Queens Hospital

On this page

• 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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last assessment we rated this key question requires improvement. At this assessment it stayed the same as requires improvement.

Most patients had their assessment and treatment delayed, stayed too long in the department and the department did not meet the relevant standards and this introduced risks. Patients were involved in the way their care was planned and delivered, and it was adapted to meet their needs.

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 service put patients at the centre of decisions about their care and treatment. Staff worked in partnership with patients to decide how to respond when their needs changed.

All patients arriving in the ED underwent an assessment which not only covered their clinical condition, but other needs such their mental health, their social circumstances and any protected characteristics.

Patients were involved in making choices and planning the care offered to them in the department. Relatives and carers were involved with the patients consent. When patients appeared to lack capacity, capacity assessments were done and if necessary best interest decisions made. This was done in the context of an emergency department where patients might be temporarily unable to communicate because of their clinical condition or the effects of medicines.

There were clinical pathways to accommodate patients with particular needs. For example, patients who were elderly or frail and those who had specific conditions not necessarily related to their admission. Staff completed mandatory training which included caring for people with dementia, autistic people and people with a learning disability.

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. However, some patients said they did not know what was going to happen when they were transferred to the ward.

For many patients, their stay in the department was much longer than should be the case. To aid their care and comfort there was a long stay checklist which was triggered when the patient had spent 6 hours in the department. Among other things this ensured the patient was made aware of the plan for their care, they were moved from a trolley to a more comfortable hospital bed. When we reviewed patient notes, we saw this was done.

We observed good interactions between staff and their patients. We saw one conversation that was open and honest about a patient’s illness and their options going forward. It was done with kindness, good humour and in a way that could be easily understood by the patient.

The department had resources to support the care of people at the end of their lives. This included bereavement boxes for newly born and older children. There was a bereavement room for the use of relatives whose loved ones had died or were critically ill.

The trust’s chaplaincy services were available 24 hours a day and accommodation was made for specific religious and cultural needs should a patient die while in the care of the department. Staff could also call on the trust’s palliative care team for support should they be needed.

There was an “End Of Life Care Sitting Service” supported by volunteers that enabled relatives and carers to have a short respite from sitting with their relative. This service was available Monday to Thursday from 8am to 4pm depending on the availability of volunteers.

As required, there was a single, mental health room which could accommodate one patient. However, there were frequently more than one patient needing this facility in the department. This meant patients were often accommodated under supervision in cubicles which was not ideal for the patient who spent too long in a clinical area and often had to be watched under 1 to 1 care.

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 service supplied appropriate, accurate and up-to-date information. However, there was limited printed information in languages other than English.

Patients had access to information about how to access the ED before they arrived. On roadways accessing the site and on arrival, the trust had signage to direct patients to the correct entrance. However, the signage within the department was not always helpful for patients to navigate around the department, particularly when escalation spaces were in use.

There was a display screen in the main waiting room that told those waiting in the number of patients in the department and the approximate waiting time. There was no facility for people to see this information online. There was an explanation for people who had been referred to the ED by the NHS 111 service that any time they had been given was a time they should arrive in the department, not a time by which they should expect to be seen.

Throughout the department we saw limited printed information, such as leaflets, about illnesses and conditions, although the opportunity to give feedback or complain was promoted.

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.

The trust had an Accessible Information Standard policy to ensure patients with sensory loss, learning disabilities, or impairments received accessible care and communication support. Patient information leaflets were available on request in alternative formats such as Braille, Easy Read, large print, or different languages. Face-to-face, telephone, and video British Sign Language and foreign language interpreters were available. The website contained step-by-step facility access guides to help map out hearing loops, accessible parking, and walking distances.

The providers website had a recite function so people with a sight impairment, or people who could not read English could listen to the information on the website. Text size could be altered, and the screen could be magnified to make browsing the website easier for people with sight impairments. The website could also be viewed as text only. The website could be accessed in multiple languages. The trust was still working towards making its website fully accessible in accordance with the Public Sector Bodies Accessibility Regulations (2018). However, most of the information, videos and documents aligned with the regulations.

Staff had access to a telephone interpretation service to use when engaging with patients who did not speak English as a first language. We saw several examples of this having been used effectively during our visit, including when it had been essential in protecting a child who was subject to a safeguarding concern.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

Staff to whom we spoke could explain the complaints process and knew how to support patients to make a complaint including the use of the hospital’s Patient Advice and Liaison (PALS) service.

There were posters around the department telling patients that if they had given a mobile phone number or email address, they might get a communication asking them to complete a survey. These posters explained how to opt out of this.

This patient satisfaction survey was titled “Your Views Matter” and as well as patient’s views it also recorded and analysed attributes of the studied population. This included diversity, protected characteristics, and other descriptors, such as previous or current service in the armed forces.

We saw complaints and compliments were discussed at divisional governance meetings in the context of both individual events and underlying themes.

While complaints were investigated and responded to, we saw from the notes of meetings that the overall business unit was not meeting its performance targets, but we did not see separate figures for the ED.

When we saw staff talking to patients they explained their suspected illnesses, the reasons for further tests and proposed treatment plans. Staff took the time to make sure patients understood what had been said and listened to their questions and their views on their treatment.

