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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked 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 people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last inspection we rated responsive as requires improvement. At this assessment, the ratings remained unchanged. This meant people were not getting care and treatment in a timely way to meet their needs. There were significant delays in patients receiving care due to high demand, over-capacity across the hospital for beds leading to poor flow and crowding leading to long and unacceptable delays for patients.

This service scored 57 (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 supplied appropriate, accurate and up-to-date information in formats tailored to individual needs. Patient information was held securely, but some was left open and unsupervised by staff not closing computer records after stepping away.

Most information given to patients or their relatives in the emergency department was verbal. There were a number of leaflets available, particularly in the minor injuries category, for people to take away. Staff said there were various ways in which they could provide information in a way people could understand. This included being able to provide interpretation for people who did not speak English as a first language. They were also able to obtain support for people who were d/Deaf and used British Sign Language.

People we asked said although it was not explicitly said, they were confident staff would not share their confidential information with anyone not authorised to see it. Staff confirmed this and said this also included making sure they checked first with patients before giving information to family or friends, in case the patient did not want this information passed on at that time.

Information gathered about patients or others was held in secure systems which met data protection legislation requirements. Access to computerised patient records was password protected with a secure login. We did see some patient information on paper having been left on desks and not supervised, but this was removed and placed securely when it was pointed out to staff. Staff we observed were aware of closing patient records on a computer they were using (they were all shared use) before they walked away. However, we did come across 1 set of medical records open on a computer-on-wheels in a public corridor. The nurse who was with us addressed this immediately and closed the records. We also noted all the patient records being looked at in Majors C were open on computers with no staff present at the time.

People told us the highest concern for them was being kept updated about what was happening to them. This was particularly with patients who were in waiting areas, as those in bays or treatment areas said staff were doing their best to keep them informed. We had information from people who contacted us who mentioned their concerns around being kept informed about themselves or their family or friend. There was a theme in comments from people saying they just needed more information or at least being acknowledged, even when there was nothing new to tell them.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Complaints were taken seriously and used to improve care and treatment where possible. The key themes from conversations with patients were the length of time spent waiting for a bed and not getting regular updates from staff about next steps.

Patients and relatives told us they felt confident about making a complaint should they wish to. Most did not know how to go about it when we asked, but said they would just ask the staff or look it up on the trust’s website. One person said they had had cause to make a complaint in the past, but they did this verbally through the trust’s patient relations team over the phone. They said they were listened to and given an apology. They then received a letter which offered an apology and said what actions had been taken as a result of their feedback. They said they were “very happy” with how the situation had been handled. Their only criticism was it had “taken a long time” before they heard from the trust.

Staff said they recognised how complaints were opportunities for learning and making things better for patients. The themes from complaints or concerns raised with staff directly or indirectly were mostly about the delays faced by patients, and the lack of communication when people had been waiting a long time. People we spoke with in Majors C, who were all waiting for beds in the hospital for further treatment said they did not have complaints except for the long time they were having to wait. One patient said the department was “hardly calming when you’re not feeling well” and their relative said staff did their best to provide updates, but “are as frustrated as we are that there’s no sign of a bed. We’ve been here 24 hours already.”

The service did not always make sure people could access timely care, support and treatment when they needed it. There were signs of improvement from better streaming of patients away from the emergency department and reconfiguration of services. However, there remained too often crowding in the department from both increased patient numbers, but also the unmet demand for ward beds for emergency department patients in a hospital often at full capacity. This was on the department's risk register and graded at the highest level of risk with a recognition of all the risk factors for patients.

The crowding and delays to ambulance handovers led at times to patients being placed in a corridor or staying for long periods in chairs in waiting areas. People also stayed for many hours and sometimes days in beds in busy areas. In patient records we selected for review at random, most of the patients had been in the department for more than 24 hours awaiting either review or onward care.

People also remained on the back of the ambulance that brought them for many hours with the crew unable to handover the patient and return to the needs of the community. Staff said there were frequently times when patients were held in the rapid assessment and triage area, in the minor injuries unit, or in waiting areas, which increased the risk of harm to the patient.

There was positive action to divert patients to other services if they did not require urgent or emergency care. The emergency department had a `nurse navigator' stationed at the front door. Their role was to meet patients as they arrived, including those coming by ambulance, and determining if there was another service the patient was more suited to attend. This included a GP service, minor injuries, the urgent treatment centre, (these 3 services co-located at the hospital) or another service in the community. When we observed the interactions with the navigator and people arriving at the front door, we saw patients diverted to other services and recognised a high number at the time who did not need to present for urgent and emergency care. This appeared well managed.

