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The Care Quality Commission checks whether hospitals, care homes and care services are meeting government standards. Visit our website at www.cqc.org.uk.

Croydon University Hospital

  • 530 London Road, Croydon, Surrey, CR7 7YE

  • Read more information about this hospital...

Type of service
Hospital

Specialisms/services
Assessment or medical treatment for persons detained under the Mental Health Act 1983, Diagnostic and/or screening services, Family Planning services, Maternity and midwifery services, Nursing care, Services for everyone, Surgical procedures, Termination of pregnancy, Treatment of disease, disorder or injury

Local Authority Area
Croydon

These checks were made using our new inspection model for NHS hospitals. If we are taking enforcement action, we highlight it below.
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Summary of inspection on 17–19 September 2013

Croydon University Hospital is the main acute hospital managed by Croydon Health Services NHS Trust. It has 565 inpatient beds, a 24-hour A&E, maternity and children’s departments, and a range of other services. It serves a large and diverse local population with one of the highest black and minority ethnic populations in South London. The trust employs around 3,500 staff and has a budget of £244 million. The UK Border Agency has its main reporting centre in Croydon and a high number of immigrants live locally and need healthcare support.

We chose to inspect Croydon as one of the Chief Inspector of Hospitals’ first new inspections due to risks identified by our ‘Intelligent Monitoring’ and resulting concerns about the quality of care. We were particularly worried about poor patient experience. The trust’s scores in the national inpatient survey for 2012/13 were among the worst in the country. This information, along with feedback from people who used the service and information from Croydon Healthwatch, and local Clinical Commissioning Groups, helped us decide where to look during our inspection.

Our inspection team of 25 included CQC inspectors and analysts, doctors, nurses, patient ‘experts by experience’ and senior NHS managers. The team spent several days on site observing care, talking to patients and staff, and looking at records and patient feedback. We held a public listening event in Croydon, which was attended by around 90 people who had used the hospital’s services. We also carried out unannounced inspections of areas where we thought there was a risk of poor care.

We consider that A&E must be improved. While staff employed by Croydon University Hospital were well motivated and tried hard to make the arrangement work, the department has high staff vacancies and the environment in A&E made it hard for staff to deliver good care. The building was badly laid out and lines of sight were poor. The trust has applied for funding to rebuild its A&E and we believe this would make a big difference to patient experience.

In addition we had serious concerns about A&E and the way in which patients move between the Urgent Care Centre (UCC), which sees people when they first arrive, and the hospital. The UCC is run by another provider, who we have inspected separately to address our concerns. The commissioners of this service must ensure that what they commission meets the needs of local people.

Staffing has been a problem for this trust for many years. This is being tackled by a major recruitment drive and staff in many parts of the hospital said that the situation was improving. We did, however, have concerns about staffing in older people’s wards. These wards were busy, and both staff and patients recognised that care was poor because of a lack of enough staff with the right mix of skills.

The quality of medical care (across wards for older people, people who have had a stroke, people with diabetes and similar) was mixed. Some wards were well-led and were delivering safe, effective care but others were under pressure and more needed to be done to ensure the basics were done well – for example, helping people who have dementia to choose their meals, and ensuring good infection control.

Maternity and children’s services were caring, safe and well led. Mothers, parents and other relatives were largely positive about the care they had received, felt supported to make choices, and were kept informed about what was going on. Care was largely responsive to people’s needs. However, we saw that the inpatient ward for children was cramped.

We saw evidence that surgery was generally safe and effective, with recent improvements in staffing numbers reflected in positive staff and patient feedback. We did, however, see good practice around the use of a safe surgery checklist. On one ward staff said more support was needed to ensure they could manage the range of specialities effectively. End of life care was also well-run, with appropriate links made with the local hospice, and multi-disciplinary teams working to make sure people’s needs were met.

More can be done to ensure the Critical Care Unit is delivering consistently safe and effective care. There was too much reliance on non-permanent staff outside of core hours and the unit was cramped.

The trust can do more to become a learning organisation and learn from audits, its own performance data, and best practice guidelines. Some service areas were let down by a lack of attention to basics such as ensuring patients were appropriately dressed before going home, care planning and record keeping.

The hospital‘s senior team has been through a lot of change. All of the executive team – with the exception of the Director of Nursing – have been in post less than a year. Many of the welcome changes at Croydon have been driven by the Chief Executive and the new team. Staff went out of their way to tell us about this.

We saw evidence that many staff from all professional backgrounds were committed to working with the new team to drive up quality. Patients had noticed this and it was reflected in feedback we got, although it is clear the trust has a history and reputation that is making it hard for it to move forward. We also heard about recent incidents at our public listening event that confirm the trust has many challenges ahead.

