Queens Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

Staff treated patients as individuals and tailored their care to their specific needs. Patients had choice over their treatment and staff were quick to respond to their changing needs. Outpatients staff had received chaperoning training, and this was pro-actively offered to patients.

Team leaders and line managers were approachable and cared about colleagues’ wellbeing. Staff felt supported by line managers although some thought senior leadership staff were not as visible. Some staff expressed concerns about pressure of work but felt they worked well as a team to provide a caring environment for patients.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were supported and treated with dignity and respect and involved as partners in their care.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff used appropriate tools to support the assessment of patients’ needs. Staff made sure patients were involved in the decision making about their treatment and care. Most patients had been referred to the clinics by their GPs.

Staff took new patients’ medical history at their first appointment. Patients’ social history, such as their home situation or support provided by other agencies, was also checked and noted. This meant staff could assess patients’ needs holistically to ensure the most appropriate treatment and ongoing care.

Staff were also aware of the specific requirements to care for patients with a learning disability or autism. They would prepare in advance for these patients and work with their family or carers to make the appointments as relaxing as possible.

Where appropriate, staff involved families, carers and other clinicians in the assessment of patients’ needs. Patients told us that doctors were responsive to their changing needs, particularly in managing pain. Clinical staff documented any changes to treatment or medication on patients’ records. Patients could request follow up appointments to discuss changes in their condition.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Clinics were staffed by skilled medical and nursing staff who had completed the appropriate training for their roles. They followed guidance on specific treatment in outpatient departments, such as standards for invasive procedures.

Leaders ensured that staff received the necessary training for their role. Staff also kept up to date with the most recent evidence-based practice in their respective specialties. At the time of the inspection, staff in the ophthalmology clinic were undertaking training on wet macular degeneration to build their skills in this area.

Outpatient staff could refer patients to other areas and practitioners, including blood clinics, physiotherapists and speech and language therapy practitioners to ensure patients received the most effective treatment. Some clinics also offered further support to support patients with their treatment, such as signposting to support groups and mental health services.

Staff kept up to date with changes to relevant guidance and best practice in their specialties.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Nursing and clinical staff worked closely together as an outpatient team within each clinic. They also attended regular multidisciplinary meetings with their relevant specialties across the trust.

The teams had effective working relationships with other teams within the hospital and referring practitioners. Staff told us they could ask for help from administrators, porters and housekeeping staff to provide the best care for patients. If clinics were running late, the whole team worked together to get them back on track and minimise disruption to patients. Staff also ensured they completed patient notes after appointments so that patient information passed to other departments was up to date.

Staff worked with multi-disciplinary teams across other specialties so that patients had smooth handovers within the hospital. They also liaised with external stakeholders, including GPs and local support groups, to ensure care from all healthcare providers was joined up and easy for patients to use. Ophthalmology staff had recently worked with the urgent care team in the accident and emergency department (ED). They shared learning with emergency care staff to help them recognise conditions or potential eye issues and understand more about the specialty. With this training, ED staff could refer patients more quickly to the ophthalmology clinics. This meant patients might require fewer appointments, which streamlined their treatment pathway.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff gave patients information about services that offered health promotion support, such as giving up smoking and vaping. They also offered advice around weight loss choices, which could improve patients’ overall health. Ophthalmology staff discussed eye protection in the sun with their patients.

Staff told us they considered patients’ health holistically and where appropriate would provide general health advice or share information about wider healthcare initiatives. The urology team had leaflets about local initiatives and support groups, particularly for those with cancer. The urology outpatient team had also set up a prostate clinic in the department, which had been well received by patients. Most of the departments also offered smoking cessation and dietician clinics. Outpatient leaders told us they were organising clinical psychology sessions for patients.

Patients told us they felt their outpatient appointments enabled them to keep in regular touch with their consultants and address any further issues promptly without needing to return to their GP. Some patients told us they were attending clinics for a longer term, where their health was being monitored regularly and specialist staff could be contacted for guidance if their condition changed.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff regularly assessed patients at each of their appointments to ensure they were continuing to receive the right treatment. If required, staff requested further testing or support to enable patients to have the best outcomes.

Staff in the respiratory team told us there was a clear treatment pathway in that a patient’s treatment usually began when they were an inpatient. The outpatient team would see them in the clinics before their discharge and keep in contact through the follow up care appointments in the outpatient clinics. This enabled the team and the wider specialty to monitor patients’ ongoing recovery process.

The service continuously monitored outpatient waiting lists to identify areas where they could reduce delays which could have an impact on overall outcomes. Although waiting times for first appointments had improved, leaders and staff were implementing better pathways and increasing clinic times and frequencies to reduce appointment waiting times.

Outpatient clinics were working in partnership with NHS England, to start using a pre-operative screening tool. As a digital tool, staff expected this would speed up the pre-operative process for patients.

Staff used appropriate assessment tools to evaluate patients’ conditions and ensure treatment was delivered safely. Using electronic systems which linked to other departments, staff could access test results and relevant clinical information, which enabled them to adapt treatment to ensure the best outcome for patients

The outpatient transformation programme was ensuring that key areas of performance, such as effective use of clinic times, appointment booking procedures and document templates meet the criteria of the national Getting It Right First Time (GIRFT) programme. This analyses data and shares best practice across health providers to reduce unwarranted variation and improve efficiency.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff explained treatment choices with patients and encouraged them to ask any questions about their options. They made sure patients had all the right information before they requested consent to begin treatment. To help patients and their families make informed decisions about their care, some clinics used aids, such as treatment decision documents which were forms to complete which ensured patients considered all their options. If a patient initially refused treatment, staff would discuss their concerns with them and their families and see if alternative treatment options were possible. If a patient ultimately decided against treatment, staff respected this decision and documented it on their record.

The service had up to date consent policies, including a Mental Capacity Act (MCA) policy which provided guidance for obtaining consent where patients may not have capacity to make informed decisions about their care and treatment. This also contained guidelines for considering patients’ best interests in these circumstances.

Staff checked patients’ mental capacity and where relevant, worked with patients and their families to consider a patient’s ‘best interests’ and provide the most appropriate care for them. Staff in one clinic told us they have a leaflet for patients about informed decision making and guidance for staff to ensure patients received the right information.

Patients told us they were asked about their consent to treatment and offered guidance about any surgical procedures. One patient confirmed that the risks and benefits of their treatment had been discussed before they were asked to sign the consent form.