Queen Alexandra Hospital

On this page

• 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

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs mostly were met through good organisation and delivery.

The service was in breach of legal regulationin relation to person centred care.

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 2. The evidence showed some shortfalls. The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

There was a lack of resources to support patients with a learning disability. Access to the learning disability liaison team was limited. The service was provided by another NHS trust but had only been contracted by Portsmouth Hospitals University NHS trust to provide a service of 2 nurses, 30 hours a week spread over 5 week days. This increased the risk that due to lack of support patients with a learning disability might not have their immediate needs met appropriately on initial admission to hospital. The learning disability liaison team had criteria for whom they could provide support for; they only provided support for patients who had a diagnosed learning disability and whose IQ was under 70 exclusively. However, we were advised by specialists in this area that neurodiversity diagnoses do not provide IQ scoring. Therefore, patients may not be able to access services solely on the basis that they had not undertaken IQ testing. They also did not provide any support for patients with autism. This meant there was no access to additional support for patients with an undiagnosed learning disability, those with a learning disability but an IQ over 70 and no access to additional support for patients with autism. At the time of the inspection the learning disability champions were no longer active in the service, which further added to the lack of resource for patients with a learning disability

The learning disability liaison team said that all wards had been provided with a resource box by an external stakeholder with equipment and activities to support patients with a learning disability. The resources included activities to occupy patients and tools to reduce stimulation and distress of patients. However, ward staff did not demonstrate an awareness of where these resources were located. When we asked the service for assurance about how they ensured there was always appropriate equipment available to meet the individual needs of patients with a learning disability there was no detail about the learning disability resources boxes. They said sensory lights and toys were provided to patients in the emergency department and these could be shared with inpatient wards in the medicine division when required.

The service did not equip staff with the skills and knowledge to enable them to support and provide person centred care for autistic patients and patients with a learning disability. They had not ensured all staff had received training about learning disability and autism that was relevant to their role and in line with legal requirements.

However, staff had good access to specialist teams to support patients with mental health conditions and dementia. The mental health liaison team were provided by a different NHS trust. The Admiral nurse was employed by Portsmouth Hospitals University NHS Trust. The Admiral nurse supported a team of dementia champions, who were available to support and guide staff in supporting patients living with dementia. During our onsite inspection we asked staff about resources for patients living with dementia. Staff described they would contact the Admiral nurse to provide support and activities to support patients.

Processes were followed to provide on to one care and observation for patients who required enhanced observation and support. This included some patients living with a dementia and some patients with mental health conditions.

Staff, patients, and carers could access interpreters including British Sign Language interpreters when needed.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Processes were in place to support joined up care. Discharge planning processes supported continuity of care once the patient was discharged and the trust had a process to make improvements to the discharge processes across all services, including the medical care services.

Access to specialist teams such as the learning disability team, the mental health liaison team, the dementia team and the integrated discharge team supported staff to ensure patients received continuity of care for their other conditions, rather than just the medical concern they were admitted with. However, limited access to the learning disability team meant there were risks that patients with a learning disability might not receive care that was joined up.

We scored the service as 3.The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service provided a range of leaflets for patients that provided advice and guidance about their admission to hospital and about the discharge process. Leaflets were able to be translated into different languages, including braille.

The trust website had a tool that allowed all information on the website to be translated into different languages. There was also the ability to change the font size and colour of the background to support people who had trouble reading or recognising the written word. However, there was no facility on the website for the information to be read aloud for patients with impaired vision. This had the potential to negatively impact on visually impaired people ability to access to information about the medical service and the hospital and was an area where improvements could be made.

Staff had access to interpreters. Staff had guidance in the Interpreting and Translation Service policy. Translation services were available for patients whose first or preferred language was not English or who had a hearing impairment that required the use of an interpreter or lip speaker. Staff confirmed they had access to interpreting facilities and followed best practice guidance not to use patient family members as interpreters.

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.

Detail about how to give feedback about care and treatment was detailed on the trust website. This included compliments, concerns, and complaints feedback processes.

A trust wide complaints policy gave staff guidance about managing and responding to complaints. Data provided by the service showed that for the months February, March and April 2025 the medical division had received a total of 21 formal complaints and the older persons medicine division had received a total of 11 formal complaints. No data was provided for the acute medical unit. Data provided by the service showed there were variable rates for completing complaints investigations and responses within the trust timescale. For the medicine division this averaged 76.86% and for the older persons medical division this averaged 33.33%

The top 4 themes from the complaints over this period included poor communication, poor attitude of some staff, discharge process and dissatisfaction with patient care.

The service also used the Friends and Family Test to get feedback and support improvements to the service.

Learning from complaints was shared with staff in team meetings, governance meetings and through presentations by the practice educators. The practice educators used patient experience stories to demonstrate how patients were affected by their experiences in hospital. The sample of patient experiences provide by the service showed the service received complaints about the use of Your Next Patient spaces and the effect that had on patients. One of the common themes was that staff did not explain to patients the reason why they were accommodated in Your Next Patient spaces. Feedback we received from patients during the onsite inspection suggested this was not fully resolved.

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.

Patient flow throughout the hospital meant patients were not always accommodated in the relevant specialty ward for their care and treatment and some patients were accommodated in areas not designated for patient care.

Processes did not always ensure people received care and treatment in a timely manner. Data provided by the service showed that between 1 November 2024 and 25 April 2025 only, 52% to 54.5% of patients on the waiting list commenced their treatment within in 18 weeks of referral. This was significantly below the national target of 92%.

