phoenix ward, staff positioned a chair in the temporary escalation space that blocked an exit and lacked both a call bell and curtains.
Staff documented people and family involvement in most care plans. However, some people reported that they did not always feel listened to, despite nursing staff advocating on their behalf.
In urgent and emergency care, inspectors found:
Leaders didn’t make sure there was enough staff in place, as secondments reduced the number of paediatric nurses in the children’s emergency department.
Staff did not consistently store or manage medicines safely. Staff often left opened medicines without revised expiry dates and some cupboards were broken, though maintenance repaired these while inspectors were on site.
Staff left the medicines preparation area unsecured and at child height, which posed a risk of access by children if staff were distracted.