Queens Hospital

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• 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 patients and communities had the best possible outcomes because their needs were assessed. We checked that patients’ care, support and treatment reflected these needs and any protected equality characteristics, ensuring staff kept patients at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last inspection we rated this key question as good. At this inspection the rating remained good. This meant there were good processes for the delivery of evidence-based care and treatment, consent was obtained in line with legal processes and care delivered met the standards required. However, there was not always effective working between the ED and some other specialities and agencies.

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.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

People’s needs were consistently assessed using a range of assessment tools to ensure their health and care needs were understood.

Staff had access to up-to-date standard operating procedures (SOPs), policies, risk assessment tools and other guidance on the department’s online system. These documents were based on guidance from external agencies such as the National Institute for Health and Care Excellence (NICE) and specialist bodies such as the Royal College for Emergency Medicine (RCEM) and the Royal College of Paediatrics and Child Health (RCPCH). This guidance was adapted to local circumstances as necessary.

Our examination of patient’s notes, our observations of care, and our discussions with medical staff showed staff mostly followed this guidance.

We saw staff using nationally recognised tools to help monitor risk. For example, they used the National Early Warning Score (NEWS2) for adult patients in the ED, the Paediatric Early Warning Score (PEWS) for children and young people, and the Modified Early Obstetric Warning Score (MEOWS) for pregnant and postpartum women. Staff consistently assessed the risk of falls for patients who had been in the department for a long time.

Managers did audits to monitor safety and quality of treatment. These audits included those from external bodies such as RCEM and NICE and also those initiated by the trust’s clinical audit department as well as local departmental initiatives. While the department participated in nationally prescribed audits, we did not see evidence of a great deal of clinical audit initiatives at a local level.

We saw evidence that monthly sepsis audits took place in the emergency department with a requirement to audit 10 records each month. We saw the results of the audit for the 3 months prior to our inspection. The results of the audits were variable.

Patients with mental health needs were referred to a service from the local NHS mental health provider which was available 24 hours a day. Many staff told us this team was responsive and worked well with them. Similarly, staff from that team were complimentary of the department’s mental health triage processes.

Staff worked well across teams and services within the ED to support patients. However, some patients experienced delays in getting into ED or being admitted into other areas of the hospital because of delays in assessment by other specialities. There were differing arrangements with the two main ambulance services which resulted in some different patient experiences.

Staff working in multidisciplinary teams across the ED. Staff communicated effectively and showed coordination and clear professional respect between each other regardless of grade or position.

Staff worked with guidance called internal professional standards (IPS). These were local standards that staff working in other areas of the hospital to follow so that patients could be assessed and admitted more quickly. Staff told us that they had a mixed experience with staff from other departments following these standards. Some specialities did not achieve the standards as well as others which meant those patients were not moved through their treatment pathway as quickly.

ED staff told us that the medical care division worked hard to admit patients. However, patients sometimes spent a long time in the ED once they had been seen. To help with this, in winter months, a specialty doctor from the medical care division worked within the department to support those patients waiting for admission into medical beds. ED staff also had a close working relationship with the Paediatric Assessment Unit (PAU) and the children’s ward which meant children and young people were seen more quickly.

Handovers from ambulance staff to ED staff were effective and, despite handover delays, relationships between ambulance crews and the department were positive and productive. Due to the geographical location of the hospital, two different NHS ambulance services brought patients to the ED. ED staff could see the 2 ambulance service’s electronic system so they knew who was coming in, and who to prioritise first. One of the 2 ambulance services provided a Hospital Ambulance Liaison Officer (HALO) to work within ED alongside ED staff. However, this role was funded by the Staffordshire Integrated Care Board (ICB) and provided by the ambulance service that covered that area. This meant the HALO was only able to support patients and crews brought to hospital by the ambulance service working across that area.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff routinely monitored patients’ care and treatment whilst in the department, and staff worked to ensure that outcomes were positive and consistent. However, the service did not routinely audit clinical quality standards.

The service participated in elements of the RCEM quality improvement programme (QIP). The QIP had clear projects outlined for improving patient safety and experience in emergency department in line with RCEM standards. These included the current RCEM projects around care of the older people and time critical medicines. However, we did not see evidence there was routine measurement and audit of RCEM standards meaning the department could not be assured that they were delivering care to those standards.

