Queen Elizabeth Hospital

On this page

• 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

We looked for evidence that people had the best possible outcomes. We checked that people’s care, support and treatment reflected their needs and ensured people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At this assessment we rated this key question as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People using the service told us it was accessible and met their needs.

The service had processes in place to assess referrals to ensure imaging was appropriate, clinically justified and prioritised according to need. People’s needs were reviewed at booking, and where appropriate extended appointment times were offered to allow more time for staff to respond to and meet people’s needs.

Staff carried out pre procedure assessments to identify people’s clinical history, risks and any factors that could affect the imaging examination. The service assessed individual risks, including pregnancy status, allergies and safety considerations specific to the imaging modality required.

Most staff identified and responded to people’s communication and information needs, including those with sensory loss, cognitive impairment or a learning disability, and made reasonable adjustments where needed.

The service assessed pain, comfort and distress, and adjusted imaging procedures to support people who were anxious, uncomfortable or unable to tolerate standard positioning. We saw the use of positioning aids which helped people who were in pain to be able to tolerate the positioning required for a successful scan to be completed.

People with additional or complex needs were identified, and staff took steps to put appropriate support or adjustments in place.

Staff told us they had enough time to meet people’s needs during appointments.

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.

The service delivered imaging care and treatment in line with current legislation and national guidance, and recognised best practice. During the assessment we observed staff following safety protocols. Checks included confirming people’s identity and selecting ionising radiation exposure to be as low as reasonably practicable (ALARP), a risk management principle requiring that risks be reduced to the lowest level possible without the cost or effort being grossly disproportionate to the safety benefit.

Staff used up to date policies, protocols and clinical pathways to guide imaging practice across all modalities. We reviewed a selection of policies and found them to be up to date, have a review by date and were version controlled. The service had systems in place to review and update guidance in response to changes in evidence or national standards.

Imaging procedures were clinically justified, and staff followed agreed referral and protocols to ensure people received the right investigation at the right time. Staff were trained and competent to deliver imaging care safely and effectively in line with evidence-based practice.

Clinical audits and quality checks were used to monitor practice and support continuous improvement in imaging services. We reviewed the audits undertaken by the service and found them to have mostly been completed on time. The service completed an annual audit programme including for example, audits of MRI imaging for suspected cauda equina syndrome, skeletal survey reporting time from study to report, and GP compliance in paediatric neck ultrasound referrals.

Care and treatments were adjusted where needed to reflect people’s clinical needs and to support safe and effective outcomes.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked collaboratively across imaging modalities, including radiology, ultrasound, CT and MRI to meet people’s diagnostic and treatment needs. Clear lines of communication supported effective day-to-day coordination of activity.

The service had positive and constructive working relationships with external partners, which helped develop the service and meet people’s needs. Care was well coordinated between hospital teams and across the wider Trust. We observed staff discussing patients and heard there was good communication about people’s needs. This included effective coordination of care for people with learning disabilities. However, we were not always assured about the service followed their own processes for people who lacked capacity/ability to consent for imaging. Following an observation of an incident we saw during the assessment where we saw a patient who was nonverbal and unable to consent having a scan. We raised our concerns with the trust and were provided with their policy and reassurance in regard to this incident.

The service worked closely with referring clinical teams, including emergency care, outpatients, wards, and specialist services, to prioritise imaging requests appropriately and support timely diagnosis and treatment.

Information was shared effectively between staff to support continuity of care. Relevant clinical information, previous imaging results, and safety information were accessible to staff delivering care. This reduced the need for people to repeat their clinical history.

Staff worked closely with multidisciplinary teams (MDTs)including radiology and hospital wide specialty medical teams to support patient management. Imaging staff contributed to MDT discussions and provided timely reports to inform clinical decision making.

Clear escalation and handover arrangements were in place. Staff knew how to raise concerns, request urgent clinical input and escalate unexpected findings to relevant clinicians to ensure people received prompt care. Imaging results were communicated in a timely way to support safe onward care and discharge planning.

