Queen's Medical Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last inspection we rated this key question outstanding. At this assessment the rating has changed to good. This meant that people and communities were always at the centre of how care was planned and delivered and health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. People could access care in ways that met their personal circumstances and protected equality characteristics.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff understood what mattered to patients and provided care that met their physical, emotional, and social needs. We observed staff delivering person centred care and meeting fundamental care needs.

Staff gave examples of making reasonable adjustments for patients. For example, staff on the acute respiratory care unit supported a patient with complex needs through flexible visiting and access to friends and family. On The Same Day Emergency Care there was a ‘You said we did ‘poster this showed a patient had requested some books and magazines be made available, while patients waited to be seen which the service provided.

Patients were encouraged to sit out of bed and use tables and chairs as part of their rehabilitation. 

Patient records were individualised and demonstrated a holistic approach to their care and treatment. For example, therapy staff engaged with patients and their families, to discuss discharge plans. Plans were communicated with the multidisciplinary team daily at ward round to effectively discharge plan and try to reduce delays.

We observed clear recording of nutritional requirements on food charts. Menus met national dietary guidance and catered for a range of needs, including diabetic, Kosher and halal diets. Food and fluid intake was monitored, and patients reported positive experiences regarding the availability of food and drinks, and the person-centred support provided by staff.

Patient visiting hours were from 11am-8pm on most wards. Staff encouraged relatives, care givers and loved ones to visit. We saw examples where staff and relatives worked together to ensure a patient with dementia was comfortable and understood what was asked of them for example taking medications on time and additional fluids.

A monthly tea party took place on ward B47 for patients and care givers to attend.

The afternoon teas were run by the Speech and Language Therapy (SALT) team at Queen’s Medical Centre. The focus of the afternoon tea was to provide a relaxed, social environment with a view to improving patients’ independence and increase their desire to eat and drink.

Staff communicated with patients to ensure they understood their care and treatment, including adapting communication methods to meet the needs of patients with communication difficulties. Staff used a "This is me" booklet for patients who had additional care needs, for example, patients living with dementia which contained key information to help plan and deliver care

The service used the Butterfly Scheme. The Butterfly Scheme is a system of hospital care designed to support patients with dementia or memory impairment. It aims to reduce distress during hospitalisation by ensuring that staff are aware of the patient's condition and can provide appropriate care.

Staff used the “This is me” booklets. These helped staff understand what matters to each patient supporting the shared decision-making.  Staff enabled patients to express their needs, maintain independence and remain meaningfully engaged whilst in hospital.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service had good relationships with other local healthcare providers which helped to maintain communication and ensure joined up care for patients.

The medicine care group demonstrated an understanding of the diverse health and care needs of people and their local communities, and there were examples of joined up and flexible care. There was a dedicated discharge service in place to support effective discharge into the community.

The service coordinated care across teams and partner organisations, so people experienced a clear pathway through their patient journey. A multidisciplinary team (MDT) approach was evident on all wards we visited, this meant staff worked together to offer continuity of treatment and promote positive patient outcomes. 

The teams worked closely with external agencies to coordinate and plan packages of care and discharge processes. A patient we spoke with felt engaged in the discharge process and that the team had taken on board their views and wishes. One patient told us how the staff were involving them in arranging their discharge from hospital and where the best possible place for them was and their family.

Staff reviewed patient risks and their care plans collaboratively through the electronic record system, enabling ward teams and the MDT to agree any next steps and maintain consistent decisions as people moved between services for example, to diagnostic and surgical settings. 

Daily staff safety huddles and board rounds kept staff teams and the MDT aligned to any changes in the patients care or routines, so medication, care plans, discharge, or rehabilitation could be adjusted promptly. 

Multidisciplinary teams met regularly to look ahead to staffing, equipment and anticipated needs, reducing handover gaps and ensuring people saw the right clinician at the right time. 

The service had a virtual ward, this enabled patients to receive the care they needed at home safely and conveniently, rather than being in hospital. The service was supported by a Standard Operating Procedure setting out its principles of safety and suitability, individualised care delivered by the multidisciplinary team.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Translation services were available for people whose first language was not English, including British Sign Language. Staff knew how to access this service and told us the service could be accessed by phone. 

There was an extensive number of information leaflets available for people to explain the different aspects of end-of-life care, the treatment available and any side effects. Staff we spoke with told us these could be made available in different formats, for example larger print or alternative language.

We observed relevant information being shared between staff during multidisciplinary meetings and the nursing handovers we attended. 

The Trust's Patient Information Policy set standards regarding accessible information which staff were knowledgeable about. The accessible information standard sets out how NHS and publicly funded adult social care services should ensure disabled people and people with impairments or sensory loss can access and understand information about NHS and adult social care services and receive the communication support they need to use those services.

The service used an electronic patient record system, staff used secure card access to access the electronic patient records. We saw staff log off from the computer terminals they had been using when they finished updating or accessing patient notes, which helped protect people’s personal information.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. We viewed several menus available to patients to choose from. We saw information in patients records about sensitivities or allergy to food items. Dietitians were involved in supporting and advising on diet to aid good nutritional outcomes for patients. Notes were updated to indicate dietitian instruction and progress.

Staff ensured that patients had access to spiritual support. Members of the Trust's chaplaincy team attended wards regularly. They provided a 24-hour confidential service to patients, care givers and staff. This service was for all people regardless of age, gender, sexual orientation or any other form of diversity and all religions and none. There was a multi- faith room available on site at QMC. A leaflet on the chaplaincy service was available on the Trust's website and throughout the hospital.

