Newham University Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that the service met people’s needs. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people were not getting care and treatment in a timely way to meet their needs.

We have not awarded this service a score for Responsive.

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

The service generally put people at the centre of their care and treatment choices and worked in partnership with them to respond to changes in their needs, although this was not always consistent in practice.

People received care that was kind, respectful and focused on their individual needs. Staff interacted with people in a compassionate way, and many told us they felt listened to and supported.

Staff were confident in the care they provided and described a patient centred approach. Staff said they felt confident advocating for patients. However, staff did not always complete individual risk assessments, including, falls risk assessments and pressure ulcer assessments.

Family members were involved in decision‑making where this was appropriate. Most relatives and carers told us they were included in the persons care and felt that the patient’s preferences were respected.

There were clear pathways for people attending the department. The hospital operated a divert scheme to local GP services.

The Clinical Decision Unit provided rapid assessment and short-term observation; however, it was being used to care for patients for longer than intended. The enhanced care area provided person centred care for people whose physical health needs had been addressed but they needed ongoing mental health assessment. These patients were cared for by experienced mental health professionals.

Emergency department staff had access to support from specialised teams, including the alcohol liaison team, homelessness team, learning disability team, and frailty team. However, during our inspection, we noted that the frailty team was not consistently available due to low staffing. The paediatric emergency department could request support from child-specific professionals, such as a health play specialist, provided by the hospital’s service for children and young people.

The mandatory training data we reviewed did not include learning disability training, so we could not determine from this data whether staff had received training to help them meet the needs of diverse patient groups, including people with autism and learning disabilities. However, in response to learning from incidents the learning disability team regularly visited the department, provided teaching to medical staff at all grades, and attended nursing team study days to support staff knowledge and awareness. The service had developed a learning disability standard operating procedure with the learning disability team. Processes were in place to support appropriate and timely care for patients with learning disabilities. This included a ‘fast lane’ system to make sure vulnerable patients were seen more quickly and required that all patients who have a learning disability were reviewed by a senior clinician.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. However, this was not always delivered consistently, with some gaps in maintaining confidentiality and keeping patients informed about delays and waiting times.

Staff provided patients, their families, and carers with information that was accessible, and supported their rights and choices.

Most information given to patients or their relatives in the emergency department was verbal. There were a number of leaflets available, particularly in the urgent care area, for people to take away. The service also displayed some signage in languages other than English. Staff said there were various ways in which they could provide information in a way people could understand. This included making reasonable adjustments for people with disabilities and interpreting and translating services for people who did not speak English as a first language. They could also obtain support for people who were deaf and used British Sign Language.

Patients told us they were not always informed of delays or the next steps in their care. A manually updated whiteboard, displaying current waiting times, was present in the main waiting area. However, the board was not consistently updated and therefore did not always reflect the most accurate waiting times.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Staff listened to people and involved them in decisions about their care. Staff encouraged people to share concerns, symptoms and preferences, and we saw evidence of shared decision‑making, particularly where people were being considered for discharge, or streamed to alternative pathways. People’s views were considered when deciding the most appropriate and least restrictive options for care. We saw records to alert staff to the wishes of patients around resuscitation.

The service had systems in place to learn from people’s experiences, including complaints, feedback and incident reviews. We reviewed the services complaints log, which recorded outcomes and action to address concerns. Learning from people’s feedback was discussed in governance meetings and shared with staff. This supported a culture where people’s experiences were used to inform improvements in care delivery.

Patients we spoke to did not always know how to make a complaint, however many felt able to speak with a member of staff. Although posters encouraged patients to give feedback, there was limited information displayed about the hospital patient advice and liaison service or how to make a complaint. In the last 12 months, the service received 194 complaints. The main complaint themes were related to perceptions of inadequate medical care, staff attitude and delays.

