Queen Elizabeth Hospital Birmingham

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

At our last assessment we rated this key question as good. At this assessment the rating fell to requires improvement. This meant people's needs were not always being met, especially when it came to accessing the service when they needed to.

Following the COVID-19 pandemic and the recovery programme of returning to NHS treatment standards, not all patients' care and treatment was timely and in line with best practice, quality standards and legal requirements. However, this was improving in many areas. But there were worsening delays in diagnostic tests, the proportion of operations cancelled and not rebooked within 28 days had increased. There were prolonged waits in physiological assessments and for urodynamics (a test that measures lower urinary tract function) the wait was nearly 3 times higher than the national average. There was more to do in some cancer waiting times, but each of these had significantly reduced.

However, the service was inclusive and took account of people's individual needs and preferences.

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.

Staff respected patients' personal, cultural, social, and religious needs. Services were generally planned and delivered in a way that took the needs of different patients into account.

People who used services and those close to them (including carers and dependants) were regularly involved in planning and making shared decisions about their care and treatment, so it was centred on them and their needs. The pre-assessment team sent out questionnaires for patients to complete prior to attending their appointment. This helped the team to identify patients with learning disabilities or patients who required special adjustments before they attended. Staff were also alerted to patients with autism who required a quiet room and were usually able to arrange this.

People's care plans reflected their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act. An `all about me' booklet was available for all patients and their relatives to complete upon admission. This helped staff personalise care provided to certain patients with different needs. It gave patients and carers the opportunity to let staff know what they or their family member would like to be called, their hobbies, previous employment, sleep pattern, information about eating and drinking, and activities of daily living.

The trust had developed guidance aimed at communicating effectively with patients with learning disabilities or autism. Staff followed a `red, amber, green' rating and flowchart when reviewing a patient with a learning disability or autism. It included actions such as daily reviews and referral to the hospital's vulnerabilities team if standards were not being met and discussing in the morning meetings.

A multidisciplinary team meeting took place for every patient with a learning disability and/or autism within 72 hours of their admission. The meeting included a number of health care professionals who discussed the purpose of the meeting, expectations of the family/carer and set out a detailed care plan.

Managers made sure staff, patients and carers could access interpreters or signers when needed. Information on interpreting services was readily available.

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.

People received care and treatment from services that understood the diverse health and social care needs of their local communities. The service planned and provided care in a way that met the needs of local people, and the communities served. It also worked with others in the wider system and local organisations to plan care. Managers planned and organised services, so they met the changing needs of the local population.

Staff worked across healthcare disciplines and with other teams when required to care for patients. For example, we observed a meeting between site managers and Band 7 managers who discussed potential delays from recovery to the wards. Delays mostly occurred as a result of delays in bed cleans or waiting for a doctor to discharge a patient. Theatre staff occasionally had to send a junior doctor from theatre to discharge patients to help patient flow.

Services were co-ordinated and responsive. For example, doctors from different specialties such as trauma and orthopaedics, neurology, cardiac surgery and maxillofacial specialty attended the day case unit to review their patients.

Services considered the needs and preference of people. Patients were able to initiate an additional follow-up consultation independent of their regular appointments across various areas using a patient-initiated follow-up approach (PIFU). Neurosurgery and neurology post-transplant patient cohorts were the group of patients placed on a dedicated PIFU plan list. This put patients in control of their follow-up appointments and gave them access to support and guidance.

People were supported to make informed choices about their treatment options and plan their future care. Patients told us they were kept informed about future appointments.

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.

Patients, relatives and their carers knew how to give feedback about their experiences including how to raise complaints or concerns. The service clearly displayed information about how to raise a concern in patient areas. Patients told us they felt comfortable raising any issues with the staff caring for them at the time.

Staff understood the policy on complaints and knew how to handle them. Data showed there had been 252 formal complaints and 207 compliments in the last 12 months for surgical services at the Queen Elizabeth Hospital Birmingham. The common themes identified were in relation to clinical treatment, communications, patient care and staff attitude.

Managers investigated complaints and identified themes. Staff knew how to acknowledge complaints and patients received feedback from managers after the investigation into their complaint.

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

Although leaders had oversight on the performance for referral to treatment and carried out harm reviews on patients who experienced long waits, performance still needed to be improved. Following the COVID-19 pandemic and the recovery programme of returning to NHS treatment standards, not all patients' care and treatment was timely and in line with best practice, quality standards and legal requirements. However, this was improving in many areas.

