Queen Alexandra Hospital

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people and staff did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 60 (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 2. The evidence showed some shortfalls. Service treated people with kindness, empathy, and compassion. However, they did not always respect their privacy and dignity.

Staff maintained the confidentiality of information about patients where possible, but this was not maintained throughout the service. Due to the lack of flow from the adult waiting area, some patients told us how staff had spoken to them or taken readings such as blood pressure, in the waiting area where this could be seen and heard by other patients. This meant staff were not always able to maintain privacy and dignity.

In escalation areas when personal care and examinations were required staff tried to move patients into the assessment bay, however this was not always possible. We also heard how if this area was used it reduced the ability to rapidly assess patients as they came in from ambulances. Although privacy screens were available, we heard how these were cumbersome, ineffective and seldom used. We saw patients on trolleys in these areas through our assessment. We heard from staff how patients could spend up to 20 hours in the corridor on a regular basis. Staff told us, if patients were particularly elderly, then a bed would try to be sourced for them instead of a trolley. However, these could not be kept in the corridor because it was not wide enough, this meant moving other patients from majors onto the corridor. Additionally, escalation areas had insufficient facilities for the number of people being cared for. For example, there was one toilet, no handwashing facilities and no sanitation pumps in the corridor.

On the third day of our assessment there were 11 patients in the corridor receiving care, 2 of whom had a ‘decision to admit’(DTA) of 9 and 14 hours respectively. An DTA means a clinical determination has been made that a patient requires admission to the hospital for treatment. This meant patients could spend long periods of time in areas of the department that did not enable staff to provide care with dignity and privacy. Staff and leaders acknowledged the difficulties in ensuring that dignified care was always upheld for patients in temporary escalation areas.

We also heard how communication between departments when signposting patients could be clearer. One patient told us how they had presented to the adult emergency department and were redirected to the Onsite GP. They were then advised that this service was too busy but as their presenting complaint was urgent, they were redirected to the Emergency Care Centre. This added to their anxiety and stress, and they had to explain their condition multiple times and attend 3 different buildings which with their condition meant they felt ‘exhausted’ moving between them.

We also heard from staff in other streaming areas how patients redirected to their area from the main emergency department had become frustrated by multiple triage assessments and they had to send patients back to the main department due to them not fitting the criterion for admission. The GP streaming service was also unable to access the monitoring system that showed capacity demands and therefore could not respond to increase in this.

Patients and their families told us they felt there were long periods of waiting where they did not know how long their next interaction would be. We heard how patients who were attending alone were not able to use the toilets in the waiting area as they had seen other patients miss their turn. We also heard that at times of high capacity, seating would become scarce, and they felt unable to use a bathroom for fear of losing their seat.

Overall, patients were positive about staff and the service. Patients said staff treated them well and behaved appropriately towards them. All patients we spoke with told us how kind and considerate staff were. We heard a patient who told us how staff ‘Talk things through and take time to ensure I understand”.

The trust provided patients with a ‘friends and family test’ (FFT) to rate their experience of the service. In April 2025, around 79% of patients had a good experience of the Emergency Department.

We saw how all staff interacted with patients with kindness and respect. This was seen in all areas from reception to admission. Staff were discreet, respectful and responsive. They provided patients with help, emotional support and advice at the time they needed it.

Staff supported patients to understand and manage their care, treatment or condition. We saw staff explaining to patients the procedures they were undertaking and ensuring they understood. A patient told us how “Staff have been amazing, telling me what’s going on”.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They mostly took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The service made adjustments for some patients – for example, by ensuring people’s access to premises and by meeting patients’ specific communication needs. Signage within the department was clear and met accessible standards for those with visual impairments. Signs were printed in braille to support patients who needed this. Wayfinding signage was in colours that supported people who might struggle to read easily.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, and how to raise a concern.

Managers ensured that staff and patients had easy access to interpreters and/or signers. Staff made information leaflets available in languages spoken by patients.

The information provided was in a form accessible to the particular patient group such as in large print font. Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. Staff ensured that patients had access to appropriate spiritual support.

However, access to the learning disability liaison team and relevant resources was limited. The service was provided by another NHS trust but had only been contracted by the trust to provide a service of 2 staff, 30 hours a week spread over 5 weekdays. This team did not provide support to patients with autism. They were also unable to use systems to identify patients before they were admitted to a ward. This increased the risk that due to lack of support and resources, patients with a learning disability or autism might not have their immediate needs met appropriately on initial presentation to hospital.

We scored the service as 2. The evidence showed some shortfalls. The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment, and wellbeing.

We spoke with multiple specialist teams of staff who worked to alongside the trust to support their patients in the emergency department. We heard how education sessions and teachings had improved staff awareness on how to support patients suffering with their mental health. The trust had used a mobile simulation environment to improve understanding of dementia patients and staff spoke proudly of the impact this had on staff. The dementia team also us meaningful trust wide learning had given staff a better understanding of the needs of this group of patients. However, when we asked about additional resources for dementia patients in UEC, such as fiddle mitts, staff were able to locate these.

