Queen Elizabeth The Queen Mother Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

We assessed 6 quality statements.

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of patients who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment in 2023 we did not rate this key question. At this assessment we rated well-led as requires improvement.

This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

We found the service did not have effective governance or leadership, with a lack of clear oversight, ownership, and accountability across key areas. Escalated risks were not acted on by senior leaders, and there was a disconnect between frontline staff and the executive team, with escalation protocols not used appropriately.

Staff were not familiar with key procedures and pathways, and there was limited multidisciplinary oversight of patient flow and risk. Leadership visibility was poor, with unclear roles and ineffective team coordination, including inadequate handovers and failure to implement agreed actions, highlighting weaknesses in operational management and assurance processes.

However, leaders engaged with partners across the system, including the ambulance service and mental health providers, and held regular meetings to discuss performance and pressures. The service demonstrated a commitment to learning and innovation, with some staff actively involved in service development, education, and quality improvement initiatives.

We have not awarded this service a score for Well-led.

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

The evidence showed significant shortfalls. The service did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand all challenges and the needs of patients and their communities.

Staff gave mixed feedback regarding the culture of incident reporting and whether risks were managed effectively. Staff told us that there was a disconnect between frontline clinical staff and the senior leadership team, that affected confidence that concerns were heard and acted on.

We reviewed the 2024, NHS staff survey for urgent & emergency and acute medicine. Responses showed very low levels of staff agreement with positive culture statements. Less than 7% of staff agreed that the service was compassionate and inclusive, and less than 6% agreed that they were recognised and rewarded.

Doctors and senior nursing leadership was reported to be present but was not visibly leading in clinical areas. The service did not always maintain a consistent senior clinical presence at central coordination points, which reduced assurance of clear operational oversight.

The service did not have effective oversight of overall risks across the department. Not all temporary escalation areas were included in safety huddles and site management meetings, which limited assurance that risks were being identified and managed in a consistent way.

Following our assessment, leaders told us the trust already had an IT-based emergency department clinical view for oversight across all areas, including escalation areas, and that Emergency Physicians in Charge (EPIC) and Nurses in Charge (NIC) would be re-educated to use it more effectively. However, the service remained at risk until this practice was embedded.

The service did not consistently provide effective clinical leadership and coordination through board rounds. We observed that the board rounds were ineffective and lacked clear leadership, accountability and a standardised approach. Following our assessment, leaders told us they planned to strengthen the EPIC and NIC board round process through further standardisation. However, the service remained at risk until this process is implemented and embedded.

Not all staff could articulate the trust values and how they fitted into delivering high levels of patient care. Not all staff knew and understood the vision and values and how they were applied in the work of their team.

Within the emergency department (ED), a strong culture of teamwork was evident; most staff described a supportive environment However, maintaining a focus on service improvement during periods of extreme pressure was challenging. The trust tried to strengthen its direction by aligning with external partners to manage regional patient surges.Leaders held joint meetings with the local ambulance service and mental health trust. These collaborative efforts created shared goals for the entire region.

The evidence showed significant shortfalls. The service did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

We found the service did not have effective leadership, with a lack of clear oversight, ownership, and accountability across key areas. Escalated risks were not acted on by senior leaders, and there was a disconnect between frontline staff and the executive team, with escalation protocols not used appropriately.

Staff were not familiar with key procedures and pathways, and there was limited multidisciplinary oversight of patient flow and risk. Leadership visibility was poor, with unclear roles and ineffective team coordination, including inadequate handovers and failure to implement agreed actions, highlighting weaknesses in operational management and assurance processes.

During our inspection, we observed that leaders did not have a good understanding of the service’s shortfalls. However, they demonstrated a genuine commitment to improvement, engaging in open and honest conversations with us regarding current struggles and future goals. However, systemic pressures often tested leaders’ capacity to provide safe and responsive care.

