The Queen Elizabeth Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated effective as good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

We have not awarded this service a score for Effective.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

During the onsite assessment we reviewed a total of 38 care records to ensure people’s care and treatment was effective.

We reviewed 5 care records for the assessment of pain during the completion of observations in line with trust policy. We found that this was not completed in all 5 care records. There was no evidence of a pain scoring tool used to assess patient pain levels to ensure it was standardised to evaluate the treatment. We requested audit data for the last 3 months and found that 3 out of 11 wards had compliance of documenting pain scores at least once per shift. The lowest compliance was on Windsor ward with 10% completion. We were not assured that patient’s pain was being monitored and therefore managed in line with policy. Divisional leaders told us the action plan function of their electronic audit tool was to be implemented to provide meaningful data in line with National and Local standards. This would allow for accurate reporting and monitoring to improve current practice. 

Care plans were not personalised and holistic. Nursing staff told us patient care plans would provide them with the necessary information required to tailor care to their individual needs. However, these documents did not support any personalised care. Most patients and relative we spoke to told us they had not seen or discussed their care plan.

We reviewed care records for 3 mental health patients on wards and found that care plans and records did not support a thorough assessment of their needs. For example, mental state examinations had not been completed. This was escalated to seniors during our assessment, and a review was completed to ensure that assessments were completed and documented.

The wards used a red tray system to identify patient’s that needed support, monitoring or supervision during mealtimes. We were told that meals could be tailored to individuals based on their dietary needs. For example, a patient with Huntington’s disease was offered finger foods to support independence with feeding.

Staff were able to access interpreters for patients where English was not their first spoken language. We saw evidence of this used within Endoscopy where an interpreter had been booked and used to explain the results and future management plan to patient who spoke Lithuanian.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff had guidance to meet patients’ needs for food and drink and for specialist nutrition and hydration by screening them using the Malnutrition Universal Screening Tool (MUST) on admission. However, we reviewed nutrition charts for 4 patients that had been identified as a medium to high risk of malnutrition on admission. We found all 4 charts were not fully completed to evidence adequate nutrition had been provided.

The division carried out audit programmes to implemented National Institute for Health and Care Excellence (NICE) guidance such as Blood transfusion and Acute Kidney Injury. Where audits showed full compliance, they were closed. We saw that there had not been an audit for NICE guidance Venous thromboembolism in Over 16’s released in 2019. Divisional leaders told us there was a plan in place to carry this out by August 2026.

Clinical governance meeting minutes from March 2026 showed that there were 21 overdue NICE guidelines as staff were working on the backlog and had lost oversight of new ones. This meant that staff did not always have access to the current best practice guidance.

Local audits and metrics were conducted and reviewed by senior leaders to provide assurances regarding the effectiveness of care and treatment. However, these were not effectively used as the action plan function of their electronic audit tool was not used to provide meaningful data in line with National and Local standards. Therefore, the local audits were not used to assist in making changes or drive improvement.

The trust provided national data to the Seninel Stroke National Audit Programme (SSNAP). This measured how well stroke care was being delivered. It also provides timely information to clinicians, commissioners, patients and the public so it can be used to improve the quality of care that is provided to patients. The team used this to drive improvement, for example they could evidence that since their implementation of a nurse led service the percentage of ‘patients treated by a stroke trained nurse within 1 hour of the clock start’ 40.4% to 66.7% in 5 months.

Staffing for specialist nurses and therapists was not adequate to meet the demand within the division. For example, the number inflammatory bowel nurses were staffed at 1.4 whole time equivalent (WTE) despite guidelines indicating needing 3.5 WTE. This meant that they were unable to review newly diagnosed patients impacting on consultant workload and a reliance of the telephone advice instead of a face-to-face clinic review.

A review of mandatory training compliance showed that all staff were not trained and to meet the needs of the patient group. For example, learning difficulties (32.9%), basic life support (59.6%), and safeguarding adults (54%).

Managers provided staff with supervision (meetings to discuss care management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. Appraisal rates for staff were 84.6% against a target of 90%. Some ward managers told us that there was not a structured supervision record to support development.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people.

Staff told us there were barriers to accessing specialty reviews for medical care patients. This was due to multiple factors such as differing referrals processes as well as a lack of responsiveness to requests made. For example, we were told that an oncology patient waited for 4 days due to a lack of acceptance of telephone referral made. This resulted in delayed care and discharge planning for a palliative patient. The clinical directors of medicine told us they were aware of cultural and procedural concerns. They did not audit the response times for ward-based speciality referrals and therefore could not be assured the service worked well across teams to support patients.

Ward therapists would support with sitting patients out for meals on wards. However, mobility advice and plans were not always followed by other healthcare professionals which at times resulted in deconditioning of patients. We were told this would be reported as a clinical incident on the ward, but they would not receive any feedback on action taken. Staff did not always refer patients for specialist review in a timely manner resulting in deterioration. For example, a lack of early referral to physiotherapy for the management of rib fracture patients. Training to take appropriate action as per the rib fracture pathway was underway at the time of the assessment.

Outlier patients were not always seen in a timely manner. Junior doctors and ward staff told us the responsible consultant for this group of patients changed on a daily or weekly basis and at times they were not aware of who to contact in an emergency. The divisional leads told us they were aware of these difficulties and had developed a rota to ensure a named consultant was assigned for the week.

