Queen Elizabeth Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement, that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question good. At this assessment the rating has remained as good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

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

The service did not always have a consistent shared culture based on equality and respect. Some behaviours and delays in organisational processes limited staff confidence in raising concerns. This meant the culture was not always supportive or aligned across all teams.

Staff reported that organisational values were not always modelled consistently across all professional groups. Some consultant behaviours made it harder for nursing staff to challenge poor practice, creating a culture that did not always feel equal or supportive. We witnessed examples of inappropriate consultant behaviour and dignity breaches, which some staff described as long‑standing concerns that had been raised before but had not always led to clear or timely action. These incidents showed that cultural expectations were not always upheld consistently across all teams, and that escalation processes had not always produced effective or sustained change. Staff told us that repeated incidents had affected morale and confidence, and some felt uncertain about whether concerns would lead to improvement. Leaders acknowledged that trust‑wide processes for addressing bullying, harassment and cultural concerns were not always timely or robust.

There was also a gap between strategic aims and frontline understanding. Although OPD areas displayed the trust’s ‘Our Vision, Objectives and Values’, not all staff could describe the detailed priority initiatives within the service strategy. Leaders understood these priorities well, but frontline staff gave limited examples of how they translated into day‑to‑day work. Some staff also told us that communication from leaders could vary between sites and teams, and that this sometimes made it harder to feel part of a single, shared direction.

Despite these gaps, some staff understood the core OPD vision and how their work supported timely, respectful, patient‑centred care. Senior leaders communicated expectations clearly through regular governance meetings, team discussions and one‑to‑ones kept nursing, phlebotomy and administrative teams aligned to operational and strategic goals. Staff said leaders were visible and accessible, helping them understand how wider trust initiatives linked to their roles.

Some staff helped shape service development by contributing ideas through improvement programmes, redesigned patient‑facing areas, tested new check‑in approaches and improved accessibility materials. Access to the improvement hub and coaching supported some staff to turn ideas into measurable changes.

Operational changes were well understood by some staff, who recognised the appointments‑based phlebotomy model delivered through healthcare appointment booking platform, as essential for safe flow, equitable access and upcoming community diagnostics centre plans. Some staff were also aware that long‑term continuity was supported by three‑year Integrated Care Board (ICB) back‑funding from April 2023.

The service had capable and supportive leaders who understood local challenges and priorities. They were visible, approachable and promoted a positive team culture. Staff felt encouraged to learn, develop and contribute to improvement.

Leaders were described as capable, experienced and knowledgeable about OPD services. Many had long‑standing experience across Lewisham and Queen Elizabeth Hospital and demonstrated a clear understanding of clinical pressures, patient flow and operational challenges. Staff said leaders were visible in clinical areas, checked in regularly and could clearly explain service performance, digital developments and the OPD transformation programme. This gave staff confidence that leaders understood both challenges and priorities for improvement.

Leaders were also seen as approachable and supportive. Staff described an open‑door culture where concerns were heard without fear, and they reported strong support from practice educators, senior nurses and managers who ensured regular supervision, huddles and governance meetings. This communication kept staff informed about incidents, learning and operational updates, helping them maintain safe and effective practice.

Leadership development was widely supported. Staff said they were encouraged to access courses, expand competencies and take on new responsibilities, including supporting students, upskilling HCAs and attending management training. Trust programmes and protected time for skills‑based learning helped staff feel valued and able to progress.

Leaders also promoted a positive team culture through huddles, incident reviews and supervision strengthened learning, and staff consistently described feeling respected, supported and proud of their work. Many spoke positively about leaders’ commitment to improving patient care, digital systems and service design, which helped build a compassionate, team‑focused culture.

However, some staff said organisational values were not always modelled consistently across all professional groups. They described behaviours from a minority of consultants that made it harder for nursing staff to challenge poor practice. Leaders acknowledged that trust‑wide processes for addressing bullying, harassment and cultural concerns were not always timely or robust, which left some staff unsure whether issues raised would be acted on. Some staff were also uncertain about how concerns such as the removal of reception desks, rising patient aggression or operational pressures were resolved, leading to repeated issues. Slow organisational processes, siloed working and frequent clinic‑set‑up were cited by some staff as creating additional strain. Reliance on bank staff sometimes added instability, although leaders continued to recruit into vacancies. Staff described this as an ongoing challenge.

The service fostered a positive culture where people felt their voice would be heard and leaders used feedback to make improvements and strengthen communication. However, some staff said they did not always feel they could speak up.

Most staff said they felt safe to raise issues with their managers and described an open‑door culture where concerns were listened to without fear. Staff felt comfortable speaking up about safety issues, workload pressures and clinic incidents.

The service ensured patients and carers had accessible ways to give feedback, including text messages, Friends and Family Test (FFT) responses, PALS, compliments and direct conversations. FFT results showed 93.57% of OPD respondents rated their experience as Very good or Good, indicating most people felt treated with kindness and respect.

