St Helier Hospital and Queen Mary's Hospital for Children

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

The service generally responded well to people’s needs and supported timely access to care. Patients said staff listened to them, involved them in decisions, and provided clear information about treatment and discharge arrangements. Staff used structured tools during board rounds to identify individual priorities and plan care effectively. People with additional communication needs received interpreters or communication aids, helping them understand their care.

However, responsiveness was not consistent across all wards. Frailty assessment was applied unreliably, and only a small proportion of eligible patients had a clinical frailty score recorded. Some families reported variable updates, particularly during complex discharge planning. While access to specialist input and early referral pathways was in place, inconsistent involvement of relatives sometimes contributed to delays for people with complex needs. The service recognised these gaps and had begun work to standardise frailty assessment and improve communication practices.

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.

Overall, most patients felt well cared for, listened to and involved in decisions, and experienced personalised care that promoted trust and confidence. However, variation in frailty assessment, communication practices and family involvement meant the service did not provide consistently person‑centred care to all patients, particularly older people with complex needs.

Patients told us that staff listened to them and took time to understand what mattered most during their stay. They described staff as attentive and said that conversations were held in private, which helped maintain dignity and confidentiality. Families were involved when patients wished this, and end‑of‑life discussions, including do not attempt cardiopulmonary resuscitation (DNACPR) and ReSPECT forms, were conducted sensitively in line with patient preferences. ReSPECT; Recommended Summary Plan for Emergency Care and Treatment form is a personalised document for individuals to record preferences for their clinical care during a future emergency if they cannot express their wishes.

Staff used structured tools during board rounds to identify individual priorities and ensure care was coordinated. Pathway reviews confirmed that patients with complex needs, such as cognitive impairment or frailty, were referred appropriately to therapy teams, occupational therapists and palliative care. There was evidence that discharge planning started early, with staff supporting patients to understand their diagnosis, treatment options and follow‑up arrangements.

However, the service did not always respond consistently to the needs of older people or those with additional vulnerabilities. Compliance with the Rockwood Clinical Frailty Score (CFS) was low (clinician-administered tool used to assess frailty in older adults). Data showed that only between 18.0% and 26.2% of eligible patients aged 65 and over had a CFS recorded in the most recent months of available data. Frailty assessment is a key part of identifying people at higher risk of deterioration, falls, and deconditioning.

Elderly patients who had been in hospital for long periods had no access to planned activities, television, or structured engagement, increasing the risk of deconditioning and reduced wellbeing.

While many patients described excellent communication, others reported variability in how well relatives were updated, which sometimes affected the smooth planning of onward care.

Discharge planning was generally effective, and patients told us that staff took account of their goals and preferences. However, the inconsistency in involving families at the final stage of planning contributed to delays for some individuals, particularly those with complex care needs.

The service recognised the risks associated with unmet frailty needs and had initiated high‑level reviews and action plans to strengthen pathways for older people. Senior teams were aware of gaps in assessment and communication and were working to standardise practice.

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 approach to providing information was proactive and inclusive, enabling patients to make informed decisions and feel reassured throughout their care journey. The service ensured that patients and those close to them received clear, accurate, and timely information about their care and treatment. Staff were observed explaining procedures, expected outcomes, and next steps in a way that patients could understand, using plain language and checking understanding before proceeding.

Written information was available in accessible formats, and staff offered verbal explanations to supplement this where needed. Patients reported they were encouraged to ask questions and felt confident that staff would take time to clarify any concerns. For individuals with additional communication needs, staff arranged interpreters and used alternative communication aids to ensure understanding. There was evidence that information about medicines, discharge arrangements, and follow-up care was provided before patients left the hospital, reducing anxiety and supporting continuity of care. Patients also knew how to access their health records and were informed about their rights regarding information sharing and confidentiality.

Where sensitive discussions were required, such as around prognosis or treatment escalation, staff ensured these took place in private spaces, maintaining dignity and trust.

