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

Staff provided evidence-based care and treatment in line with current legislation, good practice and standards. Staff worked well across health care disciplines and with other agencies to care for patients. Staff obtained consent before they delivered care, support, or treatment.

The service routinely monitored people’s care and treatment; however, outcomes were not always positive and consistent.

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.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Patients received care, treatment, and support that was evidence-based and in line with good practice standards. This included individual risk assessments to support holistic patient care.

Staff followed policies to plan and deliver care according to best practice and national guidance. Guidelines were developed in line with national guidance, such as the National Institute of Health and Care Excellence (NICE) and the Royal College of Emergency Medicine (RCEM) standards.

Clinical guidelines and policies were available on the trust intranet, and staff knew how to access them. We reviewed a sample of the hospital policies and found they were compliant with current guidance and evidence-based practice.

The service had an audit programme to monitor staff compliance with guidelines. Action plans were implemented following audits to address any areas requiring improvement.

Patients were assessed using evidence-based tools, and the ED had a sepsis pathway which followed national guidelines.

Members of the psychiatric liaison team completed full bio-psychosocial assessments for patients with mental health needs, and we saw this in records reviewed.

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.

Staff worked across health care disciplines and with other agencies when required to care for patients. We saw that information was appropriately shared with GPs, and community teams. Staff within the ED worked well with the psychiatric liaison team to care for patients with mental health needs. They also worked well with ambulance staff and obtained relevant information to care for patients arriving by ambulance.

Plans for transition, referral and discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. When people were due to move between services, all necessary staff, teams and services were involved in assessing their needs to maintain the continuity of care.

Staff held multidisciplinary meetings to discuss patients and improve their care. The service held daily multidisciplinary team huddles and staff handovers. We observed one of the huddles and saw representation from medical, nursing, allied staff, social workers and administrative staff. Staff discussed patients in the department, their length of stay, care and treatment plan.

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.

The service routinely monitored people’s care and treatment to continuously improve it. However, outcomes were not always positive and consistent.

Managers and staff conducted repeated audits and quality improvement projects to improve patient outcomes. However, the department failed to meet the standard in a range of audits conducted.

The service completed Mental Health Audit Standards in the ED using the liaison psychiatry service (LPS) referral list from August 2025. The audit was conducted using the RCEM mental health audit standards for the ED checklist. The audit reviewed 25 patients’ records for triage, ED doctor assessment, and LPS review.

Results of the audit showed low compliance with standards. Risk assessments at triage were completed in 48% (12 out of 25) cases. There were no levels of observations indicated for any of the patients at triage. 11 patients were not seen by an ED doctor and 1 patient absconded. Of the remaining 14 patients, psychiatric history was completed in 5 records (36%), there were no risk assessments completed by ED doctor and there were no mental state examinations completed. The LPS reviewed 21 patients within 1 hour of referral, completed biopsychosocial assessments for 19 patients and arranged a referral or follow-up after initial review for 23 patients.

An action plan was set up to deliver teaching to the ED on RCEM mental health audit standards, create a template for ED doctors, adapt a mental health screening form and conduct a repeat audit.

The service conducted a quality improvement project (QIP) to review Time Critical Medication (TCM) in line with the RCEM safer medicines committee guidelines. The aim of the audit was to identify current ED performance against RCEM clinical standards.

The audit reviewed the administration of TCM medications for people living with Parkinsons who took oral levodopa medication and for patients living with diabetes mellitus on insulin within 30 minutes before or after the scheduled dose. Data was collected from October 2024 to December 2024 for stage 1 and January to November 2025 for stage 2. The audit reviewed 45 patients for stage 1 and 93 patients for stage 2. The audit measured 3 standards including whether patients on TCM were identified early, whether TCMs were administered according to their usual regime, and whether they received all expected doses from their usual regime during their ED stay.

The first standard required patients on a TCM to be identified early. This was achieved for 18 out of 45 patients reviewed in stage 1. Most patients on TCM were not identified early; 15 patients were not recorded as TCM patients, and 12 patients were identified as TCM patients after 30 minutes of ED booking. Out of 93 patients reviewed in stage 2, 60 patients were identified as TCM patients before 30 minutes of booking and 33 patients were identified after 30 minutes of ED booking.

The second TCM audit standard required patients’ TCM to be administered according to their usual regime whilst they were in the ED. This standard was not achieved for most patients in stage 1. Out of the 45 patients recruited in stage 1, 30 did not have TCM prescribed, 3 had their TCMs omitted and 14 had their TCMs prescribed. Out of the 93 patients recruited in stage 2, most patients (71) had their TCMs prescribed, 19 did not have their TCMs prescribed, and 3 had their TCMs omitted.

The TCM audit showed improvement between the first and second stage of the audit.

Learning points were identified from the audit for staff to document when the patients take their medications (frequency and time). This included the aim to recognise TCM patients within 30 mins of their registration and to prescribe the TCM medications within 30 mins of their regular time taken. The audit also identified the need to ensure TCM medications were available in the ED. There was a recommendation for a re-audit to assess the impact of change and compliance. There was also a recommendation to discuss this at the quality improvement meetings and at teachings/training meetings.

We reviewed the Trust “Getting It Right First Time” (GIRFT) report for emergency medicine. The report provided by the trust was for a visit conducted in October 2022.

The trust was in the bottom 20% of providers for completeness, validity and timeliness of data submission.

For St Helier Hospital ED, less than 22% of emergency ambulance handovers occurred within 15 minutes of ED arrival. The median for EDs in England was 38%. Nearly 30% of ambulance handovers took place longer than 30 minutes after ED arrival. Mean times in the ED for both admitted and non-admitted patients were in the upper quartile of times for EDs in England.

The proportion of patients discharged, admitted or transferred before 2 hours from time of arrival (19%) was just below the median. Nearly 33% of patients who were admitted from the ED had a length of stay that was longer than 6 days. The admitted patient breach rate at 6 hours in the ED was nearly 82% and was in the worst quartile. The report stated that the excessively long delays for admitted patients in the hospital should be regarded as an outcome measure.

The report indicated that the capacity metrics at St Helier Hospital were generally favourable for the number of ED consultants.

The 7-day re-attendance rate is commonly used to reflect the safety and effectiveness of the initial care and discharge from the ED. Between November 2024 and November 2025, the average reattendance rate within 7 days of the initial ED visit was 13%. This was worse than the England average.

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

People understood their rights around consent to the care and treatment they were offered. People told us staff explained care and treatment options and gained verbal consent for physical assessments.

Staff we spoke to understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act (MHA) and Mental Capacity Act (MCA) 2005, and they knew who to contact for advice. Records reviewed showed staff completed mental capacity assessments were relevant.

Staff could describe and knew how to access the policy and get accurate advice on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

The service collaborated effectively with the psychiatric liaison team to provide training to ED staff. This included MHA and MCA training, as well as training to aid referral to the psychiatric liaison team. In addition, 45% of staff had completed breakaway training.

The CAMHS team provided a session on MHA and their role. The team had also offered training to senior nurses on Deprivation of Liberty Safeguards for 16 and 17 year olds.

The trust had identified the need to tighten processes around the application of the Mental Health Act, including reading people rights. Each site had a tracker to ensure patients could access advocacy and rights were being read.