Croydon University Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

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

The service was in breach of legal regulations in relation to good governance as systems and processes to monitor and improve services were not always effective.

At this assessment the rating has improved to good.

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. We assessed six quality statements.

Staff were supported to raise concerns and reported that senior leaders were visible. Staff felt involved in decisions or changes the majority of the time. Some initiatives were not fully in place at the time of the assessment for us to assess their effectiveness.

Where processes had been put in place to improve outcomes for patients these were not always effective as improvements had not been sustained in some places. In addition, the service did not always meet the fundamental standards of care.

The trust had a set of values which staff were aware of were of. Staff spoke highly of their managers and told us they received good support and we observed good working relationships. There were management structures and the senior leadership team were aware of the challenges and risks for the service.

There were clear governance and risk management strategies in and leaders and staff strived for continuous learning including participating in quality improvement projects. There was evidence of partnership working and senior leaders understood the needs of the local community.

We have not awarded this service a score for Well-led.

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

The service had a shared vision, strategy and culture. The service understood the challenges and the needs of people and their communities.

There was a vision which was to provide excellent care for all and helping people in Croydon live healthier lives. The values of the trust were to be professional, compassionate, respectful and safe. Staff we spoke with were aware of the vision and values and felt it linked to their team vision.

Senior staff we spoke with told us that there was a positive culture across all services and good retention of staff. Some of the staff we spoke with also told us that they would recommend the hospital as a place to work as well as their relatives to be care there.

Numerous staff we spoke with told us that managers, colleagues and senior managers were supportive and we were given examples of the positive support that was provided.

Staff across the service told us that the senor leadership team, including executive directors, were visible and approachable. They told us that we 'all work as a team' and regularly see their manager and the chief executive around the hospital and the wards. We were given an example of a member of staff stopping one of the executive team in the corridor to raise a concern. They wondered if they had been listened to but received an email from them with the action that they were taking.

The trust had a diverse workforce with more than half of its staff from a Black, Asian or Minority Ethnic group which was above the national average. This reflected the diverse community it served.

The trust had in a dementia strategy which was aligned with Croydon's place based dementia strategy. There was a new dementia steering group which included ward staff and medical staff.

The trust had objectives which included, improving health and reducing inequalities, providing high quality care, creating a great place to work and developing sustainable finances as well as acting as a leader in partnership. Senior leaders of the services were aware of these objectives and were working to these when developing strategies and new ways of working.

There was a People' Experience, Engagement and Involvement Strategy up to 2027, which the service feed into. This included the plan for ensuring the service met the needs of patients and working with people who used services.

Webinars were held via staff intranet to engage staff in the trust work and find out their view and Ideas.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. They tried to improve services in a number of areas but this was not always sustained.

Medical and elderly care services had senior leadership teams which included clinical and operational leadership. Leaders felt accountability and the collective experience within the service was strong. We observed that they were open and honest and understood the challenges and risks within the service and were working to mitigate risks and put in place actions going forward. However, we found areas of concern during our assessment which in some cases were on a downward trajectory in terms of performance and improvements were not being sustained. Both teams needed to continue working together to sustain improvements across services.

Teams were supported by the executive team and they were aware and open about the risk and challenges the team faced. They were ensuring there was support was to lead effectively and take forward the new initiatives and plans. For example access to a coaching programme to support them to become improved leaders, improve skills and enhance communication and empower them to make effective decisions.

Medical staff reported a supportive environment within the hospital both from their colleagues and from senior management.

Staff told us training needs assessments were carried out regularly and they felt supported by senior staff, example given by staff of how they progressed from charge nurse to manager within the last 5 years and encouragement and support that they had received from the trust leadership.

There was a dedicated learning and development team which offered a range of course for staff, including an aspiring leadership programme. Leaders in the services were able to access these courses. However some staff with spoke with told us that the service was supporting career progression however, there was limited availability on courses due to funding.

We observed good working relationships within all teams.

There were processes and systems so that staff were supported to raise concerns.

There was a freedom to speak up policy which was in date. It included links to resources and contact details should staff wish to raise a concern should there be a need including guidance on how to raise a concern.

There was an identified senior lead and non-executive director responsible for freedom to speak up. There were regular meetings between the freedom to speak up guardian and the identified senior lead. The freedom to speak up guardian was independent to the trust and the service was available to staff 24 hours a day 365 days a week.

Staff we spoke with were aware of the freedom to speak up processes and had been supported by their line manager. We heard positive examples of how things had changed following staff raising their concerns via freedom to speak up processes.

We were told of an example where a member of staff was able to speak up after witnessing a patient being mistreated and that the matter had been dealt with appropriately and they had been kept updated throughout the process.

When a staff member had concerns, they were encouraged to speak in the first instance to their line manager. Staff could raise concerns verbally, by letter, email or by completing an incident form. They could also contact the freedom to speak up guardian in confidence via email. Information was available on the trust intranet.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Whilst there were clear responsibilities, and systems of accountability and good governance the service did not always effectively act on information about risk, performance and outcomes to sustain improvements.

There was a clear governance structure within medical care services. There were joint governance meetings with the 2 directorates who were responsible for medical care services. At these meetings, learning from mortality reviews, incidents and complaints were presented and discussed. Actions were identified for some areas; however, it was not clear from the minutes of the meetings we reviewed, what action had been taken or to be taken to share the specific learning to the wider service from incidents and complaints.

