Queen's Medical Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that the service had a clear shared vision, strategy and culture. We checked the service had inclusive leaders at all levels who understood the context in which they delivered care. We checked staff felt they could speak up and that their voice would be heard and concerns addressed. We checked the service had clear responsibilities, roles, systems of accountability and good governance. We checked the service understood their duty to collaborate and work in partnership, so services work for people. We checked that the service focused on continuous learning, innovation and improvement across the organisation and local system.

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 have a clear shared vision, strategy and culture. Staff did not always feel they could speak up and that their voice would be heard and concerns addressed. The service did not always have clear responsibilities, roles, systems of accountability or good governance. However, the service understood their duty to collaborate and work in partnership, so services work for people. Service leaders understood the context in which the service delivered care, treatment and support. 

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. The service did not always have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people.

Staff told us they were encouraged to raise concerns and speak up about issues affecting the service. However, many felt their concerns were not always listened to or acted upon. Staff told us that learning was shared through a variety of channels, including emails and a secure messaging application. We saw examples of learning being shared through most of these channels, and also as part of emergency department specialty meeting minutes.

Leaders were committed to delivering high-quality care and worked to motivate staff to succeed. However, it was not always possible for them to make the changes and improvements they wanted within the department. Staff satisfaction levels were generally low, although many staff told us they would feel comfortable having a family member treated within the department. This contrasted with the most recent staff survey data, in which 36% of respondents agreed with the statement ‘If a friend or relative needed treatment I would be happy with the standard of care provided by this organisation.’

Staff were helpful, welcoming and professional in their communication with each other, patients and relatives. Leaders described a positive and compassionate culture within the department where staff supported each other and worked collaboratively to deliver patient care. Throughout our inspection, we observed this culture in practice, with positive working relationships evident between staff and departmental leaders, fostering trust, openness and mutual understanding. However, staff told us they did not feel that leaders outside of the department had sufficient understanding of the challenges and pressures associated with working in the emergency department.

Departmental leadership remained focused on resolving the ongoing challenges of corridor care and emergency department overcrowding. Leaders told us they were working closely with other hospital departments and external organisations to identify and make improvements. Both the senior leadership team and wider emergency department staff understood the challenges of their population and were aligned to working with partners in the wider health and care system. There was evidence of a strong commitment to system-wide collaboration and leadership. For example, working with system partners on alternative pathways to avoid ED attendances. 

We scored the service as 3. The evidence showed a good standard. The service had leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The service had inclusive leaders at all levels who understood the environment and challenges in which care was delivered. Leaders were aware of the operational pressures facing the department and had engaged with national improvement to help address and manage these issues. We found that staff and leaders shared a common understanding of the key challenges affecting the department, including overcrowding and patient flow. 

There was compassionate, inclusive and effective leadership at all levels within the department. Leaders demonstrated the experience, capacity and capability required to support the delivery of high-quality and sustainable care. Staff told us they felt able to approach members of the emergency department leadership team for both professional guidance and wellbeing support.

Processes were in place to support staff wellbeing and promote a positive working environment. However, staff told us that these measures did not fully mitigate the impact of working in a consistently busy and high-pressure department. Staff told us they generally felt well supported by their line managers, who regularly visited different clinical areas to check on staff welfare, offer support and identify any concerns.  

There were clear reporting structures in place, and key leadership positions were supported by deputy or associate roles to provide continuity. Staff mostly understood their immediate reporting structures and leaders understood their key roles and responsibilities. Most staff told us the departmental leads and senior managers were approachable, visible and provided them with good support. However, some staff told us they received inconsistent messages from leaders outside of the department.

Leaders demonstrated effective multidisciplinary team working both within the service and with external stakeholders, including local ambulance services and the mental health trust. They described positive working relationships with these organisations and told us there was regular engagement to review performance, address concerns and identify opportunities for service improvements. 

Staff had access to development opportunities, including pathways into leadership roles for those who wished to progress their career. There was inclusive recruitment and succession planning for the future within the department. The trust had effective recruitment processes and ongoing checks to ensure all staff met the legal requirements to work in the trust.

We scored the service as 2. The evidence showed some shortfalls. Staff did not always feel they could speak up and that their voice would be heard and concerns addressed.

Staff and leaders within the department promoted a culture of empowerment and encouraged staff to contribute to service improvement. Staff told us they could speak up and raise concerns without fear of negative consequences. Leaders within the department encouraged staff to raise concerns. While staff generally felt comfortable to raise any concerns with departmental leaders, many were not confident that their concerns would result in meaningful action or sustained improvements.  

