The Queen Elizabeth Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating remained as requires improvement.

This meant that people’s needs were not always met.

We have not awarded this service a score for Responsive.

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

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

During our assessment we spoke to 15 patients all of which were complimentary about the staff. They told us that although the staff and the department were busy they were given time and treated with kindness and respect.

Staff had access to interpreters and a language line to aid with communication when treating a patient where English was not their first language. Hearing loops were also available for patients who were hearing impaired. We did not see any evidence of any other communication aids within any adult areas of the department.

Children’s ED had communication aids to assist with assessment for pain and also equipment to support additional needs and neurodiversity for example ear defenders and distraction toys. We did not see any evidence of any equipment to support neurodiversity or additional needs within the adult areas.

The patient care records reviewed documented discussions with the patients, and their families/carers. Treatments plans and care outcomes were discussed to empower patients or make informed decisions about their care. Mental capacity assessments were completed where necessary and consent to care was documented.

We observed a patient who was brought into the department by ambulance who had an advanced care decision in place. Staff took the time to review the patients ReSPECT form and worked with the patient’s family to put a package of care and treatment in place to support the patient’s needs and wishes.

Staff felt more able to deliver person-centered care as the department did not carry out corridor care. This also had an impact and improved staff morale. Patients having their own cubicles in majors enabled the space to for staff to support patients more holistically.

We scored the service as a 2: The evidence showed some shortfalls. There were some shortfalls in how the service understood the diverse health and care needs of the people and their local communities, care was not always joined up, flexible or supportive of choice and continuity.

On discharge patients are directed to Quick Response (QR) codes which provide them with ongoing help and advice. There were still some paper information leaflets available but these were all found to be out of date. Staff told us they were being left on display until that ran out and would never be replaced. This would leave patients who did not have access to a SMART mobile phone or device without the means of having access to discharge advice. This method of communication was not inclusive to all patients and their relatives/carers that use the service.

The division had started work with drug and alcohol partners within the community to support complex patients with addiction. They also had a complex case meeting every week to discuss patients and how to support them better within the community to avoid sometimes unnecessary hospital attendance.

They have also adapted a multi-disciplinary approach for patients that frequently attend the ED. This is an approach where the hospital works in conjunction with a patient’s own GP and the ambulance service to provide a more supportive and collaborative approach to support patients within the community.

Leaders told us that although they were attending meetings to understand the health inequalities within the community that the hospital served, there was still a lot of work to be done within this field.

FS:DEC organised discharge packages, referred patients into community clinics or community care of district nurses. GPs and the ambulance service could phone the frailty team direct for help support and guidance that could often lead to a patient not being conveyed to hospital but supported by community teams. There was not any weekend cover for F:SDEC

We scored the service as 2. The evidence showed some shortfalls. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Patients and families told us that information around waiting times was limited. Staff could not give clear timeframes to be seen or treatments to be given. This was reflected in the patient survey results from 2024 where communication was seen as an area for improvement. Communication was also identified as a theme from complaints about the department.

Patient information leaflets in a paper form were out of date but still displayed. Staff told us they would continue to be displayed until they ran out and would not be replaced.

On discharge from the department patients were directed to a board to scan a Quick Response (QR) code for ongoing care and advice. The inclusion of a QR code was and initiative put into place following the results of a patient survey in 2024 where it was identified that improvements needed to be made in the information provided to a patient when leaving the department. Reliance on a QR code to provide discharge information does not make this method of communication inclusive to everyone that uses the service.

We observed staff using medical terminology when speaking to patients without giving explanations of the terms used which some patients found confusing and overwhelming.

Staff in children’s ED told us that medical staff did not always take the time to explain things to the patient and their families/carers. Nursing staff knew they would have to approach patients and families after to make sure that they understood everything.

There was a display within the department explaining “your journey through Accident and Emergency” which showed and explained the various pathways patients could take following arrival into the department should they arrive by ambulance or self-present at the public entrance.

Translation services were available for staff to use if English was not the first language of the patient they were treating.