The increased demand and poor flow in the department was a consequence from beds being not vacated by patients with complex discharges from hospital ward beds and delays for people who were medically fit to go home but had no immediate care provision in the community. This had a significant impact on the performance of the emergency department and the ability to be responsive to patients and meet their needs in a timely way as patients could not be moved forwards.

Despite being a major trauma centre for the region, the hospital trust did not operate a same-day emergency care acute frailty service (the frailty service had closed over Winter 2024/25). Although the hospital did operate a medical and surgical SDEC (although the surgical service was combined with the surgical assessment unit), the NHS England long-term plan recommended all hospitals with a 24-hour emergency department should provide an acute frailty service operating for 70 hours a week. NHS England described this as having significant benefits for patients not least from avoiding unplanned and longer stays in hospital. This would equally reduce the risk of infection and patients suffering hospital-acquired deconditioned (mental and or physical decline from periods of inactivity or long-stays in a hospital bed or chair).

A high degree of crowding was also indicated by the midday/midnight patient numbers. The volume of patients in the department at midnight was almost always the same as the midday patient numbers. This had improved since September 2024 for a couple of months but the gap in January 2025 was negligible. Given attendance timings, midnight volumes should be much lower than midday, which suggested a high level of crowding.

We were concerned about long-stay patients who had exceeded the 4-hour standard and urgency around the management of their bed had declined. For example, we met a patient in Majors C who had been there for a day and a half. They had been told they were able to go home but not moved on to the discharge lounge despite being suitable. There did not appear to be any urgency about this with the staff when it was discussed.

Demand for emergency services was increasing. For example, in February 2023, the trust (so all 3 emergency departments) saw around 25,000 patients (13,160 type 1). Two years later in February 2025, the latest published data at the time of writing, the trust had seen just over 33,000 patients (18,478 type 1). Bed occupancy at the trust was close to 100% much of the time, which meant there was a lack of available beds and beds in the right place to move people from the emergency department.

Due to factors described here, the department was not treating, discharging or admitting people to wards within the standards required by the NHS constitution — known as the 4-hour standard. The standard was to treat, discharge or admit 95% of people within 4 hours. There was a temporary change to the standard by NHS England following the COVID-19 pandemic and the recognised pressure on many accident and emergency departments. This reduced the standard to 78% of patients meeting the4-hour threshold. However, for those patients who required a type 1 response, the department achieved 59.5% in February 2025, although this was much the same as the England average. This had improved though from the previous February which was 54%.

Although showing signs of beginning to improve, far too many patients were spending too long in the department. In published data for patients waiting more than 12 hours from a decision to admit them to a ward bed, 17.8% of patients fell into this category in February 2025 across the trust. This was against the England average of 13%. This amounted to 1,657 patients being held for more than 12 hours. However, this was an improvement from the peak of January 2024 when 23.4% of patients waited more than 12 hours.

As we have reported above, ambulance handover delays remained a constant factor in the responsiveness of the department to giving patients timely care and treatment in the right place. At the Queen Elizabeth Hospital emergency department from 1 April 2024 to 16 March 2025, 28.7% of patients who arrived by ambulance were delayed by more than an hour before handover, and some far longer. The ambulance handover delays were on the department's risk register categorised as a high risk.

As stated already, the point of failure to meet the standard for timely care was in the inability to admit patients to a ward bed within the 4-hour threshold due to a lack of bed availability or specialist review. In data showing the responsiveness of specialty teams to patients in the emergency department, 59% of medical patients were seen within the same day indicating a high degree of effective support, surgery saw 39.5%, but trauma and orthopaedics only saw 3.9% of patients on the day. Also, 7.4% of patients attending the department were already on a waiting list for treatment. This suggested the delays caused by the backlog in elective surgery waiting lists since the COVID-19 pandemic were leading to complications for patients.

However, during our assessment we evaluated the patients remaining in the department and all had been triaged in good time and seen by a doctor. All had been reviewed by a doctor with oversight of the triage system as well. In most cases a decision about their care had been made. Those who could be treated and discharged home (known as pathway zero) accounted for around 70% of patients, and staff were proactive in doing their best to move them through the department and home. Almost all the other patients were waiting for a specialty review, with the longest patients waiting for a mental health decision or placement for ongoing care, of for transfer to a ward.

The trust (so across all 3 sites) also had relatively high numbers of patients who left before being seen. In November 2024, 7.7% of patients left the department before being seen which was the highest level of any month from January 2023 to November 2024. This was against an England average of 5.4%. In unverified data for January 2025, this had improved to 6.7% of patients but against an England average of 4.5%, so the gap had narrowed.

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.