We also saw no evidence of how adults with a learning disability were supported while in the UEC department. Staff were also unable to locate resources for adult patients with a learning disability. We were told how if additional resources were required, they could be sourced from the paediatric emergency department (PED). However, staff within PED told us that they were reluctant to loan expensive pieces of equipment as these were often damaged as they were not being used for the demographic of patients they were intended for. We also heard how face to face training around this group of patients was no longer a part of staff induction. Staff from the LD team told us they felt this reduced the understanding of this group of patients among staff and the decision to end this training had not been communicated with them. This meant patients with learning disabilities and autism may not always have their individual needs met or supported.

The emergency department had access to interpretation and communication services to facilitate contact with patients. There were hearing aid loops and interpreter sheets. We saw that signage on doors and to direct patients and families had braille text and featured colour grouping to support those with visual impairment. This meant this group of patients were supported to understand their rights, care and treatment by using different ways to communicate.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern, or distress.

Staff provided emotional support to patients, families, and carers to minimise their distress. They understood patients' personal, cultural, and religious needs. Staff gave patients and those close to them help, emotional support and advice when they needed it. All contact between staff and patients was conducted professionally, sensitively and in a way which respected confidentiality and the emotional wellbeing of both patients and their relatives and carers.

In the adult urgent care waiting area there was a ‘changing places’ bathroom to support adults and their carers with essential personal care. This space was also used for when patients presented with severe chemical or heat burns to support rapid cleansing of skin.

Within the paediatric emergency department (PED) there was a separate room for patients with specific sensory needs, equipped with specialist audio visual equipment. We heard how this could be used by children, and their families should they require it. There was also a well-furnished family room in this area for them to take a break or step away from the clinical space for some quiet reflection.

Within the PED there was a well-equipped play area for patients to use while they are waiting for review or investigations. There were also at least three portable games consoles for older children. We spoke with staff who were proud of this area and how it supported patients. However, staff said the lack of plug sockets in this area meant that a newly purchased interactive floor projector, which staff had worked hard to gain funding for, could not be used in the department to benefit children who were waiting for treatment. The service had also failed to provide sufficient or dedicated storage areas for essential resources used by play therapists. Play therapists help children process difficult emotions and experiences, like trauma, anxiety, or grief, through play.

We observed how staff always introduced themselves and established a warm relationship with their patients. Staff across all professions demonstrated caring and compassionate attitudes towards patients.

Staff followed ‘Care After Death’ national guidance standard and had a trust policy which supported this. This provided guidance which included religious / cultural variation requirements, medical and legal processes, death certification and mortuary requirements, the SWAN model of care, and provided detailed information for families.

There was a well-designed and furnished space for families to spend time with a loved one after they had passed away. We saw that this had been well designed to support families and loved ones in times of distress. There was a good stock of memorial keepsake items that would be supplied to families. This area was well positioned to ensure maximum privacy. Staff however raised concerns that the tannoy system for the department was active in this area. This meant calls for staff were broadcasted through speakers in this area and could cause distress. However there had been no known instances of families and loved ones using the room while announcements were made.

We scored the service as 2. The evidence showed some shortfalls. The service did not always care about and promote the wellbeing of their staff. This did not support or enable staff to deliver person-centered care.

Staff felt respected, supported and valued within their immediate team. However, throughout our assessment we heard how staff felt that leaders did not recognise and act upon the risks and pressure felt within the department. We heard how concerns had been raised regarding escalation areas and although these had been heard staff saw no changes to improve this or wider recognition throughout the trust of shared responsibility of risk. We heard from a staff member how they could ‘no longer cope with caring for patients in non-dedicated clinical areas and it is breaking me mentally because I can't look after patients well enough’. We heard staff use phrases such as ‘burn out’ and ‘overwhelmed’ to describe their feelings around work pressures.

We also heard how staff wellbeing was poor, particularly when they held patients overnight in areas that supported the main emergency department, and due to the continued use of escalation areas. Staff felt the pressures to get areas cleared of patients the following morning and concerns around job security were adding to this. Concerns around staff wellbeing was also reflected in management meeting minutes.

The service’s staff sickness and absence levels were similar to the provider average. Staff had access to support for their own physical and emotional health needs through an occupational health service.

The provider recognised staff success within the service through staff awards and team praise. Staff appraisals included conversations about career development and how it could be supported.

There was a wellbeing hub for staff and access to a variety of wellbeing services such as physical wellbeing support with a physiotherapy service, occupational therapy, weight management, stopping smoking, keeping fit. There were mental health wellbeing service providing stress management, staff psychology service, counselling, wellbeing hubs, access to NHS digital applications and national support services. Financial services were available to staff with cost of living advice, money saving tips, support accessing food banks, NHS discounts, salary sacrifice, and opportunities to access financial support. There was access to Freedom to Speak Up Guardians, a pension scheme and advice service, retirement scheme and advice, pastoral and multi-faith support were also available.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences. We also saw evidence that staff would report violence and aggression towards them from patients, and this would be investigated.