The service listened to people and involved them in their care, many patients reported positive experiences. Patients told us they were encouraged to ask questions and felt confident that staff would take time to clarify any concerns. One patient commented that staff “covered all bases, even before you think of a question they have answered it already,” reflecting a proactive approach to communication. Sensitive conversations, including discussions about prognosis and end‑of‑life care, were held privately, which helped maintain dignity and trust.

The service sought feedback through several routes, including informal conversations, surveys and comment cards. Patients said they were informed about how to raise concerns and felt that staff would listen and respond appropriately. Staff described how learning from complaints and compliments was shared within teams to influence improvements, and patients noticed that positive feedback was valued and acknowledged.

A significant proportion of the complaints received by the service were found to be justified, indicating concerns about the consistency and reliability of care. Over a 12‑month period, 65% of complaints were either upheld or partially upheld, with 20% upheld in full and 45% partially upheld. Many of the issues raised by patients and relatives reflected genuine shortcomings in care quality, including both clinical and personal aspects of care. The service showed a clear commitment to learning from these concerns. Formal action plans were developed following upheld complaints, and changes were made to clinical practice where needed. Leaders routinely reviewed patient experience data, confirming that themes from complaints were being tracked and used to inform improvement work across medical care.

The service had begun implementing quality improvement initiatives to strengthen communication, including the development of “bite‑size” teaching on active listening and clear, plain‑language conversations. These actions demonstrated that the service was aware of the risks associated with inconsistent communication and was taking steps to address them.

The service ensured that patients had equitable access to care regardless of their individual circumstances or protected characteristics. Pathway tracking showed that patients were assessed promptly when they arrived, with urgent needs prioritised and escalation processes in place to avoid delays.

Same day emergency care unit (SDEC) consistently applied admission criteria to ensure the service was available for those who would benefit most. Patients requiring specialist input, including frailty or palliative care support, were identified early and referred without unnecessary waits, which supported continuity of care.

The service actively monitored access for older people and those living with frailty. Through the National Frailty Improvement Collaborative, the trust set measurable goals to reduce long waits in the emergency department and increase the numbers of people discharged within two days following home‑based assessment. Early mobilisation initiatives, including a quality improvement project in the acute medical unit, aimed to mobilise suitable patients within 24 hours to reduce decreasing mobility and promote recovery. Workforce planning recognised that increasing senior medical presence out of hours would support more timely decision‑making and reduce length of stay.

However, capacity pressures meant that patients did not always move through the medical pathway as intended, and this affected equitable access. Bed occupancy on the medical wards remained consistently high, ranging from 95% to 97% between June and November 2025. Length of stay data showed extended admission durations across several specialties, including geriatric medicine (with an average length of stay of up to 17.2 days) and respiratory medicine, which peaked at 28 days. Tracking showed that the service monitored super‑stranded patients daily and by specialty. Despite this, the sustained pressure on capacity meant that some patients stayed in the acute medical unit (AMU) for far longer than planned because specialist and general medical wards were full. Many remained in the AMU for extended periods rather than progressing into the wider inpatient pathway, and most were discharged directly home from the AMU. This reduced availability of AMU capacity for new admissions and meant that not all patients had equitable access to specialist wards designed to provide ongoing medical care. On an elderly care ward, leaders told us that around 10 of 32 patients were medically fit for discharge but could not leave because of community or social care delays, which contributed to extended lengths of stay and sustained pressure on bed capacity

The same day emergency care unit was used for patients staying overnight. One patient reported having spent two nights on a recliner chair, and another described being in the unit for 24 hours. This showed that some patients were accommodated in an environment that was not suitable for their clinical needs.

Not all patients experienced the discharge pathway in the same way. There were inconsistencies in how wards used the discharge lounge, and decisions about who accessed it varied depending on individual circumstances rather than a shared set of criteria. This meant people did not have equal access to the same discharge environment or support processes. The underuse of the discharge lounge also contributed to ongoing capacity pressures by slowing the rate at which ward beds became available.

