St Helier Hospital and Queen Mary's Hospital for Children

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service did not always maintain safe systems of care. The service did not always work well with people to understand and manage risks. The department was overcrowded, and facilities did not always support the delivery of safe care.
The service was in breach of the following regulations:

1. Regulation 12 (2) (d), Safe Care and Treatment, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• The service did not always ensure that premises were safe to use for their intended purpose and used in a safe way.

2. Regulation 15 (1) (c), Premises and equipment, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Premises used by the service were not always suitable for the purpose for which they were being used.

However, the service managed patient safety incidents well. Most staff had the required levels of training to safeguard people at risk and knew what actions to take to keep people safe from avoidable harm and abuse. The service had systems to detect and control the risk of infection. Staff kept equipment and premises visibly clean. Staff used systems and processes to safely prescribe, administer, record, and store medicines according to national evidence-based practice.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The trust had a clear process for reporting and learning from incidents. Staff reported incidents on the trust electronic system. Staff we spoke to knew how to report an incident. We received varied response about feedback from incidents. Most staff confirmed they discussed learning from incidents during staff meetings and at handovers. However, one of the staff we spoke to said they did not always receive feedback from the incidents they reported.

The service regularly reviewed patient safety incidents and analysed key themes. We reviewed the ED learning from incidents report from September 2025. This identified the key themes around patients’ safety incidents from 2024 to 2025. The largest number of incidents were delayed care (26%), missed diagnosis (19%), capacity issues/crowding (11%), documentation issues (7%), time critical medications (7%) among others. The document identified individual cases and highlighted learnings from each incident. We saw evidence learnings were discussed from the notes of mortality and morbidity meetings, clinical governance and staff meetings. There were posters around clinical area highlighting learnings from incidents and national audits, for example issues around time critical medications.

Staff understood their responsibilities relating to the duty of candour and when this should be applied. We saw 95% of staff had completed duty of candour training. The service followed the duty of candour policy by disclosing incidents to patients and providing feedback on investigation outcomes when necessary. We saw examples of this in letters written to service users and their families.

The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety.

Walk-in patients attended the emergency department (ED) via the main ED reception/waiting area. A streaming nurse attended to adults while children were streamed directly to the paediatric ED via a separate reception window. Adults could be streamed directly to the main ED, urgent treatment centre or same day emergency care (SDEC) unit. There were 2 separate SDEC pathways. This included the ED SDEC which was run as part of the ED and medical SDEC run by the acute medical team. Staff had access to flow diagrams / algorithms identifying care pathway for various ailments including chest pains, trauma, self-harm, and allergy among others.

The department had significant capacity issues exacerbated by the care of patients in temporary escalation spaces, especially corridors. This had a significant impact on the timeliness of care and limited the services capacity to maintain safe systems of care. Between December 2024 and November 2025, 69% of patients spent less than 4 hours in the ED. This was below the national performance target of 78%.

Patients were seen by a triage nurse who completed a brief assessment including observations of vital signs and prioritisation of urgent cases. Most patients were not triaged within 15 minutes of their arrival in line with national standards. Between December 2024 and November 2025, 47% of patients were triaged within 15 minutes.

During our inspection, patients arriving by ambulance were received by a senior nurse within the ambulance room or ambulance corridor area. Ambulance handover times during our inspection was typically between 26 to 28 minutes. Data from the trust showed that between December 2024 and November 2025, the average ambulance handover time was 32 minutes, with higher handover times in December 2024 and January 2025 (39 minutes), March 2025 (34 minutes), and April 2025 (38 minutes).

Staff discussed capacity issues in various daily meetings (including site meetings, handovers and huddles) to identify patients ready for discharge or transfer to speciality wards.

The trust had referral pathways for people attending the emergency department with mental health symptoms. People with previous psychiatric history and typical presentation with no physical health condition identified at triage, normal observations and below 65 years could have direct referral to liaison psychiatry from triage. People who presented with self-harm, substance abuse or new onset of mental health symptoms were examined within the emergency department prior to their referral.

The trust also had a clear pathway for children or young people presenting to the paediatric ED with mental health issues. This involved referral to the Child and Adolescent Mental Health Services (CAMHS), safeguarding referral, completing the environment checklist to ensure the mental health room was ligature free, enhanced observations (were indicated) and liaison with speciality teams.

