Croydon University Hospital

On this page

• 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

At our last assessment we rated this key question as requires improvement.

There were concerns around capacity due to flow withing the hospital to manage medical patient on the right ward without the need for frequent moves within the hospital.

At this assessment the rating has remained requires improvement.

We looked for evidence that the service met people's needs. We assessed three quality statements.

There were times when there was still insufficient bed capacity to meet the needs of patients but there were specific clear procedures or policies to help manage these patients effectively. There were still a number of patients being cared for in non-speciality beds but this was improving since the last assessment as well as the number of ward moves during their admission. Occupancy levels were still high across the wards.

The service was putting in place actions to improve discharges from hospital and flow throughout the service however, these were only beginning to form and we found that discharge planning from admission was not always effective happening.

The service was providing person centred care and meeting individual needs for patients who had dementia or required palliative care.

The trust was working with other organisations to help complex discharge cases progress despite some patients waiting for care packages and an appropriate placement being found.

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 and its staff aimed to provide person-centred care.

The service showed commitment to supporting patients with dementia. As part of ongoing support the hospital had in a lead for dementia who worked closely with ward clinicians and the site team. There was a dementia assessment tool linked to the patient electronic record. We were told that this was not fit for purpose and as a result completion rates had dropped. However, a recent national audit data showed a high proportion of patients coming into hospital had a delirium assessment completed.

Patient led assessments of the environment (PLACE) in 2024 showed privacy and dignity score was 85%, food 91% and dementia friendly 87%. This was an improvement on results from 2023 where there had been actions to improve the scores for example, making more mirrors removable or providing a cover to avoid confusing the mind of people living with dementia and installing dementia friendly signage and flooring.

There was a joint community learning disability team who offered support as patients went through the hospital system and were available to signpost to other services available. This included patients who were an inpatient or an out-patient. Patients were encouraged to use a hospital passport which helped inform hospital staff about the needs of the person with a learning disability and how to support them. We observed these being used in the notes that we reviewed and staff we spoke with were able to outline what was contained in the document.

Staff were also being trained in how best to help people with learning language and communication difficulties as they can feel more vulnerable when they are ill.

Palliative care is the care of any patient who has a life limiting illness regardless of the stage of the illness. The services included the Macmillan palliative care team who worked with other professionals involved in the patient's care to help improve any symptoms. This service was available Monday to Sunday 9 am to 5 pm and an out of hours advisory service for staff, providing care to patients on the wards, by telephone from a neighbouring hospice.

There was a Macmillan cancer psychological support service available to support people affected by cancer. This included therapy groups for people with specific needs. They also worked closely with the Macmillan nurses and support officers to help people find the right support in the local community. The service was open to anyone over the age of 18 years which enabled them to support carers and family members as well.

On entry to the frailty same day emergency care service, patients were screened, with exit planning on entry. Throughout the day a geriatric frailty assessment was completed by the frailty specialists which supported the arrangement of same day packages of care. There was a high focus on holistic assessments which were person-centred and supported safety at home and connecting patients to community services on discharge.

There had been shared decision making for some of the patients we pathway tracked.

Staff who wore rainbow NHS badges were identifying themselves as available for open, honest, inclusive and non-judgemental conversations and advice to people who used services and their families who identified as LGBT+ (lesbian, gay, bisexual, transgender, the + simply inclusive of all identities, regardless of how people define themselves.) They also carried a list of helpful resources.

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 in most cases.

Information sharing between teams seemed to be cohesive. We were given examples of multiple ways in which staff shared information throughout the trust and within the respiratory team.

The majority of patients we spoke with felt they were well informed and were provided with appropriate information. Staff also told us that information they required to provide care and treatment was available but felt that more digital information would have been more helpful.

The trust was developing accessibility standards for its online forms which included voice recording and translation tools. Accessibility standards ensure websites and applications are usable by people with disabilities, including those with visual, auditory, cognitive, and motor impairments.

There were patient information leaflets available for some of the services provided.

There was a data protection officer which patients could contact if they had concerns about their personal information. Contact details were available on the trust website.

Translation services and interpreters were available to support patients whose first language was not English. This included British Sign Language.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service did not always ensure people could access the care, support and treatment when they needed it and in the most appropriate place. However, the service was taking action to improve and new initiatives were being put in place

Patient flow throughout the hospital had challenges and we were told by some staff that there were a number of patients awaiting care packages or adaptations at home before being discharged. We were also told by ward staff that delays in transport had an effect on care packages being available as the delay meant the care package had expired, for example when the renal team could not discharge the patient to their home as planned.

At the time of the assessment the integrated discharge team had very recently begun to undertake the triage of packages of care available from the local authority. The manager of the service told us that the data reviewed so far has shown that the number of care packages available met the demand. This was because some were not always required on the day due to delays in discharges as the patient may not have had all the necessary tests required to discharge them safely.

