Queen Elizabeth Hospital Birmingham

Updated 22 August 2025

This was a service assessment of surgery and urgent and emergency care services only. Please see the summaries below for these services. The location rating of ‘requires improvement' includes an aggregation of ratings for all assessment service groups for Queen Elizabeth Hospital Birmingham, others which were inspected previously to these new assessments. 

Queen Elizabeth Hospital Birmingham is an acute hospital in Edgbaston in the West Midlands. The hospital is part of University Hospitals Birmingham NHS Foundation Trust and provides a range of outpatient, inpatient and urgent and emergency care for its local community in and around Edgbaston and also a regional and national population for some services provided . The hospital is a designated level 1 trauma centre. 

We completed an unannounced assessment of urgent and emergency care services and surgery on 19 and 20 March 2025. We assessed urgent and emergency services as a follow up to our previous inspection and to determine if improvements had been made. Our assessment of surgery was carried out as this is a major service for this hospital and we had not assessed the service since 2019. Based on our previous inspection for urgent and emergency services, we looked at specific quality statements in safe, effective, caring, responsive and well-led. As this assessment was based on risk, we only completed quality statements which were connected to the areas of concern or considered pivotal for this service. For surgery we looked at a wider range of quality statements. 

At this inspection, urgent and emergency care services remained requires improvement, but the rating for safe improved from inadequate to requires improvement with improvements seen in areas of concern. Caring stayed the same at good and effective improved from requires improvement to good. Well led remained requires improvement. Responsive remained requires improvement with the department under significant system pressures, crowding and a lack of flow which meant there were long waits in the department due to a lack of available beds elsewhere in the hospital. However, there had been progress made and the department had improved, although there were still areas of concern to address. We served the trust with breaches of 3 regulations around the failure to provide timely treatment, not always having safe staffing levels, and improvements needed in governance.

In surgery, safe remained requires improvement. Effective and caring remained good. Responsive declined to requires improvement from good, and well-led remained rated as good. Overall the service dropped from a good rating to requires improvement. We served the trust with breaches within 1 regulation in relation to some people not getting timely care, medicines not being managed safely at all times, and anaesthetic equipment not being checked as required at all times. 

Updated 21 January 2025

The surgical service at Queen Elizabeth Hospital Birmingham is made up of theatres, a surgical day case unit, admissions lounge, discharge lounge, and 8 inpatient wards. These cover a number of specialities including orthopaedics, general surgery, colorectal, breast, upper gastroenterology, ear, nose and throat, maxillofacial, sarcoma, thoracic, burns and plastics, liver, renal, cardiac, neurosurgery and ophthalmology for adults. Queen Elizabeth Hospital Birmingham treats only adult patients and young people from the age of 16 and over.

We conducted a planned unannounced on-site assessment of surgical services from 19 to 20 March 2025 due to concerns about some aspects of safety. As part of our assessment, we assessed the pre-assessment unit, wards THH5, 407, 408, 409, 410, 517, 620, 726, 728, ambulatory care and enhanced post-operative care and theatres.

We observed care and treatment and looked at 28 patient records and spoke with 15 patients and their relatives. We spoke with 79 members of staff including the senior leadership team, theatre managers, ward managers, scrub nurses, anaesthetists, consultants, healthcare assistants, recovery nurses, pre-operative assessment leads and staff nurses.

The service was previously inspected in June 2021 and was in breach of legal regulations in relation to safe care and treatment (Regulation 12) and equipment and premises (Regulation 15). Improvements were identified, and the service was no longer in breach of these regulations.

We assessed 31 quality statements across safe, effective, caring, responsive and well-led. The rating following this assessment dropped to requires improvement overall with safe and responsive rated as requires improvement.

We identified a regulatory breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12: Safe Care and Treatment in relation to the proper and safe management of medicines, the safe use of equipment, and care and treatment being provided to people who use the service in a safe timely way.

Our rating for safe remained requires improvement, effective stayed as good, caring remained as good, responsive deteriorated to requires improvement and well led remained as good. The services overall rating was requires improvement.

There were concerns in the key question of safe around equipment, medicines and risk assessments. People were not able to get care and treatment in accordance with national standards due to recovering from the COVID-19 pandemic.

