St Helier Hospital and Queen Mary's Hospital for Children

On this page

• 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 people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were 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 assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People were involved in the assessment of their needs. Patients generally reported feeling supported, listened to, and involved in the assessment process. There were appropriate arrangements to ensure patients’ nutrition and hydration needs were met on the wards.

The service used evidence-based tools to screen for malnutrition. We saw in patient records a malnutrition universal screening tool (MUST) tool was used for assessing patients’ nutrition. Staff also completed comprehensive assessments for patients, including VTE risk, anaesthetic checks, and discharge planning.

People’s communication needs were assessed and met. Staff ensured that communication needs were identified during initial assessments and reviews, with patients and, where appropriate, their families actively involved in the process. Assessments considered the person’s health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes. People’s needs were assessed using a range of assessment tools to ensure their needs were reflected and understood.

The trust had implemented the Oliver McGowan mandatory training on learning disability and autism, and compliance within the division was above target across all staff groups. Staff we spoke with demonstrated a good understanding of how to assess the needs of autistic people, people with a learning disability and dementia. Staff told us they were made aware of patient's individual and holistic needs during shift handovers. We saw on some wards that there were information boards visible with information on supporting patients with dementia.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We observed in theatres that surgical safety checklists on one occasion were not performed in line with best practice, with staff performing checks from memory rather than utilising the checklists, which increases the risk of omissions. Staff also told us that implant checks were done by surgeons and scrub nurses but were not consistently included in timeout checks. Observational audits of National Safety Standards for Invasive Procedures (NatSSIPs) were not routinely performed to ensure consistent application of safety standards, and staff lacked understanding of human factors, which could affect safety under pressure.

The service carried out local audits focused on surgical safety, including the WHO Surgical Safety Checklist to improve patient outcomes. These audits were designed to identify risks and confirm that safety measures were applied consistently, ensuring compliance with national standards. However, during the 12 months before the inspection, only one audit of compliance with the surgical safety checklist was completed, in April 2025. This limited frequency reduced the service’s ability to monitor trends, promptly address gaps, and provide assurance that patient safety was consistently maintained.

We saw there was a formal annual local clinical audit programme to evidence performance monitoring, quality measures or patient outcomes relating to surgical services. These local audits highlighted areas for improvement and inconsistencies in implementing certain protocols such as pressure ulcer prevention and Dementia Awareness & Memory Cognition. Audit findings for NEWS2 and VTE also indicated that full adherence to protocols was not consistently achieved, suggesting a need for further training and monitoring. The service actively participated and performed well in various national audits to monitor and enhance care delivery, for example Falls and Fragility Fracture Audit Programme, National Vascular Emergency Laparotomy Audit and National Joint Registry.

The service planned and delivered care and treatment based on national guidance and evidence-based practice. Clinical records we saw demonstrated care was provided in line with current guidance and individualised to patient’s needs. The trust’s intranet contained a comprehensive range of policies and standard operating procedures which reflected evidence-based practice and standards practice. Staff demonstrated knowledge of these guidelines, and patients reported receiving support that adhered to best practice standards.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We saw evidence of effective multidisciplinary team (MDT) working. When people were due to move between services, all necessary staff, teams, and services were involved in assessing their needs to maintain continuity of care. Staff, including doctors, nurses, and allied health professionals, collaborated well, ensuring comprehensive and holistic assessments of patients’ needs. This collaborative approach was particularly evident during ward rounds and handovers, where specialists from various disciplines, such as orthopaedics, urology, and trauma, participated in assessing and planning patient care.

Staff informed us they worked well with other staff. Nursing staff told us doctors were available for advice and support including overnight and on weekends and there were generally good working relationships between colleagues. The outreach team were described as approachable and quick to attend. Theatre teams were observed to work well together for the safety of the patients.

We observed multidisciplinary approaches to planning care for patients. Patient records demonstrated input from the full clinical team of doctors, nurses, and allied health professionals. Regular team meetings took place to review updates for the service.

Staff had access to the hospital’s electronic health record system, which facilitated the sharing of patient information necessary for planning and delivering care. The trust had introduced a new electronic patient record system 6 months prior to the inspection, some staff told us they experienced difficulties accessing and inputting information into the system which contributed to delays. Staff were encouraged to feedback any issues and report them as incidents. Leaders told us that over time staff reported that using the system was becoming easier and more efficient, with ongoing improvements based on feedback. There had also been no serious incidents or never events since the introduction of the new system.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service demonstrated a commitment to supporting patients in managing their health and wellbeing, aiming to maximise independence, choice, and control. A multidisciplinary approach was evident, with physiotherapists, dieticians, and doctors actively involved in promoting mobility, nutritional health, and overall wellbeing. At discharge patients were signposted and given advice on where and when to seek help.

