Queen's Medical Centre

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that the service respected people’s privacy and dignity and treated people with compassion. We checked staff responded to people’s needs in the moment to minimise any discomfort or distress. We checked that the service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

At our last inspection we did not inspect caring, this key question was previously rated good. At this assessment the rating went down and is now rated as requires improvement.

This meant that the service did not always respect people’s privacy and dignity, this was difficult due to the care environment. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. The service did not always care about and promote the wellbeing of their staff.

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 2. The evidence showed some shortfalls. This meant that the service did not always respect people’s privacy and dignity, this was difficult due to the care environment and the provision of care in corridor areas. Staff mostly treat people with kindness, empathy and compassion. Patient feedback was mixed in the adult emergency department.

Staff treated people with kindness and compassion. Patients mostly told us they felt reassured by staff and were confident in their care they received. However, some patients told us they felt that it could be difficult to access a staff member at times, either because of their location within the department or limited staff availability.  

Patient experience survey results for Adult ED from May 2025 to April 2026 demonstrated a mixed picture. During this period, 47.2% of patients reported a positive experience of care within the department, while 46.6% reported a negative experience. A total of 220 patients responded to the survey over the 12-month period.

In the paediatric emergency department, staff treated children and their families with kindness and compassion. Patient experience survey results indicated a 92% positive response, with staff commonly referred to as, ‘friendly, kind and helpful’.

Staff at all levels sought to meet patients’ individual needs and demonstrated a caring and compassionate approach to people with mental health needs, patients living with dementia, and those with complex needs. However, the emergency department environment was not always the best place for providing the most appropriate care for these patient groups. The electronic and paper patient record systems enabled staff to identify and understand patients’ individual needs, preferences and cultural requirements, supporting the delivery of patient centred care. 

Staff also had access to interpretation services when required to enable effective communication with patients whose first language was not English or who had other communication needs. 

Staff worked hard to protect patient’s privacy and dignity; however, staffing pressures and the environment in which patients were cared for meant that privacy and dignity was not always preserved. We observed staff supporting patients to access toilet facilities, and privacy curtains were generally used for patients being cared for in cubicles or bays. However, patients being treated in corridor areas or in the central section of the majors area had limited privacy. There was also a lack of toilet facilities, which was exacerbated by the department operating beyond full capacity, resulting in patients often needing to wait. Staff shortages further affected the timeliness with which patients could be assisted to the toilet when required.  

During our first inspection visit, we observed multiple patients receiving care in corridor areas who had to urinate into disposable urinal bottles in their beds and patients were also, at times, left exposed. These patients had no effective means of alerting staff when they needed assistance. Although concerns regarding privacy and dignity remained, we noted improvements during our second visit, as dedicated staff had been allocated to support patients in these areas. 

There was a culture of collaboration and mutual respect between internal and external colleagues. We observed staff mostly interacting positively with ambulance staff during handovers and throughout the department. However, there were occasions when relationships between emergency department staff and ambulance staff appeared strained, particularly during periods of operational pressure. 

The judgement for Treating people as individuals is based on the latest evidence we assessed for the Caring key question.

The judgement for Independence, choice and control is based on the latest evidence we assessed for the Caring key question.

We scored the service as 2. The evidence showed some shortfalls. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

The Emergency Departments had processes and tools for assessing patients when they first presented to the department. Staff used a national triage tool to triage patients. Most patients were streamed (assessed) by the nurse at reception or in triage and sent to the appropriate services including the Urgent Treatment Centre (UTC), and Same Day Emergency Care (SDEC). Patients who required the services of the emergency department were triaged and treated. In Adult ED, patients who arrived by ambulance were seen in the primary assessment area, if space was available. During our first visit, patients who arrived by ambulance when the primary assessment area was full were not assessed in line with best practice.

