The Queen Elizabeth Hospital

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• 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

This means that we looked for evidence that peoples care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question as good. At this assessment the rating has changed to requires improvement.

This meant that 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.

We reviewed 8 patient care records. Pain assessments had been completed in the records we reviewed, however we observed one patients waiting long periods of time to be assessed and given pain relief. We requested pain score audits for the last 6 months. UEC showed a pain audit compliance of 93%, S:DEC 78% and Frailty S:DEC 92%. However, the sample size for audits was only 3 patients a month. The number of patients audited may not be a true reflection of pain assessment being completed in relation to the number of people coming through the department on a daily basis.

Patient care records we reviewed showed holistic recording of any additional needs where applicable. Food and hydration needs were assessed with swallow assessment referrals made. Treatment plans were documented, as were discussions with family and carers where recorded.

Staff completed training in Equality Diversity and Inclusion (EDI) with an overall nursing and medical combined compliance of 91%. Staff had access to a learning disabilities nurse specialist who was available Monday to Friday 9am to 5pm.

During assessment we were not assured that all patients received access to timely and prompt assessment and triage. Data reviewed showed that not all patients were seen within 15 minutes of arrival and could experience delays in the ambulance rapid assessment treatment area. Staffing, capacity and acuity within the department impacted on staffs’ ability to provide prompt and comprehensive health assessments.

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 we spoke to were experienced and qualified to undertake their roles. However not all mandatory training had been completed within the trust target of 80% which could lead to knowledge gaps within certain competencies. For example, both nursing and medical staff had low compliance in safeguarding adults’ level 3 and Basic Life Support (BLS). We were not assured all staff had the necessary training competences to meet the needs of all patient groups.

Staff told us they worked within their clinical scope of practice and if they were presented with something outside of their scope they would escalate to the nurse in charge or the Emergency Physician in Charge of the department.

The department engaged in audits. However, some audits for example NEWS2 were reported as an overall trust compliance figure. We were not assured senior leaders within the Emergency Care and Medicines (ECAM) division had oversight of this risk. We did not see evidence that patients were receiving the correct care and treatment in a safe and timely way and where improvements were needed to be made.

Sepsis was not always assessed in line with National Institute for Health and Care Excellence (NICE) guidelines. The inconsistencies we found in the monitoring and recording of NEWS2 scores indicates that Sepsis and patient deterioration could be missed. The Sepsis screening tool was not always used or completed when patients arrived in the Rapid Ambulance Triage (RAT) area and we could not be assured that sepsis was being recognised early to start treatment pathways.

The department had access to emergency specialist teams for stroke and cardiac care, and critical care outreach teams. Response for these teams were prompt to assist staff with critically unwell patients on arrival or those who deteriorate whilst in it. However, there were long waits to be reviewed by general specialities following referral for example medics, surgery and orthopaedics.

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. They did not always share their assessment of people’s needs when people moved between different services.

We observed staff morning huddles where key information was shared. Staffing, waiting times discharges and bed availability were discussed. However patient handover information was not always consistently completed between teams. For example, Staff in S:DEC told us when the area was used for medical overnight stays staff did not always receive a full handover of the patients. This led to patient medications and observations being missed and diabetic patients not having their blood sugars reviewed.

We observed good multi-disciplinary team interactions and clinical discussion within the department around the care and treatment of patients. Staff in ED told us that they worked well as a team although they were all under pressure, especially when the department was busy. Staff in children’s ED told us they often felt under supported and separated from the rest of UEC.

Staff told us patients would often have long waits to be reviewed by specialty teams, such as surgeons, orthopaedics and gynaecology. Patients were not seen by specialty teams within an hour of referral as agreed in the interprofessional standards. The service did not have a process for monitoring these long waits. Medical staff told us long waits for inpatient beds and specialty reviews put extra pressure on the ED teams as patients remained the responsibility of the department during this time.

We observed good interprofessional interactions between the department staff and the staff from the ambulance service.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The department had a health promotion display boards. This gave information to people to improve their health and wellbeing. The boards gave advice on how to stop smoking and reduce and stop drinking alcohol with telephone numbers and website information clearly seen.

Information boards also gave information to carers or family members on how they could seek help and support when living with or caring for someone with mental health concerns or issues. The department was involved in the trust smoking cessation service with the department offering help and guidance to support people to give up smoking.

The trust also engaged with local community and alcohol services to help support people with addiction in the community.

The frailty teams in FS:DEC were observed engaging with patients and families regarding support needs for ongoing care to support choice and independence.

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. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The service had monthly divisional clinical governance meetings to review national guidance and policy updates. Minutes we received from these meetings indicated that some NICE guidelines were out of date and required review. For example, acute coronary syndrome, anaphylaxis and falls in older people. This meant that staff were not always working in line with current guidelines to monitor and improve the outcomes for patients.

Staff did use recognised national observation tools to monitor patients, these were not always taken in line with the services policies or national guidance. For example, NEWS2 scores were not monitored to detect early signs of deterioration. Staff in children’s ED told us that when the department was busy hourly observations were often missed. We were not assured the service had effective and safe processes to ensure good patient outcomes and reduce risk of harm.

Long waits within the department had a negative impact on patient experiences and outcomes. The data received from morbidity and mortality meetings indicate that patients that died whilst in ED had been in the department for an extended length of time and had been waiting for specialty referral to review them.

The hospital is participating in the NHS England programme Getting It Right First Time (GIRFT) which was designed to improve clinical care, patient outcomes and maximise efficiency. The GIRFT urgent and emergency care programme focused on optimising patient flow, reducing waiting times and matching capacity with demand. The current front door streaming model was introduced by GIRFT in 2025. However, the current model does not support good care and treatment at the front door or protect privacy and dignity of patients.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff we spoke to understood the importance of gaining consent from patients prior to completing any care or treatment activities. Mandatory training was completed for both consent and the Mental Capacity Act (MCA). Nursing staff had good training compliance in both topics above the 80% trust target and medical staff were above trust target for MCA but below it for the completion of consent training at 78%. All staff were above trust target compliance for training in the Deprivation of Liberty (DoLS).

Staff also received mandatory training for mental health awareness. Nursing staff were above the trust target at 95% and medical staff below at 77%. Staff told us that although they received some training in mental health they could do with more.

We reviewed 8 patient care records and mental capacity assessments were completed and documented where needed. We reviewed 6 patient care records of people sitting in the waiting room for the recording of consent and all had consent documented. Consent was generally taken verbally, medical staff told us that written consent would only be taken if a patient was to be sedated.

Staff understood how and when to make best interest decisions for patients who may lack capacity because of life-threatening illness or injury. Staff had access to language line, this would be used when English was not a patient’s first language to enable informed consent to care and treatment.

Staff in children’s ED were aware of Gillick competence. Gillick competence determines whether or not a child under 16 can consent to medical treatment without parental knowledge or permission.