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

We looked for evidence that the service had a proactive and positive culture of safety, based on openness and honesty. We checked the service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. We checked the service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. We checked whether the service worked well with people to understand and manage risks. We checked whether the service detected and controlled potential risks in the care environment. We checked if the service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. We checked whether the service assessed or managed the risk of infection. We checked if the service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

At our last assessment we rated this key question requires improvement. At this assessment the rating has stayed the same.

This meant the service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe. The service did not always detect and control potential risks in the care environment. The service did not always assess or manage the risk of infection. The service did not always make sure there were enough qualified, skilled and experienced staff. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. However, the service had a proactive and positive culture of safety, based on openness and honesty. The service worked with people and healthcare partners to establish and maintain safe systems of care. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

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. 

Staff and leaders, we spoke with were aware of NHS England best practice guidance: Learn from Patient Safety Events (LFPSE). They told us they were encouraged and supported to raise concerns, and felt confident they would not be blamed, or treated negatively if they did so. Monitoring of overdue incidents was done as part of the emergency department's (ED) speciality governance meetings, and themes were also discussed as part of this meeting.

Learning from incidents was highlighted in the monthly Adult ED specialty governance meeting. This included the use of a private WhatsApp group for Adult ED staff and emails, however, there was an opportunity to discuss learning during daily handovers, but this was not used. In Paediatric ED, learning from incidents is shared at handover through the focuses if the month, emails to staff as well as through the Children's Hospital governance meeting (QRS). Leaders monitored staff wellbeing after incidents and worked collaboratively with educators to identify learning needs and implement training in response to incidents.

Staff were aware of the duty of candour and the need to apologise when things went wrong. Staff enacted this at a patient level when they were aware of a complaint or incident. The service used the learning from complaints and concerns as an opportunity for improvement. Senior members of staff and the clinical governance team within the department were involved in reviewing complaints and incidents. Monitoring of duty of candour compliance, including any overdue cases, was undertaken through of the ED specialty governance meeting.

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.

The department worked with internal colleagues and external partners to maintain patient safety wherever possible.

Continuity of care was maintained by effective handover of patients and communicating their individual needs. All patients arriving at both the Adult and Paediatric Emergency Department on foot were required to register at the reception desk for an initial triage assessment. Following this, they were directed to the most appropriate pathway. Depending on clinical need, patients could be taken directly to the resuscitation area, prioritised for initial assessment, or streamed to the onsite co-located Urgent Treatment Centre that provides primary care, which is run by a different provider.

Adult ED Receptionist staff explained the streaming and triage process to patients on arrival, who was also supported by a triage nurse based within the reception area. Where required, initial observations were undertaken in the waiting area whilst patients waited to be assessed by a clinician. The children’s Emergency Department entrance was separate, with patients following a similar triage process. The Adult ED waiting area was monitored by the nursing team and reception-based healthcare staff, who undertook patient observations as necessary. Patients were called from the waiting area by clinicians and directed to the appropriate assessment and treatment area.

Established care pathways were in place for patients requiring specific interventions, including trauma patients who needed immediate care and treatment. Communications processes generally supported effective handovers, helping to ensure patients received timely care on arrival. However, during our initial inspection visit, inspectors observed that some patients who were accommodated in corridors in Adult ED did not consistently receive an appropriate clinical handover when arriving to the department by ambulance. Staff reported good working relationships with other local hospitals and local ambulance services. 

The department had an established pathway for patients presenting with mental health needs. On arrival, patients received an initial assessment by the triage or reception nurse, which included mental health screening. Patients were managed within the department as required. They were then referred to the mental health team, that is provided at NUH by another provider, which directed them to the most appropriate service.

Trained security staff supported clinical staff when there was a risk of violence and aggression. We saw that they responded quickly but did not provide physical interventions unless requested by clinical staff. Both Adult and Children's ED, staff complete a mental health triage tool which was designed to improve safety, identify and assess  patients' mental health needs.

We scored the service as 3. The evidence showed a good standard. Both the Adult and Paediatric departments worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Both Emergency Departments shared concerns quickly and appropriately.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Patients we spoke with told us they felt safe in the department and that if they had any concerns or issues, they would feel comfortable to tell someone.

