Queen Alexandra 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 we looked for evidence that people’s 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 good. At this assessment the rating has remained good.

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 scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

During the onsite inspection we reviewed 20 patient care records. This showed staff used nationally recognised tools to assess patients’ conditions and needs. We saw staff reviewed care plans to ensure they still met the needs of patients. Discussion with patients indicated their conditions and needs had been discussed with them and their views about how to best meet their needs taken into consideration.

Patient’s pain was assessed and staff administered pain relieving medicine when needed. Patients we spoke with confirmed staff gave them pain relief and said their pain was well managed. The service used a nationally recognised tool to assess pain in patients who were not able to verbally communicate, for example patients living with dementia or patients who had a learning disability.

The mental health liaison team, who were employed by a local community, mental health and learning disability NHS trust, provided support with assessing patients who had mental health conditions and guidance to staff about how to support patients with their mental health needs.

Learning disability liaison nurses, employed by a local community, mental health and learning disability NHS trust, were available to assess and provide guidance to staff about who to support and care for patients with a learning disability. However, this was a limited service, and the learning disability liaison nurses had a limited scope about which patients they could provide support for. More detail about this is in the responsive section of this report.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff had access to policies and procedures that were in line with national guidance. The sample of policies and procedures provided by the service demonstrated they were kept under review and referenced relevant national guidance and practice. Staff were updated about changes to guidance in policies and processes in several ways, including electronic formats and in meetings.

Review of patient records showed staff used a nationally recognised screening tool to monitor patients at risk of malnutrition and used this to inform planning and delivery of care. Patient requiring special diets for clinical reasons, were assessed and advice given. Staff ensured that foods for special diets, such as a soft diet or low residue diet were provided.

Review of patient records showed staff used nationally recognised tools to assess patients pain levels.

Review of patients’ records showed staff used a nationally recognised tool to assess and monitor patients skin integrity. This identified whether a patient was at risk of developing pressure damage to their skin and staff used relevant pressure relieving aids, such as special mattresses, and processes to reduce the risk of skin damage.

Staff had access to the full range of specialists required to meet the needs of patients in the service. This included staff employed by the trust such as physiotherapists, speech and language therapists, physiotherapists, pharmacists, and an Admiral nurse who provided support and guidance about the support of patients living with dementia. Staff also had access to professionals employed by other NHS trusts who worked for the trust such as the mental health liaison team and the learning disability liaison team. These specialists helped to ensure patients received care and treatment that was in line with national guidance. However, the Learning Disability Liaison Service was limited, more detail about this is in the responsive section of this report.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They mostly made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Throughout the inspection we saw multidisciplinary team working in all areas. Clinical staff said nurses, doctors and allied health professionals worked well together within the medical care services. There were regular multidisciplinary meetings during the day where doctors, nurses and allied health professionals discussed patient care, ongoing treatment, and discharge plans.

Discharge policies and processes gave staff guidance to ensure relevant patient information was shared with external providers, including GPs and other care providers. However, CQC had received information from external sources, including patient relatives and adult social care service, about poor discharge information.

Staff shared information about patients during effective handover meetings within the team, such as shift to shift handovers.

Staff referred patients with acute mental health conditions to the mental health liaison service which was provided by another NHS trust. Staff said the mental health team was responsive and available to support patients with mental ill health and their treatment plans. Support and guidance from the mental health team was available 24 hours a day 7 days a week.

Staff had access to a learning disability liaison team that was employed by another NHS trust. However, the availability of the learning disability liaison team was limited. The learning disability liaison team had put tools and guidance about the support of patients with a learning disability on the trust intranet. However, they were no longer able to access the trust intranet to update this guidance and tools. This presented a risk that staff would not have access to current guidance to enable them to support patients with a learning disability effectively

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 trust had processes in place to support patients manage their health that medical care staff could access. This included access to a smoking cessation service. Data provided by the trust showed increasing numbers of patients who were referred to this service had successfully ‘quit’ smoking. However, there was no detail to determine how many of these patients were medical care patients of other specialties within the hospital.

Wards had patient information leaflets about some aspects of self-care management, including reducing the risk of developing pressure ulcers and reducing the risk of deep vein clots. Specialty areas had and displayed information about self-care management, for example there was a cardiac rehabilitation board on the cardiology ward. Information was avaible to patients in leaflets and on displays on wards to external support groups that could support them to live healthier lives.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service participated in relevant national clinical audits and benchmarking programmes. Outcomes for people were mainly positive and mostly met expectations.

The stroke service took part in the Sentinel Stroke Audit Programme (SSNAP). The most recent results from this national audit (October 2024 to December 2024) showed the service had an overall score of B, (A being the best score and E the worst score). Detail provided by the trust showed they had an overall score of B consistently from October 2023.

The neurorehabilitation service submitted data to the UK Rehabilitations Outcomes Collaborative (UK ROC). UK ROC collates patient level data from all the specialist (Level 1 and 2) rehabilitation units in England about their needs for rehabilitation, the inputs provided to meet those needs, and the outcomes that result, including gains in functional independence and cost-efficiency, in terms of savings in the cost of ongoing care to offset the initial costs of rehabilitation. Results from the audit showed outcomes were similar to that of other similar neurorehabilitation units.

The service used the NHS England Getting it Right First Time (GIRFT) programme to benchmark the service against national standards and identify areas for improvement. This included monitoring patients’ length of stay in hospital, monitoring the number of patients waiting more than 52 weeks and 62 weeks from referral to start of treatment. The service developed and followed action plans with the aim to reduce length of stay for patients and bring waiting times for treatment in line with national standards.

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 had access to a consent policy. The policy was kept under review by the trust and referenced relevant legalisation and national guidance. There was clear guidance for staff about when and how to obtain consent, how to manage consent for a patient who lacked capacity to give informed consent about a specific decision. The policy gave detail about how to access interpreting for people who did not speak English as their first language and whose first language was British Sign Language. The policy also gave detail to staff about how to access consent information in easy read, large print or braille.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff made sure patients consented to treatment based on all the information available. Staff clearly recorded consent in the patients’ records. For interventions that required written consent from patients, the service used an electronic consent process. For patients who preferred a paper based consent form, the consent forms could be printed.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Most staff could clearly describe the correct process for establishing the capacity of patients to make decisions about their care. However, some staff said assessing patients’ capacity to make decisions was the role of medical staff. This indicated that not all staff had a full understanding about whose role it was to assess the capacity of a patient.

Staff understood the use of Deprivation of Liberty Safeguards. Discussion with staff demonstrated they had a good understanding about the use of Deprivation of Liberty Safeguards, and when and how they should apply for a Deprivation of Liberty Safeguard for a patient.

Most staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act, and they knew who to contact for advice.

Patients confirmed in conversations staff had provided them with information to enable them to understand and make an informed decisions about their treatment.

Although the service did not carry out formal audits of the consent process, the electronic consent platform provided data about the number of digital consent episodes. The system also gathered feedback from patients to gather their experience of the digital consent process.