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 equality characteristics. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained the same. This meant people’s needs were not always met.

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 evidence showed a good standard. 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.

We saw the service had systems in place to deliver end-of-life care when necessary. We reviewed the notes of one patient who had recently passed away within the department. These showed the department worked with the hospital’s palliative care team to ensure that the required medications were prescribed, and escalation plans were agreed. Staff had discussed this end-of-life care with the patient’s family and had clearly documented this.

The service worked well with substance misuse teams within the hospital to ensure patients received person-centred care. Staff told us that there was a drug and alcohol team available on weekdays, which they found helpful. We observed the drug and alcohol team interacting with patients in the waiting room. Some staff were undertaking additional training with the drug and alcohol team to support them in their role. The service also worked closely with the hospital’s tobacco dependence team to help patients stop or reduce cigarette smoking. This included talking to patients in the waiting room.

The service ensured children received appropriate care and support. Paediatric patients were assessed in a separate area with a separate waiting room. The paediatric area employed a play specialist for children and young people. There were toys available for a variety of age ranges. The department also occasionally organised special events and visitors, such as singers and magicians.

The service had systems to ensure neurodivergent patients received suitable care. This included neurodiversity-specific toys. However, training on autism and learning disabilities (Oliver McGowan training) was below the trust target of 90% for relevant adult emergency department employees (72% and 20% for tiers 1 and 2 of this training respectively, however it should be noted tier 2 training has only been offered relatively recently).

We observed patients in the waiting room were not given wristbands, and that some of these patients were being given medications such as painkillers. This meant that, if a patient had a reaction to a medication or became unresponsive for another reason, staff may not have been able to identify them or assess what medication they had taken and would not have been able to tailor their care appropriately.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed some shortfalls. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Discharge summaries should be provided to all patients when leaving the department. These provide information to patients about their care and treatment. However, we reviewed a number of discharge summaries which were completed after the patient had left the department. This resulted in delays in information being available to patients and their GPs. Patients also remained on the service’s virtual ‘board’, after they were discharged.

Patients told us that staff did not always inform them of what was happening with their care. Some patients complained of feeling “in the dark” about what they were waiting for and told us they did not know what staff were planning.

Patients were not always provided with accurate information about waiting times and sometimes were provided with contradictory information. Waiting times were displayed on 2 large screens in the waiting room and these were updated every 10 minutes. However, the 2 screens did not always display the same waiting time. The largest difference we observed between the 2 screens was almost an hour.

The different areas of the department were clearly signposted to help patients find their way. We observed volunteers in the waiting room assisting patients with how to get around.

The service provided information to patients via posters in the department. These posters were available in multiple languages and included information on alcohol use and learning disability services. However, we did not see any signage about the availability and use of chaperones in some areas, such as the “red” major’s area.

Translation services were available for patients who did not speak English. These were available using portable electronic tablets. Video call options were available where required. Staff told us they found these helpful.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Patients were given information on how to provide feedback on their care. We saw posters about the complaints processes in different areas of the department. This included information on how to make a complaint including information about the Patient Advice and Liaison Service (PALS). Posters were available in multiple languages. The service displayed posters with information about the Friends and Family Test (FFT). This is an NHS initiative through which patients’, friends or family can provide feedback. We requested further data around patient engagement and feedback in the department, but this was not provided.

The CQC periodically conducts nationwide surveys of patients to better understand their feelings about the care they receive. In the most recent urgent and emergency care survey, which was carried out in February 2024 and published in November 2024, patients scored Lewisham and Greenwich NHS Trust 6.7 out of 10 for being involved as much as they wanted to be in decisions about their care and treatment, and 8.1 out of 10 for feeling that doctors and nurses listened to what they had to say. When compared with other NHS Trusts, these were somewhat worse than expected and about the same as expected respectively.

We saw evidence that complaints to the service resulted in changes. For example, following a complaint the service had introduced a designated quiet area for patients at high risk of miscarriage, with private toilet access. Staff were aware of these changes and implemented them in their care.

Patients and their families were involved in difficult conversations. We saw evidence that escalation plans, such as the use of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders, took into account patient preferences. When appropriate, this was also discussed with family members. Family members of seriously unwell patients were also involved in discussions about their care, and these discussions were clearly documented.

The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The service provided 24-hour care 7 days a week for any patient presenting to it. However, patients could not always access care and treatment in a timely manner due to capacity constraints on the service. Patients told us they had waited a long time for care.

Service leaders were aware of capacity and flow issues. These issues were added to a risk register for the department, which was reviewed monthly. Service leaders had plans in place to mitigate these risks but did not always discuss these mitigations with more junior members of staff. Staff had regular meetings to discuss patient care and had handovers at the beginning and end of each shift. During these meetings, senior leaders did not discuss the pressures on the service with staff, nor did they discuss escalation strategies such as Operational Pressures Escalation Levels (OPEL).

The service provided corridor care when it ran out of space for patients. The service doubled up patients in some areas of the department (such as the ‘green’ area and resus) to free up space. Staff told us that this was not ideal but worked well when required. We did not identify any patients receiving corridor care who should not have been due to their care needs.

The Royal College of Emergency Medicine (RCEM) recommends that all patients are triaged within 15 minutes. In the 6 months prior to this inspection (August 2025 to January 2026), the service’s monthly average time to triage ranged from 47.8 minutes to 63.2 minutes, which is significantly longer.

Because of waiting times, some patients spent a long time in the waiting room. There was limited oversight of these patients, with no member of staff allocated to or permanently present in the waiting room. We were told that staff in the triage rooms monitored these patients for deterioration, however the only evidence we saw of this was a cursory glance over the heads of these patients when calling patients for assessment. We were told that triage nursing staff were expected to reassess the observations of patients in the waiting room every 4 hours, however this was not being done. This could have resulted in patients deteriorating without staff knowing, although we did not see any evidence of this during our assessment.

We observed nursing tools and checklists were not always completed. For example, the falls prevention and assessment form, the Waterlow pressure ulcer risk assessment score, and the adult sepsis screening and action tool were inconsistently completed in the patient records we reviewed. The service monitored the use of these tools through monthly audits. These audits showed variable rates of completion of these tools (for example, these audits showed that the adult sepsis screening and action tool was completed in 40% and 86% of records reviewed in December 2025 and January 2026 respectively). We did not observe any instances of missed or undiagnosed conditions because of this.

People who presented with mental health concerns often spent long periods of time in the department. The average length of stay for adult patients presenting with mental health concerns was above the department’s 16-hour target for 7 of the previous 12 months. For children and young people presenting with mental health concerns, the length of stay was above the department’s 10-hour target for 5 of the previous 12 months. Service leaders were aware of this issue and had added it to the divisional risk register. However, we found that the department worked well with the psychiatric liaison team, who completed mental health assessments in parallel with emergency department staff. We also found that patients with mental health needs were identified in the triage process, allowing for earlier referral to the psychiatric liaison team, who saw almost all emergency referrals within 1 hour.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.