We observed long stays for patients with mental health needs. This was typically due to the long waits for transfer to specialist mental health services. During our inspection, the longest stay (160 hours) in the department involved a patient with mental health needs. Between June and November 2025, the average length of stay for patients presenting with mental health issues was 24.7 hours. During the same period the longest stays in ED by month was 202 hours in June 2025, 165 hours in July 2025, 176 hours in August 2025, 331 hours in September 2025, 132 hours in October 2025 and 184 hours in November 2025. All these involved patients with mental health needs.

The percentage of patients seen by the liaison psychiatry team within 1 hour in the ED varied between December 2024 to December 2025. Over 95% of patients were seen by the team within 1 hour in line with the trust target in December 2024 and September – December 2025. However, the service was rated amber (for 90% to 93.6% compliance) in January, March and June 2025. The service was rated red for lower compliance rate (85% to 89%) in February, April, July and August 2025.

The trust highlighted escalation processes for mental health beds through review of mental health patients at site call updates, and through collaboration with mental health providers.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff we spoke with knew how to identify people at risk of, or suffering, significant harm or abuse and the service worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff received training specific for their role on how to recognise and report abuse. Most staff had completed the right level of safeguarding training for both children and adults.

Mandatory training data provided by the trust showed that 97% of nursing staff and 92% of medical staff, had completed level 2 adult safeguarding training. However, completion rates for level 3 safeguarding adult training were below the trust target for nursing (59%) and medical staff (54%).

Compliance with safeguarding level 2 children training was 91% for nursing staff and 92% for medical staff. However, 71% of nursing and medical staff had completed level 3 safeguarding children training. This was below the trust target of 85%.

In addition to safeguarding training, 94% of staff had completed preventing radicalisation training.

During our inspection, we reviewed notes of children in the paediatric ED and confirmed that staff completed safeguarding checklists and escalated concerns when necessary.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. The hospital had a safeguarding lead and staff found them approachable and supportive.

The trust had a policy for female genital mutilation (FGM) which was available on the intranet. Staff we spoke to were aware of the policy and how to access it.

The service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff used the National Early Warning Score (NEWS) and Children’s Observations and Severity Tool (COAST) to identify adults and children at risk of deterioration. Observations were recorded in all patients’ records we reviewed, and we saw information which confirmed monitoring of staff’s completion of these assessments was carried out regularly.

Staff had completed relevant training to triage patients arriving to the ED using the Manchester triage system to quickly assess urgency and prioritise patients.

Risk assessments relating to falls, pressure ulcer and delirium screening were completed in some of the notes we reviewed. Staff informed us they checked and documented pressure areas on patients’ arrival. Staff had access to use inflatable pressure relieving mattresses for patients that required them. We noted risk assessments were completed but these were not reviewed regularly. Staff informed us that significant capacity issues in the ED impacted on their ability to care for patients.

The trust had a standard operating procedure (SOP) for temporary escalation spaces. The SOP excluded patients requiring cardiac monitoring, patients with a NEWs score greater than 2, patients requiring more than 2 litres of oxygen, patients assessed at moderate or high risk of falls, patients living with dementia, infectious patients, patients with mental health presentation, and patients requiring level 4 enhanced care. However, during our assessment we observed there were patients on trolleys with bedrails in the corridor area.

The trust had an ED escalation policy which stated that no confused, unstable or elderly patients were to be placed in the escalation area. It also stated the area will be open on a temporary basis with a plan to move patients out within a maximum of 4 hours. However, during our assessment, we observed patients with complex needs (including patients with learning disabilities) were cared for in the corridor. We also saw there were many elderly and frail patients in this area. Furthermore, we confirmed that patients were in escalation spaces on the corridor for up to 30 hours during our inspection.

Staff completion rate for resuscitation training on how to manage life-threatening emergencies was below the trust target of 85%. Compliance with basic life support (BLS) training was 83% for part 1 BLS and 81% for part 2 BLS training. Compliance with adult immediate life support training was 54%, while compliance with advance life support training was 38% (or 9 out of 24 staff). Compliance with advance life support and immediate life support training was rated red while compliance with BLS training was rated amber.