The Trust had an up-to-date patient information policy to support staff producing and using good quality information that adhered to the principles of best practice in the production of patient information set out by NHS England’s Information Standard. 

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The Trust had a Management of Complaints and Feedback Policy that gave staff clear guidance on what steps to take when a patient raised a concern. Staff understood this policy and knew how to escalate complaints when needed. Patient information leaflets explained the complaints process and how to make a complaint, and these leaflets were available on the ward or on the service’s website for patients to use.

Managers investigated complaints and identified common themes. They shared the findings with staff, and the learning was used to improve the service. When we reviewed complaint response letters, they showed the lessons that had been learned. For example, recognising the patient perspective, improving documentation and organising regular refresher training courses to ensure alignment with best practices.

All formal complaints were received through the Patient Advice and Liaison Service (PALS), and each complaint was formally acknowledged within 3 days, aligned to NHSE complaint standards.

Staff informed patients and relatives of PALS on admission and told us they would seek to resolve complaints locally where possible. Guidance regarding complaints and how to provide feedback was available on the wards we visited. 

Data provided by the service showed there had been 195 complaints raised in the 12 months prior to our inspection, and 43 were ongoing. At the time of our inspection all complaints remained within expected timeframe. Staff confirmed they received feedback on the outcome of investigation of complaints and acted on the findings.

On the acute stroke unit there was a ‘Bored board’ developed by staff in response to previous patients commenting they was little to do as they recovered. Activities, puzzles and reading were available for patients as a result of the bored board, which patients could post their ideas on. 

The service invited pets as therapy (PAT) dogs. The dogs for patients are professionally trained therapy dogs that visit the ward and interact with patients to reduce anxiety, alleviate feelings of loneliness, and promote emotional and physical healing.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed 

The service had their equality and diversity policy on their web site, along with its values and the equality, inclusion and diversion strategy. 

The hospital had wheelchairs and lifts available to access all areas of the hospital. Staff were available at the entrance of the hospital to support and direct people to the correct areas. Wards were clearly sign posted and had swipe card access.

Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work.  

There were no exclusions preventing patients from accessing medical services. There were, however, some specific criteria to manage admissions safely, to get patients to the most effective area to receive the care they needed and to ensure the patient received the right care and treatment. For example, the geriatric assessment unit only accepted patients who were 75 years old and over.

The service was accessible to patients with disabilities. The service had access to bariatric beds for patients weighing up to 150 kilograms.

All areas in the hospital were wheelchair accessible, and the wards were dementia friendly. For example. On all the wards we inspected, we found there was clear pattern free flooring, which was all one colour, and not highly polished.  Appropriate flooring supports stability, encourages safe walking and reduces falls. Poor flooring can cause injury, anxiety, loss of independence and increased reliance on staff. 

On the stroke unit there was a dementia friendly clock. The clock had an easy-to-read display with simplified numbers.

The service was inclusive and took account of patients’ individual needs and preferences and conversations with staff evidenced their understanding of person-centred care. 

We observed positive interactions between all members of staff regardless of seniority.

Staff in the discharge lounge told us they followed a clear admission and discharge criteria, and the discharge lounge supported safe and timely transfers, particularly for patients awaiting transport or community placements.

The service worked with local authorities within their geographical area to facilitate discharge from hospital. They monitored total discharges across their services, and reasons for delays in discharging patients. Frequent reasons for delay were identified as patients awaiting new or increased care packages, social work assessments, the housing environment and homelessness.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Systems, processes and policies were in place to ensure that care and treatment decisions were made without discrimination, including in relation to protected characteristics under the Equality Act, which ensured patients were treated in line with the legislative requirements.

Staff completed equality, diversity training and human rights training as part of their mandatory requirements.

Patients told us their needs and preferences were assessed and understood by staff. 

Staff feel confident about understanding people's equality-related needs and feel able to meet them.

The service had collaborated with a city hair salon to provide wigs for cancer patients who were from an ethnic minority background. The project was developed after patients advised the BAME Shared Governance group about the indignity of leaving hospital in a blue wig after chemotherapy. Others reported the impact on their mental health and self-esteem after being given pink or green wigs.

Their experiences echoed the findings of the Annual National Cancer Patient Experience survey, which found that patients from a minority ethnic background were not being offered wigs to match their hair or skin colour.

At the time of our inspection, data showed that for medical staff working on SDEC a 100% compliance for training in Equality, Diversity Human rights with nursing staff showing 93%, advanced nurse practitioners at 94% and clinical support works at 89% against the service target of 90%.

Staff actively encouraged people using the service to give feedback and they recognised the value in getting both positive and negative views. Information was available to direct patients and families or carers to share their experiences.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. 

Patients were supported to plan for important life changes, so they had enough time to make informed decisions about their future, they were supported to make decisions about their care and treatment and their future following discharge.

Staff ensured all relevant healthcare professionals and other relevant bodies were  involved in planning the care and treatment of people with complex needs. This was mainly done in multi-disciplinary meetings and discharge planning meetings.

Staff provided patients with information and medicines if needed including advice about what to do in the event of an emergency or concern about recovery at the time of discharge.

Staff supported patients to make decisions about their care and treatment and their future within the restrictions of the service. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff considered patient needs, wishes and feelings as part of the care planning process. They used the “This is me” booklet and care plans to record any preference or individual choices. 

Staff used the SWAN (Sign, words, actions, needs) model to provide support and resources for patients and their relatives at the end of life. This enabled ward teams to offer personalised care in the last days of life.