Leaders focused on reacting to problems as they happened rather than preventing them, which allowed known safety risks to persist. Audits indicated ongoing problems, yet these did not always lead to improving trends over time. Poor infection control, as well as patient dignity concerns all impacted on patient safety and experience within the service, and because leaders did not act quickly and decisively on these concerns, avoidable risks remained ongoing.

Emergency department (ED) leaders fostered an open and supportive culture for staff, though a disconnect remained between frontline staff and executive response. However, some senior staff felt their specific concerns about overcrowding were not always acknowledged, leading to frustration. While executive leaders were aware of these risks, they had not effectively shared their response plans with the team.

On 6 and 7 January 2026, a critical incident standby had been declared. During this time, at the site meetings, leaders focused operationally on discharges rather than patient risk across the trust and within the emergency department. The service experienced severe hospital‑wide flow pressures, with 63 patients waiting for admission decisions.

The trust did not ensure safe and effective oversight and leadership across key clinical areas within the emergency department. Leaders did not establish clear ownership and accountability for Majors, the Rapid Assessment and Treatment (RAT) area, and the waiting room. Gaps in operational and strategic leadership contributed to poor coordination and unclear accountability.

The service did not ensure senior nursing leadership provided active oversight of teams, emerging risks, or the deployment of staff in response to patient acuity (a measure of the severity of a patient's illness, injury, or medical condition and the resulting intensity of care and resources needed). This resulted in inadequate oversight of patient flow, risk escalation and safe allocation of patients.

The service did not demonstrate effective multidisciplinary overview of operational risk or patient flow. Safety processes were insufficient to support shared awareness and effective escalation.

We observed an afternoon huddle on 6 January 2026 which functioned as a consultant-to-consultant handover rather than a multidisciplinary (MDT) safety meeting. The service did not ensure attendance from nursing staff or senior leaders, and not all patients were reviewed. The lack of MDT contribution meant concerns and risks were not shared effectively and negatively impacted patient flow, timely assessments and overall decision-making.

The evidence showed some shortfalls. Staff did not always feel they could speak up and that their voice would be heard.

Staff we spoke with were not always sure that raising their concerns led to meaningful action. While many staff told us they felt safe to speak up, some staff told us they did not feel able to speak up and felt concerns raised previously, had not been acted upon. Where staff did not feel they could raise concerns openly, the service had arrangements for staff to anonymously raise concerns.

Leaders shared the trust wide 6 monthly Freedom to Speak Up report for December 2025. This showed that 81 cases had been raised year-to-date, with 19 cases remaining open at the time of assessment. Leaders told us key themes included management issues, behaviour and relationship concerns and system and process problems. The report also showed that 45.7% of staff sought impartial support, 35.8% had raised their concern previously but felt they had not been listened to, 13.6% reported a fear of reprisal, and 3.7% believed they would not be listened to. However, this was not specific to the emergency department.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The evidence showed significant shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

At the last rated assessment, we found that the service did not always monitor improvement actions on patient outcomes, and the national standard for admission, transfer or discharge of patients within 4 hours.

At this assessment we found the service did not have effective governance processes, with a lack of clear oversight, ownership, and accountability across key areas. Escalated risks were not acted on by senior leaders, and there was a disconnect between frontline staff and the executive team, with escalation protocols not used appropriately.

The trust operated within a highly pressured environment and did not effectively address several long-standing issues identified at previous inspections, including training compliance, patient outcome monitoring and adherence to interprofessional standards. Although risks were escalated through established governance processes, leaders did not always take timely action to mitigate them.

The emergency department faced significant operational pressures, including poor patient flow, crowding, staffing shortages and inconsistent escalation of patient safety risks. Staff did not consistently discuss and manage risks during safety huddles, board rounds and bed management meetings, and governance arrangements did not ensure patients received timely medical assessment and senior medical review.

Staff continued to express concerns about staffing levels, personal safety and incident management. While leaders implemented some measures to reduce risk, such as corridor reconfiguration, these actions did not resolve the underlying challenges. High-risk situations persisted, particularly during periods of increased demand.