We reviewed patient notes across the ED for sepsis management. We noted that observations were recorded in all 21 records reviewed for that purpose. We observed that sepsis bundle was commenced in 5 out of 5 notes where sepsis was identified. However, the sepsis bundle was not completed in 2 of the notes. Critical medication was prescribed and administered in the notes reviewed.

We reviewed 2 records of patients with mental health needs. The records showed patients received an assessment of their physical and mental health needs on their arrival at the emergency department. This included details about any risks to themselves or others. In 1 record reviewed, a patient was supported by security officers for about 9 hours overnight as no mental health support worker was available. This was contrary to the Royal College of Emergency Medicine guidelines which states that security staff should not be used for 1:1 observation.

An audit review of antibiotic administration timeliness in the ED across sites (January – March 2025) showed that 9 out of 19 patients (47%) exceeded the target time of 60 minutes for antibiotic administration. This meant that antibiotics were not always administered in a timely manner.

We were provided with an audit of standards of paediatric sepsis presenting in the ED. The audit reviewed a random sample of 50 patients attending paediatric ED from April to May 2024 in each ED location. Results for St Helier Hospital ED showed that staff achieved 100% for completing COAST scores on patients’ arrival. However, there was low compliance with the trust guidelines. The results showed that the sepsis screening tool was commenced in 46% or 23 out of 50 cases, and sepsis was triggered on the sepsis scoring system in 13% or 3 out of 23 cases. A senior review was completed within 1 hour in 33% or 1 out of 3 cases, patients were reviewed by a senior clinician within 1 hour in 33% or 1 out of 3 cases and blood pressure was recorded in 67% or 2 out of 3 cases. In addition, no antibiotic was prescribed in any of the 3 cases required. The audit identified the need to remind staff in triage to complete the sepsis screening tool in children. It also identified the need to remind doctors of the importance of documenting any de-escalation or further treatments.

We reviewed the audit action plan in relation to standards for paediatric sepsis presenting to the paediatric ED. It highlighted concerns such as incomplete sepsis pathway, documentation with poor signature, timeliness of seeing children who trigger sepsis, lack of repeat observations and lack of review for de-escalation. Actions were highlighted with a named person to improve the service. This included, improving documentation, and timeliness of observations and care.

The service did not always detect and control potential risks in the care environment. They did not always make sure facilities supported the delivery of safe care.

The premises and facilities did not always support the delivery of safe care. The ED environment was crowded, and a significant number of patients were cared for in temporary escalation areas. Patients were cared for in narrow corridors including areas identified as the side corridor, back corridor, and ambulance corridor. In addition, extra trolleys were added to clinical areas including the resuscitation unit and majors.

During our inspection it was difficult to move along corridors. We observed a paediatric patient who arrived by ambulance and was transferred through the resuscitation area. Staff informed us the resuscitation area was often used as thoroughfare.

During our inspection, we found the environment around the back corridor was unsafe. Patients were cared for on 4 trolleys on a corridor leading to the fire escape and people had to wriggle past the trolley to walk through the corridor. The situation around the environment meant there was a high risk to patient safety in the event of a fire incident or medical emergency. Following our inspection, we raised concerns to the trust regarding this area. We observed during our follow up inspection that the trust had taken immediate actions to address our concerns and the back corridor was no longer used as an escalation area.

The trust had a standard operating procedure (SOP) for temporary escalation spaces in the department. This included 3 trolleys in the reverse queue majors area, 8 trolleys in the side corridor, 5 trolleys in the back corridor and 4 chairs in the GP/treatment room.

The trust had an ED escalation policy which set out a red line beyond which capacity could not be exceeded. This was set at 7 trolleys for the resuscitation area, 12 trolleys for the majors area, 4 trolleys and 3 chairs for the rapid assessment and treatment (RAT) trolley area, 5 chairs for RAT chair area, 6 chairs for the ambulance corridor, 4 trolleys for the back corridor, and 5 chairs for the UTC/ ED SDEC. The total capacity was set at 32 trolleys and 32 chairs.

