Queen Elizabeth The Queen Mother Hospital

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 patients care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

We assessed 5 quality statements.

We looked for evidence that patients 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 patients 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 did not rate this key question. At this assessment we rated effective as requires improvement. This meant the effectiveness of patients care, treatment and support did not always achieve good outcomes or was inconsistent.

The service did not consistently provide effective care and treatment. Patients’ needs were not always fully assessed, reviewed or monitored, and leaders could not provide assurance that risks to patients were consistently identified and mitigated.

Delays in patient flow, including extended waits for admission, resulted in patients receiving care in inappropriate environments and contributed to delays in assessment, treatment and specialist review.

Staff did not consistently follow clinical pathways, standard operating procedures or observation requirements, and inaccurate triage and ESI scoring affected the timely prioritisation of patients. The use of multiple, non-integrated electronic systems reduced continuity of care and increased the risk of communication failures.

The service did not always deliver care in line with evidence‑based practice or monitor outcomes effectively. Record‑keeping and risk assessments were inconsistent. People were not always involved in decisions about their care.

However, staff worked collaboratively across disciplines, used community healthcare records where available, and supported coordinated discharge planning. Key outcomes were monitored, including strong performance in sepsis screening and timely antibiotic administration, alongside contributions to national quality improvement work on time‑critical medicines. Staff also had access to responsive mental health support, offering advice and specialist input for patients and staff.

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 evidence showed some shortfalls. The service did not make sure patients' care and treatment was effective because they did not check and discuss patients' health, care, wellbeing and communication needs with them.

During our assessment we found evidence that the service did not always assess risk or do everything reasonably practicable to reduce the risk of harm to patients in the emergency department. We saw 21 patients waiting for admission, some of whom had waited more than 72 hours. We were concerned that a lack of patient flow through the emergency department, despite the actions taken to address overcrowding, meant patients were at increased risk of harm and unmet care needs.

Staff told us, and we observed, that patients were not always placed in appropriate clinical areas for their needs. The service did not always ensure that patients were cared for in suitable environments. We saw examples of patients waiting in inappropriate areas and being placed in temporary overflow spaces that did not meet their needs. The service had 28 patients in temporary escalation areas and 50 patients in the waiting room on 7 January 2026. These were in addition to the patients in the specialty and observation areas. This meant that staff may not recognise that patients may deteriorate in this area.

Patients reported waiting between 6 and 12 hours to see a doctor. Staff described delays in diagnostics, including CT imaging that was requested in the morning and not reported until late evening, alongside mismatches between requests and completion.

Staff did not consistently remotely monitor patients outside resuscitation areas. Although central monitoring systems were available, they were not fully utilised.

The service used 2 separate electronic systems for the emergency department and the urgent treatment centre. These systems did not connect with each other, resulting in reliance on paper-based handovers and an increased risk of communication failures.

Staff did not always assess or respond to patients’ physical health needs effectively. We were particularly concerned about the assessment, monitoring and recording of physical health needs for patients in the mental health lounge. We reviewed 5 patient records and found gaps. Although initial risks were sometimes identified on presentation, the service did not ensure these were consistently followed up or reassessed as patients’ conditions changed.

Staff identified risks relating to low blood pressure, nutrition and hydration, frailty, and medicines management for a patient, but records did not show ongoing monitoring, timely medical review, completion of requested investigations, or consistent documentation to demonstrate these needs were being reassessed.

In the paediatric emergency department, the service worked well across teams and services to support patients and staff. Children’s care and treatment was coordinated.

Staff had access to the paediatric consultant and senior clinicians; we saw effective multi-disciplinary meetings. Staff shared risk information appropriately about the patients.

The evidence showed some shortfalls. The service did not always plan and deliver patients care and treatment with them, including what was important and mattered to them.

Staff could not always make reasonable adjustments due to crowding and limited staffing. Despite efforts, patients did not consistently receive the support they needed to access the service. For example, patients needed support with their mobility when toileting. Due to their mobility and frailty challenges, they were left for long periods on trolleys without the ability to seek assistance.

We reviewed over 50 sets of patient notes and found that all contained an omission or error. We saw examples of risk assessments not being fully completed or patient specific information being omitted. We saw examples such as incomplete skin integrity risk assessments, diet and hydration recording and the assessment of pain.

Audit information provided by the trust (November 2025) following our assessment, confirmed issues with the completion of risk assessments/care plans and this had been identified as an area for improvement. We saw leaders had developed action plans to address these issues. Ongoing themes included care plans that were not up to date and did not match the care seen. In addition, although falls risk documentation had been completed, follow up discussions with staff identified poor knowledge of how to mitigate risks.

The hospital scored worse than expected in the CQC Urgent and Emergency Care Survey 2024, regarding questions such as were patients involved enough with decisions relating to their care and scored much worse than expected for whether staff explained why tests were needed in a way patients could understand.

However, the hospital scored similar to other trusts, regarding questions such as availability of food and drinks and were family, friends or carers given the opportunity to talk with a doctor or nurse.

The service had contributed to the Royal College of Emergency Medicines (RCEM) ‘Time Critical Medicines’ quality improvement programme (QIP), which aimed to ensure people received their time-critical medicines according to their usual regimen while in the department. We saw evidence of action plans and some improvements arising from this work, and overall performance was broadly in line with national averages.

