Queen's Medical Centre

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

At our last inspection we rated this key question good. At this inspection the rating has remained the same. 

Leaders had created a positive and proactive culture of safety-based openness and honesty. Concerns about safety were fully investigated. The managers’ ensured lessons were learnt to identify and embed good practices. There was a very positive learning culture with staff managing incidents and safeguarding patients well. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. There were processes to ensure the service had enough staff with the right training, skills and qualifications to keep patients safe.

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

Leaders promoted a culture of safety and learning within the service.

Leaders and staff were fully aware of their responsibilities for reporting incidents, other safety events and accidents.

The service held mortality and morbidity meetings.  These are recurring, peer-reviewed medical meetings where healthcare professionals analyse adverse patient outcomes, complications, or unexpected deaths. The primary goal is to identify medical errors, modify clinical judgment, and drive systemic quality and patient safety improvements and consider if incidents contributed adversely towards patient safety.

Staff reported incidents through the Trust's electronic reporting system which all staff had access to. Staff reported incidents in line with the Trust's incident reporting policy.

Managers reviewed all incidents and escalated incidents in line with the Trust's incident management framework.

Managers shared learning from incidents, and this was used to identify and embed good practice.

There was a Trust policy in place that provided guidance on the requirements of duty of candour, and all staff we spoke with were knowledgeable about this.

Leaders had implemented the NHS Patient Safety Incident Framework (PSIRF) to develop effective systems and processes to respond, learn and improve from patient safety incidents. Incidents were methodically reviewed and were discussed at the clinical governance meetings, to review trends and lessons learnt. 

Staff understood the duty of candour. We reviewed incident reports that demonstrated the service was open and transparent when giving patients and families a full explanation when things went wrong. 

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There were processes and pathways for patients transferred between wards, and collaborative arrangements with other local services to ensure safety and continuity of care. Leaders and staff worked closely with healthcare partners where appropriate to ensure people were cared for at home. For example, patients who were over 75 could be referred and admitted to the Geriatric Assessment Unit (GAU), if they met the other specified criteria. This process supported patients receiving the right care, by the right team in the right place. Patients could be referred to the GAU by the urgent and emergency care team. This included patients who were cared for in the virtual ward, otherwise known as hospital at home and those who had been re-admitted to hospital. 

The GAU and the geriatric virtual ward team were connected within the community staff teams through by an electronic system. This meant they could access patient acuity and needs and organise a multidisciplinary team across the virtual ward to prevent readmission wherever possible.

The virtual ward team offered support and treatment to patients in their own homes, this was assessed and planned in advance of discharge. Patients spent a maximum of 14 days in the virtual wards, before being discharged into the care of their GP or other community-based services.

The Same Day Emergency Care (SDEC) service aimed to prevent hospital admissions by providing a timely assessment for patients referred from the emergency department, GP practices and community services. This enabled many patients to receive the care and treatment they needed on the same day and return home.

There was a set of criteria for staff to follow to ensure that patients were referred appropriately to the SDEC. The referral and admission processes ensured patient needs could be safely met. 

During our inspection we saw that some of the wards were boarding patients daily. A boarding patient is one who had been admitted onto a ward and was temporarily placed in a non-dedicated bed space, often a hallway or waiting area, due to bed capacity issues. Staff told us they only boarded patients that were safe to be boarded and reviewed them regularly to ensure that had not changed. We reviewed the patients being boarded during our inspection and found  they were all suitable to be boarded, had a risk assessment in place  and were able to reach a call bell. 

The service held staff safety huddles (the number varied dependent on the level of patients waiting to be admitted to hospital) and daily bed meetings to identify patients who were ready for discharge and discuss arrangements for their discharge.

For discharge, an integrated team collaborated with external agencies to resolve barriers and support patients and relatives through the process. This included focusing on more complex discharge planning to increase discharge opportunities and reduce patient length of stay to achieve better patient flow through the service. 

The discharge lounge accepted patients with planned discharges from all wards across the hospital. The electronic system showed how many bed spaces and sit up chairs were available to allow staff to transfer patients waiting for discharge. Discharge lounge staff arranged medicines to take home and transport for patients and liaised with the families and intended discharge location. At times of critical capacity and pressures on inpatient beds across the service, the discharge lounge would open overnight for patients who were planned to be discharged the following day. The Transfer of Care Unit (TOCU) had overnight beds for those patients whose discharge was the following day or delayed. There was access to bathroom facilities and meals to cater for patient needs whilst on the discharge lounge.

Staff in the service worked with other NHS services, local authorities, social services, and community teams to co-ordinate and facilitate patient discharges. However, we observed the service had significant levels of delayed discharges on the wards. At the time of our inspection where was an average of 15 delayed discharges per day. The total for April 2026 was 446. This was often due to patients awaiting suitable care home placements, new equipment required at home, or new or changes to care packages.

Data was received from the service. However, a site-level breakdown was not available, and the data could only be provided at service level.

We scored the service as 2. The evidence showed some shortfalls. The service did have processes and systems in place to safeguard patients. Staff did demonstrate experience, skill and knowledge in safeguarding patients.