Staff we spoke with knew how to identify adults and children at risk of, or suffering, significant harm. Staff understood how to protect children, young people and their families from abuse and the service worked well with other agencies such as the police and local authority safeguarding teams to protect them. There was a process in place to identify children who left the department before being seen by a doctor. These patients were flagged to the social work liaison team to ensure any follow up actions were undertaken. 

Not all staff were up to date with training on how to recognise and report abuse. Staff had access to training up to level 2 for Safeguarding Adults and level 3 for Safeguarding Children. Data provided by the service following our inspection showed that compliance with safeguarding training in the Adult Emergency department with completion rate of 44% for Safeguarding Adults Level 2 and 36% for Safeguarding Children level 3.  For Children's ED submitted data showed training compliance rates of 86.9% for level 1, 89.1% for level 2, and 69.5% for level 3. When we requested this data, the Trust told us that there was a move to national content for the Think Family package, as required by NHS England. The Trust needed to manually award this to staff, and this was planned to be completed by the end of May 2026, which led to much lower levels of completion.

Staff had access to the Trust's safeguarding policies, which referenced appropriate legislation and best practice guidance. Safeguarding information was displayed throughout the department. Staff told us they were confident in raising safeguarding concerns and the process for referrals on the Trust’s electronic patient record system, which was easy to complete. Staff were able to tell us when they recently completed referrals. Staff told us who provided support and advice when needed. Staff knew where to find safeguarding information on the intranet and would approach the Trust safeguarding team if they required support.

The service shared concerns quickly and appropriately. Where applicable, doctors completed Mental Capacity Assessments (MCAs) for best interest’s decisions. Best interest decisions apply when an adult lacks the mental capacity to make a decision. Under the Mental Capacity Act (2005), any treatment must be necessary, non-discriminatory, and use the least restrictive option. Restrictions on freedom must be proportionate to prevent serious harm and avoid unnecessary confinement. The trust had delivered training courses on the Mental Capacity Act staff told us they found the training helpful. Staff considered patient’s capacity when assessing them. Staff recorded an assessment of capacity in one of the records we reviewed.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Both Emergency Departments had effective processes and tools for assessing patients when they first presented to the department and monitored patients for signs of deterioration when they are taken into the department. However, in Adult ED when patients arrived by ambulance and the primary assessment area was full, they received care in a corridor area. During our first inspection visit, we found these patients were not consistently triaged or monitored effectively. This meant they had not been prioritised based on the urgency of their healthcare needs. We escalated this to senior leaders in the department, the service and the wider organisation as a patient safety concern. When we returned to the department for a second visit, we found that action had been taken to strengthen the assessment and oversight of patients arriving by ambulance. As a result, the majority of patients accommodated in the corridor areas were awaiting admission to medical wards and had received an initial clinical assessment and management plan. This allowed assessment areas to be used for the timely triage and assessment of patients arriving by ambulance.  Staff told us these changes had improved patient flow within the department and the overall triage process. However, they remained concerned that when demand increased and the department reached capacity, the same challenges would re-emerge, resulting in unassessed patients being cared for in corridor areas and placing pressure on the department’s ability to maintain timely assessment and monitoring.

Patients told us they mostly felt safe and supported while receiving care in the emergency department (ED). They told us they felt able to raise concerns if their health was deteriorating and they were confident staff would respond to their concerns. However, some patients in the department told us that it was difficult to get a response from staff as they were very busy. Patients being cared for in corridor areas reported difficulties accessing staff, particularly during our first inspection visit, when some patients experienced lengthy periods without direct observation.

Patients we spoke with, mostly told us they experienced a timely triage process. Triage assessments were undertaken by appropriately trained nurses. Patients who were deemed well enough to wait for treatment in the waiting area were overseen by the reception-based nurse when on duty. Staff also carried out regular observations and monitoring of patients in the waiting room when clinically indicated. 

