Newham University Hospital

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• 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 people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work. Staff provided evidence-based care and treatment in line with current legislation, good practice and standards. However, data was not consistently monitored to drive improvements.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.

Staff demonstrated awareness of relevant legislation and guidance that protects patients’ rights. They understood how to apply this knowledge in practice to support patient safety, autonomy, and dignity.

Staff followed policies to plan and deliver care according to best practice and national guidance. Guidelines were developed in line with national guidance, such as the National Institute of Health and Care Excellence (NICE) and the Royal College of Emergency Medicine (RCEM) standards. We saw evidence of audits being performed against compliance to RCEM clinical guidance. The service participated in national audits and peer review programmes to assess alignment with national clinical standards.

Clinical guidelines and policies were available on the trust intranet, and staff knew how to access them. The emergency department had strengthened how it delivered and monitored evidence‑based care through a structured Quality Management System (QMS). The service had policies and procedures in place to support evidence-based care, including the use of corridor care, rapid tranquilisation, and observation protocols for safeguarding. Staff were aware of these policies and applied them as part of safe, person-centred care.

People reported receiving thorough examinations, clear clinical explanations, and effective treatment plans. Staff completed assessments for patients with mental health needs, and we saw this in records reviewed. However, patients were not always assessed using evidence-based tools, as indicated by a lack of documentation in patient records.

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.

The service worked well across teams and services to support people. Staff had access to information needed to appropriately assess, plan and deliver people’s care, treatment and support. The trust used an electronic record system accessible to all relevant staff. This helped facilitate better communication between healthcare professionals

There was effective coordination of care between teams in the hospital and the wider trust. This extended to care for people who, for example, had a learning disability or dementia. There was specialist trained teams and individuals who made themselves available to the emergency department, staff, and patients for support, such as the alcohol liaison team, safeguarding team, and learning disability team.

Staff knew to whom they should delegate patients’ care and treatment for specialist input and when transfers of care to other hospital teams were necessary. Staff reported quick responses from specialty teams. Leaders had worked with colleagues in gynaecology to establish a focussed pathway to support ED flow. A gynaecology assessment unit had been introduced to receive appropriate patients for planned, same-day or next-day attendances. Referrals from the emergency department were made digitally and accepted automatically.

We observed effective liaison with other teams, speciality units, site managers and flow coordinators to manage capacity and flow within the ED. There was a hospital wide approach to managing capacity.

ED staff also worked well with ambulance staff and obtained relevant information to care for patients arriving by ambulance. Ambulance staff we spoke to said they had good working relationships with the ED team. They informed us handover with ED staff was relatively prompt and effective and they didn’t have to stay in the ED for too long. This was reflected in the data we reviewed which showed average ambulance handover time for the service was typically in line with or below the national average.

Staff we spoke with were positive about team working within their immediate teams. Many described improvements in the culture and felt able to provide effective care and treatment. However, staff survey results indicated that cross-team working was less effective, with only 49.6% of respondents feeling that teams across the organisation worked well together to achieve their objectives.

There was a strong multidisciplinary approach to patient care, with assessment, planning and coordination supporting effective treatment. However, incomplete records meant staff did not always share patients’ risk assessments and care needs effectively, for example when they moved to inpatient wards. This increased the risk that falls and pressure ulcer risks would not be identified or acted on promptly, which could lead to avoidable harm, inconsistent care planning and delays in putting preventive measures in place.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service had systems and processes to monitor people’s care and treatment and to support improvement. However, in some cases the effectiveness of this was variable, and the impact of improvement activity on patient outcomes was not always clearly demonstrated.

The service had systems to monitor and improve outcomes. The service demonstrated a systematic approach to monitoring outcomes through participation in audit and service evaluation activity. We also saw evidence of targeted local audits such as time-critical medications, safeguarding in infants, thoracic aortic dissection, and red eye assessment. However, we found that data was not always used to drive improvement. The service's deteriorating patient dashboard revealed consistently low rates of completion for National Early Warning Scores (NEWS2), Paediatric Early Warning Scores (PEWS), and sepsis screening. Because this trend had persisted over several years, it limited the service’s ability to demonstrate measurable improvement in patient outcomes.

A range of quality improvement projects demonstrated targeted action to improve outcomes, including reducing time to triage and improving trauma call quality. ED performance data was reviewed through governance structures to support oversight and quality improvement. The service had also developed further mechanisms to support oversight and learning, including weekly quality improvement huddles and multidisciplinary audit days. However, much of the improvement work was still in progress, and the impact on patient experience and outcomes was not yet clear and consistent.

Observations and staff feedback confirmed that learning was shared through handovers, newsletters, and governance boards, and that staff were generally aware of key risks and improvement priorities. However, pressure ulcers were identified as a recurring incident theme for patients. This suggested that the service was not consistently able to demonstrate the impact of delays on patient outcomes or the effectiveness of actions taken.

We found that records of rapid tranquilisation administration were not always accurate, and there did not appear to be an auditing process to ensure appropriate vital signs checks were carried out afterwards. We were only able to review 2 recent examples, which had been administered orally and not intramuscularly: one of which was recorded as administered intramuscularly, but staff said that this had been an error. The last audit of rapid tranquilisation included data up to April 2025, and indicated improvements were needed in recording de-escalation attempts, the patients’ weights, and post dose monitoring. This limited the service’s ability to monitor whether rapid tranquilisation was being used safely and in line with guidance. However, we also saw that in October 2025 a new proforma had been introduced to improve documentation quality, support safer monitoring practices, and promote greater consistency of care. A re-audit was planned to evaluate uptake and utilisation of the proforma, with results of this work due to be presented at the departmental quality improvement presentation day in July 2026.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. There were practices carried out by clinical staff to ensure people gave valid consent to any care or treatment. Most consent was obtained verbally or by clear indication, which complied with legal requirements.

Staff understood the importance of people being able to fully understand what they were consenting for and the importance of obtaining consent before care or treatment was delivered. We heard consent conversations taking place between staff and patients, and all were conducted appropriately. Most staff were aware of legislation when it came to a patient who was not able to give their valid consent. Staff knew if the patient was not conscious then they had a duty to act to save their life or provide the right care and treatment. Reasons for treatment being necessary would be explained to the patient when they regained consciousness and were judged as able to understand.

Staff assessed whether a child was mature enough to make decisions about their care and treatment, using the test of 'Gillick competence'. This ensured children could make their own decisions when they had sufficient understanding and intelligence to be capable of making an informed decision. Most staff we spoke with demonstrated a reasonable understanding of the Mental Capacity Act 2005 as it pertained to consent to treatment.

Staff we spoke to understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act (MHA) and Mental Capacity Act (MCA) 2005, and they knew who to contact for advice.

There was a formal consent policy for the service. This policy was due for review in December 2024. A decision was made by the trust not to update the existing consent policy as the trust had embarked on a transition to an electronic consent (e-consent) process.