Queen Elizabeth Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also ensured that people’s liberty was protected when it was in their best interests and in line with legislation.

At our last assessment, we rated this key question as requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

At the previous inspection the service was in breach of safe care and treatment in relation to medicines management. At this assessment, the service was in breach of safe care and treatment, relating to management of corridor care, risk assessments and infection prevention and control.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had a positive culture of safety and learning. The service fostered a culture of a no blame approach, which empowered staff to report any issues without fear of negative consequences. Staff understood their responsibilities to raise and record safety incidents, concerns and near misses, and were encouraged to do so by senior leaders.

Staff reported incidents through an electronic system which could be accessed via the trust intranet. This system was available to all staff, who also reported that they were debriefed and received support after a significant patient safety event.

The service ensured that lessons were learned, and improvements made when things went wrong. The service had a Patient Safety Incident Response policy in place which supported staff to identify which learning response would be the most appropriate depending on the patient safety event. These learning responses included patient safety incident investigations (PSII), after action reviews (AAR), case reviews, multidisciplinary (MDT) reviews, structures judgement reviews (SJR) and mortality and morbidity reviews. The service had reported 4 significant patient safety events in the past 12 months, all of which were under investigation as PSIIs, and none had exceeded the trust’s 6 month completion timescale.

Staff reported that they received feedback on incidents they reported, and learning was shared through handovers, emails, safety huddles and team meetings. The service also facilitated learning events where incidents, and the changes made as a result, were discussed. For example, we saw targeted training on recognising and responding to deteriorating patients using assessment tools and clinical judgement had been introduced following a serious incident. Staff also reported that a quality improvement (QI) project resulted in the introduction of a new type of dressings on the respiratory ward. The QI project was commissioned after staff observed an increase in pressure ulcers on patients ears due to their oxygen masks.

All staff we spoke with were aware of the complaints and compliments process. We observed posters on the wards advising people how they could make a complaint if needed. The service monitored complaints and made appropriate changes in response. An example of this was an increase in complaints from patients and their families about corridor care within the unit due to a lack of inpatient beds. In response, the service introduced a formal letter for all patients in corridors, explaining the reason for their placement and the plan going forward. The service reported a positive response from patients following to this introduction.

Staff understood the duty of candour. They were open and transparent and gave people and families a full explanation if and when things went wrong. The service completed formal duty of candour for incidents and had a 90% compliance in the last 12 months. The service did not identify the trust target.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. However, the service did not always ensure patients who were no longer suitable for corridor care were transferred in a timely manner and we observed breaches in length of stay in clinical areas.

Most patients were admitted to the service from the emergency department, while others were referred directly by hospital departments or their general practitioner (GP). Patients would either be sent to the acute assessment unit (AAU) or directly to a medical ward. The AAU opened in November 2025 and comprised several areas, including the Acute Assessment Unit (AAU), Frailty Same Day Emergency Care (Frailty SDEC), the Acute Frailty Unit (AFU), and the Acute Medical Unit (AMU). The area was a specialised short‑stay unit for assessing, diagnosing, and treating patients with acute illnesses before being discharged or transferred to an inpatient ward. Each area within the unit had defined inclusion and exclusion criteria and a targeted time for patients to stay (length of stay).

During the assessment we observed the longest length of stay within the unit was 7 days, which was outside the trust’s target of 3 days. The service had introduced patient flow co-ordinators to monitor and manage patient flow, who were available in the unit 24 hours a day, 7 days a week. Flow coordinators used the electronic bed system to monitor admissions into the area, transfers of patients to inpatients wards, and oversaw the discharge of patients. They were physically on the AAU every shift and monitored the electronic bed management system that all areas within the service had access to, to facilitate flow. Flow coordinators reported having good relationships with all areas to facilitate flow throughout the service.