Leaders and staff were able to clearly describe the risk assessment processes used to keep patients safe. Security staff were trained in least restrictive approaches to restraint, and any use of restrictive intervention was only used as a last resort. When assistance was required, security staff responded promptly and worked under the direction of the clinical team. They helped the clinical team to manage challenging behaviours in a calm and proportionate manner which helped to maintain the safety of patients, visitors and staff.

We saw posters about Martha’s rule in the emergency department. Martha’s rule enables patients, families and carers to seek an urgent clinical review if they felt concerned that the clinical condition of an adult or child patient was actively deteriorating. 

Staff we spoke with were able to clearly describe the processes used to identify and manage patients at risk, including the assessment and documentation of mental capacity. They demonstrated a person-centred approach, involving patients in their clinical risk assessments and decisions about their care wherever possible.

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The equipment and facilities mostly supported the delivery of safe care. Although patients experienced long waits, waiting rooms and designated areas were mostly suitable. Patients mostly told us they were well looked after by staff. There was a separate department for children and their families, which was accessed through a separate entrance. There were toys to keep children occupied and helped patients and families to remain calm and reduce stress.

Computers were widely available throughout both emergency departments, which meant staff did not have to wait to access them. However, we observed several unlocked and unattended computers displaying confidential patient information on the inspection throughout all areas of the departments.

Staff, mostly, had access to all the equipment they needed and guidance or instructions for using it. Planned preventive maintenance and electrical appliance tests were completed and recorded centrally in the wider organisation. Most electrical equipment we checked had undergone electrical safety checks within the last 12 months; however, there were some instances where electrical equipment testing was out of date. The service's fire safety equipment and emergency systems such as call bells, were tested and maintained appropriately. Fire exits were not blocked; and evacuation routes were signposted.

The Adult Emergency Department included a resuscitation area with capacity for 9 patients. The Paediatric Emergency Department had its own resuscitation area to treat children, containing 2 bays and 11 major bays with the ability to have a further 2 resus patients in majors if necessary. In the Adult ED, Majors area, there was an open area which had 30 designated bays. However, we observed that up to 8 additional patients were at times receiving treatment outside of designated cubicles, including in spaces between bays and within central circulation areas. This increased congestion within the department and, in some instances, made it more difficult for staff to move around the area and maintain clear observation of patients, especially when patients were accompanied by relatives or carers. This also impacted on the privacy and dignity of the patients.

Equipment, facilities, and technology supported the delivery of safe care across the service. Standardised equipment was available in each treatment area, helping to reduce the risk of patient harm. By ensuring consistency of equipment, staff working across different areas were more familiar with the devices in use, which minimised the potential for errors. Staff providing care in corridor areas, also had access to equipment required to deliver safe and effective care.

Both Emergency Departments were split into defined areas to accommodate patients with differing clinical needs. Those requiring immediate treatment were taken directly to the resuscitation area. In cases of significant trauma or other critical conditions, patients were often pre-alerted, enabling staff to prepare to receive them. In the Adult Emergency Department, patients arriving by ambulance were initially directed to the primary assessment area.  Following initial assessment, patients could be managed within the secondary assessment area or the majors area, depending on the nature and severity of their condition. In cases of significant trauma or other critical conditions, patients were often pre-alerted, enabling staff to prepare to receive them. Following initial assessment, patients could be managed within the secondary assessment area or the majors area, depending on the nature and severity of their condition. 

Patients were treated in corridor areas when demand on the emergency department's exceeded capacity. In Adult ED during our first inspection visit, these spaces were mostly occupied by patients who had arrived by ambulance and were waiting for initial assessment, alongside some patients who were waiting for admission to an inpatient medical ward.

We raised concerns following this visit regarding the care of unassessed patients in corridor areas. During our second visit, we found that patients in corridor spaces had been assessed and were waiting transfer to a medical ward. However, when the department reached full capacity, including all 30 corridor spaces designed for assessed patients, unassessed patients could still be cared for in the corridor areas.