During the inspection, physiotherapists were observed supporting patients to mobilise on the wards, encouraging physical activity as part of their recovery process. Nursing staff were also receiving training to support patients with early mobilisation following surgery to enhance recovery.

The service helped people improve their health and reduce risks before surgery. The division had a programme of improvement to ensure that patients were optimised for surgery. This meant that they tried to ensure that patients were not only fit for surgery but had taken steps where necessary to improve their general health, so they recovered as quickly as possible. Staff used health screening and optimisation bundles to identify issues such as anaemia, diabetes, high blood pressure, frailty, and poor nutrition. People were also offered advice and could be referred to services, including smoking cessation and dietician support. Plans for opportunistic blood pressure checks were being introduced in outpatient clinics to detect undiagnosed hypertension. Digital health questionnaires were piloted to identify needs earlier, reduce cancellations, and improve patient experience. This ongoing pilot, conducted with local hospitals, was achieving strong questionnaire return rates. Chaplaincy services were also available to support emotional and spiritual wellbeing.

Staff sought to empower patients with knowledge about their care. Patients told us they received post-operative information, including leaflets that provided practical guidance on managing their conditions. This information helped them prepare for life after hospital care and supported them in maintaining healthier lifestyles.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There were effective approaches to monitor people’s care, treatment and their outcomes. The service monitored performance through local and national audits and a structured ward accreditation programme. Ward accreditation used a tiered system (Platinum, Gold, Silver, Bronze, and Requires Improvement) to assess care standards and trigger timely re-inspections and improvement plans. Services rated as requiring improvement were supported with action plans and quality summits. These processes helped identify areas for improvement and maintain high standards. Staff gave positive examples of work to improve patient outcomes such as initiatives to ensure early mobilisation following orthopaedic surgery. Audit schedules were set up to assess a wide range of patient care. However, although for some of the audits we reviewed, recommendations had been made, there was an absence of measurable goals to drive improvement.

Patient reported outcomes were recorded via an electronic platform within all elective orthopaedic surgeries. Trauma and general surgery patient reported outcomes were captured via national databases and national audits. National patient outcome data we reviewed showed generally good performance. For example, the hospital performed well in the National Joint Registry in 7 out of the 8 indicators reviewed, including hip and knee revision rates and mortality. Data from the National Falls and Fragility Fracture Audit Programme (FFFAP) indicated better-than-average mortality rates and improvements in length of stay. However, hospital performance for acute length of stay and timely mobilisation after surgery ranked in the lowest quartile.

Consent practices were generally effective and embedded in routine care. However, the service needed to strengthen monitoring of Mental Capacity Act.

Consent practices were embedded in routine care, and staff adapted communication for people with additional needs. Records showed documentation of consent discussions, treatment options, and risks. We heard consent conversations taking place between staff and patients, and all were conducted as they should be. People told us they felt involved in decisions and received good explanations about their care. However, the hospital was a negative outlier in national audit data for the National Joint Registry in the percentage of cases submitted to the registry with patient consent confirmed. A local audit of consent in the service showed that consent was generally well documented and highlighted that improvements were needed in the legibility of forms.

Staff demonstrated awareness of the Mental Capacity Act and safeguarding processes, and patient passports could be used for people with learning disabilities. People's capacity and ability to consent was considered, and they, or a person lawfully acting on their behalf, were involved in planning, managing, and reviewing their care and treatment. Staff generally showed understanding of when and how to assess whether a patient had the capacity to make decisions about their care. However, the service and trust did not consistently monitor the use of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) to ensure compliance, an audit was last completed in 2023. Data collection began in April 2025 but was suspended due to other clinical priorities, staff vacancies, and leave. Meanwhile, the safeguarding committee approved a group-wide Mental Capacity Act and Deprivation of Liberty Safeguards audit which had not yet started. The audit in 2023 demonstrated that MCA and DoLS training was effectively supporting clinicians to record the required information when a patient is deprived of their liberty, and it showed an improvement in the quality and standard of DoLS authorisations compared with the previous year.