The trust had a public website that had an accessibility tool built in. This enabled people to enlarge fonts, read aloud, change webpages colours and convert text to over 134 languages. Information about UEC was limited, however the trust worked in partnership with an accessibility partner that shared information about department layouts facilities available.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

How to complain and provide feedback information was displayed within the department and waiting areas. Friends and family test information for feedback was also displayed in various different languages. Feedback cards were also available for patients, their families and carers to complete. There was also information displayed to inform under 18s how they could provide feedback on mental health support they may have received.

Staff new how to direct and advise patients to make a complaint if asked. Staff told us they would also direct patients to the Nurse in charge to see if any complaints raised could be dealt with at the time.

Some patients told us that they had access to the NHS app which they could use to give feedback.

The department used patient feedback to make improvements. The waiting room now has vending machines and the house keeping department provides the area with water and hot drinks, this was a response to a family and friends card regarding food and drink provision within the waiting area.

A poster had also been developed and displayed asking patients if they have recently travelled. This was a response to a concern raised by a patient that was not asked about any recent travel.

There were 55 complaints relating to UEC, 53 in relation to adults and 2 relating to children within the 6 months prior to our inspection. Main themes were communication, delayed care and discharge concerns. ECAM as a division had a total of 222 complaints and were 68% compliant in responding to them within 30 days as per policy. We do not know how many of the complaints relating to UEC have been responded to within the policy time frames.

Both complaints and compliments were discussed at divisional ECAM meetings.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Patients entering the service did not always have equity in the access of the care and treatment received. Delays in being triaged and extended lengths of stay within the department to be reviewed by specialities impacted on the timely treatments, diagnosis and ongoing care.

S:DEC being used overnight for patients waiting for ward beds or discharge meant that patients that would meet the criteria for S:DEC, and a more appropriate pathway of care, would not be accepted due to capacity.

Frailty S:DEC did not provide any weekend or weekday after 5pm provision. This meant that frail elderly patients would have to stay in ED and not receive the same speciality support that would normally be provided by the frailty team. The ambulance service, GPs and other community health workers could not seek help and guidance from the department for pathways of community care and support. This could lead to unnecessary conveyance to the ED.

Staff had access to interpreters through a language line for patients where English was not their first language. Children’s ED had picture communication aids, equipment to support additional needs and neurodiversity for example ear defenders and distraction toys. We did not see any additional communication aids or support for neurodiversity within the Adult ED.

We scored the service as 2. The evidence showed some shortfalls. Staff and leaders did not always actively listened to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Older frail patients did not always have equity in experience when they were taken into the hospital as Frailty S:DEC did not provide any provision at the weekend or after 5pm. It also had an impact on the ambulance service and GPs seeking help and guidance, to provide a more suitable pathway of care, from the frailty team to prevent unnecessary conveyance of people into the ED.

Staff had completed training in Equality, Diversity and Inclusion (EDI), supporting staff to recognise when individuals might face barriers in communication, understanding or engagement and tailor their approach accordingly.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Equality impact statements were applied to trust policies to ensure that policies do not inadvertently discriminate against specific groups and actively promote equality.

The Trust was a member of the NHS Anchors Network which brings together NHS providers and Integrated Care Boards (ICB) to work in collaboration to share approaches to improve health and social inequalities.

Senior leaders within the division of Emergency Care and Medicine (ECAM) told us that although they were attending meetings to understand the health inequalities within the community that the hospital served, there was still a lot of work to do within this area.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We observed staff supporting patients and their families that were coming to the end of their lives. We observed patients who had Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form which documented advanced wishes and care preferences of the patient. Detailed handovers were observed to hospital staff from ambulance crews. Staff respected the wishes documented and contacted family members to discuss possible treatment options.

Staff acted proactively to support future care planning, for example medical staff had compassionate and holistic conversations with family members regarding their wishes and best interest decisions for their relatives. Conversations were documented and paperwork completed.

There was an End of Life (EoL) lead within the department. An information pack had been created for families that have experienced miscarriage or still birth. The EoL lead also has connections with local hospices to help families with EoL care and support. The department also had a bereavement suite a respectful quiet place for families to use.