However, we found there was mostly a good safety culture and patients were cared for in a safe environment. Staff delivered good care and treatment following evidence-based practice and people had good outcomes. Staff were kind, caring and compassionate. People were always at the centre of how care was planned and delivered. Staff felt supported and guided by their leadership team. The service had a shared vision, strategy and culture. Leaders understood their responsibilities to their teams with supportive structures to ensure a bottom-up approach worked effectively. Leaders operated effective governance processes.

Updated 21 January 2025

The Queen Elizabeth Hospital Birmingham’s emergency department is a type 1 major trauma centre providing all levels of urgent and emergency care in and around the Birmingham area, including for those patients who are severely or critically unwell. The service saw around 133,000 type 1 patients annually (measured from March 2024 to February 2025) which was around 365 each day.

The Queen Elizabeth Hospital emergency department is 1 of 3 run by University Hospitals Birmingham NHS Foundation Trust, with the others at Good Hope Hospital in Sutton Coldfield, and Birmingham Heartlands Hospital in Bordesley Green. There is an urgent treatment centre at the trust’s Solihull Hospital. The Queen Elizabeth Hospital is commissioned to treat only patients aged 16 or above. However, the team will provide care to those patients under 16 years of age who self-present to the emergency department. Another local NHS trust provides full paediatric emergency services for the local population.

We carried out this assessment of the emergency department on the 19 and 20 March 2025. It was carried out to determine if improvements had been made following our previous inspection in April 2023. At the previous inspection, we rated safe as inadequate. This had improved at this assessment to requires improvement, although the department still had work to do to meet the requirements of being a safe service at all times. Responsive and well-led remained requires improvement, and caring remained good. Effective had improved to good from requires improvement. The service overall is therefore rated as requires improvement. However, there were elements of good in all the key questions.

The 9 regulatory breaches from our inspection in April 2023 had been met, but other aspects of the service needed a focus of attention. This included ensuring records were maintained to show risks had been assessed and care had been delivered in accordance with the trust’s requirements for maintaining patients’ records. There were some concerns with adherence to uniform standards and those related to infection prevention and control. Some areas in medicines management were not picking up on issues we identified or supporting people with time-critical medicines.

There was a high vacancy rate for nurses, not least due to the pressures on staff causing a high turnover as they coped with the crowding and the resulting higher workload. However, a successful recruitment strategy for nursing staff would bring the vacancy rate down when new staff came into post in the coming months. The number of consultants fell short of the recommendations of the Royal College of Emergency Medicine by as much as 40% and there was no trauma team leader available within the 5-minute requirement for a major trauma centre.

Due to the continued pressure on the department from crowding and demand, which was caused by a lack of available beds from delayed discharges of patients mostly to social care, patients were waiting far too long in the department. This was of concern also for patients who had mental health needs and their families and having to often wait many days for a specialist bed. Governance and risk management was not yet to a sufficient standard to manage the areas of risk identified specifically around patient records.

However, staff were willing to learn, most were not fearful of speaking up, listened to patients or those who spoke for them, and worked well with others to give a multidisciplinary approach to patient care. They followed evidence-based care and treatment protocols. Patients were able to give their consent or staff followed legal frameworks when patients did not have the mental capacity at the time to provide their own valid consent. We observed how staff treated people with kindness and compassion, although some patients wrote to us about different experiences. There was mostly a culture of commitment and teamwork although a considerable amount of change meant this needed continual focus. The leaders had skills and experience to manage what was an inexperienced or relatively new team in some areas. There were opportunities for learning, change and innovation whenever possible, but the often-overwhelming workload meant this did not always have the focus of attention it needed. The governance system was not demonstrating how the service was delivering good quality and safe care and treatment.

