Accident and Emergency Services at Queen's Hospital (2023 and 2024)

Although the main Emergency Department is provided by the hospital trust, Barking, Havering and Redbridge University Hospitals Trust (BHRUT), A&E services also include a Streaming and Urgent Treatment Centre(UTC) (provided by PELC - the Partnership of East London Co-operatives) and the Ambulance Reception (provided by the London Ambulance Service -LAS). Healthwatch visited all three centres.

The full report of the visit is now available - see below...

The physical environment of Accident & Emergency Services at Queen’s Hospital has continued to change – mainly positively – beyond recognition since before the Covid pandemic. Since 2023, the main Atrium of Queen’s Hospital has been greatly improved from what went before.

The Accident and Emergency services at Queen’s Hospital are the busiest in North East London and among the busiest in Greater London, and indeed England as a whole. Queen’s Hospital now serves a population far larger than that envisaged when it was planned some 25 years ago. This increased population is a primary cause of the pressures under which the hospital operates, although cultural changes – especially since the COVID disruption of 2020/21 – among the population also play their part.

That said, most staff working in A&E want to do the best they can for their patients and find the constraints that they face frustrating - one staff member told our team that “it’s hard to leave a shift and go home knowing you hadn’t given the care you wish you could. It’s even harder to return the next day, and nothing has changed!”.

These constraints have no specific cause: the growth in population could not have been foreseen; the lack of space is an inevitable consequence of having to deal with more and more people in accommodation that is hampered by its physical environment. There are mitigations in hand: the transfer to the recently opened St George’s Health and Wellbeing Centre in Hornchurch provides an opportunity for vacated accommodation to be repurposed for use either directly or indirectly by freeing up space for A&E services. Changes have been made during 2024 and further changes are planned for 2025, which we will observe with keen interest.

Although at times in the past, relationships between to BHRUT, PELC and the LAS might have been strained on occasion, that appears no longer to be the case (other than for the occasional, minor misunderstanding). This can only be beneficial for patients.

In terms of recommendations, the management of A&E services is clearly complex and there is little that we can recommend that has not been thought of already.

It is often, however, the little things that make a difference.

As the two case studies related in Appendix 3 of the report demonstrate, it is easy for individual patients to feel overlooked, and even to feel obliged to help others despite their own problems. People are often unwilling to complain – not for fear of retribution, but simply because they do not want to seem “ungrateful” or to “be a nuisance” – even though complaints are often the only way of drawing attention to problems that could be solved. That said and granted that the staff are very hardworking and focussed on dealing with patients’ clinical needs, much could be achieved by staff displaying a more empathetic and compassionate approach – the patients’ stories set out in Appendix 3 both provide examples of clinically-correct care that could have been improved by a little more thoughtfulness.

There are also suggestions that some facilities are left in an unhygienic condition – the pressures on turnaround for patients cannot excuse the continued use of soiled bedlinen, as experienced by the patient referred to in Case 1 of Appendix 3 nor the potential compromises of good standards of hygiene and infection control that could thereby arise.

Moreover, simple improvements to the environment in A&E would also be beneficial. Three examples illustrate this:

• The lighting in the corridors used to accommodate patients awaiting attention or transfer to wards is very bright (it was designed for a corridor environment, not a treatment area) – softer lighting would undoubtedly reduce patients’ stress
• Patients are called by name when it is their turn to be treated, despite the area where they are waiting being noisy and busy (and few staff having a “parade-ground voice” that can cut through); a screen-based calling system, or even the use of a Tannoy-type loudspeaker, would be easier for staff and patients but their use is resisted despite the fact that many other healthcare facilities make use of screens – for example, the new St George’s Centre has numerous patient call screens for exactly that purpose – and the risk that people who are hard of hearing may not hear their names and not come forward for treatment
• Patients waiting in the corridor, often for long periods, seem to be left to their own devices (as illustrated in Appendix 3). While clearly clinical staff are “working flat out” in the ED and may not have time to oversee the patients in the corridor on a full-time basis, it would be helpful if volunteers could be assigned to the area to keep patients under informal observation and to call clinical staff to attend to any who might be experiencing difficulties. It would also be helpful if some means of entertainment were available to alleviate the boredom of waiting for what must sometimes seem an interminable period.

Suggestions for improvement

Arising from the visits, the team have put forward the following suggestions for improvement (not in order of any priority):

1        That the Havering Place-based Partnership (HPbP) take the lead in working with BHRUT, PELC and local GPs to improve local communication to persuade those patients who do not need hospital care that they can be treated without the need to go there – this would reduce the volume of patients going into A&E and reduce the bottle necks in the discharge process and lessen the number of patients in the corridors.

2       That the HPbP work to raise public awareness of the alternatives to A&E for minor health issues, such as social prescribing and the presence of ARRS/Allied Healthcare staff in surgeries such as pharmacists, physiotherapists and paramedics.

3       That as more space becomes available in the hospital (following the activation of the St George’s Centre in Hornchurch), the accommodation available to A&E services be expanded in order to provide better facilities for patients.

4       That lighting within the corridors used as auxiliary facilities for the ED be made dimmable so as to reduce the night-time glare that can adversely affect patients. [Note: since the visit, we have been told that this possibility is being actively pursued by BHRUT]

5       That the possibility be explored of providing low-level means of entertaining patients who are waiting in the corridor area to be transferred to a ward – perhaps through the provision of one or more TVs, magazines or books.

6       That the system for calling patients for attention be improved by the installation of a loud speaker system or, preferably, of screens on which names can be displayed.

7        That attention be paid to ensure that soiled bedlinen is not re-used, that the area is kept clean and that infection control measures are continuously implemented.

Appendix 4 to the report sets out BHRUT's response to the report.