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 requires improvement. At this assessment the rating remained requires improvement. This meant people's needs were not always met.

The service was in breach of legal regulation for 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.

The service did not consistently make sure people were at the centre of their care and treatment choices. The environment of the paediatric ED was well designed for younger children. Children could watch programmes on the television in the waiting area. Soft seating areas meant they could move around easily without risk of injury. There were ample play resources. There was water and juice available for children and parents. Snacks were also provided by a local charity. There was a dedicated play specialist within the paediatric ED who was dedicated and passionate about providing children with a wide range of resources while they were in the department.

However, a dedicated waiting area for older children and teenagers, was small and poorly designed with no resources beyond a television. The area had windows on 3 sides which offered little privacy and dignity. During our inspection, we saw that the television in this area did not function. We also heard how staff and families had raised concerns that it could not be used as the surrounding windows meant younger children could also see this television which restricted the programmes teenagers and young people could watch. We heard how a young person’s feedback session had been held prior to the new department opening to determine the resources this group felt would be beneficial, however staff who undertook this work felt that there was little evidence this was considered when the waiting area was completed.

Specific patients’ needs were identified on the electronic patient record. This allowed red flags to be placed on the patient record for patient with additional needs such as dementia. Staff knew how to contact the dementia care specialist nurse for support. However, time limitations meant staff were not always able to take meaningful action to support individual needs. Patients living with dementia should ideally be placed in high visibility calm areas to enable good oversight of their needs. However, during our assessment, we saw patients with dementia placed in escalation areas, this did not meet their needs.

There was also no system for flagging patients with a learning disability (LD), and specialist teams were unable to access UEC patient systems. Patients were encouraged to use a hospital passport which helped inform hospital staff about the needs of the person with a learning disability and how to support them.

The LD liaison team said that all departments 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. Staff were familiar with the use of hospital passports; however, staff did not have awareness of where LD resources were located. 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.

In addition, they were contracted only to provide support for patients who had a diagnosed learning disability and who had an IQ 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 resources for patients with a learning disability. 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 presentation and once admitted to the hospital. This meant the service lacked the capacity to provide care for patients with these needs.

In the CQC UEC Survey 2024 in response to the question ‘did you have confidence in the health professionals treating you’, the trust measured above the national average. Additionally, in relation to the question, ‘were you involved as much as you wanted to be in the decisions about your care and treatment’, the hospital scored better than national average. This meant that for some patients, staff empowered them to make their own decisions about their care and treatment.

Multidisciplinary team reviewed and planned care for complex patients and people who attended the department often. This was in line with The Royal College of Emergency Medicine (RCEM), Best Practice Guideline, Delivering Interventions and Services for High Intensity Use Frequent March 2024.We heard how specific alerts on electronic care records for high intensity users, allowed their presentations to be audited and multidisciplinary team meetings to take place involving learning disability and Alcohol Liaison Services to plan for future attendances.

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.

Patient notes were shared across hospital systems to ensure they were accessible to both medical and nursing teams, this supported cross-team integration. GP and pharmacy services were provided with discharge information to support ongoing care.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. We were told how staff could refer or redirect patients to other services such as:

• Other services within the Organisation such as Older Persons Medicine, Maternity, Palliative Care, & Alcohol Team
• Charitable Organisations
• Counselling Organisations
• Community Services
• Social Care
• High Intensity User Groups (supporting those that attend ED frequently using a multi-agency approach)
• Schedule outpatient follow-up (primary care, palliative care, or social services).
• Offering contact information for services that can support life transitions (housing, transportation, disability services).

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.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, and how to raise a concern. Information provided was in a form accessible to the particular patient group (for example, in easy-read form).

The trust provided information leaflets available in languages spoken by patients. Information governance systems included confidentiality of patient records. Staff made notifications to external bodies as needed.

Staff ensured carers and families were regularly updated about the patient’s progress. Due to the size of the department, reception staff provided visitors with wayfinding tickets which directed them to the area their loved one was in. This made it easier for any members of staff subsequently asked for the location of the patient, as the details were on the ticket.

Staff were responsible for providing discharge advice and ensured it was in an accessible format for the patient. When altering or adding medication, this was written down for the patient as well as communicated to their GP via electronic discharge letter sent straight to the surgery. The hospital provided clothing for patients who may be unable to leave in the items they were brought to hospital in.

We scored the service as 2. The evidence showed some shortfalls. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. However, they did not always tell them what had changed as a result.

