Queen Elizabeth 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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected characteristics.

At our last assessment, we rated this key question as requires improvement. This key question has improved and has been rated good. This meant people’s needs were met through good organisation and delivery.

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.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Most patients described staff as kind, respectful and focused on what mattered to them. Clinicians generally explained care clearly and checked understanding, helping people make informed decisions. Patients said they felt listened to, and staff adapted care to individual needs, including arranging translators when required. One patient with rheumatoid arthritis told us she consistently received a next‑day appointment when she called for support, which helped her feel in control of her care.

People with learning disabilities received personalised adjustments that supported choice and involvement. Staff told us that they used patient passports to understand individual communication needs, clinical histories and personal preferences, particularly for people with learning disabilities, autism or complex needs. These passports helped staff adapt their approach, including allowing extra time, reducing sensory triggers, using visual prompts or adjusting the order of procedures to help the patient feel calm. Staff told us these documents helped them avoid repeating distressing questions and ensured they did not overlook important details about how each person preferred to receive care. However, examples of passport use were not available for review at the time of this inspection. Learning‑disability liaison nurses also told us that helped staff use simple language, speak at eye level and involve carers in discussions. Carers described staff as patient, kind and reassuring, and these adjustments helped patients understand and agree to treatment. The OPD also accommodated people who used wheelchairs or required specialist equipment, demonstrating strong partnership working and a commitment to shaping care around individual needs.

Holistic Needs Assessments helped people discuss what mattered to them at key points in treatment and supported personalised care planning that considered physical, emotional and social needs. Staff held supportive conversations and signposted people to local services, helping ensure care fit within the context of people’s lives.

However, some people did not always find the OPD environment easy to use, which affected how person‑centred the experience felt. Confusing signage, unclear reception layouts and unreliable self‑check‑in kiosks made it hard for some to navigate independently, and older patients in particular reported feeling unsure about where to go without staff support. Some people also received repeated appointment texts and letters, which caused confusion and did not meet individual communication needs.

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.

The service used clear systems to support integrated, patient‑focused care, including face‑to‑face, telephone and video appointments to meet individual needs. These virtual options helped people avoid travel, reduced late arrivals linked to parking concerns and supported continuity for those who struggled to attend in person. Clinicians were expected to plan and record outcomes in real time so that follow‑up care could be booked before patients left clinic, supporting smooth transitions between appointments.

The booking office worked across both hospital sites to manage new and follow‑up appointments by using referral systems and patient-initiated follow-up (PIFU) pathways to direct patients to the right service at the right time. Where patient needs changed, some clinics offered short‑notice appointments when a condition worsened, helping people receive timely review. Weekend clinics were also used for urgent demand, fast‑track pathways and elective recovery, helping patients avoid long waits.

The service monitored attendance and non‑attendance closely. Data from booking systems was used to identify trends in DNA and barriers to attendance, which supported services to adjust clinics or offer alternative appointment types. The structured 6‑4‑2 process and weekly room audits helped ensure clinics had the space, staff and records they needed so that appointments could run safely and efficiently.

However, some areas of care did not consistently meet expected standards. During the assessment, several clinics were running considerably behind schedule, including long waits in the phlebotomy area. Leaders were aware of these delays and had begun planning improvements to clinic flow. Some staff highlighted that OPD services had previously struggled with responsiveness and punctuality, and that the department continued to face pressure from high demand and complex pathways. Some patients faced delays or confusion because clinic space was not always used efficiently, particularly when rooms were booked but left unused or when clinics were cancelled at short notice. Short‑notice clinic changes also required services to contact patients directly, increasing the risk of miscommunication and late notice changes that could affect continuity of care.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Information helped people make informed decisions about their care.

Patients received clear details about treatments, rights, complaints and local support through posters, leaflets and clinic discussions. Information leaflets covered a wide range of conditions, and interpreters were easy to access, supported by posters listing 28 languages. Interpretation was free, and some staff spoke commonly used local languages.

The service met the Accessible Information Standard. Appointment letters were available in braille, large print, increased font and easy‑read formats, and staff knew how to arrange these. Families and carers were kept updated where appropriate, and information sharing followed secure governance processes.