Managers used patient, carer and staff feedback to make improvements, which lead to changes such as having clearer signages, better communication materials and improved storage areas. Leaders shared outcomes through “You said, We did” updates, helping staff see how feedback influenced change.

Patients and carers were involved in service developments through improvement work, patient‑experience forums and opportunities to speak with senior leaders during walkabouts. Leaders’ visibility in clinical areas helped people feel heard and assured their feedback mattered.

Staff had multiple ways to engage senior leaders, including executive walkabouts, team meetings, Safe Space sessions and visits from the Freedom to Speak Up (FTSU) Guardian. Guardian visits across both sites ensured all staff groups had confidential support, which staff said increased their confidence to raise concerns and contributed to higher trust‑wide reporting.

However, some staff were not always confident concerns would be acted on quickly or consistently. They described delays in follow‑up after raising issues about clinic pressures and communication. Some staff also said they did not feel comfortable speaking up about consultant attitudes and behaviours due to their band, being new in the service and some staff told us that they raised concerns before but had not always led to clear or timely action. These experiences echoed trust‑wide FTSU findings, where slow responses, limited updates and unclear outcomes were common themes. This sometimes left staff unsure whether speaking up would lead to change.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service demonstrated good practice as staff described an inclusive culture and felt the service was becoming more supportive of diversity. The trust had active staff networks for LGBTQ+, disability and ethnic minority groups, offering events, forums and safe spaces that helped staff feel represented.

The trust workforce was highly diverse: by August 2025, 63.7% of staff were from Black, Asian or minority ethnic backgrounds, Band 6 and above, representation was higher at 49.6%, and 3.3% identified as LGBT+, reflecting the local communities in Lewisham, Greenwich and Bexley.

Staff said they could request flexible working and that managers were generally supportive of adjustments for caring responsibilities or health conditions. Training for managers on disability passports, reasonable adjustments and equality, diversity and inclusion (EDI) awareness helped them better support staff with additional needs. Workplace adjustments were being strengthened through new systems linked to the trust’s EDI action plans.

Leaders also promoted development opportunities for underrepresented groups. Career‑coaching days and leadership programmes were targeted at ethnic minority and disabled staff, with 66% of participants in non‑mandatory training from ethnic minority backgrounds by late 2025. Staff said these opportunities encouraged them to progress.

However, some staff felt that trust‑wide EDI initiatives did not always translate into day‑to‑day practice. Feedback across Allied Clinical Services (ACS) showed some staff wanted greater involvement in decisions, more collaboration between teams and better recognition. Some also reported delays in flexible‑working processes, creating uncertainty for those with caring or health needs. Trust‑wide EDI data showed 31.2% of disabled staff felt reasonable adjustments were not made quickly or consistently, creating a risk that some colleagues were less well supported to work safely and confidently. Furthermore, at Band 8a and above, 35.3% of staff were from Black, Asian or minority ethnic backgrounds, compared to 58% across the Trust workforce, showing there are room for improvement in ensuring equal opportunities for development.

The service had clear responsibilities, roles, systems of accountability and good governance. However, risks were not reduced in a timely way and continued attention was needed to ensure mitigations led to sustained improvements.

Governance arrangements were clear, and staff understood how information flowed through the service. Each outpatient clinical service had its own governance route, feeding into the monthly Outpatients and Phlebotomy meeting and then into divisional boards. Staff told us they understood how to escalate concerns, and governance records showed regular review of incidents, complaints, staffing pressures, estates issues and audit findings. Information shared at governance meetings was supported by daily huddles, where immediate issues were raised and actions allocated to responsible staff. This meant leaders had frequent oversight of operational pressures and the quality of care being delivered.

Learning from incidents and complaints was shared through meetings and action logs, and staff confirmed that resulting changes had been implemented. Governance minutes demonstrated that teams reviewed outstanding incidents to ensure they were closed promptly when actions were complete, and that lessons were considered at each meeting. Staff also told us that improvements to incident‑routing processes, allocation lists and reception arrangements had been made in response to previous learning, and audit activity continued to be embedded in routine practice. Governance minutes also showed that mitigations were already in place for several of the recurring issues. Infection‑prevention and health‑and‑safety reviews for Area G were underway, Fire‑evacuation training for supervisors had been completed, with practical drills planned. Security improvements were also being addressed, with body cameras ordered for phlebotomy and delays escalated for action. Staff continued joint work with clinical specialties to manage clinic overruns, and request‑list oversight processes were strengthened through the Request List Working Group. These mitigations showed that leaders monitored risks and initiated appropriate actions when concerns were raised

Staff understood how their work was linked with other teams, and governance documents showed effective collaboration with patient‑experience, booking, rescheduling and estates teams. This included reviews of Friends and Family Test feedback, updates to clinic signage and layouts, and joint work on incident‑mailing lists for shared areas. Services also worked with clinical specialties to reduce clinic overruns and improve waiting‑time consistency across sites. Environmental audits and refurbishment work were used to support quality improvements, and the service had processes for reviewing risks linked to patient flow, accessibility, and estates.

