Queens Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We rated caring as requires improvement. We looked for evidence that people were always treated with kindness, empathy, and compassion. We checked that people’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

At our last inspection we rated this key question as good. At this inspection the rating fell to requires improvement.

Because of crowding in the department, the staff could not always provide patients with privacy and dignity. While staff were given support for their wellbeing it did not mitigate all the effects of stress from their workload. However, staff treated patients with kindness and compassion, and they took account of their individual needs.

We have not awarded this service a score for Caring.

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

The service did not always provide patients with privacy and dignity. However, staff treated people with kindness, empathy, and compassion. Staff treated colleagues from other organisations with kindness and respect.

Not all patients had a dignified or private experience when in the department. The main waiting room was arranged so patients booking in at reception could be overheard by the interceptor/navigator nurses as a safety measure. However, other patients could hear conversations about why they had come to the ED. This meant the privacy and dignity of patients was compromised. It was possible for patients to be taken somewhere private, but this was by exception rather than normal circumstances.

We also saw, on several occasions, when assessments took place in the ambulance pitstop area, staff did not always draw the curtains around the bedspace. Sometimes staff could not easily draw the curtains due to the number of staff around the patient. However, at other times there was room, but staff chose not to draw the curtains. We also noted that in this area it was frequently possible for patients and their carers or relatives to hear staff discussing other patients, particularly handovers from ambulance crews.

Staff in SDEC told us they struggled to have private conversations with patients because of the space constraints within the area.

Almost all patients commented positively on the staff who had looked after them, most spoke of their kindness and empathy. For example, one patient told us staff “had been brilliant”, “can’t speak highly enough of them”.No patient to whom we spoke made negative comments about staffs attitude despite them telling us how busy they were.

However, staff felt they did not have enough time to be as caring as they would like to be. Many staff told us they were dissatisfied with the time they were able to spend with patients and had to be task focussed to keep patients safe and to promote flow through the department.

On several occasions we saw staff with patients and their relatives who were distressed and anxious and we saw the staff being empathic and kind, responding to each person’s individual circumstances.

The ED carried out patient satisfaction surveys titled “Your Views Matter”. When they did this, they recorded and analysed attributes of the studied population including diversity, protected characteristics and other descriptors, such as previous or current service in the armed forces.

Over the nine months before our visit, most patients who used the ED had a positive experience. Just over half (58%) said their care was very good, and 18% said it was good. However, 5% rated their care as poor and 9% as very poor, while 9% did not give an opinion. Feedback from the Same Day Emergency Care (SDEC) area was more positive, with 78% of patients rating their care as very good and 16% as good. Only 2% rated their care as poor and 2% as very poor, while 3% did not give an opinion.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Independence, choice and control during this assessment. The score for this quality statement is based on the previous rating for Caring.

Some patients did not have access to seating within the ED, to the extent relatives were asked to leave parts of the department when it became busy. This left some patients without emotional or practical support. Not all patients received support with their basic care needs. However, staff responded to people’s needs in the moment and acted to minimise any discomfort, concern, or distress.

At busy times, there was not enough seating in the main waiting area. Some patients had to stand, wait outside, or sit in other parts of the department. In some cases, patients sat or lay on the floor while waiting. This did not meet patient’s basic needs of having somewhere comfortable to sit, particularly when they were ill. In the SDEC staff told us they sometimes had to ask relatives who were not acting as carers, to leave when they were used as an escalation space.

Staff did not always support patients with basic care needs while in the department such as giving food, drink and assisting with personal care. Audit data showed not all staff recorded these basic care checks as regularly as they should. Patients in majors and SDEC who stayed for some time were given regular meals. Other patients told us if they requested food or drink, they were provided with something. Patients and relatives who were able to mobilise and pour drinks had access to water and cordial without having to ask staff. This meant we were not assured that all patients who could not speak for themselves, or mobilise, would obtain support during long waits.

Patients were asked how they preferred to be addressed and staff wore name badges so they could be identified

Most patients had access to a call bell, and we saw these being answered quickly. Patients in the pitstop area, and those who were accommodated in escalation spaces did not have access to a call bell. However, in all these areas the patients were under observation by staff in their immediate area and could easily attract their attention.

We observed staff give pain relief when patients requested this. Patients told us this happened.

Staff had access to resources in a dedicated storage area to be used for patients who had died or were dying''. These included bereavement packs for adults and children. Staff had access to information about how to correctly care for patients who had died in ways that accommodated differing cultural and religious needs.

The main waiting area had a breast-feeding room and a separate toilet for children to use.

Staff were under stress and the measures taken by the department and the wider trust could not always mitigate the effects of their workload. However, the service cared about and promoted the wellbeing of their staff and supported staff to deliver care.

Most recent staff survey results (from 2024), although 18 months old at the time of inspection, showed staff were negatively affected by their work.

The results showed that staff thought their managers were approachable and supportive, especially when it came to work-life balance and flexible working. However, many staff felt they had too much work to do and not enough colleagues to help. Fewer than 20% said they had realistic workloads, and only 10% felt there were enough staff in their role.

The survey also showed that many staff were struggling with tiredness, stress, and burnout. Although working in an ED is known to be challenging, the responses suggested that staff were under a lot of pressure. Around 90% said that feeling exhausted at work affected their wellbeing outside of work as well. Many staff told inspectors they were frustrated because they could not provide the level of care they wanted to give patients. Even with these challenges, nearly 70% of staff said they would recommend the department as a place to work. During the inspection, staff were often seen supporting each other and getting along well.

Staff were provided with conflict resolution and security awareness training as part of their mandatory training and the targets were largely met. Senior managers spoke of the increasing levels of aggression by patients and relatives, and their view that it resulted from frustration and people with mental health issues being cared for too long in unsuitable environment waiting to go to another provider.

Other staff said they sometimes felt vulnerable at night when there was overflow into areas that were only used during the day and they were working in parts of the department that could be accessed from other parts of the hospital. While there was not lone working staff still told us they felt uncomfortable.

Staff had access to a break room. Managers encouraged staff to use this and recognised it was important for them to get away from the patient areas during work breaks.

Staff told us they were given support following upsetting and distressing incidents. Several staff members told us of a recent case where there had been an immediate debrief by the consultant for all staff involved and how helpful it had been. This had been followed up with other support in the following days for those staff who wanted it.

A newly recruited member of staff said they had just completed their supernumerary period but still felt they were being supported and cared for. They said that after a recent, particularly difficult shift, the nurse in charge had phoned to ask how they had coped and then came to speak to them the following day as well.

Staff were complementary of the training and support they received. One said, “I feel valued and other staff are keen to teach me”. Several staff in training, including doctors and nurses, told us they had felt supported and education programmes were good. Some told us they had seen there were promotion opportunities and wanted to stay in the specialism and the department.

Managers monitored staff sickness and supported staff to return to work with adjustments where needed. Nursing staff had lower sickness rates than is typically seen in emergency departments, while medical staff had sickness rates that were average or slightly below average. These low sickness levels suggested a more positive workplace culture. Governance records identified stress as the main cause of sickness across the wider division which wards and departments beyond the ED.