Queens Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

Leaders promoted a positive culture which enabled staff to develop and provide the best care for patients. Staff were valued and encouraged to speak up if they had concerns.

Some staff felt that there was still inconsistency with information sharing across teams in different specialty clinics. However, work was underway to improve the cross-specialty communications and improve the effectiveness of the outpatient departments.

Teams worked closely with other services and local communities to build relationships and improve people’s care. Leaders encouraged innovation within the service to enhance staff and patients’ experience.

At our last assessment we rated this key question requires improvement. At this assessment the rating is now good. This means the outpatients departments at Queen’s Hospital are consistently managed and well-led.

We have not awarded this service a score for Well-led.

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

The service did not always have a shared vision, strategy and culture. They did not always understand the challenges and the needs of staff in the various specialties. However, staff aimed to work to the values which were based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

Outpatient leaders aimed to create culture of positive collaboration and innovation. They were visible and met regularly to discuss staffing issues and share concerns about themes which might impact other departments. This worked well in outpatient areas A and B. However, information sharing across the various specialty clinics meetings was not always consistent. This meant not all staff were aware of incidents, complaints, and updates to policies.

Some staff felt that the formal integration with Royal Derby Hospital (RDH) in 2018 was not entirely embedded and had led to a split relationship between the two sites. Although teams had worked to forge links and minimise the impact of this, staff told us they thought that patients had also noticed the change in culture at Queens hospital since the integration. However, staff in some clinics told us that they worked well with their counterparts at RDH. They told us they had frequent multi-disciplinary meetings with colleagues elsewhere in the service. Clinic leaders (Band 7 nursing staff) told us that they would welcome more opportunities to meet as a group of outpatient clinic leaders to share good practice as this might strengthen relationships between the different specialty outpatient teams.

Despite these wider challenges, clinic staff were engaged and passionate about the services they provided and delivering person-centred care. They worked to the 3 organisational values of compassion, openness and excellence. Staff told us they felt the culture within the department of the Queen’s hospital site was generally good. They had established good working relations across the hospital site and there was a low turnover of staff.

Staff worked collaboratively with other departments, such as the blood and micro-suction clinics, to provide more joined-up care for patients. They said that despite daily challenges, staff morale was good and they pulled together as a team.

The service had inclusive leaders in the outpatient departments who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Outpatient leaders were knowledgeable about the various clinics and were proud of the quality of care given to patients. They encouraged staff to take ownership of their clinics and created learning opportunities to build skills and support professional development for colleagues. They also recognised and praised teamwork that went beyond expectations.

Data showed that 80% of outpatients staff who responded to the staff survey felt their line managers listened to their concerns and gave clear feedback on their work. The survey also indicated that 70% of respondents said that their manager encouraged them and asked their opinion before making any decisions which impacted their work. This indicated that outpatient staff generally felt supported by their team leaders. Staff told us their local leaders were approachable and listened to their concerns and ideas for improvements.

Outpatient teams worked closely with divisional (specialty) leaders across the hospital. However, some staff told us that specialty managers did not visit their department very often, and some felt that senior trust leaders were not so visible at the hospital.

People did not always feel they could speak up and that their voice would be heard.

The service had policies and procedures for staff to speak up formally. Staff told us they were aware of the formal freedom to speak up (FTSU) process and some colleagues had used this in the past. However, team leaders did note that due to the anonymity provided by the FTSU process, it was sometimes a challenge to investigate the concerns and make improvements.

Data from the survey of staff in outpatients at Queens hospital indicated that only 60% of colleagues felt safe to speak up about anything that concerned them with same percentage of staff felt these concerns would be taken seriously.

However, outpatient team leaders encouraged a positive culture where people felt they could speak up and their voice would be heard. Staff told us they felt confident they could raise concerns with their line managers.

The service aimed to promote diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service had policies about equality and diversity, which contained action plans to ensure inclusive recruitment, progression, and a diverse representative workforce. There was also specific guidance to support transgender individuals.

The trust operated under workforce race equality standards (WRES) and workforce disability equality standards (WDES). The service had also devised a high impact equality, diversity and inclusion (EDI) plan to address any issues of bullying, harassment and discrimination. Senior leaders acknowledged there was work to be done to address concerns that colleagues often chose not to report a disability or long-term condition and were considering appropriate actions to address this.

Outpatient leaders worked to create an inclusive working environment. They encouraged staff to get involved with trust wide equality and diversity initiatives and ensured that staff were given the right training and support to provide the best care for patients with complex needs. Staff were mostly positive about inclusivity across the organisation with 80% of respondents feeling that the trust respects individual differences.