There was a mixed experience for patients with suspected cancer and for those with cancer waiting to start treatment. For the period April 2024 to April 2025, the service mostly met the NHS England target for the 28 day faster standard. The national target was that 75% of people should have cancer ruled out or receive a diagnosis within 28 days of an urgent cancer referral. The service met this target except for January and April 2025 when 72.4% and 72.3% of people had cancer ruled out or received a diagnosis within the 28 days.

Performance against the 31 day standard had improved. The national target was that 96% of people with a cancer should begin their treatment within 31 days of the decision to treat their cancer. Data provided by the service showed that between April 2024 and April 2025 they had met this target, except for April 2024, January, February and April 2025 when they achieved 92.5% to 94.5%. This was an improvement from the April 2023 to April 2024 when they did not meet the target in any months.

Performance against the 62 day standard did not meet the national target for any of the months between April 2024 and April 2025. The national target was that 85% of people with a cancer should begin their treatment within 62 days of an urgent referral.

Patients experienced delays in admission to wards from the emergency department. Data provided by the service showed patients frequently spent more than 4 hours in the emergency department after the decision to admit to a ward.

Data provide by the service showed that between November 2024 and April 2025 across medicine, older person medicine, regional cancer and renal and transplant there were a total of 2,333 patient bed moves between 10pm and 6am. Across the urgent care service there was a total of 2,746 patient bed moves between 10pm and 6pm. However, the service could not identify how many of these were for non- clinical reasons and could not detail how many patients experience multiple non- clinical bed moves. Patient bed moves, particularly when frequent, can lead to disorientation, increased falls risk, loss of belongings, and communication breakdowns between care teams.

There were significant numbers of patients who experienced delayed discharges. There were significant numbers of patients who experienced delayed discharges. Data provided by the service showed that between November 2024 and April 2025 18.5% to 19% of patients on medical wards experienced a delayed discharge. This equated to 1938 to 2064 patients per month who experienced a delayed discharge. This had a major impact on how the service managed patient flow through the hospital.

The ward environment supported people living with dementia to have equal access to facilities. Toilet and shower rooms had dementia friendly labelling. Door frames and toilet seats were of a contrasting colour to the walls and floors to make them clearly visible for both patients with dementia and for patients who were visually impaired.

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.

The trust and the service did not take steps to ensure there was equity of experience for all patients.

Patients with a learning disability were at risk of a poor experience because access to the Learning Disability Liaison Team was limited. There was no provision of specialist support for autistic patients or for patients with a mild learning disability, which increased the risks they might not have their specific needs met and would not have a positive experience. This did not demonstrate that the trust and the service took account of the national Learning Disabilities mortality review 2022 that identified more people with a mild learning disability died from an avoidable death than those with a moderate, severe or profound learning disability. However, the service did follow the national Learning from Lives and Deaths -People with a Learning Disability and Autistic People (LeDeR) programme. Death of patients with a learning disability or autism were reviewed and any learning shared with staff to support improvements in the care of patients with a learning disability or autism. The service did not provide any examples of improvements made because of this process.

Learning disability champions within the trust had not been actively developed and this meant local level knowledge on supporting these patients was not always available. Leaders told us that these roles would be relaunched to allow local level knowledge availability about supporting these patients.

The service had not carried out any reviews to identify whether patients with protected characteristics received care and treatment in a timely and equitable manner as compared to patients without protected characteristics.

However, there were processes in place to support staff to deliver care and treatment that did not put other patients with protected characteristics at disadvantage. Staff said measures were in place to support patients with mental health conditions, this included support from the mental health liaison team provided by a mental health trust. There was guidance for the use of rapid tranquilisation and restraint, to ensure staff understood the legal framework for the use of them. Trust policy was that only security staff who had completed required training and the police could carry out physical restraint.

For patients living with dementia, staff had support and guidance form an Admiral nurse who was employed by the trust. Admiral nurses are specialist dementia nurses who predominantly provide free, expert advice, support and understanding to help families care for their loved one. The trust had employed an Admiral nurse to provide support and guidance to staff as well as to families of people living with dementia. The service used the nationally recognised “This is me” document. The ‘This is me' document helps health and social care professionals better understand who the person really is, which can help them deliver care that is tailored to the person's needs. It can therefore help to reduce distress for people with dementia and their careers. It can also help to overcome problems with communication and prevent more serious conditions such as malnutrition and dehydration. However, the use of this was not yet fully embedded into the service and the Admiral nurse was working with staff and dementia champions to address this. Dementia champions had been trained and were present throughout the service to also support this patient group. The trust had employed an admiral nurse to support this patient group and their families and were making meaningful impact in 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

Staff supported patients to make decisions about their care and treatment and their future. The service followed the Portsmouth Hospitals University NHS Trust Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policy. Compliance with the policy across the trust was audited in November 2024, with 50% of the records audited being in the medical and urgent care services The results showed improvements in form completion compared to the previous year and identified areas for further improvement, but no areas of concern, DNACPR forms we reviewed during the onsite inspection identified they were completed appropriately and where able included the patient in the decision making process.

Planning ahead for end of life which included patients’ preferences for place of care in last days or weeks of life and patients’ priorities at the end of life were predominately undertaken by the palliative care team. Anticipatory care forms were completed by clinicians on the trust electronic patient records system.