The service worked effectively with external organisations where required, such as community services, to maintain continuity of care and avoid unnecessary delays.

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, reduced their future needs for care and support.

Staff supported people to understand the purpose and outcomes of diagnostic imaging investigations. Information was provided in a way that helped people make informed decisions about their care and next steps in their treatment pathway.

Staff supported people to live healthier lives by delivering effective diagnostic imaging, recognising risks early and contributing to coordinated care that promoted positive health outcomes.

During the assessment of the service, we saw leaflets in waiting areas that provided information to support patients to live healthier lives.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were consistent, and that they met both clinical expectations and the expectations of people themselves.

The service monitored key clinical and operational outcomes, including image quality, reporting turnaround times and adherence to referral and screening pathways. This helped staff identify variation and take action to improve performance.

Quality assurance processes were in place to review the accuracy and quality of imaging and reports. This supported safe and timely diagnosis and helped ensure outcomes met recognised clinical standards.

The service reviewed performance data and audit findings to inform service improvement. Where shortfalls or risks to outcomes were identified, actions were taken and monitored to improve care. During one set of minutes re reviewed we saw a review of the getting it right first time (GIRFT) guidelines to ensure compliance procedures are met in regard to QA processes.

Outcomes were reviewed for different groups of people where appropriate, including those attending requiring repeat or complex imaging. This helped ensure outcomes were equitable and consistent throughout the service.

The service used internal and external benchmarking, where available to understand its performance and support improvement. The service had started work to join an accreditation scheme. For example there was confirmed by royal college and QSI that the trusts community diagnostic centre sites had met benchmark to qualify for QSI stamp accreditation, achieving this halfway through the process and therefore ahead of schedule.

Learning from audits, incidents and feedback was shared with staff. We reviewed the service’s newsletter where feedback was presented, and staff told us they found the newsletter was accessible and very informative. This supported continuous improvement and helped staff understand how their practice contributed to better outcomes for people.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

During the assessment of the service, we saw the majority of staff gaining consent from people to perform all types of diagnostic imaging procedures. The majority of staff understood the importance of consent and whether a person had the capacity to make a decision about undertaking a diagnostic imaging procedure. The service could raise any concerns they had to the referrer about a person’s capacity.

Staff generally understood how and when to assess whether a patient had the capacity to make decisions about their care. Mandatory training data we reviewed showed 99% of staff had completed training in the Mental Capacity Act (2010) (MCA) and Deprivation of Liberty Safeguards (DOLs). This meant that staff were able to assess a person’s capacity to provide consent.

However, on 1 occasion during our assessment we observed staff did not raise concerns about a patient who lacked capacity. The patient was also unable to verbally give consent for their diagnostic imaging procedure. We reviewed the patients’ record and there was no best interest’s decision-making process documented. We highlighted this concern to the service leadership who took prompt action to address this. We also found x-ray request forms did not have contact details of the referrer which would make it difficult to contact them if needed.

Staff explained imaging procedures, including the purpose of the examination, any associated risks (such as radiation exposure or contrast administration), and what people could expect during and after the procedure. Information was provided in a way that people could understand, allowing them to make informed decisions about their care.

The service respected people’s rights to give, refuse or withdraw consent. Staff understood that consent was an ongoing process and checked consent at the point of care, particularly where procedures were invasive or involved contrast agents.

Written consent was obtained when required, including for higher‑risk procedures, contrast‑enhanced imaging, and screening procedures. The approach taken was proportionate to the level of risk associated with the examination.

Reasonable adjustments were made to support people to understand and give consent. This included using clear language, allowing additional time, and adapting communication for people with sensory impairment, learning disabilities or those whose first language was not English.

Consent processes were supported by clear local policies aligned to national guidance. Staff were aware of these policies and could describe their responsibilities for obtaining and documenting consent.

People’s consent decisions were documented accurately in imaging records and booking systems. Records showed that consent discussions had taken place before procedures and that staff acted in accordance with people’s wishes.