Some staff reported they did not meet with their senior leaders on a regular basis which meant that there was a lack of regular support and awareness of the difficulties they were experiencing within their service.

Staff held multidisciplinary meetings to discuss discharges to optimise patient flow and minimise length of stay. Staff told us they were disjointed due to poor processes and poor culture with teams.

Daily handovers were held to convey updates and daily treatment discharge plans for patients on the ward. However, there was no structured handover guidance to reduce risk of critical details not being communicated and maintain continuity of care amongst all medical care wards.

We observed the use of SBAR handover documents when patients were transferred from the emergency department to the wards as well as nurses phoning wards to handover the care of patients being admitted.

The NHS 'Blue Ribbon' scheme was used to prevent moving palliative or those with dementia unless reviewed by senior managers process in place to minimise bed moves for patients at risk of developing delirium. We saw this in place during our onsite assessment.

We scored the service as 2. The evidence showed some shortfalls. The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Staff had access to guidance to support patients to live healthier lives for example, through participation in smoking cessation schemes. Patients would be screened for smoking and alcohol use within the admission booklet. The screening questions allowed for staff to identify and offer a referral to specialist services alongside advice leaflets. However, we reviewed 6 patient records for completion of smoking and alcohol use on admission and found that this had only been completed in 2 records, showing processes were not effective.

The palliative care and frailty teams engaged with patients and their families to support people with making choices around their future care and supported independence of patients. For example, a choice was given to patients that were palliative to be placed on the end-of-life ward or community setting.

Mealtimes were protected on wards to enhance nutritional intake and provide a calmer environment for patients. We observed posters advertising adaptive cutlery sets available for patients on the care of the elderly wards to allow individuals with physical, neurological, or cognitive challenges to eat independently and with dignity.

We scored the service as 1. The evidence showed significant shortfalls. The service did not routinely monitor people’s care and treatment to continuously improve it. Audit systems in place did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The division did not always audit against the implementation of NICE guidance such as Venous thromboembolism in Over 16’s released in 2019 and Stroke & Transient Ischaemic Attack in over 16’s, last updated in 2022. Auditing against these guidelines is vital to identify gaps, reduce unwarranted variations, and ensure patients receive the most effective, evidence-based treatments available.

The purpose of Sentinel Stroke National Audit Programme (SSNAP) is to measure and improve the quality of stroke care within the NHS. The stroke team submitted data to SSNAP and used this to monitor the effectiveness of their service. The most recent submission of data for October to December 2025 showed that the hospital provided a level of stroke care assessed as requiring substantial improvement. The division were aware of this and there was a Stroke Improvement Plan in place.

The service carried out Friends and Family Test (FFT) to measure if care met patient expectations. We requested the results for the division, but these were not provided as the data was collected trust wide. Monthly divisional meeting minutes evidenced that there was a poor compliance of completion of FFT within the division. This meant there was limited learning from the patient experience.

Local audits were conducted to monitor compliance against trust policy; however, the action plan function of their electronic audit tool was not utilised to provide meaningful data in line with national and local standards. This would allow for accurate reporting and monitoring to improve current practice. 

Structured Judgement Reviews (SJR) were used to evaluate the timeliness of care, decision-making, communication, and adherence to best practice of patients that had died in care or experience significant clinical events. The outcomes of these were used in several ways such as team or individual learning, transparency and workforce education. We requested the 3 most recent reviews but were provided with only 1, so we were not assured that the process was fully embedded or being used consistently to drive improvement. Governance minutes also showed 94 overdue patient‑safety reviews and 40 SJRs outstanding, indicating that harm was not being reviewed in a timely manner, limiting the division’s ability to learn and improve outcomes.

Staff used National Early Warning Score (NEWS) 2, a recognised tool to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. However, the division did not audit compliance of the recording, documentation and escalation of these in line with trust policy to be assured the best outcomes for all patients.

The division used the trust’s power BI health inequalities reporting dashboard to examine admission patterns by ethnicity and deprivation across elective and emergency admissions and tooth extractions. Evidence showed deprivation was the strongest and most consistent signal, the most deprived patients in our population carry a higher burden of both elective and emergency admissions and that gradient had been present and sustained throughout the two years covered. Divisional leaders did not tell us what action they had taken as a result of this data review.

Staff used technology to support patients with a flag system. An inpatient electronic database enabled staff to identify patients with additional needs, such as a Learning Disability at the point of care, ensuring appropriate reasonable adjustments are made, and mobile apps to escalate and refer patients to the respiratory physiotherapist for review.

We scored the service as 2. The evidence showed some shortfalls. The service did not always document consent accurately in patient records when delivering care and treatment.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. However, staff did not always assess and record capacity to consent appropriately and in line with trust policy. We found only 2 out of 13 records supported all clinical care delivered on wards and in line with policy, including best interest documentation. Enhanced observation assessment records were not monitored divisionally to ensure that the correct level of enhanced observation was prescribed and that mental capacity assessments were consistently completed when required.

Patient’s told us staff always sought verbal consent prior to care and treatment. Most patients told us they felt comfortable asking for another member of staff if it was of the opposite sex for personal care.

Staff took all practical steps to enable patients to make their own decisions, for example, staff used language line to provide interpretation and translation services to ensure patients whose first language is not English can access and understand their care.

Within the endoscopy unit we reviewed 5 care records that showed consent had been obtained and reviewed again prior to commencing procedures. We saw evidence of choice with regards to anaesthetic and where possible the type of procedure that was completed.