Croydon University Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated this key question as Requires Improvement. At this assessment we rated it as Requires Improvement because dignity and privacy was still not being maintained.

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 incidents of privacy and dignity not being maintained. Data provided by the trust showed that patients could spend long periods in these areas.

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.

We have not awarded this service a score for Caring.

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

The service did not always maintain privacy and dignity. Patients could spend long periods of time in areas of the department which did not enable staff to provide care with dignity and privacy.

Due to the crowding in the emergency department, escalation areas were in use patients can be in the area for long periods, for example data provided by the trust showed that the longest wait in the nurse cohort area in March 2025 was 63 hours and 65 hours in the subwait area.

The majors sub wait area and the nurse cohort corridor (known by staff as the resus corridor) compromised privacy and dignity. These temporary escalation areas were in a busy through area and there was constant activity around the patients waiting there. There were no curtains in those areas. The corridor was brightly lit. We saw doctors talking with patients, delivering news to them and discussing plans for their care in areas that did not preserve privacy and confidentiality because they could be easily overheard by other patients waiting nearby. We saw a patient in the cohort corridor trying to make themself comfortable; their underwear was in view to other patients in the area and anyone walking past and CCTV was in operation in that corridor.

The rapid assessment and triage area is just next to the majors sub wait area which is a high activity area. On assessment this was very busy which meant some patients in the sub wait area being treated were very close to patients and relatives awaiting assessment. In the nurse cohort area, we observed numerous occasions of ambulance crew and trust staff moving through the area as you would expect in a busy department, past patients in beds and trolleys waiting for care and a bed.

In the majors sub wait area, patient’s chairs were very close to each other. It was not possible for people to have a private conversation in this area. Staff told us they moved patients into a cubicle for more privacy, if possible, but we saw staff discussing patient care and assessments in this area. Patients received treatment in this area including intravenous fluids and antibiotics.

Staff told us that when non-ambulatory patients waiting in the nurse cohort corridor needed personal care, they needed to identify an appropriate space, usually in the resuscitation room which was not always available, leading to delays in care. It also has safety implications when areas for the most unwell patients were used for personal care.

Five patients and one carer we spoke with said privacy and dignity were not respected in the temporary escalation areas. This was consistent with the Urgent and Emergency Care Survey 2024, which indicated that the trust’s section score for respect and dignity (section 10) was worse than expected.

The Care Quality Commission UEC Survey 2024 showed the trust performing worse than expected for 9 metrics including Q.10 Were you given enough privacy when discussing your condition with the receptionist?; Q.31 While you were in AE, did you feel safe around other patients and visitors?; Q.42 Overall, did you feel you were treated with dignity and respect while you were in AE? On assessment we observed patients describing symptoms and personal information in reception in very close proximity to other people.

Friends and Family Test (FFT) data showed that positive responses had improved form 70% in November 2024 to 82% in March 2025. Negative themes included comfort, feeling safe and politeness of staff. Positive themes included professional and competent staff, compassion and emotional and physical support. Actions such as “You said, we did” had been taken in response to these findings.

However, we saw staff treating people with kindness and compassion. We also saw healthcare assistants providing one-to-one support to vulnerable patients. The majority of patients we interviewed during the assessment told us that the staff were caring and supportive and felt confident in their care. A patient said staff “are always asking if I need anything”.

The frailty team were co located in the emergency department allowing prompt review of people needing their input. Chaplaincy staff and facilities were available to support patients, carers, and staff. There was a bereavement room for families and staff had received training delivering bad news and supporting patient’s relatives with difficult news.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Independence, choice and control during this assessment. The score for this quality statement is based on the previous rating for Caring.

There were delays in responding to people's individual needs.

The Urgent and Emergency Care Survey 2024 found 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. Specific questions with negative responses were around access to food and drinks, help from staff to take medication and being able to get help from staff to manage symptoms. This meant there was a risk that patients may not always have their immediate needs met to minimise any discomfort.

Data provided by the trust showed long waits in the department. Patients were offered meals three times a day. However, hot food could not be provided regularly because of lack of appropriate kitchen facilities within the department. We saw staff offering hot drinks to patients and carers during the day.

Staff told us that that it was not always possible to respond appropriately to the immediate needs of patients experiencing a mental health crisis. There were two rooms for adults in the department; however, staff told us this number was not enough considering the volume of patients in mental health crisis attending the department. There was one CAMHS room in the paediatric ED and staff in this service also reported this is not enough for what is required.

In cohort areas, particularly the nurse cohort corridor, there were insufficient facilities for the number of people being cared for. For example, there was one toilet in the cohort corridor. At the time of our assessment there were 8 patients in the corridor and data showed it could be more. One patient waited 15 minutes to use the toilet as it was already occupied. There were no call bells in the cohort areas.

Following our assessment the trust had instigated regular matron rounds to review the needs of patients, particularly in the cohort areas, to identify and pre-empt patient needs in those areas.

Staff had a sense of belonging in the workplace. Several staff members told us that ‘they loved working’ at the hospital because of the team spirit and referred to the staff as a family. Staff had a positive experience of supervision, training and peer support. A member of the staff said they had “the right balance between autonomy and support” and the best part of their job was the team. Staff felt work culture was positive.

The service supported staff with an induction programme when they joined the department including a period of supernumerary status and time to gain experience in different parts of the department. There were opportunities to undertake training relevant to the emergency department as well as simulation training. New staff were assigned a mentor for support and guidance.

The trust had a Health Wellbeing Strategy And a health and wellbeing team and there were different health and wellbeing activities organised through the year which included Employee Appreciation Day, and wellbeing week. The health and wellbeing team also supports different teams and departments to overcome specific challenges.

Staff in the department were supported by TRiM. TRiM is a trauma-focused peer support system to support staff after difficult or traumatic events. There were incidents reported on trust systems that showed violence and aggression involving staff in the emergency department. Staff were aware of different support structures such as chaplaincy services, professional nurse advocates and staff networks.

Leaders were aware of the demands of the department and staff wellbeing. Culture and support had been a priority for senior staff and ensuring staff were able to take planned breaks. The majority of staff told us that although they were very busy, they could take their breaks.

The ED leadership team showed awareness of specific cultural challenges and commitment to overcome those difficulties. Actions had already been taken and further initiatives were planned. Leadership capability and capacity had been improved as well as increased staffing. with specific actions in place.

Staff told us they felt able to suggest improvements and most were confident to escalate concerns. They reported being supported and described senior leadership as approachable.

Staff also told us that they had a high volume of patient violence and aggression towards staff, which impacts on their health and wellbeing. The department was supported by security 24 hours and had a psychiatry liaison available. Data provided by the trust showed a number of incidents in relation to violence and aggression in the department.

In the 2024 NHS Staff Survey the emergency department performed slightly worse than the organisation average for safe and healthy work (5.18 versus 5.98).