Some of the processes were not effective as areas of non-compliance with regulations was still occurring and actions following audits had not always been fully effective as improvements have not been consistently achieved and in some areas had deteriorated following improvement. For example compliance with completion of mental capacity assessments.

There were electronic systems available for staff to use but were not being fully implemented which meant that additional `work around' processes were being used by staff instead of the electronic system.

The service completed regular performance reports to the trust integrated quality and performance review board. These were undertaken on a quarterly basis and discussed quality, staff training, workforce and financial performance. However, skill mix on the wards not in line with guidance and no actions had been identified in the report that had gone to the board to increase or review the skill mix in establishments or the reason why.

The trust had policies and associated procedures and processes which gave a framework to follow in responding and managing a wide range of incidents and emergencies that could affect health and care. Business continuity plans for the medical wards outlined roles and responsibilities and actions to take. We also observed a business continuity pack on one of the wards we visited.

The trust had recently completed Equality Delivery System (EDS) tool to help address any health inequalities. Action plans were in place where needed. The outcome of the assessment for the trust overall was rated as developing. It is a requirement on both NHS commissioners and NHS providers. The EDS is an improvement tool for patients, staff and leaders of the NHS. It supports NHS organisations in England in active conversations with patients, public, staff, staff networks, community groups and trade unions.

There was a daily rhythm system to help teams be proactive in managing bed capacity for patients who needed a ward bed. This allowed for changes and flexibility based on need whilst still providing a general pattern to the day especially during times of increased challenge.

There were risk management structures and escalation processes in line with the trust risk management processes. The risk register highlighted risks across medical services and controls outstanding were identified to address the risk. Each risk had an owner.

We were shown dashboards that had been developed to allow a comprehensive view of complaints and patient safety incidents. The dashboards were used to provide oversight of themes and numbers of incidents and work with matrons and managers to progress completing the processes.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The hospital was part of the London Dementia Alliance Network which aimed to unify approaches across hospitals so patients received consistent care regardless of location. Staff from the service feed into this network.

The trust was part of the integrated care system in South West London and was working together to build a more resilient workforce and reduce variations in care.

There was a five year strategy which was developed with input from clinicians from the service as well as other health and care professionals. The aim was to work together with partners to improve care for the local community. This was a ‘place based’ strategy and informed the wider integrated care system (ICS) joint forward view across health and care services.

The integrated discharge team held regular multidisciplinary meetings to discuss any patient who had complex needs. These included senior staff from specialties within the hospital, housing, commissioners, and the local authority. The aim of these meetings was to help unblock any barriers to a patient’s discharge.

Senior leaders were aware of the diverse local community and the needs of the people who used the services.

Leaders and staff strived for continuous learning. An example of learning that was shared with us was following a visually impaired patient who had undergone a procedure in one of the services, faced a number of challenges at multiple points in their journey. Learning opportunities taken forward by the service was for pre-procedure information developed in partnership with patients to ensure it met their needs, Wi-Fi to be accessible for visually impaired patients and all staff to be mindful of the use of their language and conduct themselves in line with the trust values.

Patients and those close to them knew how to raise concerns or make a complaint. There was a system to investigate complaints and concerns, review themes and highlight any areas to escalate to the trust board. Some of the medical ward staff members told us that a high proportion of complaints on their ward related to delays to, or absence of, communication and delays in transfers of care. Staff were able to outline an example of learning from a complaint investigation.

Staff felt able to raise concerns or ideas. For example, a member of nursing staff had raised choking risks for patients at meal times. This resulted in a meal time observation process which had been adopted throughout the trust.

The hospital was currently putting in place a specialist complex pathway. This was to better manage patients with both physical and behavioural needs who may not fall under the Mental Capacity Act but still required a tailored, multi-disciplinary care package. Included individuals who after their immediate medical needs had been addressed, remained in hospital for extended periods due to a lack of appropriate services.

The frailty team were looking at a business case for the making the service substantive and expanding the service, the pilot had demonstrated an increase in positive patient experience and outcomes.

There was a process for mortality and morbidity reviews which included structured judgement reviews. We saw evidence of these being completed together with identified areas of good practice and where care could have been better. Actions and recommendations were made following these reviews and discussed through the service clinical governance meetings.

There was work currently underway to improve the hospital environment so it was more dementia friendly. For example new signage had been put up which were clearer for people to follow. Another project was the dementia garden which was hoped to create a space which could be accessed for all wards without having to go through the hospital. This would give patients living with dementia a quiet space and help those who were agitated by allowing them to step out of the ward environment.

There were volunteers with iPads who supported in gathering feedback as well as patient experience officers who visited wards and patients weekly to gather real time feedback. This allowed the service to react proactively to any concerns raised.

Staff we spoke with told us that they were supported to be involved in quality improvement projects and had access to study leave to take forward the quality improvement projects they were involved in.

We observed ward quality initiatives being displayed in ward areas, for example of the acute medical unit we saw that the quality improvement priorities included reducing medication omissions and improving recognition and escalation of deteriorating patients. Some staff on the unit were aware of the quality initiatives but some were not able to tell us about them.

The organisation had a service wide Quality Improvement (QI) program, although we were told that QI had been delayed in being rolled out across services but was now becoming more embedded. The improvement team supported several priority improvement programs. There was individual ward based quality priorities. For example an improvement in the completion of venous thromboembolism risk assessments. At the time of the assessment quality improvement plans were paper based but there were plans in the future to use QR codes to make data accessible on portable devices.