Queen's Medical Centre

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 the service planned and delivered people’s care and treatment with them. We looked to see if staff worked well across teams and services to support people. We checked the service monitored people’s care and treatment to continuously improve it. We checked the service told people about their rights around consent.

At our last inspection we did not inspect effective, this key question was previously rated good. At this assessment the rating remained the same and was good. 

This meant that the service planned and delivered people’s care and treatment with them. Staff worked well across teams and services to support people. The service told people about their rights around consent. However, the service did not always routinely monitor people’s care and treatment to continuously improve it.

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

The judgement for Assessing needs is based on the latest evidence we assessed for the Effective key question.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. 

The Trust’s intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected current practice. It had guidance for staff around collaboration with multi-agency teams to ensure the right people delivered evidence-based care and treatment. There were numerous clinical pathways which were known to staff. 

The service planned and delivered care in partnership with patients, taking account of their individual needs, preferences and what was important to them. Care was provided in line with relevant legislation and current evidence-based practice, and recognised standards. For example, on arrival to the department, patients were asked appropriate questions about their condition to support assessment, decision making and the planning of their care. 

At the time of our inspection, the Trust had not submitted data for the three Royal College of Emergency Medicine (RCEM) Quality Improvement Programmes (QIPs) for 2025/26. The Trust told us that progress had been delayed due to issues with project management through the RCEM portal, which prevented the audits from being completed. Due to this, the audits were listed as partially completed because access to the portal had been restricted, preventing the specialty team from progressing the work. This was recognised by the specialty and escalated through the appropriate governance channels via the Care Group to the organisation’s Clinical Effectiveness Governance Group. The Trust stated that the problem had subsequently been resolved with support from the Medical Directors Office and anticipated developing action plans from the audit findings by the end of the year.

Systems were in place to ensure staff were up to date with evidence-based guidance, best practice standards, and legislation. Clinical records reviewed during our inspection demonstrated that care was provided in line with current guidance. Triage assessments included questions tailored to patients’ presenting conditions and individual needs.

Patients told us they had been offered food and drink during their stay, and we observed staff providing refreshments. Patients who spent more than 24 hours in the emergency department were offered hot food, typically, a baked potato. However, the range of hot food available was limited due to ongoing catering challenges, which had been escalated by the service to the wider organisation. People accompanying and visiting patients were able to bring food into the department for patients if required.

The service worked collaboratively with other departments and organisations to ensure patients who did not require emergency care were directed to the most appropriate service. Within the emergency department, streaming and triage arrangements were in place to enable suitable patients to be referred and transferred to the on-site Urgent Treatment Centre or the Same Day Emergency Care (SDEC) unit.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to assess, plan, and deliver care, treatment, and support in line with patient’s individual needs. The service used an electronic patient record system, which enabled staff to access the relevant clinical information and documentation required to provide safe and effective care.

In Adults ED, handover process was primarily used to communicate staff allocations and responsibilities for the shift. However, there was limited discussion of patient safety issues, learning from incidents, or current risks affecting the department. In the Children's ED, handover is also used to discuss 3 focuses of the month to share learning from incident themes. There is a nursing handover, a medical and nursing huddle throughout the day as new clinicians start their shifts which includes any current issues including staffing.

The service worked collaboratively across teams and services to support patients’ care and treatment. Leaders told us that staff from across the organisation responded positively when additional support was requested to support the emergency department (ED). During periods of escalation, staff from ward areas across the organisation assisted in caring for patients in corridor areas. 

Care was coordinated effectively, with everyone working together to meet patients’ needs. During our inspection, we observed staff interacting with patients in a kind and compassionate manner. Information relating to patient care, advocacy services, support for carers, charities, mental health resources and patient feedback was clearly displayed throughout the department. 

Staff worked closely with external partners involved in patients’ care to promote continuity of treatment and support. This included collaboration with GPs, ambulances services, and other healthcare providers where appropriate. Staff also reported positive engagement with safeguarding partners, which helped to support the identification and management of safeguarding concerns.  

The judgement for Supporting people to live healthier lives is based on the latest evidence we assessed for the Effective key question.

We scored the service as 2. 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. 

Treatment plans were evidence based and were monitored to assess patient outcomes. Staff used recognised assessment tools to support the early identification of and response to clinical deterioration and ensure timely intervention. Patient care was reviewed and updated regularly, and appropriate referral pathways were in place to ensure patient needs were addressed effectively. However, there were significant delays in admitting patients to inpatient wards following decisions to admit, largely due to the availability of beds across the wider organisation. During our first inspection visit, there were also delays in triaging patients when the emergency departments were operating beyond full capacity. This resulted in some patients experiencing prolonged waits before receiving a full assessment, treatment plan, and access to appropriate referral pathways.

Many patients told us they were not sure how long they would have to wait to be seen although staff made efforts to keep them up to date. Information displayed in the waiting area included estimated waiting times, helping to provide patients with an indication of when they could expect to be assessed. 

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Patients were supported to understand their rights in relation to consent for care and treatment. Information about care and treatment was provided in a way that patients could understand, with appropriate support and sufficient time to make informed decisions. Staff had access to the trust’s consent policy and understood the relevant consent and decision-making requirements of legislation and guidance relating to consent and decision making, including the Mental Health Act (1983), Mental Capacity Act (2005) (MCA), Deprivation of Liberty Safeguards, and the Children Acts (1989 and 2004). Staff knew who to contact for advice when required. 

Staff had access to support from the mental health team, that is provided at NUH by another provider, to assist both patients and emergency department staff. While staff told us the team was helpful and supportive, they told us that responses were not always timely, particularly during periods of high demand. There was no mental health staff employed within the emergency department. Staff told us that the mental health team aimed to see patients within one hour, although this target was not always achieved. The current system used by the trust does not capture the response time of external mental health clinicians.

During our inspection, we observed staff seeking and obtaining consent from patients for their care and treatment in line with legislation and best practice guidance. Staff received training on the application of the Mental Capacity Act (2005), including assessing a patient’s capacity to consent to treatment. However, data provided by the service following our inspection showed average staff compliance with MCA training was 68%, which was below the expected compliance target of 85%.

Where patients did not have capacity to make decisions about their care, staff made decisions in their best interests and documented the rationale for those decisions.