Where shortfalls were identified and improvements warranted, the provider used proven quality improvement tools within a project management and governance framework.

Staff could see data that told them how the department was performing in real time. They had access to a “dashboard” of key performance indicators that was presented on screens across the department. It was also available to managers in other areas of the hospital, including decision makers in the trust and site flow and capacity meetings. It showed the number of patients in each area of the ED as well as the total number of attendances for the day. It showed the number of patients waiting for speciality review and the number waiting for beds. Numbers of patients who were currently in the department and the time they spent there was also shown. This helped senior staff and managers understand the current capacity in the department and to make plans.

This information was analysed into performance figures so the department could understand performance indicators such as time to initial assessment (TTIA), and 4-hour performance.

Staff used the sepsis six emergency care bundle to identify and treat sepsis. Patients at risk of sepsis were identified through their early warning scores or because of clinical suspicion and this was supported by automated alerts on the trusts EPR.

We saw evidence that monthly sepsis audits took place in the emergency department with a requirement to audit 10 records each month. We saw the results of the audit for the 3 months prior to our inspection. The results of the audits were variable. A review of 41 patient records found that all patients were screened for sepsis within the required timeframe. While they showed consistent use of sepsis screening, senior reviews, and timely monitoring of patients' observations, performance in other areas was less consistent. Around 70% of patients at risk of developing sepsis received antibiotics within one hour which was below the 90% target set. Audits of confirmed septic patients showed a higher compliance of 100% in the last two audits in July and September 2025. The deteriorating patient group within the trust monitored sepsis audit results and the trust’s response. The trust also had an ongoing sepsis improvement plan focused on education, audit, information sharing, and improving clinical practice which was reviewed and demonstrated improvement.

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

The department had procedures and guidelines which reflected best practice and current legislation. These covered situations where patients were unconscious or unable to consent for other reasons. Consent often relied on verbal agreement and was recorded in the patient’s notes, which was appropriate in the context of an emergency department

Staff were trained in consent and particularly its applicability in an emergency department where patients might have reduced levels of consciousness and be confused or distressed. Staff talked confidently about mental capacity assessments, which are an assessment as to a person’s ability to understand and make decisions, and what they would do in different circumstances. Staff recognised that in an emergency department patients might undergo a change in their state of consciousness due to their illness or have their judgment affected by medicines or substance abuse.

Where necessary decisions about care and treatment were made within the requirements of the Mental Health Act (1983), the Mental Capacity Act (2005), the Children Act 1989 and Children Act 2004. This included consulting others as part of best interest decision-making and ensuring that people with legal authority were involved in making any relevant decisions.

The department had a process for supporting people subject to Section 136 of the Mental Health Act. When a person attended the department under Section 136 of the Mental Health Act, they remained the responsibility of police whilst waiting for the assessment. Staff told us that the experience of some patients who were brought in by police had changed recently, particularly patients detained under the Mental Health Act; Section 136. Section 136 allows police to detain someone who appears to be experiencing a mental health crisis and is in immediate need of care or control and take them to a place of safety. There were ongoing discussions with the police about this, but because the hospital received patients from three force areas, each of which had differing approaches, this was complex.

Gillick competence and Fraser guidelines were used to assess the ability of young people to consent to treatment and sexual health advice and treatment. Gillick competence is concerned with determining a child’s (person aged under 16 years) capacity to consent through assessment of their intelligence, competence and understanding to fully appreciate what's involved in their treatment. Fraser guidelines were used specifically to decide if a child could consent to sexual health advice and treatment.

Most patients told us they had been kept informed during their stay in the department and this enabled them to be involved in planning their care. Where present, staff took account of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) documentation in their decision making and similarly advance care plans, which are plans that people make in anticipation of them losing their mental capacity.

Staff received Mental Capacity Act (MCA) modules as part of their mandatory training package. The overall completion rates for the department met the trust targets. However more detailed figures revealed that within the different staff groups while nursing and other health professionals staff groups were meeting the trust target, medical staff groups were falling short of the target with scores around 60%.

We were sent a record review for 41 patients who had stayed for a time in the department, and we noted that for every patient need for mental capacity act assessment had been considered.