In the clinic areas, patients said that staff regularly updated them on waiting times when clinics were running behind, either by speaking directly to people in the waiting area or by checking in with individuals who had been waiting for longer. Staff told us that they proactively monitored waiting lists on the clinic boards and that nurses often walked through the waiting area to explain delays, reassure people, and make sure nobody had been missed. In areas where patients had difficulty hearing their names being called, staff adapted their approach by checking in more frequently or calling names more clearly to avoid confusion. These updates helped people understand what to expect and reduced worry about being forgotten.

However, some people told us that information within the department was not always easy to follow, especially when trying to locate clinics. Patients said the signage was confusing, and some posters and signs were not positioned in a way that helped people move around safely or confidently. Staff recognised this and had commissioned a full review of signage to make it easier for people to find their clinic. Reception staff and volunteers helped people who were unsure where to go, but the long walk from the main entrance to several clinic areas meant patients needed to remember directions, which increased the chance of getting lost. Staff also told us that clinic signs used letters rather than naming the specialty, which made navigation harder.

The service did not always make it easy for people to share feedback or raise concerns. Staff did not always respond to issues in a timely or sensitive way. This meant people’s concerns were not always acted on effectively.

Some people told us that when they raised concerns, the service did not always respond in a timely or sensitive way. One complaint described a relative receiving an automatically generated letter about a missed OPD appointment shortly before the patient had died, which caused distress. The relative also struggled to reach the booking office, and an email replying to their message about the death incorrectly rebooked another appointment. This showed that staff had not always reviewed information properly before responding. Another patient reported that during a glucose tolerance test they experienced poor communication, a lack of dignity, and inadequate clinical practice, and later learned that one of their blood samples had been lost. This caused avoidable distress and reduced confidence in the service.

Although patients could give feedback through the Trust’s usual routes, such as Friends and Family Test surveys and comment cards, these were not always visible within outpatient areas, and some people told us they were unsure how to provide feedback unless they escalated their concerns through PALS or the formal complaints process.

The trust investigated complaints and identified that most complaints in the last 12 months related to staff attitude, communication, and appointment issues, showing clear themes across OPD, including Phlebotomy. Phlebotomy services were an outlier and accounted for most complaints, with 28 of the 42 complaints in the period reviewed. Appointment delays, rude or dismissive interactions, and failures in communication were the most common concerns. No complaints from the previous 12 months had been referred to the ombudsman.

Despite these concerns, the service had a wide range of methods through which people could give feedback, including FFT surveys, comment slips and feedback cards, national surveys, email, PALS and the formal complaints route. Patients could also share their experiences through the Trust’s Patient Story programme or during listening events. OPD had recently carried out a listening exercise to better understand patient experience, and this feedback was used to create a structured improvement plan, such as introducing supported seating, adding an email contact option, strengthening interpreting arrangements, and completing equality impact assessments with patient involvement.

The service investigated complaints and provided feedback to people who raised them. Where issues were identified, the service apologised, addressed staff behaviour through appropriate management actions, and took steps to prevent recurrence. Complainants were kept informed and confirmed they were satisfied with the outcomes.

Patients were given clear information on how to complain, including contact details for the Complaints Team. Staff understood the complaints process and were encouraged by managers to address concerns promptly at a local level to avoid unnecessary escalation. Staff explored issues with people raising concerns, documented actions taken, and acted professionally to protect people from discrimination or unfair treatment. Leaders shared learning with teams, reinforcing expectations around introductions, clear communication, maintaining privacy, and handling patient information appropriately.

The service did not always make sure everyone could access care when they needed it. Some people experienced delays or barriers linked to the environment and waiting times.

Some patients still faced barriers when accessing appointments. People told us that unclear signage and long distances between reception and the OPD made independent navigation difficult, particularly for those with reduced mobility. Staff and volunteers frequently guided disoriented patients, meaning the environment did not support equal access for all.

In phlebotomy area, staff reported that the digital waiting‑room display had been non‑functional for a year, requiring manual calling of patients. Some patients and relatives told us they did not hear their name being called and waited up to an hour. This manual system attributed to delays and long queues witnessed by us in the phlebotomy area. Managers explained they had attempted to replace the display, but budget constraints had prevented progress. The trust informed CQC that a business case that incorporated a new call system was in development.

RTT performance data also showed that although access had improved overall, with the service is performing better than the London regional average, several specialties continued to experience longer‑than‑planned waits. The trust’s 52‑week waiting list remained above expected levels for several months, and first outpatient waits in some specialties continued to exceed national thresholds. These issues indicated that access was not always equitable.