Staff were experienced and qualified and had the right skills and knowledge in all aspects of safeguarding. However, training data we reviewed showed that safeguarding training compliance was below the Trust's compliance target of 85% safeguarding. 

Safeguarding training data for the service was received however, a site-level breakdown was not available, and the data could only be provided at service level.

Managers and staff told us that operational pressures had impacted training compliance; however, recovery plans were in place to improve compliance. Following our inspection, we spoke with a safeguarding lead at the Trust who told us that training compliance, especially among medical staff, was low. This had been recorded on the Trust's risk register, and actions had been identified to improve compliance. A recovery plan was in place to support the Trust in meeting national mandatory training compliance.

Staff were able to describe how to make a safeguarding referral and knew who to discuss safeguarding concerns with. Safeguarding concerns were discussed during safety huddles to inform staff of any safeguarding referrals made or patients likely at risk of harm.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act (2010).

The Trust had a safeguarding team and staff found them approachable and supportive.

Resident doctors, registered nurses and healthcare assistants were able to explain their understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and how to act in accordance with the MCA when providing care and treatment. All records we reviewed that required MCA documentation, had it and it was completed as required.

On the stroke unit, we looked at 2 mental capacity assessments and 2 Deprivation of Liberty applications and found that both had been completed correctly and in line with legislation

Staff understood the importance of supporting equality and diversity and provided care and treatment in accordance with the Equality Act (2010). Staff gave examples which demonstrated their understanding and showed how they had considered the needs of patients with protected characteristics.

At the time of our inspection, the Trust was undergoing a transition to a national content for the “Think Family” agenda. This agenda recognised and promoted the importance of a whole family approach as required by NHS England.

Staff were able to describe how to make a safeguarding referral and knew who to discuss safeguarding concerns with. Safeguarding concerns were discussed during safety huddles to inform staff of any safeguarding referrals made.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

All patients underwent a series patient specific risk assessments when admitted to a ward. These included assessments of falls risk, pressure ulcers risk, nutrition and hydration and venous thromboembolism (VTE).

Staff used the National Early Warning Score (NEWS) tool to monitor vital signs and to identify patients at risk of deterioration.  The devices would alert when a patient NEWS score was out of range. Any patient with high scores would be alerted to a senior member of staff to review.

Staff completed these assessments regularly. Sepsis pathways were used appropriately, and outreach and resuscitation teams were available to provide support when required.

Staff enabled patients to make advance decisions when appropriate. We saw examples in medical records we reviewed where patients and their families had discussed refusing life-sustaining treatment, such as resuscitation or antibiotics, even if it meant a shorter life. These decisions were documented in patient records.

Our reviews of patient records showed risk assessments for Venous Thromboembolism (VTE), pressure ulcers and falls were regularly completed by staff once patients had been admitted to a ward.

Staff could access out-of-hours medical support through a bleep system. 

Allied health professionals including occupational therapists, physiotherapist and dietitians who visited the patients were provided with written and verbal information to ensure that all staff involved in a patient’s care were fully informed of the patient’s condition, support and care needs.

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 those patients who had additional care needs, for example patients, living with dementia which contained key information to help plan and deliver care.

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 who had additional care needs, for example patients, living with dementia which contained key information to help plan and deliver care. 

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service followed national guidance and had appropriate facilities and equipment for patient care.

Staff had swipe or keypad access to clinical areas. Staff conducted daily safety checks on specialist equipment. All equipment we reviewed conformed to the relevant safety standards and had been serviced annually.

All the areas we inspected were visibly clean, tidy and well maintained, with appropriate equipment available to maintain safe levels of care. Medical equipment was appropriately tested and in date. Sterile equipment was stored off the floor on appropriate shelving.

There was a process to manage the safety, maintenance and repair of facilities, premises and equipment. 

Staff carried out daily safety checks of specialist equipment. For example, we inspected 9 resuscitation trollies and found all of them had been checked daily, and an up-to-date checklist confirmed all equipment was ready for use. The trollies were easily accessible and located within each individual ward or area. 

Oxygen was readily available and accessible throughout the wards we inspected.

Leaders made sure that equipment, facilities and technology supported the delivery of safe care and treatment. 

However, on wards C54 and C52, we were unable to read the service dates on the portable fire equipment, we were therefore unable to establish whether they were in date.  We escalated this to senior hospital staff who told us they were actively in the process of reviewing all portable fire equipment as part of a change in service provider and that the Nottingham fire and rescue service were aware of this. We met with senior hospital staff following our inspection, who advised that all the portable fire equipment had now been updated.

Sharps bins on all wards we inspected were set up correctly and were dated and signed.

Pressure relieving mattresses were available as needed. Throughout our inspection, we found that call bells were always in reach of patients.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Managers made sure there were enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. Staff worked together well to provide safe care that met people’s individual needs.

Managers informed us there were sufficient numbers of nursing staff on duty during the majority of shifts. At times the numbers of nursing staff were more than the planned number due to the increased acuity of patients, for example on the stroke unit and the acute stroke unit.

The service had enough staff to keep patients safe. All staff had a period of induction and had supervision before commencing work.  At the time of our inspection, the Medicine Care Group had a 5% vacancy rate, a 7% staff turnover rate and 6% sickness rate.