February 2026 data showed that the average length of stay in AAU was 28.8 hours, against a target of 24 hours. The average length of stay in AFU and AMU was 72.2 hours, against a target of 72 hours. The service reported that the increase length of stay in AAU was due to patients being discharged directly from this area, as opposed to being transferred to an inpatient ward and occupying a bed for a longer period. This meant that although the length of stay was increased, discharges were being facilitated quicker due to increased medical staffing in AAU.

The trust had increased bed occupancy rates of over 96% between February 2025 and January 2026, which coincided with the national picture of increased demand for care. Trust-wide, there was an acuity tool, internal flow and escalation policy and multiple bed management and flow meetings throughout the day, to safely manage patient flow through the hospital. Due to ongoing national challenges with patient flow, staff reported that additional patients were sometimes cared for in areas designed to accommodate fewer patients. This was done through boarding, where additional beds were placed in bays or ward corridors. During the assessment we observed 4 wards boarding patients. Data showed the number of patients using escalation beds was 274 in November 2025, 277 in December 2025 and 577 in January 2026. This data showed an increased demand on the service, particularly in January 2026.

The decision to initiate corridor care was made by senior leaders, who followed the trust policy process which includes a risk assessment for each patient. According to the trust, patients being cared for in a corridor should have a regular risk assessment completed. This included but was not limited to assessing whether the patient was suitable for the area, privacy and dignity was maintained, there was access to a call bell and locker and whether routine observations were carried out. Evidence submitted by the trust showed that these risk assessments were completed regularly. However, transfer of patients who began to deteriorate whilst being boarded in corridors was not always done in a timely manner. During the assessment we observed a patient who was originally assessed as suitable for corridor care deteriorate. Due to lack of capacity within the service the nursing team were unable to move the patient to a patient designated area immediately, which impacted the patient’s dignity. This was escalated to the nurse in charge, and the patient was appropriately moved to an inpatient bed.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. Each clinical area held daily multidisciplinary board round meetings where patients were discussed in detail including their discharge plans. We observed a board round meeting which was led by the nurse in charge and included representatives from the nursing, therapy, medical and discharge teams. Patients’ needs were thoroughly assessed and discussed at the meeting, and support for discharge was identified early and actions put in place. We observed how the team spoke respectfully to one another and were knowledgeable about each patient's individual circumstances and took early action to prevent issues with discharge.

The service used an electronic patient notes system that was used across the wider trust. This meant all staff could access patients historic and current care records securely and instantly. Staff also had access to diagnostic testing, which were requested via an electronic system and staff did not report any issues with access or delays.

Staff planned for patients’ discharge; the trust had a discharge team and a transfer of care team to facilitate discharges and reduce readmissions. Both teams liaised with clinical staff, social services, local authorities daily, to facilitate discharges to the community, care homes or specialist units. Electronic discharge summaries were provided to appropriate care providers on discharge to inform them of the patient’s admission to hospital, medications, and any follow up care that may be required.

Data showed that the service was able to consistently discharge over 80% of patients before 5pm between November 2025 and January 2026. Delayed discharges were monitored. The average delay for patients, after being declared medically fit for discharge was 6.6 days in September, 6.3 days in October and 6.3 days in November 2025, against a trust target of 6.5 days. Staff reported the most common reasons for delayed discharges were lack of appropriate placement in the community including rehabilitation placements and social issues.

The service had an ongoing action plan in place to avoid delayed discharges. This included but was not limited to the development of a weekend discharge planning structure, introduction of 7 day working for social care and discharge teams and the introduction of a new discharge system.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately.

Staff knew and understood how to identify people at risk of, or suffering, significant harm and worked with other agencies to protect them. Staff we spoke with could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

We observed patients with vulnerabilities such as safeguarding needs, specific mental health needs, learning disability needs, autism and cognitive impairment being identified in patient notes. The trust had a safeguarding team in place, and staff knew how to contact them for advice and support. They also knew how to make a safeguarding referral.

The trust had a Safeguarding Adults policy and a Safeguarding Children, Young People and unborn policy in place both of which were in date and comprehensive. Staff had a good understanding of deprivation of liberty safeguarding practices (DoLS) and the mental capacity act (MCA). Staff were able to show us completed DoLS forms on electronic patient records (EPR) and could explain how they were managed.