Staff informed us 200 – 250 patients attended the ED daily. The service admitted 40 to 45 patients daily, however, the unit was designed to accommodate 24 patients. This created significant capacity issues impacting on patient care and treatment. The capacity issues were exacerbated by delays in transferring patients to speciality wards. For example, 48 patients were waiting for an inpatient bed by 14:28 on 2 December 2025.

We observed during our inspection that capacity often exceeded the red line set by the ED escalation policy. For example, there were 9 patients on the ambulance corridor by 14:28 on 2 December 2025. We observed that patients arriving via ambulance were often on ambulance trolleys around this corridor. This was an area marked for 6 chairs in the escalation policy.

Premises were not suitable for the purpose for which they were being used. Most patients in the majors area were patients with “decision to admit” (DTA) and newly admitted patients were often cared for on the corridors. This meant patients who were seriously ill but not critical enough for the resuscitation area could not always be cared for in the area designated for them.

The ED did not have sufficient facilities for patients with mental health needs. The ED had one room for assessing mental health patients. This room met Psychiatric Liaison Accreditation Network (PLAN) standards. Staff completed ligature risk assessments of the room and there was a toilet fitted with anti-ligature fittings next to the room. However, during our inspection, there were up to 3 patients with mental health needs in the ED.

The designated mental health room was often not available, due to people with mental health needs having long waits to access beds. In these instances, psychiatric liaison members of staff used other rooms in the department, such as rooms used as nurse practitioner rooms previously. One patient, for example, had been assessed in the phlebotomy room. These rooms were not ligature free and contained equipment, which could be used to harm. Nurses told us they would try and remove what they could.

On the day of our inspection, one person with mental health needs had spent 4 days on a chair in the rapid assessment and treatment (RAT) area.

There were no showers in the department. If a person needed to use a shower, patients could use a shower on the Acute Medical Unit. The members of staff we spoke with told us that they would risk assess this.

The paediatric ED had taken action to address concerns about facilities for children with mental health needs since our last inspection. The department had 2 mental health rooms with toilets next to them. The facilities were ligature free and in line with national standards. The paediatric ED had a sensory room to designed to provide children with a calming and stimulating environment.

The ED had a separate entrance to the main hospital. There were 2 reception desks in the main waiting area for streaming adults and children. There was a separate assessment area for the paediatric ED. Once booked in, children were admitted to the paediatric waiting room, which had secure access. Points of entry to clinical areas had swipe card access.

Staff conducted daily safety checks on specialist equipment. All equipment we reviewed conformed to the relevant safety standards and had been serviced annually. Staff had received training to use equipment.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to meet patients’ needs but often felt constrained by capacity issues in the ED.

The service used the Safer Nursing Care Tool to manage staffing. We reviewed the data for planned and actual nursing hours from September 2025 to November 2025. We noted that actual nursing hours in the adult and paediatric ED were above the planned hours which meant extra nursing staff had been rostered to cover the shift in the 3 months prior to our inspection. This was in part due to filling gaps in rosters for band 4 staff with band 5 staff and the utilisation of extra nursing staff during winter pressures.

Staffing data provided by the trust showed that the department was rated amber for the vacancy rate (10.8%) and sickness rate (5.7%). Staff turnover was rated green (8.37%).

Vacancy rate for nursing staff was 14%. The trust stated that the nursing vacancy rate was projected to decrease by February 2026 with HCAs, band 5 and band 6 nurses recruitment campaign. The service used mostly bank staff to fill any gaps in rota.

Nursing cover included 15 nurses and 6 healthcare assistants (HCAs). Daily nursing staff included 1 band 7 nurse in charge, 1 streaming nurse, 1 triage nurse, 3 nurses in majors, 3 nurses in the resuscitation area and 6 nurses in the assessment area (which included the side corridor, back corridor, fit to sit area, ambulance queue area and waiting room). Nursing cover at the paediatric ED included 4 nurses during the day, 1 covering a twilight shift and 3 nurses at night.

Each shift had 2 mental health support workers to care for patients with mental health needs. Staff we spoke with told us it could be difficult to allocate people when the department was busy. The lead nurse could request extra members of staff for 1:1 observations, but these members of staff took time to arrive.