The trust also lacked effective oversight and governance of mental health pathways. Staff did not have clear, implemented procedures to support patients with mental health needs, and the service carried out limited audit and assurance activity in this area. Although leaders planned improvements, including the introduction of mental health training and new pathways, these had not yet been embedded.

Despite these concerns, the service maintained processes to escalate risks to board level and facilitated monthly meetings between emergency department staff and the liaison psychiatry team to discuss operational issues and support collaborative working.

The evidence showed some shortfalls. The service did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Staff reported a reduction in the use of Section 42 safeguarding referrals. They told us that patients were often being discharged back to care homes without discharge documentation or Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms. However, when a resident had attended the Emergency Department (ED), a GP summary was sent back to the care home, as discharge documentation would only be relevant for patients that are admitted.

Staff also raised concerns about the number of patients who absconded from the service, stating that incidents were not always being documented appropriately and records were not being completed correctly.

Leaders engaged with system partners and identified actions to improve, although these were not fully embedded at the time of assessment. The service worked closely with the local NHS ambulance trust and mental health trust and staff with the aim to provide joined-up care.

Staff worked with partner organisations, including the NHS mental health trust, children’s mental health services, the police and ambulance service, to support the movement of patients between services and help develop a mental health framework.

The trust’s Council of Governors Membership and Engagement Strategy (2022–2027) aimed to increase member involvement, strengthen existing partnerships and support new collaborations.

The trust also worked with The League of Friends and the Patient Voice and Involvement Team to improve patient experience, facilities, and wellbeing in the Thanet area. Through fundraising, the League of Friends provided equipment and resources for local hospitals.

However, it was unclear how these partnerships and collaborative arrangements provided assurance to patients, carers and the public that the ambitions of the strategy were being achieved.

The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for patients. They did not always actively contribute to safe, effective practice and research.

Staff reported that the acuity tool was introduced without prior training. Although training was provided after implementation, staff felt that the trust had subsequently lost sight of the need for continued training and development. We were told that training remained a concern, with staff describing a lack of understanding of the tool among some doctors. Staff praised the specialist nurses for the support and training they provided, explaining that they did not feel adequately supported by the education team.

To address previous concerns regarding continuous learning, the provider had implemented a structured three-year strategy covering the period 2023–2025. The strategy placed a strong emphasis on peer learning, digital innovation, including remote patient monitoring, and learning from patient safety incidents to drive service improvement.

The trust was currently developing its new organisational strategy, which will set out its long-term vision and the approach it will take to continue improving services. The strategy will build on existing improvement initiatives while outlining future changes and developments. Key priorities would include improving patient outcomes, reducing health inequalities, and delivering sustainable, high-quality care for the populations it serves.

The department had implemented several initiatives, including the support of an interim Practice Development Nurse (PDN) who provided guidance to student nurses during their placements. The PDN had also established a mobile-based information group, enabling students to easily access relevant policies and procedures while on placement.

Staff, including the PDN, told us they had contributed to the development of a trauma course that was undergoing validation. The course was intended to be made available to paramedics and other clinicians beyond the trust, supporting shared learning and the dissemination of best practice across the wider system.

Staff told us that some staff had received a Cavell Star Award for demonstrating exceptional care and support to colleagues, patients and their families. The Cavell Star Awards recognise nurses, midwives, nursing associates and healthcare assistants who show outstanding compassion, care and commitment to others.

Staff showed a commitment to patient care and spoke positively about development opportunities, particularly within paediatrics. However, leadership gaps and limited system grip during surge reduced staff confidence that escalation would result in change.

Staff told us the trust demonstrated a commitment to learning and innovation by acting as an early adopter of developments in emergency care. Staff described how the service tested new ways of working, including total triage and remote consultations in primary care, and the introduction of Same Day Emergency Care (SDEC) to reduce unnecessary hospital admissions.

Leaders told us the service went live with the Same Day Emergency Care units project update in November 2024, supporting learning, evaluation, and system‑wide improvement.