The service provided safeguarding training on how to recognise and report abuse and had the appropriate level training for their role. Overall staff compliance with safeguarding adults training level 1 to 3 was 94% and 91% for children and young people level 1 to 3. Both of which exceeded the trust target of 90%. However, within the figures we noted areas of poor compliance particularly for rotational medical staff and neurology nurses who both had 70% compliance. In response to this the service reported that they had sent a reminder to the leads for all areas and temporary bank staff.

The trust provided MCA and best interest training as part of mandatory training, with compliance exceeding the trust target of 90%. The trust is also providing Oliver McGowan training. Compliance for tier 1 and tier 2 training was 88% and 60% respectively, both of which met the NHS England (NHSE) target of 30% by the end of April 2026.

Staff provided care to meet people’s needs that was supportive and enabled people to do the things that mattered to them. However, risk assessments were not always completed in line with trust guidance.

Staff had access to policies and procedures to support them with assessing risk of harm and deterioration of patient’s conditions, which included the type of risk assessment and how often they should be carried out. However, staff did not always complete risk assessments for each patient using nationally recognised tools.

Risk assessments included, but were not limited to, falls prevention and assessment, pressure ulcer, waterlow, sepsis and pain. We reviewed 7 patient records which showed good compliance with risk assessment completion. However, audit data showed falls prevention and assessment compliance was 72% in November 2025, 58% in December 2025 and 63% in January 2026, which was below the trust target of 90%. The service had an action plan to address the poor compliance. This included but was not limited to the introduction of ward-based education sessions, daily spot checks by senior nurses and development of fall prevention champions for each ward.

Audit data for pressure ulcers also showed poor compliance of 63% in December 2025 and 64% in January 2026. The service had an action plan to address the poor compliance. This included but was not limited to increased senior oversight through daily audits.

Staff we spoke with reported that they received up to date training on sepsis and the management pathway for patients with septic symptoms. However, we did not observe any patient notes that required this pathway to be triggered, and the service did not provide sepsis audit data. This meant that we could not be assured that the service was adhering to national guidance of sepsis management.

Staff used a nationally recognised tool to identify deteriorating patients. The National Early Warning Score (NEWS2) was used in the service to identify patients at risk of deterioration. NEWS2 charts reviewed during the assessment were completed, scored and escalated appropriately if required to medical staff. Audit data showed over 90% compliance between the months of November 2025 and January 2026. However, we observed a patient’s notes with an increased NEWS2 score with no record of escalation to medical staff.

Patient pain levels were documented in all patient records we reviewed. Audit data showed pain assessment compliance was 88% in December 2025, 98% in January and 97% in February 2026 against a 90% target.

Staff communicated with patients and their families so that they understood their care and treatment, including finding effective ways to communicate with people with communication difficulties. Staff informed us that translation services were available for people whose first language was not English, as well as hearing loop availability for people with hearing impairments. All patients and families we spoke with told us they were involved with the decision making about their treatment.

Systems were in place for patients and their families, friends, or carers to escalate concerns about their conditions. The service had implemented ‘Martha’s rule’ which allowed patients and their families to contact the critical care outreach team, if they felt their condition was getting worse and was not being addressed by the staff on the ward. Posters advertising this service were visible on the wards however, this was only available in English. Which meant patients whose first language was not English may not utilise this function if required.

The design of the environment followed national guidance. However, staff did not follow national fire safety guidance.

Fire safety risks were not always mitigated in clinical areas. We observed the door to the dirty utility room, which was also a fire door, being wedged open. This was not in line with national guidance as this was a fire door and should have been kept shut at all times. We also noted that the utility room was overloaded with boxes and equipment, which was another fire safety risk. This was escalated to the nurse in charge, and the fire door was immediately closed, and staff attempted to arrange the room appropriately. We also observed a fire exit within a clinical area being obstructed by a bed, and saw this was resolved by moving the bed to an appropriate location. However, the service did have an in-date fire safety policy, and each area had a fire safety folder which included a fire safety risk assessment.