Both Adult Paediatric EDs had a dedicated room designed to support people with mental health needs; however, it was not used routinely by emergency department staff and was primarily used by staff from the mental health trust. In Adult ED, the room was located in a quieter area of the department, providing a more suitable environment for assessment and support. In Paediatric ED there were mental health specific rooms in which children and young people could stay whilst they awaited further treatment or discharge. Both areas contained minimal furniture and had no obvious ligature anchor points, helping to reduce potential risks to patient safety. Staff told us the emergency department environment was not well suited to meet the needs of patients with complex mental health needs.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. 

The service did not always have enough nursing staff to keep patients safe. Leaders regularly reviewed staffing levels and skill mix, making adjustments throughout the day. Staffing resources were redeployed as required, to meet the needs of the patients attending the different areas of the department; however, this often resulted in some areas within the department operating below planned staffing levels, particularly when staff were assigned to care for patients in the corridor areas. During our second inspection visit, we observed that staff were redeployed to the Emergency Department from ward areas to provide additional support in corridor areas. However, this resulted in ward areas across wider acute medical services were operating below planned staffing levels.

The service had made significant efforts to recruit substantive ED medical staff and had successfully increased the size of its workforce. Despite these improvements, increasing demand continued to place pressure on staffing capacity. The service faced ongoing issues with workload, rota gaps, the experience level of resident doctors, staff retention and sickness absence. At the time of our inspection, the adult ED had 10.1 whole time equivalent (WTE) medical staff vacancies. 

Across the Adult Emergency Department, excluding medical staff, there were 41.6 WTE vacancies across a range of roles. This included 13.9 WTE Emergency Department Assistants (EDA) vacancies, 8.9 WTE Clinical Support Workers (CSW) vacancies, 3.7 WTE Emergency Nurse Practitioners (ENP) vacancies, 3.3 Band 6 nursing vacancies and 1.3 WTE Band 7 nursing vacancies. These vacancies placed additional pressure on the existing workforce and contributed to challenges in maintaining safe staffing levels across all areas in the department.

In the Adult Emergency Department had an overall sickness rate of 5.1% which was in line with the NHS average of 5.1%. The department had a turnover rate of 6.4% across all staff groups, which was below the NHS average of 10%.

The paediatric ED was staffed in line with national guidance. Between March 2025 to March 2026 the turnover rate was 3.4%, and the sickness rate was below 5%, both of which were below the NHS average. There were no vacancies for medical staff.

The service had effective recruitment processes in place to ensure staff, including agency staff and volunteers, were suitably experienced, competent, and able to carry out their roles. All newly appointed staff received a comprehensive induction programme appropriate to their role and responsibilities. Newly qualified nurses were supported through a structured preceptorship programme designed to facilitate their professional development and transition into practice. Where required, the programme could be extended to provide additional support and ensure staff achieved the necessary competencies. 

During our inspection, the Adult Emergency Department was operating under significant pressure, caring for a higher number of patients than its intended capacity. Staff told us this was the situation most days within the Adult ED. Rising attendance levels had increased demands on the service, placing additional pressure on staff. Staff told us that responding to escalating demand while maintaining safe standards of care was challenging. However, staff spoke positively about the support they received from colleagues and the culture of mutual respect within the department. We observed effective and cohesive teamwork in the department despite the challenges they faced.

Staff received mandatory training relevant to their role; however not all staff had completed mandatory training they required. Overall compliance for all adult emergency department staff was 63%. Overall compliance for all children’s emergency department staff was 77%. The trust compliance target was 85%. Department leaders had plans in place to address shortfalls in mandatory training. Staff did not receive specific mental health mandatory training, despite being responsible for monitoring patients with mental health needs. However, Adult ED staff, did receive some training relating to mental health patients during their inductions and local education days to support staff working in the department and caring for patients with mental health needs. 

The service had arrangements in place for staff appraisals, although these were not always completed in a timely manner. Adult ED, appraisal completion rates were low among nursing and midwifery staff (52%), additional clinical services staff (55%), and administrative and clerical staff (45%). In contrast, 94% of staff in the Paediatric Emergency Department had an up-to-date appraisal. Most medical staff were up- to-date with their appraisals, were supported by named supervisors, and resident doctors were provided with protected time for teaching.