Patients knew how to complain or raise concerns. Staff knew how to handle complaints appropriately. Staff protected patients who raised concerns or complaints from discrimination and harassment. Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs.

Staff received feedback on the outcome of investigation of complaints and acted on the findings. We saw how changes in requests for bloods, and the way prescription information was presented had changes implemented, following concerns raised by patients.

Patients and their families could give feedback on the service, and their treatment and staff supported them to do this. There was a ‘wonder wall’ in the main hospital building where patients could post praise around their care. The hospital policy aimed to complete complaint investigations and complete final sign off within 35 days. However, 8 complaints from February 2025 had not yet been closed and exceeded the expected resolution timeframe. When patients complained or raised concerns, they did not always received feedback in line with the hospitals’ own policy. These were missed opportunities for the hospital to make improvements and involve patients in this.

Within the children’s emergency department there was a board where children and parents could say what they felt had been ‘Tops’ or ‘Pants’ about their experience. This showed equal amounts of positive and negative feedback. There was also no evidence of how this feedback was acted upon. In addition to this the ‘You said, we did’ board in this area had not been completed and was blank.

Leaders had access to the feedback from patients, carers and staff and this was used to monitor themes and implement changes. However, we did not see evidence that demonstrated how these theme and trends were acted upon more broadly.

We also heard how patients and carers were not always fully utilised in decision-making about changes to the service. Staff told us how listening events had been used to determine user needs for spaces such as the young person’s waiting area and the MH assessment areas. We heard how these spaces had been designed with little consideration of these views, and it was not clear how they considered user voice.

We also heard how patients and carers were not always fully utilised in decision-making about changes to the service. Staff told us how listening events had been used to determine user needs for spaces such as the young person’s waiting area and the MH assessment areas. We heard how these spaces had been designed with little consideration of these views, and it was not clear how they considered user voice.

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 and their families we spoke with told us about long wait times they had experienced whilst in the emergency department. Patients waited long periods of time in the department after the decision to admit had been made. People and their loved ones told us that more clarity regarding wait times for admission to ward areas would have helped manage expectations and relieve any uncertainties they had.

People could not always access care, treatment, and support in a timely manner due to capacity constraints and patient flow across the hospital. The hospital operated in accordance with the Operational pressures escalation levels (OPEL) in conjunction with the continuous flow policy to support rapid discharge and movement throughout the hospital. However, throughout our inspection we saw evidence that this patient flow was not achieved in the department. This meant that this policy did not achieve the outcomes it was designed to achieve and patients waited longer in the department before moving to a ward.

We scored the service as 2. The evidence showed some shortfalls. Staff and leaders did not always actively listen 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.

Patients with a learning disability were at risk of poorer experience because access to the Learning Disability Liaison Team was limited. The team supporting this patient group lacked the capacity to support all patients within the trust, so local level staff were key in ensuring resources and support was available. The trust did not develop learning disability local roles, and this meant local level knowledge on supporting these patients was not always available. Leaders told us that these roles would be relaunched, and staff supported to attend.

There was also 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 had 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.

The trust had also failed to respond and act on concerns that spaces designed for vulnerable patients in times of mental health crisis, did not meet Psychiatric Liaison Accreditation Network (PLAN) standards and posed an ongoing risk to patients. These standards provide benchmarks for best practices in psychiatric care, aiming to improve patient experience and treatment outcomes.

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

Staff within the service and the wider organisation promoted a culture in which people using the service felt empowered to give their views but it did not always actively listen to them for all patients.

Staff were trained in equality, diversity, inclusion and human rights as part of mandatory training and 96% of staff had completed this.

We heard how dementia champions had been trained and were present throughout the service to 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.

Due to the dynamic environment of a UEC, supporting patients with life changes and life planning was not always achievable. Staff told us how patients who were on EOL pathways would be prioritised for admittance on to the most appropriate ward. Where possible the department used resources to support life planning.

Multi agency working ensured care for people who are nearing the end of their life was managed and communicated in a sensitive and dignified way. There were chaplaincy services available for all patients and their loved ones if required.

Patient discussion and their wishes along with registering referrals to services were recorded in patient’s electronic notes and where possible information for services would be given to patients and their relatives.

We heard how staff looked for triggers that patients may require support with wider life changes. These included

• Chronic or life-limiting illness
• Frequent ED visits
• Serious diagnosis or new disability
• Geriatric patients or those with cognitive decline

Staff ensured all relevant healthcare professionals and other relevant bodies were involved. Where appropriate, staff could refer or redirect patients to other services in planning their care and treatment.