In summary:

  • This is a new management team that is working to change culture (through the ‘listening into action’ programme,’ which is working well). It is early days but the new team is having an impact.
  • The A&E unit is not consistently providing safe care, mainly because of relationships with the UCC run by another provider.
  • Poor patient experience is still a theme across the trust, and the hospital needs to continue its work to improve this.
  • Staffing has been a problem for this trust for many years and this is being addressed through a major recruitment drive. There are still significant staffing problems in A&E and on the older people’s wards.

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Background information for inspection on 17–19 September 2013

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Inspection areas

Summary of inspection on 17–19 September 2013

While most services were delivered safely, the A&E must be improved. It is crowded, badly designed, and staff vacancies are high. We are concerned about staffing levels in some parts of the hospital and whether they always have enough skilled, experienced staff to deliver safe care. There were not enough staff in wards for older people and this must improve.

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Summary of inspection on 17–19 September 2013

Services are largely delivered effectively and outcomes for patients are within expected ranges. We found no evidence of concerns about mortality rates or infection rates. Quality assurance (including audit findings and lessons learned meetings) is not always well understood at ward level.

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Summary of inspection on 17–19 September 2013

Most people we spoke to were positive about their care. Much of the care we observed during the inspection was good. However, we have concerns about outpatients and about there being too many discharges – particularly of older people – in the evening. There have been serious problems with patients’ experience of care in the past (including some recent cases that were not acceptable, including some raised at our listening event) and there needs to be evidence of improvement here. But other patients were full of praise for staff, and the staff themselves wanted to make clear that there had been real improvements in recent months.

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Summary of inspection on 17–19 September 2013

The hospital needs to do more to be responsive to people’s needs, particularly in A&E (while four-hour targets are currently being met, a high number of people are being discharged just before four hours is up) and for appointments for orthopaedics and eye conditions (both areas the trust has already taken steps to improve). Some parts of the hospital are in poor condition and this means care is not delivered as effectively as it could be.

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Summary of inspection on 17–19 September 2013

The trust’s new senior management team has made impressive strides in the past six months in particular. Staff wanted to tell us about the impact they have made. More evidence of sustained improvement is needed, but we saw and heard many positives. Complaints are not always responded to within an appropriate timescale, and some patients told us staff were defensive when responding to their concerns.

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Checks on specific services

Summary of inspection on 17–19 September 2013

The provision of care in A&E needs improvement. We had serious concerns about the way in which patients move between the Urgent Care Centre (UCC), which sees people when they first arrive, and the hospital. The UCC is run by another provider who we have inspected separately to address our concerns. The A&E environment was not well designed or maintained. It was cramped and lacked lines of sight between staff and patients. The observation ward was very crowded. Vacancy levels were high. Staff were, however, positive about changes to care pathways and about the training and support they were receiving. The dementia zone was singled out as an example of good practice.

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Summary of inspection on 17–19 September 2013

We saw a mixed picture of quality across these wards. While we saw clear evidence of good care and leadership in some wards, quality elsewhere was let down by a lack of attention to good practice or detail (for example, in record-keeping and infection control). The older people’s wards were the biggest area for concern, with patients saying there were not enough staff and staff confirming they were always under pressure. The trust is in the process of changing the skill mix and number of staff in these wards to ensure care is delivered safely. We saw many examples of good care, although some patients complained (for example, staff speaking over them in a foreign language) and older people did not always feel involved in their care. Patient records frequently did not include care plans that reflected all the needs of the patient. This meant there was a risk that they would not get the help and care they required.

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Summary of inspection on 17–19 September 2013

We had few concerns with surgery and overall this service was safe, effective and well-led. Patients told us that the surgical wards had enough staff to meet their needs and thought staff were caring. Staff said that the number of permanent nursing staff had recently improved. The wards were visibly clean and good infection control practice was largely followed. Theatre teams were using the World Health Organisation’s ‘safe surgery checklist’ which is designed to prevent avoidable mistakes, and this was a well-managed process. We saw some examples of excellent care and staff were largely positive and aware of good practice (for example, the ‘butterfly scheme’ for dementia care). One ward, Queens 1, covered a broad range of specialities and staff need more support to cover them all.

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Summary of inspection on 17–19 September 2013

More can be done to improve quality in this area, particularly on the Critical Care Unit. The unit was using high numbers of agency and bank staff (non-permanent staff) at weekends and nights. We had concerns about the lack of space in the unit. The admission areas for the theatres were breaching single-sex guidelines. The trust was not, however, using the Intensive Care National Audit and Research Centre audits programme and we believe it should do this to make sure services are being delivered in line with best practice.