We scored the service as 2. The evidence showed some shortfalls. The service did not always assess or manage the risk of infection. Staff were not always trained in infection prevention and control.

During our inspection, we observed staff adhering to the ‘bare arms below the elbows’ policy, in accordance with National Institute for Health and Care Excellence (NICE) guidance. Personal protective equipment (PPE) and handwashing facilities were readily available throughout the service. We observed staff washing their hands between patient interactions and using PPE when required. 

However, staff told us that access to handwashing facilities was more limited when caring for patients in corridor areas, which presented challenges in maintaining hand hygiene practices. Trust data indicated that hand hygiene audits scheduled for the adult emergency department in November 2025 and March 2026 had not been completed. Despite this, the service carried out regular audits of cleanliness, and performance in these audits was consistently good.  

The Trust had an infection prevention and control policy that staff were aware of, and which set out key information for staff to support safe infection prevention, prevention and control practice. However, compliance with mandatory infection prevention training was below the trust target of 85%. In the adult emergency department, training compliance with infection prevention training was 28%. In the paediatric emergency department 44% of nursing staff and 82% of advanced care practitioners (ACP) were up to date with their mandatory infection prevention training. The service had identified the staff that needed to complete this training and aimed to reach the required compliance by July 2026. 

Domestic staff were visibly present within the department. We observed both clinical staff and the cleaning staff diligently cleaning equipment and the environment. We saw ‘I am clean’ stickers placed on surfaces that had been cleaned. The floors were clean despite heavy foot traffic and the constant movement of people and equipment. The cleaning schedule set out by the service was followed. We saw disposable curtains labelled with the date they were last changed. Cleaning records were up to date and demonstrated all areas and equipment were cleaned regularly. Clinical waste was disposed of safely. 

Clinical areas were clean and had suitable furnishings, which were clean and well-maintained. Toys in the paediatric department were cleaned regularly and routinely checked to ensure they remained safe and in good condition.  

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

Medicines were stored securely in designated areas that were accessible only by authorised staff. Intravenous fluids were stored separately and colour coded to reduce the risk of staff selecting the wrong product or strength. However, temperature monitoring was not always completed on a daily basis to ensure medicines were being stored in the correct environmental conditions. We found that temperatures in some storage areas exceeded the recommended temperature limits. The Trust was aware of this ongoing issue, and a risk assessment was in place across the wider organisation.

Emergency resuscitation trolleys were checked daily, and full checks were completed weekly. Staff showed us how they used ‘mykitcheck’ to monitor stock levels and expiry dates, helping to ensure equipment was ready and safe to use. 

Pharmacy teams were well embedded within the emergency department and were available to provide specialist support for patients with complex medication needs. However, due to sustained capacity pressures across the emergency department, it was not possible for the pharmacy team to review every patient’s medication needs. The electronic prescribing medicines administration (EPMA) system included digital flags to alert staff of high-risk patients, such as those who were prescribed time critical medicines. However, these flags relied on the admitting doctor to manually record this information in the patient’s record, creating a risk that some patients could be overlooked for a pharmacy review. Data showed that only 25% of patients prescribed time critical medicines received a pharmacy review in the emergency department. This figure rose to 40% for patients prescribed high-risk time critical medicines, including treatments for conditions such as Parkinson’s Disease.

During our inspection, we identified a patient experiencing serious mental ill health distress who had not had their medicines reviewed. As a result, there was a significant delay before essential medicines required to manage their condition were prescribed. 

Some patients were receiving care in corridor areas rather than allocated bed spaces due to ongoing pressures and overcrowding within the emergency department. Given the layout of the emergency department, it was not always clear which staff members had overall responsibility for monitoring these patients. This increased the risk that patients could miss important medication reviews or the timely administration of essential medicines. 

Paediatric patients had access to a separate resuscitation area, which was well managed by staff. Although no children were being treated in the area at the time of our inspection, staff demonstrated a good understanding of their roles and responsibilities. Dedicated spaces were also available for the care of high-risk paediatric patients when required, together with separate areas for the safe preparation and administration of medicines.