The service did not make sure that people could access the care, support and treatment they needed when they needed it. Many patients waited too long for assessment and treatment and spent too long in the department.

Due to the continued pressure on the department caused by a lack of available beds in the rest of the hospital, from delayed discharges of patients, mostly to social care, patients were waiting too long in the department. The ED saw more patients than it had capacity for. Average attendances to the department were around 200 to 220 patients a day. Because the department was relatively small it did not take many sick patients before it came under pressure.

During our inspection visit we noted an increased number and acuity of patients arriving in the department had a significant effect on assessment and treatment times. For example, while the waiting area had sufficient seating capacity during most of the day, as “walk in” patients arrived in the late afternoon, it quickly filled, and by the evening patients were sitting, or in some cases lying on the floor and spilling out into the ambulance bay. The waiting time for patients who did not need urgent assessment or treatment was up to 7 hours. When there were two very sick patients who needed resuscitation, this had a “knock on” effect for several hours afterwards. While those patients got the care they needed, staff were not available to assess and treat other patients.

Sometimes patients had been given expectations by other providers that they would be seen quickly and this caused frustration. We saw there were signs in the department informing patients that any time they might have been told was a time to arrive, not a time by which they could expect to be seen.

Managers tried to plan and organise services, so they met the needs of the local population but, due to pressures in the wider health and social care system, the ED, along with the wider hospital was experiencing blocked flow. This meant facilities and premises were not always appropriate for the services being delivered and there was not enough staff to meet the needs of patients.

The service was frequently operating at a capacity that triggered internal and external escalation. This was because patients could not always be transferred out of the department in a timely way. Subsequently patients, including in the ED, were being looked after in escalation areas that were not always the most appropriate for their needs.

The trust worked with their system partners to establish alternatives to hospital care, so patients received the right care, at the right time, in the right place, for example, virtual wards. They had an established frailty service, and same day emergency care (SDEC) units, and other initiatives to help keep people out of the ED and therefore reduce demand on the service. However, demand on the department continued to exceed the resources available.

There was a virtual ward system for patients who resided in Staffordshire. Staff from the Community Rapid Intervention Service (CRIS) attended the department and identified those patients in the Emergency Department (ED), Same Day Emergency Care (SDEC) and Ambulatory Medical Unit (AMU) who could be stepped down and return home for treatment. This service had been running for around 2 years and there were 40 virtual beds available. Staff told us access to these beds was “easy”. Examples of such patients would be those who needed Intravenous (IV) antibiotics, patients with Chronic Obstructive Pulmonary Disease (COPD) or Acute Kidney Injury (AKI). A senior nurse told us they were always worried that the patients were “really OK to go home”, but in practice there were effective escalation procedures should the patient deteriorate and readmission rates were low. They also told us there was a vacant inreach practitioner post and were this filled more patients could be placed into the virtual ward. However, similar virtual wards were not available for patients residing in the areas managed by other ICBs.

The department had also introduced a virtual ward for specifically for ED patients with 6 virtual beds. These beds were covered by the ED consultant for clinical management, and the patients were considered to still be patients of the department.

Despite the long stays, staff worked to try and make sure patients did not have to stay in the ED longer than they needed to. Managers and senior hospital leaders met regularly throughout the day to look at how flow could be created within the hospital to ensure adults and children who needed to be admitted to a ward could be. Senior departmental leaders escalated waiting times in bed management and capacity calls with their system partners.

The trust had made changes to manage increasing patient attendance such as recent building work, that had increased capacity and efficiency in terms of the use of space within the department. However, there was a limit to how much the department could be expanded due to the site constraints as well as the overall size of the hospital.

Under the NHS England Plan there are 2 targets that trusts must work to achieve. Firstly, 78% of patients should not wait for more than 4 hours in the emergency department from arrival to admission, transfer or discharge. Secondly, 10% of patients should not wait for more than 12 hours in the emergency department from arrival to admission, transfer or discharge. Data from 2025 showed neither of these targets were consistently met for the adult ED.

The NHS England plan sets a 45‑minute maximum ambulance handover time. Between September and December 2025, long handovers fluctuated but were generally more than the England average of around 14%. The hospital largely tracked the England average for most of the year but experienced significant increases in October and December where at times the percentage of handovers greater than 60 minutes was over 30%.

Not all patients had equity as a result of where they lived. The ED provided care and treatment to patients from several different counties including Staffordshire, Derbyshire and Leicestershire. Senior leaders had full engagement from the local integrated care board (ICB) in which the hospital was located. However, leaders reported that they did not have the same relationship with other ICBs. They had an established frailty service, and same day emergency care (SDEC) units, and other initiatives to help keep people out of the ED and therefore reduce demand on the service. However, demand on the department continued to exceed the resources available.

Similarly, due to the hospital’s geographical location, 2 local ambulance trusts conveyed patients to the emergency department. Patients received different care and treatment depending on which service brought them due to differences in operating procedures. For example, 1 service were not permitted to supervise patients who had started hospital treatment whilst on the back of an ambulance without a trust staff member being present. The other service permitted this. This meant some patients received treatment more quickly.

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.

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.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.