Croydon University Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question as Requires Improvement. There had been improvements and on this assessment in monitoring patient outcomes and we rated it as good.

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 urgent treatment centre offered an effective care pathway for patients not requiring admission.

The service carried out regular audits, including monitoring against the emergency care standards. Staff worked in a strong culture of evidence-based practice. Practice was evidence based. Staff worked together and with others when assessing people’s needs and shared information to maintain continuity of care.

We have not awarded this service a score for Effective.

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

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff used the trust’s systems to follow the latest guidance and evidence-based practice. The trust kept its database of guidance up to date. Staff used information given regularly in safety briefings and newsletters to implement new guidance or changes to existing procedures.

The trust’s intranet contained a range of up-to-date policies and standard operating procedures which reflected current and best practice. Staff in the department had access to these policies and procedures.

There were clear pathways for staff around working with multi-disciplinary teams to ensure patients were seen by the most appropriate people. The new triage and streaming system directed people to the most effective area for their needs. The UTC offered an effective pathway for patients not requiring admission. Pathways were in line with best practice and national guidance. Triage questions were appropriate for the patient and their needs for example, people presenting with emotional needs were properly and sensitively assessed.

The service mostly planned and delivered people’s care and treatment with them, including what was important and mattered to them. However, the trusts scored poorly on the Urgent and Emergency Care Survey 2024 regarding questions such as availability of food and drinks and were patients involved enough with decisions relating to their care.

The department offered patients food and drink. Patients told us that they had access to food and drink. However, long stays in the department meant that some patients were receiving the same food for longer periods. Information received prior to the assessment from a patient told us they had been offered sandwiches for a number of meals over 2 days. We saw patients being supported with their dietary needs and also being assisted with drinks.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance. For example, we observed from care records that care pathways such as sepsis were followed, that staff knew the actions to take and they were properly recorded.

The service worked well across teams and services to support people. Handovers between teams were effective at conveying important information about patient care, plans for treatment and referral to other specialties where required. Patients requiring additional support needs were highlighted to all staff so that appropriate care could be provided.

The multidisciplinary team were all involved in assessing people's needs. We observed plans being made for a discharge from the emergency department and that the patient's anticipated needs were planned for. There was effective communication with community nursing and community therapy teams.

Care was coordinated well with the majority of teams, with different teams alerted in time to review patients or be on hand in the event of an emergency. There was clear collaboration between the different emergency care streams such as the UTC with cross referrals made where this was required.

Staff were noticeably very busy in the department but all spoke of the positive support and relationships in the department. We saw good multidisciplinary working which demonstrated mutual respect amongst staff.

There were medical clinical staff based in the department for general medicine and care of the elderly. This enabled prompt review of patients and early plans for care. As there could be extended periods of time spent in the emergency department, this supported specialty review of these patients. However, we were told that there could be some delays in specialty review for some patients such as those requiring surgical review

There was good communication between directorates, for example medical care services which included the same day emergency care unit (SDEC). There were regular meetings to increase collaboration and identifying opportunities to improve pathways for example, there were plans on increasing the use of SDEC and early admission to that unit by ambulance to ensure patients received care in the most appropriate place.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service routinely monitored people's care and treatment to continuously improve it. We found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

Care pathways from triage to the urgent treatment centre were an effective pathway for improving outcomes. The urgent treatment centre saw approximately 5000 patients per month and gave access to people to medical review and treatment in a timely way. National guidance supported prompt decision making and the most appropriate place for care.

The department took part in the Royal College of Emergency Medicine(RCEM) audits and benchmarked their performance against other departments. For example, the trust participated in the consultant sign off audit, pain in children 2021/ 2022 and fracture neck of femur. Results were mixed, for example the department was below national average and did not achieve national standard in assessment of pain but was above national average and did achieve national `fundamental' standard in administration of first pain relief. Action plans had been developed in response to the RCEM audits.

We heard mixed feedback on how patients had been supported to manage pain or discomfort during waiting times. Some people we spoke with reported they had received help to manage their pain; other reported that they had to ask for help. One patient reported that some staff did not respond to their requests during the night. The Urgent and Emergency Care Survey 2024 showed that the response to `Do you think the hospital staff helped you to control your pain?' was about the same comparing with other trusts. The trust pain audit for adults found good compliance with action being taken in response to a pain score but to a question about a pain score recorded in last 4 hours varied significantly between 17% and 83% between week 1 to 12 2025.

There was a full audit plan in place for the department with clear audit leads and timetable in place. Senior leaders could describe the outcomes of audit and actions taken in response to them. Data provided by the trust showed clear steps taken in response to audits and reauditing them to monitor and manage improvement.

There were quality visits completed by a matron using a standardised auditable template. The department used these to identify areas for improvement. Some items were repeated concerns including patient identifiable information being accessible to the public and concerns with medicines management.

In terms of the rate of unplanned attendances within 7 days, there was an improvement in late 2023 compared with the beginning of the year and was below the regional and national average.

Staff had a mixed understanding of when consent should be sought with regards legislation requirements. We had mixed responses from staff about who completed Mental Capacity Assessments.

Staff had access to policies and guidance for taking consent from adults and children. We saw an example of a completed consent form for a patient requiring a surgical intervention which was clear and had been signed. The patient was aware of what they had signed and understood the procedure including risks.

We spoke with 8 staff of varying seniority who gave us a mixed response about who would complete Mental Capacity Assessments. For example, we were told doctors completed these assessments and also told that a psychiatrist would complete them. Everyone caring for people should understand their responsibilities under the Mental Capacity Act 2005 as they may be required to make a best interest’s decision promptly to ensure patient safety. Staff told us that nurses were not empowered or prepared to complete MCA assessments.

Staff understood specific requirements of taking consent from children. They had received training and knew how to apply for example Gillick competence.

The psychiatric liaison team were available for support and guidance when caring for patients with mental health needs. Staff told us they had a good relationship with the team who were supportive and responsive with the most people seen within an hour by a specialist clinician.

Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. We saw two completed forms that had been properly discussed with the patient and family and that had been and the reasons for the decision clearly documented.