The Queen Elizabeth 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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question requires improvement. At this assessment the rating remained requires improvement. This meant the service management and leadership were inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

The evidence showed some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

The trust moved to a group model of working with two local trusts to form the Norfolk and Waveney University Hospitals Group in May 2025 with a shared leadership structure. Staff we spoke to were unaware of this leadership structure and said nothing had changed locally. However, staff from general surgery and the theatre department told us changes within leadership structure, reporting lines and uncertainty about the future of the service had not been effectively communicated and they were unaware of plans for general surgery services in the future.

Staff we spoke to told us there was a positive and supportive culture within their immediate teams. Staff told us they were proud to be part of the team. However, staff told us that they did not always feel listened to, valued or appreciated by senior leaders external to the division.

The NHS Staff Survey 2024 results highlighted division staff did not have confidence that leaders would act on concerns, they had a poor experience of appraisals that limited their perceived value and there was an increased intention of staff to leave the organisation. Leaders provided us with actions implemented to address these concerns. At the time of our assessment the 2025 survey results had not been published.

The trust had a 10 point strategy developed in 2024 and clearly defined what success will look like. Staff we spoke with understood this strategy and were proud of the actions taken within the surgery division such as reducing the length of stay for patients undergoing elective joint replacements.

The evidence showed some shortfalls. Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation.

There was an established leadership team within the division comprised of a directorate lead, operational lead and nursing lead, who made up the divisional triumvirate. Staff we spoke with told us these leaders were visible and approachable.

Leaders told us they visited clinical areas and supported on the wards when required to identify challenges and potential solutions. Staff told us department leaders were visible but where unaware of who the site leadership teams were. However, the NHS Staff Survey 2024 results for the division scored below the average for burnout and morale. This meant that leaders were not aware of the issues faced by staff.

Staff we spoke to described informal appraisal mechanisms. Division appraisal rates were below the trust target of 90% as of February 2026. For medical staff the rate was 82%. For other staff groups the rate was 77.7%. We are not assured that staff received work appraisal from their immediate managers to support development.

Medical staff told us support was available from peers but not from leaders. The General Medical Council (GMC) trainee doctor survey 2025 showed general surgery was ranked poorly in 11 of 16 indicators. These indicators included “supportive environment” and “clinical supervision”. Medical staff were not aware of actions being taken to address these results.

Leaders were knowledgeable about challenges and priorities for the service and told us they could access appropriate support from the executive board. They explained challenges such as bed capacity and elective surgery backlogs.

Leaders told us they had a number of systems to support staff wellbeing and these were underpinned by policies and procedures such as the attendance management policy and flexible work policy. However, staff told us leaders did not follow these policies consistently with some staff feeling pressured to attend work when unwell.

The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

Patients and carers were able to provide feedback in ways that suited their individual needs. Feedback cards were available throughout the areas we visited. NHS Friends and Family data for August to November 2025 showed 85% of respondents from the two non-elective surgery wards reported a positive experience compared to a trust average of 95%. Staff could not tell us of changes being implemented to improve this result.

Staff could access the Freedom to Speak Up (FTSU) Guardian in the trust if they were not able to speak to their manager. Themes for FTSU referrals for the division included human resource processes and staff wellbeing and psychological safety. There had been a reduction in the number of cases with the FTSU Service in 2025 compared to the previous year. Although the number of cases is lower the service had a reduced resource owing to staff turnover. When adjusted for the 2025 resource, case numbers were on par with previous levels.

The service promoted a positive culture by encouraging staff to speak up supported by up to date policies. However, staff feedback in relation to feeling confident in speaking up was mixed. Some staff felt confident raising concerns with managers whilst others did not always feel concerns were listened to. Staff we spoke to told us they were less likely to report concerns as they did not feel leaders would take action.

Staff told us they had raised workplace cultural concerns and listening groups had been completed as a result. However, they were unaware of changes that had occurred as a result and felt concerns remained.

The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders supported work towards an inclusive and fair culture by improving equality and equity for staff. Staff came from a variety of ethnic backgrounds.