Staff did not always respond to patient’s needs in the moment or act to minimise any discomfort, concern or distress. We observed a patient not being listened to or provided with pain relief in a timely way after telling staff repeatedly that they were in discomfort and pain. We observed a patient with an unassessed head injury be unnecessarily transferred back onto an ambulance as they were not ready to be seen in primary assessment, rather than wait in the corridor with an ambulance crew. During out first site visit we observed it was difficult to respond to patients need when they were in corridors and they were often trying to get the attention of passing staff. This had improved on our second visit with better staffing in this area.

The service had a clear system to identify people with mental health needs and align to the appropriate pathway. During triage, mental health patients were identified, and the mental health team were informed. Psychiatric liaison members of staff who provide a service at NUH from another provider, then completed assessments. Care for mental health patients was appropriate, however it was difficult to manage them in the environment due to the busyness of the environment.

ED had access to the Children’s Adolescence Mental Health service team (CAMHs) for an assessment and treatment of children and young people. The Paediatric ED had mental health specific rooms in which children and young people could stay whilst they awaited further treatment or discharge.

There was clear information at the ED front door that stated patients would be treated according to the severity of their condition. Patients awaiting further assessment or testing were seen as soon as possible. 

There were mechanisms to address patient’s comfort needs. Staff conducted comfort rounding in Adult ED, to ensure that every patient was offered food and drink throughout their stay which met their needs. Patients’ nutritional preferences, including cultural and religious needs, were identified during the comfort rounding. Patients were offered sandwiches throughout the day, and if they were in the department for over 24 hours, they would be offered hot food, which would be a jacket potato. In Paediatric ED, a range of food options is available to support patient's nutritional needs.

There was clear signage in the waiting room for patients to raise a complaint. Staff were aware of the complaints process and could provide examples of patient complaints. 

We scored the service as 2. The evidence showed some shortfalls. The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centered care.

There were mechanisms in place to collect staff feedback and respond to concerns with the aim of delivering high quality, person-centred care. However, staff told us they did not always feel listened to by leaders and reported concerns raised directly with management and leadership teams which were not consistently acted upon. Some staff told us they did not always feel comfortable raising concerns.

Findings from the most recent staff survey for Adult ED also demonstrated these views. Only 46% of respondents agreed with the statement ‘I feel safe to speak up about anything that concerns me in this organisation,’ while 20% agreed with the statement ‘If I spoke up about something that concerned me, I am confident my organisation would address my concern.’ This was not reflected within the paediatric department, where survey results were considerably more positive, with 100% of staff reporting they felt safe to raise concerns. 

Staff mostly told us they felt they were unable to influence change or contribute to decision-making in the department. Many told us they had repeatedly raised concerns and sought to drive improvements but felt their views were not listened to or acted upon by trust leaders. 

Despite these concerns, there was a positive organisational culture within the department that enabled a sense of belonging among staff. Leaders within the department and at trust level told us staff wellbeing was important to them. They recognised that staff were often under pressure within a very busy department and worked in very difficult circumstances. Several staff spoke positively about their colleagues and described a supportive team culture highlighting that staff worked together across all grades to support one another when the department was very busy.                                                                                                             

The service supported staff effectively when they joined the organisation and promoted ongoing professional development. Newly qualified nurses received preceptorship to support their transition into practice. Dedicated training days were also provided and focused on areas relevant to staff roles and service needs. 

Leaders had taken steps to recognise and support staff wellbeing, including providing the necessary resources and facilities for safe working, such as breaks and rest areas. However, staff told us it was sometimes difficult to take all their breaks due to staffing pressures within the department. 

Staff told us they felt valued by leaders within the department, although they did not always feel valued by the wider trust. Support mechanisms were in place to assist staff following particularly challenging or traumatic incidents, including immediate “hot” debriefs to provide an opportunity for reflection and support. 

The service demonstrated a commitment to the wellbeing of staff. The Trust had a comprehensive wellbeing programme, including access to a range of support services and staff groups, that was utilised by the service. Staff told us that senior leaders within the department regularly visited clinical areas to check on staff welfare, provide support and enable concerns to be raised. However, some staff felt this level of visibility and engagement was not consistently demonstrated by the Trust wide leadership.