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 and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring 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 our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were good, and care reflected the needs of those using the service.

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.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

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 trust’s intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected current practice. It had guidance for staff around collaboration with multi-agency teams and for delegation of clinical tasks to ensure the right people delivered evidence-based care and treatment. There were numerous clinical pathways which were well known to staff.

The service planned and delivered patient’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. For example, we saw a patient who had had a fall have the appropriate investigations to ascertain the potential cause of their fall and who had been prescribed pain relief.

The trust submitted data to the Royal College of Emergency Medicine (RCEM) 3 Quality Improvement Programmes (QIPs) in 2025/26. These included self-harm in patients with a mental health issue, care of the older person and time critical medicines. The data submission date had passed the week before our inspection and the department was awaiting the results of their submission. The trust audited practice against evidence-based research.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance. For example, we reviewed the records of a patient who attended with a head injury. We saw care and treatment provided was in line with NICE guideline: Head injury: assessment and early management May 2023. Triage questions were appropriate for the patient and their needs for example, people presenting with emotional needs were properly and sensitively assessed and specialist help sought early.

Patients said they had been offered something to eat and drink. We observed hostess staff offering patients refreshments. In response to patient feedback, hot food had been made available to patients. Patients were offered a range of food which met their dietary requirements.

The service worked with a third party to direct patients to other departments and organisations for patients who did not require emergency care. Within the emergency department there was good access to and use of treatment units, frailty services and same day medical and surgical units. The service had some volunteers who worked within the emergency department.

The evidence showed a good standard. 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 have access to the information they need to appropriately assess, plan, and deliver care, treatment and support in line with people’s individual needs. However, this was often split across paper and electronic records. This meant staff had to review 2 documents to appraise themselves of the patients journey and changes in condition or observations. The service was moving to a new electronic patient record management system in the summer, and staff were keen for this to occur.

The service worked well across teams and services to support patients. Leaders told us staff were responsive across the organisation when requested to support the ED. There were specialist teams, such as the psychiatric liaison support team and the substance misuse team who in reached into the department to provide advice and support to the staff working in the ED.

There was a rapid assessment and treatment area (RAT) which only operated when there was capacity within the department. This service aimed to facilitate streamlined patient care and rapid discharge or onward care of a patient. However, due to delays in other departments and long waits for diagnostic tests this area did not function as expected. We saw this area open on the second day of our inspection, and it rapidly reached the maximum number of patients. Whilst some patients were seen, assessed and treated in a timely way others were awaiting tests.

The same day emergency care pathway had been redesigned and is described in the medicine report. These services had dedicated doctors to assess and care for patients. The units took patients from local GPs within a defined criteria. They also took emergency patients who were assessed as being of a lower risk than requiring emergency department intervention. If the patient was assessed as needing a speciality referral they would be transferred to the relevant assessment unit where one existed. If it was decided that they required admission, they would remain on the appropriate unit until a bed became available. There was a “pull/push” model in place. This meant that staff in the main ED would assess if patients could go to one of these services and that the unit staff would monitor ED for any potential patients that could go to their units. This meant that patients followed the most appropriate care pathway.

Care was coordinated, and everyone involved in their care worked well together. We observed good quality, kind and compassionate interactions between staff and patients. Information was displayed on notice boards relating to care, advocacy access, information for carers, charities, mental health and feedback on care.

Staff worked well with external partners involved with patients. External partners, such as GPs, community nurses and social workers were involved to enable continuity of care and support for discharge. Staff reported good engagement with safeguarding partners.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

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

Staff told us treatment plans were evidence based and monitored for outcomes. Patients care was reviewed and updated, and appropriate referral pathways were in place to make sure that needs are addressed. Staff were able to tell us about when treatment had led to learning following debriefs and mortality and morbidity meetings. This included the lowering of the trauma threshold for scans following elderly patients with neck injuries.

Many patients told us that they were not kept up to date with how long they may wait. Yet in the Urgent Emergency Care Survey 2024 results, in response to were you kept updated on how long your wait would be, was rated better than the national average. The next survey is currently having data submitted to it.

The service had completed an audit in March 2025, highlighting that people with sickle cell disease were not always given pain relief promptly. Whilst the service had highlighted actions to be taken through a quality improvement project, we did not see evidence of completion of the actions or performance improving through the project for it.

The trust percentage of patients reattending the ED within 7 days of the original attendance was 2.3% of all patients seen in the ED. This was lower than the national average between February 2025 and January 2026. The service regularly monitored the care of patients with mental health issues through attendance and presentation at their governance meetings of staff from mental health services. The audit programme and data oversight of mental health in the department seemed limited. The department is completing an audit of rapid tranquilisation currently. The governance meetings also included assigning leads to external audits and discussion of issues raised in audits or inspections.

The service had invited NHS England in to follow up on recommendations from the Emergency Care Intensive Support Team (ECIST) in 2023 to monitor progress and suggest further improvements. The leadership team is also working with the Getting It Right First Time (GIRFT) team to drive improvements to outcomes and patient care. These recommendations are embedded into the work programmes for the service and monitored through quality and governance meetings.

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

Patients understood their rights around consent to the care and treatment they were offered. Patients received information about care and treatment in a way they understood and had the appropriate support and time to make decisions. Staff had access to the trust consent policy and understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act (1983), Mental Capacity Act (2005) (MCA), Deprivation of Liberty Safeguards, and the Children Acts (1989 and 2004). Staff knew who to contact for advice.

Staff had access to the mental health team 24 hours a day to support them and patients. We were told the team were responsive and supportive.

We observed staff gain consent from patients for their care and treatment in line with legislation and best practice guidance. Staff received training on the application of the Mental Capacity Act for staff who would need to assess patients to give consent. When patients did not have capacity to consent, staff made decisions in their best interests and documented them. The service had a process for dealing with patients who were detained on a Section 136 of the mental Health Act. We saw police officers in attendance with patients that they had detained. Staff worked well with these officers and ensured that patients were aware of their rights whilst detained.