Consultants were present from 8:00 to 22:45, 7 days a week. This was not at the level recommended by the Royal College of Emergency Medicine (RCEM) which required 16 hours presence in the department. A consultant was on call at all other times. The service had 18 WTE consultants which was sufficient to meet the Royal College of Emergency Medicine (RCEM) recommendations based on the annual attendance at the ED. Other medical staff were rostered to provide cover for 24-hours a day, 7 days a week.

Medical staffing in the paediatric ED consisted of 4 paediatric emergency medicine consultants and 9 paediatric (middle grade) registrars who provided rotational cover across the paediatric ward and paediatric ED.

Consultant cover in the paediatric ED was from 08:30 – 22:00, Monday to Friday and 13:00 – 22:00 on weekends. A paediatric consultant was on call out of hours. Other medical staff were rostered to provide cover for 24 hours a day, 7 days a week. Overnight, medical cover for both the paediatric ward and paediatric ED was provided by one paediatric registrar and one SHO supported by a consultant on call.

At the time of our inspection there was a vacancy for a substantive paediatric consultant. A locum paediatric consultant had been appointed to commence work in January 2026.

Medical staff were very positive about the opportunities for training and development and felt well supported by the local leadership team. They spoke highly of their induction and weekly teaching opportunities. The service had an educational lead for medical staff and team specific tutor programs for all grades. Senior staff informed us they received a letter of commendation from the NHS England last year for their education/training program. On the other hand, nursing staff expressed disappointment with the lack of opportunities for training and development (beyond basic routine training). During the period of our inspection, the practice development nurse was on long term leave.

We observed handovers on the unit. This was multidisciplinary and involved input from medical, nursing and allied staff, as well as social workers. Staff discussed patients on the ward, treatment options and whether they were ready for discharge.

We also observed medical staff handover. Staff discussed patients in each area of the ED and mandatory training compliance.

Overall compliance with mandatory training was 86% in line the trust target of 85%. Overall compliance rates for nursing (88%) and allied health professionals (100%) were above the trust target while overall compliance rates for medical staff (79%) were below the trust target. Areas of low compliance included level 3 safeguarding training and resuscitation training.

Staff had completed an induction and competencies to carry out their role. The appraisal rate for ED was 71%. This was below the trust target and rated amber.

Staff informed us they worked well together to meet the needs of patients. However, some felt they were not always able to provide the level of care they wanted due to constraints presented by the capacity issues in the ED.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We observed that all areas of the service were visibly clean. Cleaning records were up-to-date and demonstrated that all areas were cleaned regularly.

Staff were ‘bare below the elbow’ and adhered to infection control precautions throughout our inspection, such as hand washing and using hand sanitisers when entering and exiting the unit and wearing personal protective equipment when caring for patients.

There were handwashing sinks available. Soap and disposable hand towels were available next to sinks and instructions on how to effectively decontaminate hands were displayed above the sinks.

The service carried out monthly hand hygiene audits. Between April 2025 and December 2025, the service achieved an overall compliance rate of 90% in the main ED, 94.4% in the paediatric ED and 100% in SDEC.

We reviewed the ED infection control audit feedback report dated 12 November 2025. This showed the service achieved a low compliance score of 71%. The audit identified several issues with the general environment, sharps handling and disposal, waste disposal, storerooms, and care of equipment among other issues. An action plan was implemented to address the issues raised and strengthen infection prevention and control.

We observed the general environment and equipment were visibly clean during our inspection. There were adequate arrangements for handling, storage and disposal of clinical waste, including sharp instruments.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely. The service had a medicines management policy, which described the handling, storage, prescribing, recording, safe administration, and disposal of medicines.

Staff completed medicines records and kept them up to date. We reviewed patient records which showed prescription charts were completed, signed, and dated. Staff recorded information about patient allergies.

We found medicines were stored securely and appropriately. We reviewed the controlled drugs register which was correctly completed and noted the entries had been signed by designated members of staff as required. Medicines we checked were in date and reconciled with the records.

The ED had made improvements to medicines management following our last inspection.

Medicines requiring cold storage were stored in locked fridges and the temperature was monitored daily. Medical gas cylinders were stored securely and in a safe position. Medicines and equipment for use in emergencies were checked daily.

Staff informed us a pharmacist was available to support the ED, and they were responsive to enquiries. They could also contact the pharmacy team out of hours via an on-call service.