Staff told us that trust leaders listened to the issues they raised but felt that concerns were not addressed effectively. Findings from the most recent staff survey for Adult ED reflected these views.  Only 46.2% of respondents agreed with the statement ‘I feel safe to speak up about anything that concerns me in this organisation,’ while 20.3% agreed with the statement, ‘If I spoke up about something that concerned me, I am confident my organisation would address my concern.’ This contrasted with the experience of staff within the paediatric department, where survey results were more positive, with 100% of staff reporting that they felt safe to raise concerns.

The service had established Freedom to Speak up arrangements. Information about the Freedom to Speak Up Guardian and details of how to contact them was available to staff through the trust’s intranet. While not all staff knew the name of the trust’s Freedom to Speak Up Guardian, they knew how to raise a concern and access the appropriate reporting channels.

Patients were aware of how to make a complaint or raise concerns. The service displayed information about how to raise a complaint. Managers investigated complaints, identified themes and shared feedback with staff. Staff understood the policy on complaints; however, it was difficult to identify any learning that had happened as a result.

When things went wrong, patients and those close to them received a timely and sincere apology and were informed of actions being taken to reduce the risk of similar incidents occurring in the future. Staff were aware of their responsibilities under the duty of candour regulations. 

The judgement for Workforce equality, diversity and inclusion is based on the latest evidence we assessed for the Well-led key question.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance arrangements were subject to regular review and there were systems and processes in place to support effective oversight and accountability. A structured and collaborative approach was taken to working with partner organisations to improve outcomes for patients. The service used its governance framework to identify learning opportunities, drive improvement, and support innovation. 

Staff at all levels told us that change could often be introduced quickly within the department when required. However, some staff told us that it could be challenging to use the formal governance processes to progress and implement wider service improvements that required support from the wider organisation, which could limit the pace of change.

Structures, processes and systems of accountability, including those relating to governance, partnerships, joint working arrangements, and shared services, were clearly set out and understood across the service. Staff were clear about their roles, accountabilities and reporting arrangements. Audits were undertaken to support quality improvement. However, at the time of our inspection, the trust had not submitted data to the Royal College of Emergency Medicine (RCEM) three Quality Improvement Programmes (QIPs) in 2025/26. This limited its ability to benchmark performance and identify learning though these national improvement initiatives. 

The service had policies and procedures in place to support escalation and the delivery of care. However, during our first inspection visit, there was a no clearly defined process for the management and oversight of patients receiving care in the corridor areas.  

Leaders maintained oversight of risks within the emergency department and tracked risks through departmental risk registers and governance meetings. The service had separate risk registers available for adults and paediatric services, enabling risks to be monitored and managed appropriately. Risks were assessed and graded according to their level of impact, with mitigating actions identified and recorded to support risk reduction and ongoing monitoring. 

Regular emergency department specialty governance meetings were held, providing oversight of key areas including performance, risk, audit, and workforce matters. Meeting minutes demonstrated that concerns were identified, and actions were agreed to support learning and improvement. While changes had been implemented in response to identified issues, staff told us that improvements were not always made as quickly as they believed was necessary. However, the service had taken action to improve the care of patients being treated in corridor areas following our first inspection visit. 

Patient information was maintained within both paper and electronic record systems. During our inspection, we observed that computers across all areas of the department were not always locked or logged out when left unattended. In some cases, devices remained logged in within rooms that were not under direct staff observation. This created a risk that unauthorised individuals could access confidential patient information and records. 

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work for people. They share information and learning with partners and collaborate for improvement.

Leaders told us they mostly felt listened to and supported by key stakeholders and external partners and that their views were considered when developing services. They described positive working relationships with clinical partners and other organisations across the local health system.  For example, the service worked collaboratively with a provider who streamed and triaged patients directly from the walk-in area to the onsite urgent treatment centre (UTC) which was operated by a primary care provider.

The trust worked in partnership with the local health and care system. Directorate leaders engaged with external stakeholders, including the local ambulance service, GP’s and the Integrated Care Board (ICB). These partnerships supported discussions on system-wide initiatives, service improvements and responses to emerging issues, helping to ensure pathways and schemes were coordinated across organisations. 

Staff told us that relationships with external partners were generally positive and collaborative, enabling a shared understanding of challenges facing the local health and care system and the needs of the population it served. Staff also reported positive working relationships with the local police force, mental health providers and the ambulance service, which supported effective partnership working and the delivery of patient care. 

The judgement for Learning, improvement and innovation is based on the latest evidence we assessed for the Well-led key question.