Staff could apply to work flexibly. For example, flexible working agreements to accommodate personal circumstances such as caring responsibilities and health issues. Managers approved reasonable adjustments for staff members to help them effectively carry out their role.

Staff mostly said they felt like part of a family and were recognised for their contribution by both their managers and their peers.

Staff had access to multiple networks including;

• Race, Ethnicity and Culture Hertitage Network
• Disability Network
• LGBTQ+ Network.

The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was a lack of effective governance for the service. We reviewed the divisional risk register and although all risks had recent updates, we found that not all risks identified during our inspection such as, poor MUST assessment, poor safeguarding training compliance and poor medication management training compliance were not recorded on the service risk register. This did not provide the leadership with effective assurance and risk oversight. We are not assured these issues are being addressed at leadership level.

Leaders told us that staff meetings had been standardised within the past 3 months. We reviewed a sample of meeting minutes from teams within the surgical service and found most showed discussion of patient feedback, incidents, and learning but there was no standardised approach. These meetings were not held consistently. This meant information was not always received or escalated to all staff in a timely manner from board to ward and vice versa.

Specialities within the surgical division held regular governance meetings. At these meetings, learning from mortality reviews, incidents and complaints were presented and discussed. Actions were identified for some areas; however, it was not clear from the minutes of the meetings we reviewed, what action had been taken or was to be taken to share the specific learning to the wider service from incidents and complaints.

Learning from incidents, audits and complaints was not consistently shared, and many staff were unaware of the top risks facing the division. Staff wellbeing concerns were also not addressed, even though they contributed to risk and performance pressures. These issues showed ineffective governance, poor oversight of risks, and a lack of reliable systems to ensure accountability or improvement.

Following the independent review by the Royal College of Surgeons (RCS), general surgery at the trust was operating with governance oversight and clinical leadership from the team at the neighbouring trust which was part of the Norfolk and Waveney University Hospitals Group (NWUHG). Leaders shared with us standard operating procedures and details of how the general surgery team could communicate with the oversight team. Staff from the general surgery team told us that the department structure was unclear and there was an uncertainty around roles and responsibilities. We were not assured all staff were aware of these processes.

Staff of all levels within the division told us the uncertainty around the future structure of the general surgery team was exacerbated by poor communication from leaders.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Staff and leaders engaged with people, communities, and partners to develop and improve patient experience. They used these networks to identify new or innovative ideas that led to better outcomes for people. For example, the adaptation of clinical environments to meet the needs of patients with neurodiversity.

Staff told us they worked with Norfolk First Support (NFS) where required to ensure safe and timely discharge from the hospital.

We saw hospital volunteers actively supporting patients and visitors. They created a welcoming and reassuring presence. Volunteers were approachable, friendly, and easy to recognise, which helped patients feel comfortable asking for assistance. Their contribution added value to the patient experience by providing practical help and emotional support in busy environments.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.

Staff were encouraged to complete quality improvement (QI) training and 200 members of staff from the surgical division were trained in QI. The majority of the staff trained were medical or nursing staff but there was inclusion of other staff groups. QI initiatives included the introduction of adaptive cutlery for patients and adjustable orthopaedic chairs to improve patient comfort.

Quality Improvement Projects (QIPs) are structured initiatives that aim to improve patient care, safety and service efficiency. The service had 8 projects registered with the Quality Improvement team since October 2025 and as a result these had not been embedded in practice. These projects included;

• Improving monitoring in patients receiving Total Paternal Nutrition (TPN)
• Improving patient handover from the operating department to the critical care unit to align with National Institute of Clinical Excellence (NICE) guidance
• Improve the safe prescribing of antibiotics commonly used within general surgery
• Develop ultrasound guided vascular access to improve clinical skills
• Improve the prescribing of intravenous fluids for patients nil-by-mouth awaiting surgery
• Improving the standard of ReSPECT form completion
• Improving the consent process for patients receiving infusion therapy
• Improving the monitoring of frail patients lying and standing blood pressures

The trust is part of a national research project into the treatment of anaemia following emergency surgery. There have been over 160 participants meaning it is one of the national leads in the project.