Queen Mary's 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 changed to good. This meant people’s needs were met through the organisation and delivery of responsive services.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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.

There were processes in place to ensure that people could receive the most appropriate care and treatment for them. This included a clear criteria for patients receiving treatment at the surgical treatment centre (STC). Pre-operative assessment processes ensured that patients added to the STC lists met the required parameters and were fit for surgery as a day case.

Staff gave us examples of where they had responded to changes in people’s needs. This included where people were unwell following surgery or where their recovery took longer than anticipated.

We observed staff delivering patient centred care and saw they respected the individual needs of each patient. Pre and post operative care and support was planned by taking account of people’s individual needs. This included people requiring additional support, for example, for people with a learning disability or dementia.

Staff understood how to meet the information and communication needs of patients with a disability. The service had access to interpreting and signing support services by telephone or face to face for patients who needed it.

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.

Managers planned and organised services, so they met the needs of the local population. Trust leads worked collaboratively with local partners to meet people’s needs. For example, the surgical treatment centre was developed in 2021 in response to issues around longer wait times for patients to receive surgery across Southwest London. Surgical lists were provided for other Southwest London NHS trusts as well as those for internal trust day surgery.

People’s care and treatment was delivered in a way that met their assessed needs and was well coordinated. The service was not equipped to deal with medical emergencies, therefore, patients who experienced complications during surgery or in recovery were transferred to the St George’s accident and emergency department by emergency ambulance. Follow up was then arranged by the consultant surgeon. Systems were integrated across the trust to ensure continuity of care in the event of complications.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Assessment processes ensured that people’s individual information needs were identified. Staff made reasonable adjustments to help patients access services. Information was provided in different formats and in line with the Accessible Information Standard. This included people who required support with translation, interpreting and signing.

We observed staff sharing information with patients and checking their understanding. This included post operative information leaflets about wound care, ongoing recovery at home and when it was safe for them to start normal daily activities. Patients were also given information on how to escalate concerns within normal hours and out of hours.

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

There were opportunities for people to feedback about their care and experience of the service. Patients were given feedback surveys to complete. Results were collated by service leads and feedback was shared with staff by way of governance reports and meetings. Feedback reports we viewed were consistently positive.

Patients were informed of how to make a complaint should they need to, with information displayed. There were processes in place where managers investigated complaints, identified learning and shared this with staff to ensure improvements were made and embedded where necessary. Patients we spoke with understood how to complain and felt confident giving feedback should they need to. However, all patients told us they were happy with the service, with only one comment about the time they waited to go into theatre.

Feedback from compliments was also shared with staff.

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

Performance in relation to referral to treatment times was in line with the England average, yet below national standards. There was ongoing improvement work in relation to this.

Patients were added to the surgical treatment centre day surgery lists based on them meeting the criteria for accessing day surgery. Surgical lists included dermatology, cataract surgery, plastics, urology, vascular, renal, gynaecology and orthopaedics. Surgical treatment centre staff checked the patient records prior to their surgery day to identify any issues, which on occasion may lead to cancellation of their surgery.

The trust monitored cancellation rates, theatre utilisation, late starts and delays. We reviewed cancellation data for October 2024 and saw that 92% of planned surgeries went ahead. Of those that did not go ahead 23% were unfit for surgery, 18% did not arrive and 18% were due to clinical decision making. In addition, 18% of those that did not go ahead were due to service error or rescheduling or due to the theatre list being overbooked or delayed. Theatre utilisation was between 63% and 67% between October and December 2024, against a target of 85% and there was a theatre utilisation group focused on increasing utilisation. We were told that delays and cancellation data was reviewed as part of theatre utilisation reviews.

Staff staggered patients' arrival times to reduce the amount of time they waited for. Patients we spoke with were aware of this and appreciated the efforts staff made to reduce waiting. One patient told us they were happy with the care they received but felt communication around waiting times could be better. We reviewed data about days to surgery start times and saw that most of these were due to medical staff delays that were classed as appropriate. Other causes included theatre overrunning or delays due to patient issues.

Staff worked to ensure people did not stay longer than they needed to. Because of the nature of day surgery all patients were discharged home on the day of surgery, unless unexpected medical needs necessitated an acute transfer. We were told that delays to patient discharge were minimised. The main cause was due to lists over running, delays in patients being fit for discharge and issues with transport. However, we were told that staff were flexible and would stay to support patients until transport arrived, and they were fit to go home. Staff reported issues with transport delays as incidents and managers followed up to promote improvements going forward.

Staff and leaders actively 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.

People’s care, treatment and support promoted equality and protected their rights. Staff demonstrated a good understanding of individual people’s needs and took action to make reasonable adjustments so they would not be disadvantaged. Examples included patients with additional needs being able to be accompanied in the waiting area and recovery, whereas usually patients attending for day surgery were not able to be accompanied.

People were supported to plan for the future.

Staff took account of people’s decisions about their future, however, due to the nature of the day surgery service, staff did not generally have discussions with patients about their future, including at the end of their life. The trust had a clear ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) policy. Staff had received training in end of life care and compliance was 93%.