Despite these concerns, the service had made clear progress in improving access. The OPD was wheelchair accessible, and staff provided practical support by escorting patients to clinics and responding quickly when physical or wayfinding barriers were identified. A full signage review had been commissioned following patient feedback to improve independent navigation. The trust’s Elective Access Policy (EAP) set expectations for fair access, and weekly oversight of long waiters helped ensure people did not slip through the system.

RTT performance improved steadily across 2025–26. The number of people waiting over fifty‑two weeks fell from around 2,950 in April 2025 to about 2,450 in February 2026, a 17% reduction. Eighteen‑week performance rose from about 46% to 51%, showing a gradual recovery in timely access. “Wait to First OPA” data also showed around a 20% reduction in the longest waits over the 12‑month period, with waits over 50 weeks falling. The “Wait to First OPA by Booking” dataset showed similar improvements, with performance increasing by roughly four percentage points from the start of the year. These gains reduced variation across specialties and supported more consistent access to assessment.

The trust also strengthened equity through targeted outreach. Screening initiatives in breast, prostate, and other cancer pathways focused on groups with historically lower uptake, helping to reduce preventable delays and improve access to early diagnosis for communities less likely to come forward.

The service listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Some staff and leaders promoted an open culture where people felt able to speak up. The service strengthened feedback mechanisms through improved telephone access via electronic systems and clear clinic information on how to raise concerns or suggestions. Staff described an environment that encouraged people to discuss their experiences and people with additional needs benefited from improved communication support as the service used communication tools to help remove barriers. Managers reinforced respectful and compassionate communication through local engagement work and the OPD Respect and Compassion principles, supporting more equitable interactions.

Policies and procedures were reviewed to ensure they did not disadvantage people with protected characteristics. Equality impact assessments were completed for key OPD processes, including e‑outcome forms and room‑management procedures. Staff completed mandatory equality, diversity and human rights training, with most allied health staff achieving 100% compliance.

The planned rollout of a new e‑outcome form was expected to reduce inequity by improving follow‑up and increasing visibility of clinical updates, particularly for people who found complex appointment systems difficult to navigate. The set‑up of clinics reflected the needs of the local population, and the service continued to work with partners to improve equity of experience.

However, Patients told us they find the layout of the OPD structure challenging to navigate. Equity in outcomes were not always consistent for people with more complex communication needs. Staff said these tools were not yet embedded across all OPD areas, leading to variation depending on where people were seen. Training compliance also varied: Tier 2 Oliver McGowan training stood at 55%, below the trust’s 75% target, and equality, diversity and inclusion training compliance in Macmillan OPD was 88.89%, below the 90% trust target. This meant not all staff had completed the enhanced training required to effectively support people with cognitive, communication or sensory needs, and the slight shortfall in EDI compliance meant the service could not assure itself that all staff in Macmillian OPD had the depth of knowledge required to recognise and appropriately respond to the diverse cultural, communication and accessibility needs of people using the service, increasing the risk of inconsistent or less personalised care for those who may already face barriers in accessing outpatient services.

The service supported people to make plans about their future care. Staff held clear discussions about treatment options and recorded people’s wishes. Coordinated planning helped people understand what would happen next.

Staff supported people to make informed decisions about their future care. Personalised discussions helped patients understand their treatment options, and clinicians handled DNACPR decisions and other sensitive conversations with dignity, involving families and carers when appropriate. Care plans reflected each person’s wishes, cultural needs and priorities.

People with complex needs received coordinated planning across multiple teams. Staff worked closely with specialist clinicians, nurses, physiotherapists and external partners to ensure that patients who required input from different services had clear, joined‑up plans. This MDT approach seen for example in gynaecology pathways, supported timely decisions for patients with long waits or complex conditions, using shared assessments and up‑to‑date clinical information.

Digital improvements strengthened the safety and consistency of future planning. The new e‑Outcome form reduced the risk of people being lost to follow‑up by prompting appropriate next steps, improving clarity of referrals and ensuring clinicians could see what had been agreed with each patient. Its clearer layout and improved logic also supported more accurate recording of investigations, appointments and treatment decisions.

However, some people told us they were not always clear about what would happen next, especially when future steps depended on specialist advice, further triage or updated investigations. In some pathways, delays or limited specialist capacity meant future plans took longer to confirm, creating uncertainty for people with complex or long‑term needs. As a result, planning processes were not always consistent for everyone using the service.