The provider responded in a detailed and compassionate way to people’s concerns. Complaint responses acknowledged where listening and communication had fallen short, offered apologies, and clearly explained what had happened and why. Explanations were given of how people’s feedback was used to identify learning, including reinforcing expectations around compassionate communication, privacy, dignity, and clear explanations. This showed efforts to ensure people’s voices drove improvement.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The service had systems to support equitable access to care, but these were not always effective in practice. People could not always access timely care, support, and treatment when they needed it. There were signs of improvement from better streaming of patients away from the emergency department and work with mental health services. However, there remained too often crowding in the department from both increased patient numbers, but also the unmet demand for ward beds for emergency department patients in a hospital at full capacity. This had a significant impact on the performance of the emergency department and the ability to be responsive to patients and meet their needs in a timely way as patients could not be moved forwards.

There was variation in waiting times across the different urgent and emergency care pathways. In the urgent treatment centre, there were waits of approximately 2 hours, although we observed waits could be higher at night. We observed that patients in SDEC experienced prolonged waits to be seen by a clinician, at times over 5 hours, some patients were sometimes moved into SDEC later in their pathway, rather than at the point of initial streaming, contributing to extended overall waits.

The crowding, delays, and limited physical space meant at times patients being placed in a corridor or staying for long periods in chairs in waiting areas. Although, over the last 12 months, approximately 7.9% of attendances resulted in an admission. Some people experienced significantly longer waits, depending on factors such as their time of arrival, availability of beds within the hospital, and availability of beds in mental health hospitals. Patients we spoke with described staying in the emergency department for many hours and, in some cases, several days, often on beds in busy areas. However, on average, over the last 12 months fewer than 2% of patients awaiting admission had waited more than 12 hours from the decision to admit to being admitted.

The longest stays regularly occurred for patients with mental health needs. This was due to long waits for transfer to specialist mental health services. Data showed the average length of stay for adults presenting with mental health needs was over 19 hours and over 11 hours for children and young people. The longest stays in the last 6 months included a wait of 179 hours (7 days) for an adult in March 2026, and 208 hours (8 days) for a young person in March 2026. In both cases, patients were waiting for an appropriate social care transfer outside the local area, and the ED was considered the safest available place for them to remain while this was arranged. Most commonly long waits for adults were due to waits for a mental health bed, and for young people were due to waits for an appropriate social care placement.

Pathways such as rapid assessment, GP redirect, SDEC, and specialty streaming were in place to help people access the right care promptly. Staff described ongoing work to improve processes and reduce unnecessary waits, particularly for people who could be safely managed outside of the emergency department. An acute frailty service was available from Monday to Friday, 9am to 5pm, though it was not in operation on one day during our inspection due to staffing shortages. This level of provision did not meet the NHS England long-term plan recommendation of all hospitals with a 24-hour emergency department offering an acute frailty service for 70 hours each week.

Patients were not always triaged in a timely way. On average in the last 12 months, the average time to triage was 25 minutes. For paediatrics, the average time to triage was 27 minutes. The triage times in the department were not meeting the clinical guidance for triage which was to see all walk-in patients within 15 minutes of arrival.

In the last 12 months, the service was below the national constitutional standard of 95% of patients being seen and treated within 4 hours. Performance ranged from 66.7% to 73.7%. The standard for ambulance clinical handover and offload is completion within 15 minutes of arrival. Over the past 12 months, the service's average handover time was approximately 27 minutes.

The service had an escalation process to address delays and limited capacity. This defined specific trigger points and corresponding actions for scenarios such as lack of resuscitation capacity, more than 5 ambulances waiting, or patient wait times exceeding 10 hours. This was supported by the hospital full capacity protocol, which provided a structured approach to managing patient flow when the ED was at or nearing its operational limits.

Improving patient flow and reducing delays within the ED were an organisational priority. This was being managed as a hospital wide priority with executive ownership of the actions required. Weekly multidisciplinary improvement huddles were introduced within the service to support rapid identification of delays, testing of changes, and continuous improvement activity. However, these initiatives were not yet fully embedded across the service, and evidence of sustained improvement was still emerging.

A range of initiatives were in place to tackle health inequalities and meet the specific needs of the local population. These included giving priority to patients with learning disabilities by ensuring they received early senior reviews and prompt decision-making, enhancing specialist involvement from the diabetes team to better manage conditions that are particularly common in the area, and improving the referral pathway for accessing support from the on-site independent domestic violence advocate.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.