Information provided by the trust showed that at times there was a shortage of medical beds and a number of patients placed on wards that were not best suited to meet their needs (also known as outliers). Between April 24 and March 2025 data showed that there had been 517 medical outliers at the hospital. Patients who were outliers were reviewed on a daily basis by a member of the medical team. We were told that the service avoids medical outliers as much as possible and the data we reviewed showed this. During the assessment there was a minimum number of outliers and there had been an overall improvement from the last assessment.

Bed occupancy rates between January 2024 and December 2024 were consistently above the recommended 92% and higher than the national and regional averages.

The most recent information for January 2025 showed, patients who weren't discharged on the same day as their planned discharge date tended to wait longer at 14.9% waiting 21 days or more compared to the national rate of 5.8%.

Between November 2024 and February 2025 the overall percentage of occupied beds which have been occupied by a patient whose stay was over 7 days was 55% which was higher than the England overall percentage of 47%.

Information provided by the trust showed during the period April 2024 to March 2025 some patients experienced one or more ward moves during their admission. The average number of moves in the previous 6 months prior to our assessment, was 2 during the day. Patient moves between 10 p.m. and 6 a.m. was also monitored and kept to a minimum. The average number of transfers out of hours was 21 a month. This excluded transfers from the emergency department. These results show that whilst a number of patients admitted to medical services were not treated in the correct speciality ward for the entirety of their stay this was kept to a minimum and had reduced from the last assessment.

There were procedures to support staff and patients when the hospital and medical wards were working at full capacity. For example when there were a specified number of patients waiting in the emergency department for a bed on the wards a process known as 'boarding' would commence. In hospitals 'boarding' refers to holding patients in temporary locations whilst awaiting an inpatient bed. We were told that patients were only moved to the temporary location when staff were aware a definite discharge was happening and patients were never 'boarded' overnight.

Once the number in the emergency department with a decision to admit was around 40 then this triggered the full capacity protocol to be implemented. Senior staff told us that it had been recognised that this process did not begin to happen until later in the day but had recently been changed to happen before 9 am and again at 10.30 am. This was to ease pressure in the emergency department as soon as possible and to help ensure patients receive any ongoing care in the most appropriate place to meet their needs. Senior staff we spoke with also told us high occupancy levels and discharges not happening until later in the day had an impact on patients being transferred to a medical bed.

Staff we spoke with told us that they felt the discharge lounge could be more effectively used by patients being transferred there once transport had been booked rather than when the transport request had confirmed. These could be managed by staff in the discharge lounge.

There was a 14 bedded extended discharge unit which was supported by 2 elderly care consultants and other medical staff. There were nurses and healthcare assistants who worked on the unit to support patients. Patients who were ready for discharge within the following 48 hours were transferred to the unit in preparation for their discharge. However, we found that some patients had been on the unit longer than 48 hours due to social needs and an appropriate placement not being found.

Some patients stayed a little longer on the acute medical unit waiting for a speciality bed as patients were only moved when the relevant specialist ward had a bed available and were not moved to another ward unless absolutely necessary. There was a risk that specialist input may not happen in a timely way, although we were told that medical specialist would visit the unit as required.

The integrated discharge team included a discharge navigator on each ward and discharge facilitators who also completed any mental capacity assessments and best interest meetings to help ensure patients were able to leave hospital safely.

The trust monitored discharges from wards via a dashboard. This showed that in November 2024 the average discharges each day was 13.78%. This was the percentage of patients discharged from the number of patients on the wards. Between March 2024 and November 2024, the majority of patients were discharged before 1 pm with the rest being discharged by 5 pm.

We spoke with 6 patients who had been admitted to the wards as part of the urgent and emergency care pathway and we tracked their pathway from the emergency department through to the ward we visited them on and also reviewed their care record. We found that 3 of these patient's discharge was delayed due to waiting for diagnostic or therapeutic tests.

The trust had an electronic system for tracking patients through their care pathway to ensure patients were receiving care in the most appropriate place for their needs. However, we were told that this was not currently being used effectively and more work needed to be done to use this to its full potential. We were told that currently staff were using a manual spreadsheet to understand discharge status of patients and were aware that there was a risk that this would not be 100% accurate. Senior staff told us that whilst change was just at the beginning they felt that they were beginning to see staff thinking differently and some impact on the flow of patients through the hospital.

Staff told us they were aware of some new plans to help with flow but these had not yet been fully implemented at the time of the inspection. They told us that they had been involved in the plans and that senior leaders were listening. However, they felt that earlier discharges would help ease the pressure and ensure patients were moved to the most appropriate place to continue their care at the earliest opportunity.

We were told that some delays to patient discharges had meant that there was a risk that patients became unwell from being in hospital and we were given examples of having to reset discharge arrangements.

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.