Royal Cornwall Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The evidence for this ward indicated good practice. However, as we only looked at 1 ward during this assessment, this does not change the key question overall rating for the medical care (including older people’s care) assessment service group which remained at good. We assessed 4 quality statements for the well led key question. The leadership team led by example and were visible, capable and knowledgeable of the issues and priorities on the ward. The governance and management of Zennor Ward was more stable since the change to a ward providing older people’s care. However, there was insufficient physiotherapy support for the number of patients on the ward that needed it. Leaders had worked to bring the team together by involving staff in the transition to a ward providing older people’s care and arranging for further study and upskilling training. Not all staff had received Freedom to Speak Up training, but all knew how to raise concerns. Trust audits showed that the rate of falls on Zennor Ward had fallen significantly from 9.43 falls per 1,000 bed days in January 2024 to 4.81 falls per 1,000 bed days in May 2024 (the trust target was 5.32 falls per 1,000 bed days).

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff felt that the ward leadership team was visible, experienced and capable. The nurse in charge and sister often helped to look after patients. Some staff said they felt encouraged to speak up with ideas for improvement. Since the change to a ward providing older people’s care, the ward sister felt she was well supported by the Acute and Emergency Medicine care group and attended weekly speciality catch-up meetings.

The ward sister used the results of a team engagement and development exercise to arrange staff study days and away days to address areas for focus and improvement. Staff were also given upskilling training in older people’s care .

Most staff that we spoke to had received Freedom to Speak Up training. They knew how to raise concerns and felt confident in doing so.

Staff training data was reviewed. 79% of all staff and 63% of managers had completed Freedom to Speak Up training (the trust target was 90%). The ward sister tried to give staff time and support to complete training, although this was difficult due to workload. Three clinical educators based on the ward were available to assist with this. The trust had a Freedom to Speak Up Guardian with dedicated time for the role. They worked closely with a group of 53 Freedom to Speak Up Champions and were supported by the Executive Lead for speaking up. There was an anonymous reporting app for staff to raise concerns.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff were involved in the re-purposing of Zennor Ward to a ward providing older people’s care and were encouraged to share their visions for making the ward a good place to work. Staff now felt that the ward had a focus and was more stable. All patients were under the same consultant and the ward benefited from other specialist input such as speech and language therapy. As physiotherapy support was provided by the surgical team, some patients did not receive the level of physiotherapy support they needed. However, senior staff were preparing a business plan to rectify this. Staff told us that team meetings were not happening. The ward sister explained that this was because attendance was often limited due to staff workload. As regular team meetings were difficult to implement, news and learning was shared in daily huddles and the ward sister was implementing a newsletter to share information with staff.

On admission, nurses completed a holistic assessment of each patient which was recorded electronically. This was supported by trust policies covering adult nursing assessment and care planning; falls prevention, assessment, and effective management; and prevention of slips, trips and falls. There was a falls folder kept in the nurses’ station for staff to use as a resource for step-by-step action post-fall and staff were fully aware of this. Patient notes were stored in locked trolleys outside of each bay. We reviewed 4 sets of notes, and all had daily entries from the multidisciplinary team. The ward had a dedicated discharge co-ordinator who started discharge planning on admission. They liaised with other services and arranged discharge meetings to ensure patients had effective discharges and patients and their families were kept up to date.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

All staff had completed the trust’s ‘Journey to Improvement’ training, which covered areas such as falls, nutrition/hydration, pressure injuries and pyjama paralysis (weakness due to a prolonged period of bed rest). As a result of a team engagement and development exercise, a team away day was also arranged specifically for Zennor Ward by the practice educators, based on areas for improvement highlighted by this toolkit. Staff were aware of the process to follow when a patient falls however, some staff felt there was a need for more dementia training for healthcare assistants.

The trust’s monthly falls report from May 2024 showed that Zennor Ward had 4.81 falls per 1,000 bed days in May 2024, below the Trust target of 5.32 falls per 1,000 bed days. The trust had prepared it’s Integrated Falls Prevention Improvement Plan for 2024/25, which set out its plan for reducing the incidence of falls and covered improvements such as preparing an information sheet on orthostatic hypotension (a drop in blood pressure when you stand up after lying or sitting down, which can make you feel dizzy and can even cause you to faint), looking at ways to support those with visual impairment, a trial of ultra-low beds and making falls prevention training essential for all clinical staff working in inpatient settings with adults at risk of falls. The trust undertook audits to monitor performance. For Zennor Ward, the most recent audit of nursing fundamentals of care showed compliance had increased from 84% in February 2024 to 90% in May 2024. The senior nurse checklist compliance had increased from 74% in January 2024 to 97% in July 2024.