We also noted that an inpatient ward had not completed the recommended actions in response to a ligature risk assessment. This was escalated and the service reported that the emergency response to a self-harm attempt and the location of ligature cutters were being discussed at staff huddles.

Doctors reported space constraints in clinical areas and difficulties with clinic room availability. We observed this concern being discussed at the January 2026 divisional governance meeting, which reported that the trust was reviewing space utilisation.

Patients could reach call bells and staff responded quickly when called. We observed staff ensuring all patients had call bells within reach as well as other equipment, for example walking aids. Patients we spoke with told us staff mostly responded to them quickly.

The design of the environment followed national guidance. Security arrangements were in place to ensure only authorised personnel entered wards. Staff gained access to wards and clinical areas with electronic swipe cards. Visitors gained access using an intercom system, which enabled staff to monitor visitors and patients entering the wards.

All wards we inspected were arranged to ensure separate male and female bays, with separate toilet and washing facilities allocated to each bay. Piped or portable oxygen and suction equipment were available at each bed space.

Staff generally carried out daily safety checks of specialist equipment. Emergency equipment was easily accessible and were available on each ward and clinical area. There were tamper proof tags on the drawers used to store equipment and medication. Checks were recorded electronically and compliance was monitored by management. Resuscitation equipment we reviewed onsite were checked daily and all items were present and in date.

The maintenance and use of equipment kept patients safe. Electrical appliances and equipment we checked during the inspection had been tested and serviced to ensure they were safe to use and had stickers with appropriate dates to show that this had taken place.

Staff managed clinical waste well. Waste management was handled appropriately with separate colour coded arrangements for general waste and clinical waste. Sharps, such as needles, were disposed of correctly in line with national guidance. We observed cleaning equipment stored securely in locked cupboards.

However, we noted that an inpatient ward had not completed the recommended actions in response to a control of substances hazardous to health (COSHH) risk assessment conducted. This was escalated and the service reported that ward managers were working with the health and safety team to close all actions, with a target for completion in March 2026.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

Medical and nursing staffing met planned numbers on both days of the assessment. Staffing charts were clearly displayed on all wards, showing both the planned and actual staffing levels. Trust data showed staff fill rates were consistently over 100% between September and November 2025.

The service planned and regularly reviewed staffing levels and skill mix to ensure people received safe care and treatment. Leaders used recognised staffing tools to ensure that there was enough staff to deliver care and treatment and completed a staffing exercise biannually. However, staff did not always feel that the staffing exercise and adjustments to staffing as a result were always reflective of the clinical pressure. Staff felt comfortable raising their concerns to senior leadership and leaders adjusted the staffing template where possible after consultation with staff.

Staff reported that temporary staffing was used to cover consultant vacancies. The vacancy rate for consultants was 11% as of October 2025, which exceeded the trust target of 10%. The current average vacancy rate for nursing and medical staff within the service was 10%, which met the trust target.

Senior leaders reported that they are currently recruiting which should mitigate against some of the vacancies. Bank and agency staff received induction to the service and told us they regularly worked at the service as their preferred temporary employer.

Medical staff reported that there was adequate 24-hour medical cover. Data submitted by the service showed medical cover between 12am and 8am was 96% in November 2025, 86% in December 2025 and 99% in January 2026. This was an improvement from the last inspection in 2020.

All staff we spoke with told us they enjoyed working at the service. The staff turnover rate within the service was 9.25% in September, 9.13% in October and 9.32% in November 2025, which was below the trust target of 9.5%. The current average sickness rate for nursing and medical staff within the service was 4%, which was in line with the trust target of 4%.

Staff had received and were up to date with appropriate mandatory training. Mandatory training included topics such as conflict resolution; equality and diversity; fire safety; health and safety; infection control; information governance; medicines management and moving and handling. Mandatory training compliance for all staff was 91% which exceeded the trust target of 90%. and was an improvement from the last inspection.