Updated 14 February 2024

Updated 13 February 2019

Our rating of this service stayed the same. We rated it as good because:

• The safeguarding team and senior ward staff maintained consistent standards of safeguarding. Teams thoroughly investigated safeguarding incidents and implemented learning that improved practice and patient safety.
• Standards of infection control practice, such as hand hygiene, were consistently good during our inspection. Infection control was audited and monitored by a dedicated team and housekeepers with extended training.
• A range of systems and strategies were in place to assess patient risk. This included electronic deterioration monitoring systems, out of hours senior medical cover and advanced training for staff in managing acutely unwell patients.
• Antimicrobial stewardship and sepsis programmes were well established with a rolling, comprehensive programme of audits and substantive training programmes for staff and doctors.
• Shared learning was a significant focus for staff and there was extensive evidence of detailed, multidisciplinary investigations of incidents and complaints that led to improved practice and training.
• Staff delivered care and treatment in line with national and international standards and clinical guidance. Systems were in place to ensure this remained current and specialities were demonstrably motivated to achieve accreditation status with professional bodies.
• Medical care services had a significant research profile and staff were supported to develop projects that placed them on the leading edge of current knowledge in their specialty.
• Allied health professionals were highly active in audit, benchmarking and research and led numerous projects that positively impacted medical care services. One project, relating to dietary management in radiotherapy patients, resulted in 88 saved bed days.
• Pain services were multidisciplinary, comprehensive and led by audit and research benchmarking.
• Audits to drive service improvement and to improve understanding of patient behaviour were embedded across medical specialties. Staff were passionate and motivated in the development of audit plans, such as in recent examples of a wide-ranging falls review project and a health promotion focus on alcohol and tobacco reduction.
• Multidisciplinary specialist teams facilitated a wide range of education, learning and development opportunities for staff. This focused on future service sustainability, the development of a highly specialised in-house workforce and the retention of staff through internal development.
• Staff demonstrated resourcefulness and resilience when managing highly complex situations that involved multiple agencies and organisations.
• There was extensive evidence of staff going beyond their responsibilities to deliver individualised, compassionate care that made a significant difference to patients and others living in challenging circumstances.
• Teams had developed processes and communication strategies to increase the involvement of patients in their care planning. This was reflected in new handover processes, consistently good documentation of conversations with patients in medical records and positive results in the NHS Services Seven Days a Week Forum's seven-day services priority standards for patient involvement.
• Staff continually looked for new ways to further meet patients’ needs to improve their experience and ensure the service maintained momentum.
• Staff were dedicated to safely reducing the length of stay for inpatients, reducing delayed discharges and improving flow and capacity. Multiple innovative projects and trials contributed to this, reflecting efforts from different groups of staff, including clinical teams, allied health professionals and divisional groups.
• Ward teams and specialties were responsive to learning from complaints and implemented changes and improvements as a result of learning.
• Divisional governance and leadership structures were clearly embedded in the operation of clinical services and leadership teams had developed effective systems of quality and performance improvement.

However, we also found areas for improvement:

• There were significant shortfalls in some elements of medicines management, including in storage and disposal, that had not been addressed by pharmacy teams.
• Staff described their greatest challenge and cause of staff as persistent shortages in nursing teams.

Updated 8 March 2024

Updated 15 May 2015

Overall we rated end of life care services as ‘good’. Staff provided compassionate care for patients. Services were very responsive to patients’ individual needs and those of their families and next of kin. We saw and heard about many examples where practical, emotional and spiritual needs were considered and met.

Although the trust did not take part in national audits, data from their own survey showed that relatives were positive about the quality of care and their experience of the service. We observed comprehensive and dynamic multidisciplinary working taking place, which covered all aspects of care. The trust’s electronic information system ensured that do not attempt cardio-pulmonary resuscitation (DNACPR) records were managed safely. Medicines were prescribed and administered in a safe way and there was guidance available for anticipatory medications.

At the time of our inspection, the service was on the cusp of significant change which the trust believed would enhance and improve the service. It was clear that leaders of end of life care services worked collaboratively across the hospital and their commitment to delivering a good quality service was evident.

Updated 14 February 2024

Updated 13 February 2019

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with our previous rating.

