- NHS hospital
Queen Elizabeth Hospital Birmingham
Report from 21 January 2025 assessment
Contents
Ratings - Urgent and emergency services
Our view of the service
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.
People's experience of this service
Those patients and any family or carers with them we met were mostly positive about the staff treating them with kindness and providing good care and treatment. Most said they were seen quickly on arrival by trained nursing staff to find out more about why they had attended the emergency department (triage) or if arriving by ambulance were also seen in a rapid assessment and triage service by a nurse and/or a doctor.
Records showed patients were given the tests they needed following triage usually promptly, and they felt staff were on hand if they needed them for help or support. People said they did not feel anxious about raising concerns and felt they were listened to.
In the CQC annual Urgent and Emergency Care Survey 2024, results for the Queen Elizabeth Hospital Birmingham’s emergency department were mostly ‘about the same’ as other trusts delivering similar services. In those that were ‘somewhat worse than expected,’ fewer patients than average said the nurse or doctor told them what would happen next; fewer than average were told how long they would have to wait to be treated; and fewer than average were kept updated on how long they might wait. Fewer patients than average said they were able to get help with their symptoms or condition while they waited. There were no results which were ‘much worse than expected.’
The questions around waiting times and being given information put University Hospitals Birmingham as a trust within the lowest group in the region for scores in this section. It also featured in the lower end of the regional scores for the hospital environment and facilities and for support and care after the patient left A&E.
In information provided to us from patients in our ‘give feedback on care’ online reporting tool, we were told of concerns from patients about long waiting times, poor communication, privacy concerns, staff under pressure, pain management and staff attitude.