Queens Hospital

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• 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

This means we looked for evidence that the service met patient’s needs.

At our last assessment we rated this key question as good. At this assessment the rating has remained the same. This meant patients’ needs were met through good organisation and delivery.

Patients were routinely involved in planning and shared decision-making. Staff discussed advance care planning with patients and their families. Patients, relatives and carers knew how to complain or raise concerns. Patients could access the care, support and treatment they needed.

We have not awarded this service a score for Responsive.

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

The evidence showed a good standard. The service made sure patients were at the centre of their care and treatment choices and they decided, in partnership with patients, how to respond to any relevant changes in patient’s needs.

Patients were routinely involved in planning and shared decision-making. Staff were able to describe what arrangements they could make to accommodate the specialised needs of patients with a learning disability. In all areas we visited, patients with a learning disability were able to have families, visitors/ carers with them at all times.

The service took account of patients’ individual needs and circumstances and where possible made reasonable adjustments. There were policies that covered equality, diversity and inclusion and staff operated within them.

Patients we spoke with understood their diagnosis, investigation results, treatment options, and care plans. Those close to the patient were involved in care and discharge planning. A patient told us, “The whole team have been brilliant and very attentive. I feel able to speak up for myself and feel very safe here. I know who to approach if I am worried about anything, and staff really do listen.”

Care plans were personalised and holistic. Staff completed a comprehensive health assessment of the patient in a timely manner at, or soon after, admission. A psychiatry liaison team was available on site to support patients presenting with mental health needs. The team provided timely assessments, advice, and intervention for patients experiencing acute mental health concerns, behavioural distress, or requiring specialist psychiatric input. We reviewed patient notes and found that a delirium screening tool was included within the documentation.

Assessments included patient’s social circumstances, mental health needs and vulnerabilities including any protected characteristics.

A dedicated palliative care team was available and actively involved in reviewing patients receiving end‑of‑life care. Staff demonstrated a personalised approach, with all patients observed to have individualised care plans.

Staff ensured that older patients were actively involved in their care wherever possible. We saw staff using appropriate communication equipment and aids to support patients to express their needs and preferences, which promoted person‑centred care and patient involvement.

When care plans changed, we observed staff clearly communicated the changes to patients and their families.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff encouraged patients to ask questions or express concerns if they had any. They ensured patients could obtain information on treatments, local services and patients’ rights such as how to complain. Staff ensured carers and families were regularly updated about the patient’s progress.

The service complied with the Accessible Information Standard. The Accessible Information Standard ensures that patients with additional communication needs get information in a way they can understand and the support they need to communicate when using health and care services. Clear pathways were in place to support patients with learning disabilities. Staff told us they contacted the learning disability specialist team to assess the patient and provide appropriate communication tools. Reasonable adjustments were identified, documented, and implemented, including use of simple language and access to a quiet space to support understanding.

Staff made information leaflets available in different languages. Patients we spoke to said information had been provided to them in a way they could understand, and adjustments had been made as necessary, departments had information leaflets available about procedures. Managers ensured that staff and patients had easy access to interpreters including British Sign Language.

Staff within the Same Day Emergency Care (SDEC) service were responsive to patients’ needs and concerns. Some patients told staff they were unclear about why they had been referred to SDEC and what to expect from their attendance. In response to this feedback, staff had identified the need to improve patient information and told us they were developing a patient leaflet. This was intended to provide clear and accessible information about the SDEC service, including what patients could expect during their visit. This demonstrated a proactive approach to listening to patient feedback and making improvements to enhance patient experience.

The evidence showed some shortfalls. The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

Patients were generally positive about their care and spoke highly of staff. They felt listened to and said staff were responsive to their needs. However, this was not reflected in how quickly the service responded to concerns. Only 44.8% of complaints in Medicine were responded to within target timescales, meaning more than half were late.

There was also a significant backlog of complaints. In Medicine, 119 complaints were overdue and 32 had been open for more than 6 months, which is longer than the timescale expected under national guidance. This showed that delays were ongoing and not being resolved quickly enough.

Current activity showed that the service was not keeping up with demand. In December, 67 complaints were due, but only 46 were closed, leaving 121 overdue. This indicated that the backlog was continuing to increase.

Most patients and families we spoke with understood how to give feedback or raise concerns and were aware of the different ways to do this. However, feedback from Healthwatch indicated that not all patients were clear on how to make a complaint, which meant communication could be improved.

