- NHS hospital
Croydon University Hospital
Assessment report published 16 July 2025
Contents
Ratings - Urgent and emergency services
Our view of the service
We inspected the Urgent and Emergency Care Service at Croydon University Hospital which included the emergency department and the urgent treatment centre. The emergency department sees around 12500 patients per month and the urgent treatment centre around 5000 per month. Activity in the department had increased by around 11% each year for the preceding few years. It delivers services to a diverse population with a comparatively high proportion of people requiring care and support with their mental health.
Patients experienced long delays in the emergency department though the non-admitted pathway including the urgent treatment centre was much shorter. The crowded department resulted in escalation areas being used. It also meant that there were not always sufficient facilities for people who needed care in the department.
We carried out this assessment on 1 and 2 April 2025 as part of our system pathway pressures programme. We inspected 24 quality statements across the key questions Safe, Effective, Caring, Responsive and Well-led and have combined the score for each of these areas to give the rating.
During the assessment, we visited the emergency department and the urgent treatment centre. We reviewed the environment and staffing levels and looked at care records and prescription records. We spoke with patients and family members, staff of different grades, including nurses, doctors, ward managers, therapists, a domestic assistant, and the senior managers who were responsible for urgent and emergency care services. We reviewed performance information we held about the trust. We observed how care and treatment was provided.
We found new breaches of regulation in relation to safeguarding and Mental Capacity Act, safe care and treatment and privacy and dignity. Improvements in governance were not found the service remained in breach of regulation.
Patients’ pathway of care sometimes meant they were cared for in areas that were not designed for patient care including patients requiring support with their mental health. Doctors mandatory training was low and children’s safeguarding training was also below trust target. Staff gave us inconsistent information about how the Mental Capacity Act was followed in the department.
Patients documentation was inconsistently completed with some risk assessments not being completed or acted upon. There were concerns with medicines in the department.
National Early Warning Scores (NEWS 2) were completed regularly and results acted upon. There were the right numbers of competent staff available and we saw staff following infection, prevention and control procedures when carrying out their work. We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.
The service carried out regular audits, including monitoring against the emergency care standards. Staff worked in a strong culture of evidence-based practice.
Patients privacy and dignity was not maintained in the department. The crowded nature of the department meant that escalation areas were in use. The use of escalation areas, the majors sub wait area, and the nurse cohort corridor did not offer privacy and dignity. We observed staff offering compassionate care to patients and patients we spoke with were positive about the care they received. However, at times the service did not meet patients individual needs. Staff worked in a high-pressure area that with incidents making their workplace challenging. Most staff were positive about where they worked, and leaders were sighted on the risks to the workforce and the support required. Due to challenges with flow in the hospital patients did not always have access to care and treatment in the emergency department when they needed it. Patients continued to wait long periods for admission. There were examples of long stays in the department whilst patients waited for an appropriate place of care. This included extended periods in environments that were not intended for patient care. There had been mixed culture in the emergency department. Leaders were aware of this and were taking steps to address it. Whilst leaders could describe the vision and strategy for the service, not all staff could and we were not provided with a strategy. Leaders were aware of concerns in the department and whilst they had taken some action, it was insufficient to address the safety and privacy of patients in the department. Governance systems were in place but not always effective.
In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded. We have also asked the provider for an action plan in response to the concerns found at this assessment.
People's experience of this service
Most patients and any family or carers with them were all positive about the staff treating them with warmth and kindness and providing effective care and treatment and we saw examples of patients being treated with compassion. However, the department was very crowded which impacted privacy and dignity.
Patients were offered food and drink in the department but hot food was not available. Patients told us there were seen quickly when they arrived however some patients could be in the department for extended periods and cared for in cohort and escalation areas that were not intended for patient care.
The Care Quality Commission Urgent and Emergency Care Survey 2024 showed overall that patient feedback for Croydon Health Services NHS Trust was more negative than the scores nationally with 15 questions rated either `somewhat worse than expected' or `worse than expected', and with no questions rated in a positive direction.