The service took steps to remove barriers to access for people with protected characteristics. Staff were aware of potential challenges such as language, sensory impairment and digital exclusion, and interpreters and communication aids were available for patients who did not speak English or who had communication difficulties. Written information was provided in accessible formats. Governance oversight for people with learning disabilities was in place, including regular presentation of a learning disability report at safeguarding meetings and access to an information booklet covering ‘hospital passports’, communication tools and best practice for assessing capacity.

For patients with more complex needs, there was evidence of personalised reasonable adjustments. For example, a patient‑specific plan set out priority triage, quiet waiting spaces and one‑to‑one support for an individual with autism and a learning disability, demonstrating how staff adapted environments and processes to ensure equitable access. Staff used tailored pain assessment tools for non‑verbal patients to ensure pain was recognised and managed appropriately.

The service also considered the needs of the armed forces community. Staff received armed forces awareness training to support understanding of military culture and the potential impact of service‑related issues on patients and families, helping to ensure inclusive and unbiased access to care.

Transport arrangements supported timely transfers to and from virtual wards and SDEC, ensuring that patients with limited mobility or personal support were not disadvantaged. Review meetings monitored compliance with service level agreements for timely assessment, indicating that access performance was subject to routine oversight.

Patients told us they felt able to access care when they needed it and did not feel discriminated against or delayed because of personal characteristics.

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.

Patients told us they felt staff discussed their future care needs openly and that they were supported to understand what to expect as their condition changed.

The service supported people to plan for their future care needs, including decisions about treatment, preferences and escalation of care. Staff held discussions with patients and, where appropriate, those close to them, and recorded these in treatment escalation plans (TEP), do not attempt cardiopulmonary resuscitation (DNACPR) forms and ReSPECT documentation. These plans were visible in the clinical record so the wider multidisciplinary team could understand people’s wishes and deliver care that reflected their preferences.

Further work was underway to improve the quality and consistency of future care planning. The trust had been identified as an outlier nationally for rates of cardiac arrests occurring in ward areas and the emergency department, and for the number of resuscitations attempts in patients aged over 75. In response, a quality improvement action plan was taken to the reducing avoidable death and harm (RADAH) meeting in August 2025. This plan focused on strengthening decision‑making, documentation and review of TEP, DNACPR and ReSPECT forms to ensure sensitive and timely recording of people’s wishes. This demonstrated active oversight at senior governance level and a system response to improving the safety and appropriateness of future treatment planning.

People living with frailty were identified early, and staff used tools such as the Clinical Frailty Scale (CFS) to support planning for future care. For patients with higher levels of frailty, staff worked with frailty and community teams to anticipate needs beyond the hospital stay. The developing integrated neighbourhood‑based model of care supported this approach by linking patients with community teams after discharge. This included a proposed pathway for patients with a CFS score of 5 and above, designed to ensure proactive follow‑up, reduce deterioration and lower the risk of readmission. Recruitment of additional consultant geriatricians strengthened the specialist clinical input available to support these future‑focused pathways.

Planning for future care also included work to manage existing delays and long stays, which impacted patients’ ability to move into appropriate settings. The service had formal escalation processes for people identified as medically fit for discharge or not meeting the criteria to reside. Daily lists were circulated to clinical and operational teams, and staff held daily transfer‑of‑care huddles with external partners to progress discharge planning. A fortnightly complex discharge panel reviewed patients with length of stay greater than 35 days and escalated complex cases to senior leadership. These processes demonstrated structured, ongoing management of delays, which formed an essential part of planning for people’s future care needs as they moved through the pathway.

The trust planned to update its Hospital Discharge and Criteria to Reside policy by the end of quarter four 2025/26 to reflect new terminology and processes following the introduction of the electronic patient record system. This contributed to ensuring that future discharge planning was aligned with current systems and national expectations.