We rated it as good because:

• Staff were clear on how to report incidents and received feedback from investigations. The service had a clear process to investigate and learn from incidents through root cause analysis. It communicated any findings across the services and to patients and families in line with the Duty of Candour
• Arrangements were in place to minimise risk to patients and these were supported by policies and procedures. Risks to outpatients awaiting a follow up appointment were appropriately managed. Nurses and clinicians had a high level of awareness of how to care for vulnerable patients. The service was delivering an enhanced level of safeguarding training to level 3 to ensure all nursing staff were trained to safeguard children
• Since our last inspection, governance, risk management and performance management in outpatients and cancer service had improved. Task and finish groups addressed specific improvement projects in outpatient services, and risk and quality were managed at specialty and divisional level.
• Action planning to drive performance had improved since our last inspection. Outpatients and cancer specialties developed action plans and trajectories to address underperformance and recover backlogs. They recruited to areas where they lacked capacity and used locums where necessary. There were specialty level, divisional level and corporate meetings to monitor performance and progress on action plans in outpatients and cancer services
• Patient list monitoring processes were in place, supported by technology which enabled staff and leaders to clearly identify where patients were on their treatment pathway
• Access and flow in the service improved since our last inspection. It had the technology to monitor patients waiting times in clinics and investigated the root cause when patients had waited more than 60 minutes. This led to a problem-solving approach to delays, and shorter wait times
• The service had tailored consultation times to the needs of outpatients with complex conditions. It had increased the facilities available for them by moving more specialist clinics to other buildings, in response to the overcrowding we found in our last inspection. This allowed more complex outpatients to have longer consultations. Specialities also reviewed templates and consultation times within the Queen Elizabeth outpatient clinics and developed action plans to make improvements
• Leadership had strengthened around performance improvement. Meetings at appropriate levels within specialties and weekly RTT and RCA assurance meetings meant that leaders took decisions to improve performance, requested action plans and monitored them
• Outpatient specialities responded to local needs and were adapting services to meet increasing demand. The services responded to unmet need and this was leading to new types of clinic. Specialties were working in partnership with HGS and commissioners to deliver new services in the community, and using new technology such as virtual clinics
• Outpatient specialties demonstrated a strong approach to working with other services to deliver joined-up holistic treatment for patients. The cancer service had 24 multidisciplinary teams which meant they tailored treatment to the individual patient as much as possible. Highly trained clinical nurse specialists ran clinics which gave outpatients practical support and increased access to services
• The service ensured that unqualified and qualified nursing staff were competent to work in clinics. Staff were encouraged to develop their skills and this was supported by the outpatient clinical educator role, and mentoring from experienced nurses. The outpatient service did not use agency nursing staff, instead preferring to use in-house bank staff with the appropriate level of training if there was a staff shortage
• Clinicians and nurse were kind and reassuring with outpatients. They displayed understanding of the needs of older patients, people living with dementia and learning difficulties
• The service supported outpatients well. Clinical nurse specialists provided good emotional support to patients with life changing diagnoses in outpatients and cancer services. For example, an Eye Clinic Liaison Officer gave practical help to patients adjusting to sight loss and clinical nurse specialists talked through diagnoses with cancer patients
• The service adapted to the needs of some patients for example, there were bariatric chairs in waiting areas and access to interpreting services for those who did not speak English as a first language. Specialist liver nurses visited liver clinic patients in prisons.
• Many of the outpatients and cancer services were innovative. For example, the cancer service was active in the 100,000 Genomes project and had tumour boards in place. The ophthalmology specialty was nominated in the UK Ophthalmology Awards for its Uveitis service.

However:

• For the period July 2017 to June 2018 the trust performed worse than the 85% operational standard with a rate of 76.0% for patients receiving their first treatment within 62 days of an urgent GP referral. The England average for this time was 82.1%. Trust performance was 79.6% in August 2018. At this hospital 65.3% of patients referred by their GPs were treated within 62 days
• The service did not have a systematic approach to identifying and planning for the access and communication needs of diverse groups of patients. For example, it was not always easy for older people to find their way to the appropriate waiting area because there was no visually accessible internal plan of the hospital provided with the appointment letter
• Procedures around checking resuscitation trolleys and fridges were not sufficiently embedded and we found examples of non-compliance
• Flow did not always work smoothly for patients. The queuing system before arrival at fracture clinic meant that frail or injured outpatients had to stand for up to 20 minutes before proceeding to x-ray
• Patient privacy was not always maintained. A drugs storage room doubled as a room where staff took blood samples from patients and this process was interrupted by members of staff entering to remove supplies
• Services did not work seven days a week, although some clinics offered appointments at the weekend or during the evening