Risk‑management systems were accessible and understood by staff. Local risk registers reflected the concerns raised in clinical areas, including environmental constraints in Area A, patient‑flow challenges, and fire‑safety actions. Risks had assigned owners, review dates, and documented updates. Leaders ensured they had access to timely and accurate information to support safe decision‑making, and governance papers confirmed that data on performance, incidents, staffing, outcomes and utilisation were monitored routinely. The trust remained compliant with the national Data Security and Protection Toolkit (DSPT), confirming safe handling of patient information.

Emergency and major‑incident plans were in place and understood. Staff knew how to access the Trust’s Major Incident Plan, command structures and continuity arrangements. Governance minutes confirmed that evacuation training had been completed, and further practical drills were scheduled. This supported preparedness for unforeseen events

However, despite the clear structure and regular oversight, we found that several governance risks remained unresolved. The most significant was the long‑standing backlog of incomplete clinic outcome forms and missing RTT updates, recorded since July 2020. This created a risk of missed follow‑ups and patients being lost in the system. Controls were in place, including full‑time staffing to address the historic backlog, weekly monitoring of un‑outcome activity by the transformation team, daily reports to clinics not managed internally, and training on 18‑week RTT rules and correct outcome‑form completion. Regular audits were used to identify whether errors came from incorrect clinical outcomes or administrative actions. Despite these measures, mitigations were only partially effective, and the risk remained high with a current score of 9 against a target score of 3. The issue had been escalated to divisional and executive levels, with monthly position reports circulated to maintain oversight.

Governance minutes also showed several recurring issues that had not been resolved quickly. These included ongoing clinic overruns in Area G, delayed infection‑prevention and health‑and‑safety updates, and inconsistent progress with security arrangements, such as call‑bell repairs and body‑camera deployment. Estates‑related constraints, including fire‑safety work and layout challenges, reappeared across multiple meetings, and some actions remained incomplete for several months. This indicated that while risks were identified and recorded, the pace of improvement varied, and some mitigations were dependent on wider trust teams, which slowed progress.

The service worked in partnership with other organisations to improve care and pathways. Leaders shared information with partners and collaborated to address system‑wide challenges. Joint working supported more consistent and coordinated care.

Leaders had strong relationships with commissioners, primary care and system partners. Senior OPD leaders attended MDT system meetings where performance, waiting times, cancer pathways and operational pressures were openly discussed with ICB leads, trust managers, GPs, other providers and community teams. These forums showed clear senior engagement and joint planning to improve pathways and resolve interface issues.

Patients and staff could also share feedback through these partnership meetings. OPD performance data, experience themes and operational changes were presented at system boards, and primary care colleagues could raise concerns directly. The Greenwich and Bexley Interface Forum enabled community clinicians to escalate issues such as referral quality, pathway delays and communication gaps, supporting transparency and shared problem‑solving.

Partnership work supported population needs. The trust worked closely with south east London partners to reduce long waits, improve quality and bring waiting times in line across the system. GIRFT, a national programme designed to improve NHS care by reducing unnecessary variation, supported this work by helping providers compare performance, share good practice and agree consistent pathways. Through GIRFT, trusts learn from one another, adopt better ways of working and reduce avoidable delays, unnecessary procedures and differences in how services are delivered. Within this partnership, the trust and its system colleagues jointly reviewed GIRFT recommendations, validated waiting lists and tested shared triage models. This helped improve pathway consistency across sites and supported better waiting‑list performance, ensuring patients across the local population received a more reliable and coordinated outpatient service.

However, some system challenges remained. Primary care fed back that patient discharged from PIFU sometimes returned to GPs for support, highlighting gaps in communication and pathway understanding. External partners also noted variation in specialist advice use and lower diversion rates than other providers, resulting in more referrals into OPD and added pressure on waiting times. These issues indicated that some shared pathways and feedback processes still required strengthening.

The service supported learning and improvement. Staff used quality‑improvement methods and contributed to projects that improved patient flow and experience. Innovation was encouraged, although pressures sometimes limited capacity for improvement.

Staff were encouraged to innovate and use formal quality‑improvement methods. The trust’s 6‑4‑2 approach gave teams a clear structure to test changes and monitor impact, and staff were familiar with using it locally.

Improvement projects led to measurable results. At QEH, the kiosk‑utilisation project used QI tools to address poor patient flow and introduced remapped kiosks, clearer signage, removal of generic clinic locations, and receptionist training. Check-ins increased from about 340 to 938 per week, reducing reception workload and improving access.

Staff also drew on national programmes such as GIRFT, Further Faster, elective recovery work, and digital initiatives. Governance records showed OPD involvement in patient‑portal rollout, kiosk optimisation, and work to reduce missed appointments. These innovations supported more efficient care and gave staff opportunities to shape new ways of working.

The service contributed to national audits and used findings to improve booking processes, patient experience, and flow.

However, improvement work was not always consistent. Staff said clinical pressures sometimes limit their capacity to engage in QI, and issues such as generic clinic codes slowed progress. Some changes depended on wider system teams, which reduced the pace of innovation.