Data was received from the service. However, a site-level breakdown was not available, and the data could only be provided at service level.

The service used the electronic 'Safe Care' tool to manage staffing. Staff said they escalated any staffing issues to senior staff who worked to ensure they had sufficient safe nursing staff levels. Bank and agency staff were used to fill gaps in rotas when required.

Where bank and agency staff were used, the service used regular staff who were familiar with the wards and the service. Bank staff told us they received an induction to the area where they worked and support from ward staff. We reviewed the staffing rotas and confirmed that this was the case.

Staff held safety huddles twice a day at the start and end of each shift. However, when times were exceptionally busy, they would hold huddles up to 8 times a day.

New and agency staff completed an induction when joining the service. The skill mix on the wards we inspected, were suitable for the acuity of the patients at that time.

Managers reported that staffing levels were sufficient, while staff working in the discharge lounge described a different experience. Some staff told us they did not always feel there were enough staff on duty and that managers sometimes moved staff to other areas at short notice.  Staff on all the wards we inspected told us they were able to raise concerns about staffing levels and any support they required.

Managers assessed and changed staffing levels based on the 'Safe Care' tool. This meant managers could move staff between wards to meet the required ward staffing levels, based on patient acuity for the ward areas.

The ward teams had dedicated allied professionals such as physiotherapy and occupational therapist working on the wards. Other staff such as psychologist, specialist nurses and dietitians visited patients upon request. 

There were link champions such as tissue viability, infection prevention and control and dementia on the wards, who attended meetings, training and provided updates to staff on the wards.

Nursing staff had completed their Nursing and Midwifery Council re-validation checks and updates to maintain their registration and competencies.

Patients we spoke with said that staff were busy but there appeared to be enough staff. One patient on the stroke unit told us, “There are too many nurses, they keep asking me how I am and if I have had enough to eat or do I want to go to the bathroom”.

Staff we spoke with confirmed they had completed a meaningful appraisal in the last year. 

Any concerns would be raised directly with the staff at the time.

We scored the service as 3. The evidence showed a good standard. 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.

All areas we inspected, were visibly clean and free from clutter. Cleaning records were up-to-date and demonstrated that all areas were cleaned regularly. “I am clean” stickers were placed on equipment to indicate pieces of equipment that had been cleaned.

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

Hand sanitizer, liquid soap and disposable hand towels were available next to hand washing sinks and instructions on how to effectively decontaminate hands were displayed above the sinks.

All areas and wards we visited were visibly clean, tidy and had suitable furnishings, which were well-maintained. 

Environmental cleaning was undertaken by cleaning staff who had enough equipment and completed a daily checklist of cleaning activities. Staff on the wards carried out daily cleaning of the equipment and environment. Cleaning and alcohol wipes were available throughout the hospital.

Signs for infection prevention and control (IPC) were displayed on doors to alert people about IPC risks when entering certain areas or side rooms.

Data provided by the service at the time of our inspection showed a 94% compliance rate with hand hygiene audits.

Data was received from the service. However, a site-level breakdown was not available, and the data could only be provided at service level.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Medicines were stored securely within designated areas only accessible by authorised staff. Some cupboards on medical wards were dated and not fit for purpose. However, senior staff informed us these were in the process of being replaced. Fluids were kept separate from oral medicines and organised clearly so staff would be able to pick the correct item with less chance of error.

Emergency resuscitation trolleys were checked daily, and full checks were completed weekly. Staff showed us the system used for this - ‘Mykitcheck’ which showed when items were due to expire.

Controlled drugs, which required extra storage and documentation due to their potential for being abused or misused, were stored securely. Regular checks were completed on wards by two members of staff to ensure safe custody and documentation was carried out.

Pharmacy teams were well embedded on the wards we visited. We saw evidence on the stroke ward that medicines reconciliations, an accurate list of a patient’s current medicines taken on admission, were completed in a timely manner to ensure the correct medicines were prescribed when they were admitted onto the ward.

The service had a target of completing 40% of medicines reconciliations within 24 hours of admission. From February to April 2026 this rate was an average of 52%, which meant they were above target level. During the same time, 94% of patients had received a medicines reconciliation during their stay.  Electronic prescribing and medicines administration (EPMA) was in place within the wards and staff could navigate this well. The system had flags in place to show important patient information, e.g. if someone was prescribed an anti-coagulant or time critical medicines. We saw evidence that time critical medicines prescribed for Parkinsons’ disease were administered on time.

The electronic systems used also showed vital information from other areas of care, including ambulance handovers, blood results and any historical encounters the patient may have had within the service.

Staff showed us how they prioritised workload and the EPMA had a dashboard of medicines awaiting ordering. Systems were in place to streamline this process and the teams worked well together to ensure medicines arrived from pharmacy in a timely manner.

When visiting the Discharge Lounge, an area where patients await transport or medicines from pharmacy to take away (TTOs) we saw caring staff supporting patients.

The service had a target of dispensing discharge medicines within 2 hours. From February to April 2026 the average of discharges completed within this time was 82%, with an average turnaround time of 59 minutes.