Nursing staff told us they were able to work flexibly and can plan their clinics to enable them to have an appropriate work/life balance. Staff survey data showed that 80% of outpatients staff thought managers were happy to discuss requests for more flexible working arrangements.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Outpatient leaders had monthly governance meetings which covered themes for learning and emerging issues. These included all specialty teams and clinic leads. Data about clinical governance across the department was shared with specialty leaders. Staff had access to the right equipment and technology to enable them to provide safe patient care.

Specialty clinic leads held weekly meetings for clinic staff. Incidents and complaints were discussed; learning was shared and actions taken to improve patient care and outcomes. Good practice and guidance from other areas of the specialty was also discussed with staff. Newsletters were circulated to staff and safety ‘flashes’ were used to highlight urgent situations. 

The outpatient senior sister had fortnightly meetings with specialty leads to review planned activity, extra pressures or cancellations. Monthly clinical governance meetings were held by specialties, with outpatient team leaders attending and providing input from their areas. These meetings considered risk, incidents and updates to trust or national guidelines. Leaders also shared examples of good practice and learning at these meetings.

Staff understood the arrangements for working with other teams within the hospital and external agencies, to meet the needs of the patients. They felt confident they could raise concerns and emerging risks with their managers who would take action to mitigate these risks.

Staff were involved in local clinical audits. These audits were reviewed by leaders and if required the leaders took action to improve shortfalls. Staff could escalate concerns to managers about their equipment, environment or other risks which could impact patient care.

At the time of the inspection, the Queen’s Hospital outpatient department had one risk on the main trust risk register, which related to the lack of an appropriate sink in one clinic. At the time of the inspection, although mitigation was in place, there were no permanent solutions to resolve the issue.

Leaders had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. For example, staffing numbers in the outpatient teams were mapped to the previous year’s activity and forecast plans from the respective specialties. Leaders used specific programmes to ensure staff skills were matched to the activity. They also sent recommendations to the trust’s finance team for budget planning for the outpatient department.

Leaders told us that the service had implemented 7 annual mandatory risk assessments including welfare, potential ligature points and manual handling. These were monitored regularly and steps taken to address any concerns.

Patient records were stored securely on an electronic system, but some staff used paper notes for each patient during clinics. These would be scanned at the end of each clinic and clinic leaders ensured that any paper records were disposed of securely. Most paper notes were secure; however, in one clinic we saw that patient files were laid out on a reception desk in a waiting area. These files were promptly removed when we informed clinic managers.

The service understood its duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Outpatient staff worked with other departments across Queen’s Hospital and within their respective specialty to provide effective and seamless care for patients.

They had monthly meetings with the local ambulance service that provided patient transport services to discuss queries and issues around patient transfers. The departments also communicated with the trust patient liaison officer every week to plan the allocation of patients entitled to free patient transport who were due to attend appointments. 

Some clinics worked with other services in the local community hospitals and volunteer community groups to provide further support for patients. Senior leaders worked with 2 integrated care boards due to the trust locations being situated over 2 counties - Derbyshire and Staffordshire. These boards are responsible for planning and commissioning local health services, managing NHS budgets, and improving population health. Staff told us that working with two integrated care boards could be challenging, as this influenced to which community services staff were able to refer patients.”

Outpatient departments were also working in partnership with wider organisations, such as NHS England, including the use of nationally recognised tools to improve outcomes for patients.

Most patients said that outpatient staff liaised effectively with other services within the hospital which meant the care they received from different teams in the hospital was efficient and effective.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Leaders told us that although staff were aligned to specialty teams, they encouraged staff to develop their roles in the outpatients department and arranged training to achieve this. They organised staff rotation around the various specialty clinics to build multi-faceted skills. Healthcare support workers were able to access nursing associate training to enable them to progress in their careers.

Clinic leaders told us that they aimed to promote staff within the team. This boosted location specific skills and improved morale. It also meant the team would be stable and patients experienced continuity of care from staff they already knew. Some clinics were involved in specialist training for their area. Staff said that they’d been given ample time to train and develop, including working towards degrees and taking independent courses.

The outpatients department had introduced a variety of improvement measures, including an online translation service, and clinics to help with smoking cessation, and nutrition.

The trust had implemented a major improvement project for the outpatients department. Workstreams were set up to improve capacity & clinic utilisation and use digital technology more effectively. Leaders were standardising administration processes across the clinics and regularly reviewed staff numbers. These were analysed against the predicted benefit to patients and reported to trust management. In December 2025, a report on the project showed increased outpatient attendances with reduced cancellations and missed appointments. Improved booking systems had also enabled staff to increase clinic capacity.