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Summary of inspection on 17–19 September 2013

Most women and family members were happy with the maternity services and we saw evidence that they were both safe and caring. The unit was well-led and positive changes were being made and sustained. Women were offered choices and most found doctors and midwives caring, with some exceptions at night. Systems were in place to recognise and respond to emergencies quickly. The hospital cares for a relatively high number of high-risk pregnancies and the midwives we spoke to were passionate about ensuring women got the right care and support. The staff team included a range of specialists to meet the diverse needs of local women. Staffing levels were improving and staff were positive about the service they offered. Some women mentioned delays in the antenatal clinic.

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Summary of inspection on 17–19 September 2013

Overall this was a safe, caring and well-led service, with some issues around premises. We found contrasts in this area between a well-equipped modern day surgery unit with good facilities, and a cramped and inadequate inpatient ward that staff told us was always “very busy”. Recruitment was under way to help with this. Parents and children were happy with the care they received and we saw good examples of care, compassion and communication. Doctors were visible on the wards and staff told us communication between nurses and doctors was very good.

Discharge arrangements were good and parents said they were well-informed about what was going on. We saw clear evidence that the service was responsive to patients’ needs, including clinical governance meetings that included learning from patient feedback and building on lessons learned. We reviewed a number of policies and procedures that reflected best practice guidelines.

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Summary of inspection on 17–19 September 2013

We found that this service was generally safe, effective and well-led, with multi-disciplinary teams meeting daily to discuss people’s needs. The palliative care team had links with the local hospice and we heard examples about where the hospice had worked with hospital staff to help people understand choices about end of life care and treatment. The trust was using the Liverpool Care Pathway and had taken steps to make sure it was correctly implemented. The trust has an end of life care steering group that oversees good practice. We saw evidence of learning from audits of recent deaths to ensure that care and treatment had been appropriately delivered.

There were some areas for improvement. We saw that not all ‘do not attempt cardiopulmonary resuscitation’ orders were properly completed. The trust must address this. We also saw an example of a family, whose relative had just died, who were not given enough privacy.

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Summary of inspection on 17–19 September 2013

The premises and facilities in some outpatients departments were inadequate. In busy periods people were left without seats and, in some clinics (notably orthopaedics), this meant people were uncomfortable and waiting too long. Some waiting lists were poorly managed and many patients were arriving expecting to wait for many hours beyond their appointment time. Although staff knew there was a regular problem with overbooking, they did not seem to understand why or how this could be better managed. This was not responsive to people’s needs.

We saw examples of good care throughout the inspection once people were actually seen. For example, the Chronic Obstructive Pulmonary Disease clinic was run by caring, passionate staff who were having a marked impact on preventing readmissions. Staff across outpatients were caring and friendly, and patients were positive about the care they had received. Comment cards were largely positive and staff liked working there. Services are being transferred from Croydon to Purley Memorial Hospital and this move should result in improvements.

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Latest Inspection

The latest check of this hospital was carried out on 17–19 September 2013 using our new inspection model.

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Inspection Reports

Carried out on 15 July 2013 during a routine inspection
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100.87 KB
Carried out on 6 September 2012 during a check to make sure that the improvements required had been made
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43.13 KB
Carried out on 15 June 2012 during a routine inspection
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110.59 KB
Carried out on 20 March 2012 during a themed inspection
Carried out on 22 November 2011 during an inspection in response to concerns
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72.22 KB
Carried out on 5 October 2011 during a check to make sure that the improvements required had been made
Carried out on 5 April 2011 during a themed inspection
Carried out on 4 February 2011 during an inspection in response to concerns
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136.44 KB
Carried out on 21 July 2010 during a routine inspection
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161.38 KB

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What our icons mean

All standards were being met when we inspected the service. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.
At least one standard in this area was not being met when we inspected the service and we required improvements.
At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.


What does a grey cross mean

At least one standard in this area was not being met when we inspected the service and we required improvements.

What happens next
The service will tell us how it is making improvements. Once we are happy that the improvements have been made, we will update our judgement to show a green tick. Other times, we may have to carry out a 'follow-up' inspection to check improvements.


How can I get more information
Our inspector's report will give you more information about why the service received a grey cross. You can also contact the service directly or visit its website for more details on any improvements it has made.



What does a red cross mean

At least one standard was not being met when we inspected the service and we took enforcement action.

What happens next
The type of enforcement action we take depends on the seriousness of our inspector's findings, and the service must make improvements before we update the judgement on our website.


How can I get more information
Our inspector's report will give you more information about why the service received a red cross. You can also contact the service directly or visit its website for more details on any improvements it has made.