The trust audited practice against evidence-based research. For example, between September and December 2025 an average of 94.5% of patients who met the criteria had intravenous (into a vein) antibiotics started within 1 hour for the management of sepsis in line with sepsis guidance. Sepsis is an extreme reaction to an infection.

The evidence showed significant shortfalls. The service did not work well across teams and services to support patients. They did not share their assessment of people’s needs when patients moved between different services.

Staff did not always have timely access to the information they needed to appropriately assess, plan, and deliver care, treatment, and support in line with people’s individual needs. The service experienced challenges with multiple computer systems, and cross‑site sharing of information was difficult, affecting services beyond the emergency department. Patient records, blood test results, and investigation findings were accessed through an electronic system, whereas nursing notes were maintained in paper format. This meant staff had to access several systems to gather information, increasing the risk that important information could be missed. Staff told us this was time‑consuming and impacted on care delivery.

However, some staff told us they were able to access community healthcare records when needed, which supported assessment and decision‑making for some patients.

During our assessment the medical handover (“board round”) observed took over 1 hour, was frequently interrupted and lacked clear structure. Task allocation and accountability were unclear.

We saw that remote monitoring of patients outside resuscitation areas was inconsistent, although central monitoring systems were present, they were not fully utilised.

We looked at data in the trust Emergency Department Governance Report for November/December 2025. Tables showed the delay/failure incidents for the period June to November 2025. The number reported was similar to October, with a decrease in the subcategory self-discharge against medical advice, but an increase in discharge planning failure/delay, inappropriate or delayed transfer and incorrectly identified patients.

The service did not always coordinate care effectively between teams. Although some specialty services were based within the department, patients requiring review by other specialty services experienced delays due to pressures elsewhere in the hospital and across the wider system. Staff told us that while specialty teams reviewed patients following referral, this often took longer than expected, delaying specialist input and onward admission to ward areas. Staff also reported ongoing issues with the patient transport provider, which at times impacted discharge arrangements and patient flow.

Leaders told us the service met regularly with the mental health trust and the ambulance service to support coordination, address operational pressures, and improve joint working across organisations. Staff were visibly very busy, but spoke positively about support, relationships, and teamwork within the department. We observed effective multidisciplinary working and mutual respect between teams. We also noted the use of a flow coordinator who linked all areas of the department effectively.

Staff told us there was a disconnect between local leadership, care group leaders, and the executive team, which impacted consistency in communication and decision-making.

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 evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

During the assessment we saw significant delays in medical and specialist assessments being undertaken, which meant there were delays in recognition of serious and time‑critical conditions.

The service did not always demonstrate that established clinical pathways were followed in practice, for example for patients who had sustained a broken hip. Documentation was not consistently available to confirm that care had been delivered in line with trust guidance, and staff were not always familiar with specific pathways when asked. This meant care may not be delivered consistently and in line with national guidelines.

Staff did not always follow standard operating procedures relating to the use of clinical areas. Patients with complex needs, including those requiring oxygen therapy, were not always managed in line with local guidance, indicating gaps in staff awareness and application of procedures.

Systems for monitoring outcomes and responding to delays were not always effective in driving timely improvement, resulting in variability in patients’ experiences and outcomes.

The CQC Urgent and Emergency Care Survey 2024 showed that the response to ‘Do you think the hospital staff helped you to control your pain?’ question was worse than expected when compared with other trusts.

The trust provided a retrospective audit of self-discharges between 1 November 2024 and 31 January 2025. Learning from the audit was limited, as it focused mainly on staff compliance with self-discharge processes rather than wider drivers or outcomes. Recorded reasons for self-discharge were largely related to delays, including emergency department waiting times (22%), waiting for specialty review (18%), and waiting for a bed (6%). Patient choice was also identified, with 20% of patients reporting they felt better, while 34% had no reason recorded.

However, the service monitored some key outcomes to support improvement. The service audited sepsis screening and the timely delivery of antibiotics, which are critical to improving outcomes for patients with suspected sepsis. Audit data reviewed for the period September to December 2025 showed that antibiotics were given within 1 hour for patients with red flag sepsis in an average of 94.5% of cases (monthly compliance ranging from 93% to 96%). Compliance with completion of the sepsis screening tool during this period was 100%.

The evidence showed some shortfalls. The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The service did not ensure that all staff completed consent-related training and did not have effective oversight of the recording of consent through local audit arrangements. required, nor did it review the recording of consent within local audits.

During the assessment, we requested evidence from the trust to demonstrate how consent training was delivered and monitored, and how compliance was monitored. While the trust provided training compliance data across staff groups, this did not allow us to determine whether specific consent training had been completed by all relevant staff.

The trust also provided copies of local audits of patient records. However, when we reviewed these audits, we found that they did not include checks on whether consent had been appropriately obtained, recorded, or reviewed, which limited assurance that consent practices were being monitored for compliance.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. However, due to a lack of training compliance, we could not be assured that all staff would be able to achieve this.

Training compliance data demonstrated variation between staff groups. Dementia training had only been completed by 69.6% of medical staff. However, 99% of nursing staff had completed this training.

Staff had access to the mental health team 24 hours a day to support them and patients. We were told the team were responsive and supportive. We observed the mental health team in the department supporting patients and offering advice to staff.