The service clearly displayed information about how to raise a concern in patient areas. The service had PALS and displayed information to direct patients how to make a complaint if they needed to. Patients we spoke with knew how to raise a complaint. Staff understood the policy on complaints and knew how to handle them. Staff told us they would try to resolve complaints at the point of care, however if it could not be resolved they would give the patient and family their ward manager’s details and PALS information.

Ward managers dealt with complaints or concerns which had not been resolved at the point of care and told us they would speak with patients and their families directly. For formal complaints they investigated these and completed a report which was sent back to the patient relations team. Following this process and interactions with the patient and their families, lessons learnt would then be shared with staff.

Information about how to raise concerns or make a complaint was publicly displayed. We saw details of PALS clearly displayed on a ward noticeboard.

Managers shared feedback from complaints with staff and learning was used to improve the service. Learning from complaints and concerns was shared at team meetings and daily huddles.

The evidence showed a good standard. The service made sure that patients could access the care, support and treatment they needed when they needed it.

Staff made reasonable adjustments for patients. For example, patients with mobility issues were provided with walking aids and shower chairs.

Staff planned for patients’ discharge, including good liaison with care managers/co-ordinators. Staff were aware of access barriers and engaged with affected groups to improve services. For example, staff said Staffordshire did not have a specialist respiratory community service, which resulted in limited community input for patients from that area. To address this gap, the respiratory team offered additional outpatient clinics to support Staffordshire patients. There were also virtual wards available.

Discharge delays reduced bed availability as demand and patient needs increased, and wards used different processes. The trust was working with the wider system to address barriers including community and social care capacity. The Trust responded by starting a 'Flow and Discharge Major Project' to standardise and coordinate discharge across teams.

Seven-day services were available to support transfers to community and social care. A live digital system was in place to track patient flow, and all managers had access to it.

Staff mostly ensured patients were assessed, investigated, diagnosed, and treated promptly. The Same Day Emergency Care (SDEC) service saw at least 50 patients per day. Patients were referred from GP surgeries, the emergency department (ED), ambulance services, and for those who required an infusion prior to discharge.

The ward manager told us that SDEC had been effective in preventing hospital admissions, reporting that approximately 13% of patients attending the service avoided admission as a result of SDEC intervention. They described this figure as a conservative estimate. This demonstrated the service’s positive impact on patient flow and reduction of avoidable admissions, although outcomes were not routinely shared visually with staff or patients within the clinical area.

Ambulances could convey directly to SDEC instead of the emergency department. Staff told us that this arrangement occasionally impacted the service the following day, as beds were not always available for planned GP referrals or patients returning to complete treatment. They said ED activity was prioritised to enable ambulance off‑loading, which could limit SDEC capacity during peak demand.

The facility was designed to accommodate diverse needs such as sensory sensitivities. For example, ward 7 was a general elderly ward that received patients from Ward 9 and Ward 5, which served as assessment areas. During the visit, we observed a bay where ceiling tiles had been fitted with therapeutic imaging. The visual design appeared to be particularly beneficial for patients living with dementia, providing a calming and supportive environment.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed a good standard. Patients were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

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

Staff understood and worked in accordance with National Institute for Clinical Excellence best practice guidance around decision making and mental capacity.

Staff we spoke with demonstrated a clear understanding of the trust’s resuscitation policy and ‘ReSPECT’ documentation. The ReSPECT process creates personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices.

Patients and their relatives participated in discussions about their treatment plans and their future. This included when further treatment was no longer in the patient’s best interests. When we looked at patient records, we saw that any Do Not Attempt Cardiopulmonary Resuscitation decisions were discussed and recorded.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. Occupational therapists and physiotherapists reviewed patients with complex needs on the unit. Their assessments supported safe mobilisation, functional evaluations, and planning for ongoing care needs or discharge.

Staff supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Although patients did not stay overnight within the SDEC service, staff ensured that patients attending for treatment remained at the centre of their care. We observed that staff focused on delivering person‑centred care throughout patients’ attendance, responding to individual needs and involving patients in decisions about their treatment. This demonstrated a commitment to maintaining high standards of care and prioritising patient experience, despite the short stay nature of the service.

The service worked with other health and social care providers as well as commissioners to offer a service that met the needs of the local population.

Staff told us they discussed advance care planning with patients and their families where appropriate. We saw evidence that these discussions supported patients’ preferences and involved families in decision making about future care.