All staff we spoke with told us they received yearly appraisals. Appraisal compliance for all staff was 94% which exceeded the trust target of 90%.

The service did not always manage the risk of infection spreading.

Staff did not always follow infection, prevention and control (IPC) principles, including the use of personal protective equipment and being bare below the elbows. Patients with infections were nursed in side rooms with appropriate signage displayed to reduce the risk of spreading infection. Apron and gloves were stationed near to all side rooms to ensure that both patients, relatives and staff were protected. However, we observed staff entering side rooms without using the appropriate personal protective equipment (PPE).

Hand hygiene signage was displayed throughout wards and the service regularly audited hand hygiene. Hand hygiene data between November 2025 and January 2026 showed an average of 95% against a trust target of 95%. However, during the assessment we observed staff members were not always bare below the elbow, and some staff had false nails, which is against the Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance. This was escalated to senior leaders on the first day of the assessment and we observed a reminder being given to staff at handovers the next morning.

Clinical areas were not always visibly clean. Cleaning was carried out against a cleaning schedule and records we reviewed were up to date and demonstrated that all areas were cleaned regularly. However, we observed trolleys with visible layers of dust, clinical areas with blood on the floor and a door to a dirty utility area being left open. This was escalated to senior management and rectified immediately. The service had suitable furnishings which were well-maintained.

The trust monitored key metrics in relation to infection rates, including Clostridioides difficile (C. Difficile), Methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli (E. Coli). In November 2025 the trust reported 2 cases of C. Difficile, 0 cases of MRSA and 4 cases of E. coli. All cases were monitored and managed in line with the trust policy.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines, including controlled drugs, were stored in secure storage areas with access restricted to authorised staff.

In records we reviewed, we saw that people received their medicines as prescribed, including medicines that were time sensitive.

We also saw the Venous Thromboembolism (VTE) assessments were completed and prophylaxis prescribed where appropriate. Staff recorded information about patient allergies.

Wards were supported by pharmacy team members including pharmacists, pharmacy technicians and pharmacy assistants. Whilst there was not always enough staff to support every ward, the service used a flexible cluster support system to direct clinical support the areas that needed further support. There were twice daily meetings to discuss areas of need, learning and ad-hoc training. The pharmacy team support was embedded on the wards. We saw positive interactions and interventions from the pharmacy team with ward-based staff. On all the areas we visited, people’s medicines were reconciled in line with national guidance. (Medicines reconciliation is the process of accurately listing a person's current medicines and comparing them with the current list in use to reduce the risk of medicine related patient safety incidents). Evidence provided by the service showed that they performed generally well across the hospital in regard to medicines reconciliation. According to data provided by the trust, 70% of patients had their medicines reconciled within 24 hours of being admitted. Where people did not receive medicines reconciliation, pharmacy technicians supported timely completion of drug histories and prioritised patients for further review.

We saw that medicines to take away (TTAs) were supplied in a timely manner. We saw that the pharmacy department consistently met trust targets for timely turnarounds of TTA medicines. The service used satellite dispensaries to support people being discharged in a timely manner. However, staff told us that pharmacy space was limited and this could affect capacity to safely dispense medicines.

Staff told us they could access medicines they needed in a timely way, including medicines that were not routinely stocked. The service had a process for staff to obtain medicines during out of hours.

People were offered regular pain relief. We saw that the service completed regular audits around pain management where most areas scored consistently above the service target of 90%.

The service completed regular quarterly audits and medicine management compliance checks. We saw that areas that were not compliant were discussed at the medicines management working group with actions to improve in non-compliant areas.

Staff told us they had access to trust medicines guidelines and policies. They had also access to medicines related national guidance and resources.

Staff received regular and ad hoc training medicine related training including weekly focussed sessions held on teams. Pharmacy team members were supported to develop and supported to complete clinical diplomas.