From a low baseline after the pandemic, the trust had shown an improved performance against the NHS constitutional standard to see 92% of patients referred to treatment within 18 weeks, although it remained behind national and local averages. For February 2025, the trust had seen 51.4% of patients within 18 weeks, against a national average of 59.2% and regional Midlands average of 56.8%. In February, there were 112,137 patients on the trust's waiting list, which had dropped from over 160,000 at its peak in July 2022. The trust had a target set by commissioners for 60% of patients being seen within 18 weeks to be achieved by March 2026 and senior leaders believed this to be achievable.

In terms of long waits, there were no patients waiting over 78 weeks; 40 patients were waiting over 65 weeks in January, which was close to the national average; and 4,708 patients were waiting for more than 52 weeks. These long waits for patients represented 4.2% of the waiting list against a national average of 2.6% and the Midlands region of 2.4%. However, this had reduced from around 6% over the previous February 2024. Performance was expected to improve with the opening of the Solihull Hospital elective surgical hub in early 2025. The new operating theatre unit had 6 new theatres which had a planned procedure rate of 15,000 each year.

There had been an increase in longer waiting times for diagnostic tests. The NHS constitutional interim standard for NHS trusts was for no more than 5% of patients to wait over 6 weeks of a referral for their test (the pre-Covid standard was 2%). In March 2025, 35.7% of patients at the trust had waited more than 6 weeks. This was around twice the national average of 18.4% waiting over 6 weeks. A significant number of patients (14.1%) had been waiting more than 13 weeks. This was also more than twice the national average of 6.1%. Performance was expected to improve with the opening of the new Community Diagnostic Centre located in Chelmsley Wood Shopping Centre in mid-May 2025. The centre was established to provide X-rays, Computed Tomography (CT) scans, MRI scans, ultrasound and endoscopy services.

There were too many patients not having cancelled operations rebooked in accordance with guidance, although the number of cancellations was in a downward (improving) trend. From October to December 2024, 711 operations were cancelled which was a reducing number since June 2024. However, the proportion of operations not rebooked within 28 days stood at 61%. Physiological assessments and urodynamics were particularly affected, with 73.3% of urodynamics patients waiting over 6 weeks and 40.8% waiting over 13 weeks for their procedures to be rebooked. The waiting time was double the previous year's figure and nearly 3 times higher than the national average of 21%.

There was more to do in some cancer waiting times, but each of these had significantly reduced. In cancer performance, the trust saw and reported results back to 81% of its patients with their diagnosis within 28 days (the faster diagnosis standard) against a national average of 78.9%. This was the highest level for the trust since this data was commenced in April 2021 (when the trust reported 50.1%). The trust treated 89.4% of patients within the 31-day standard (national average 91.4%), which for the trust had stayed relatively constant; and 60.8% within the 62-day standard. This was against a national average of 71.4% but much improved from 40.5% in April 2022 and was above the agreed trajectory.

We raised this with service leaders who said clinical oversight of patients who were on the cancer patient tracking list was formally undertaken to prioritise patients in terms of urgency. Decision making was driven by clinical prioritisation such as listing for surgery or other treatment if demand was greater than the available capacity. There were core processes for oversight of patients on a suspected cancer pathway and staff held weekly patient tracking meetings and weekly clinical delivery group-led performance reviews for each specialty. A weekly trust oversight meeting which focused on high-volume and tumour sites which were `off-track' compared to their improvement trajectory took place to enable changes to be made to procedures where needed. Staff reported potential or known harm on the trust's incident management system for review by the relevant clinical team.

Although some theatre utilisation rates were below national averages, for example in gynaecology and ophthalmology, there were realistic explanations for this. We discussed the low number of cases for each session in some specialties and senior staff told us due to the nature of the service, staff carried out more complex procedures which lasted longer in theatres. Some procedures lasted 3 hours and shorter procedures were mostly being sent to other hospitals. This meant theatre utilisation appeared low.

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

People did not experience discrimination or inequality in their outcomes. People with additional needs did not feel they were disadvantaged. This included making reasonable adjustments for people with disabilities, those with communication difficulties or cognitive impairment to give equity in their outcome. People were listened to when they wanted to share their experience in order to tailor their support to improved experience and outcomes.

Staff tailored the care and treatment they provided to meet the experience of patients. Leaders we spoke with demonstrated they understood the local population. Staff proactively sought out ways to address barriers to improve people's experience. People's care, treatment and support promoted equality, removed barriers or delays and protected their rights.

A trust-based vulnerabilities team was available for people with learning disabilities. Patients with a learning disability had hospital passports to help staff support them and were usually nursed in side rooms in various ward areas. A link nurse was usually allocated to care for patients in various areas.

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.