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. The service was in breach of legal regulation safe care and treatment due to crowding in the emergency department. At this assessment the rating has remained Requires Improvement as there is an ongoing breach in safe care and treatment.

We looked for evidence that the service met people’s needs.

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.

The service was not always good at providing information for patients using the service.

However, the service generally delivered person centred care and performance in the urgent treatment centre had shorter waiting times than the regional and national average for those not requiring admission.

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 made sure people were at the centre of their care and treatment choices wherever possible.

The majority of patients we spoke with during the assessment told us that they felt they were at the centre of their care and treatment and sufficiently involved in planning and making decisions. However, in the UEC Survey 2024, in relation to the question, were you involved as much as you wanted to be in the decisions about your care and treatment’, the hospital scored worse than the national average.

Specific patients’ needs were flagged on the electronic dashboard. The electronic system allowed red flags to be placed on the patient record. However, we were told that there was not an acute dementia-specific flag. Staff told us that they could contact the dementia care specialist nurse for support.

Patients living with dementia were often placed near the nursing station to enable good oversight of their needs. Although not dementia-specific, there was a frailty same-day emergency care pathway in ED so that people presenting with frailty or cognitive impairment could be identified and moved if appropriate from ED to quieter more suitable areas for assessments.

The trust had implemented the red bag programme to help care home residents admitted to hospital. The bags contain key paperwork, medication and personal items as well as ‘This is me' information. This is a support tool to enable person centred care and records details about a person who can’t easily share information about themselves. For example, their cultural and family background and their likes and dislikes.

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. Staff told us they had used them previously and were familiar with their use and safeguarding leads ensured learning from LeDeR reviews were considered.

Multidisciplinary team reviewed and planned care for complex patients and people who attended the department often. This was in line with The Royal College of Emergency Medicine (RCEM), Best Practice Guideline, Delivering Interventions and Services for High Intensity Use Frequent March 2024.

The environment of the paediatric ED was child friendly. Children could watch cartoons on the television in the waiting area. There was water and juice available for children and parents as well as resources for drawing and colouring to keep the children relaxed in the environment. There was not a dedicated play specialist within the paediatric ED, but staff could request support from play specialists from the paediatric ward if required.

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 did not always supply up to date information for people using the emergency department.

The service did not provide real time waiting information for patients in the ED. patients told us that they did not know what the waiting time was. The Urgent and Emergency Care Survey 2024 showed the trust scored worse than expected for questions such as; Were you informed how long you would need to wait to be examined or treated?; Were you involved as much as you wanted to be in decisions about your care and treatment? And If you had any tests, did a member of staff explain why you needed them in a way you could understand?

Prior to our assessment we received information from patients telling us about poor communication in the department, getting support from staff for care and pain relief and an example of poor communication on discharge letters. These concerns were covered the year before and up to our assessment.

The majority of patients we spoke with considered they had received enough information about their condition, care and next steps. However, a patient told us that they did not know "what was going on".

The trust had an online platform/ application called MyCare Croydon Health Services. This was an online system servicing Croydon University Hospital and Purley War Memorial Hospital, for patients 16 and over, where patients can look at their hospital records, view hospital appointments, receive a selection of test results and receive messages from their hospital care team. It is also available from a smartphone. The trust has started to integrate this portal with the NHS app.

The service also used the London Care Record which enabled a variety of professionals to review key information. The London Care Record is used by health and care professions involved in a patients care. It is a secure way of reviewing information to help communicate between care professionals across London.

There was a variety of information provided in the department in relation to health care, either displayed publicly on walls or screens or as part of leaflets and other materials. Information was provided in different languages and large print if required.

Discharge letters were sent electronically to GPs and other professionals if required (for example community nursing). The London Care Record meant different professionals could see key information about patients to ensure their care was planned and transition between services was managed. Patient records were held on a secure electronic patient record system which was accessed by individual staff log in.

There was a screen in the emergency department that displayed information for patients. The content could be changed according to feedback so if a particular concern was raised by a patient, the information could be changed to address those concerns.

The department had access to a translation line at all times which included British Sign Language and there was also option to request face-to-face interpreters. More broadly, the service was sensitive to multi faith needs with arrangements in place to support these wherever possible. One member of staff described how they had responded to specific needs, enabling them to meet with external religious leaders.

Staff received General Data Protection Regulation training (GDPR). Completion rates were inconsistent.

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.

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.

The service did not always provide care in a timely way. The service 4-hour time to decision was worse than the England average with a higher proportion of 12 hour waits in the emergency department. The service had made some adjustments to enable access for all, but the department was crowded with regular use of escalation areas that were not designed for patient care.

Staff told us long delays in these areas were common. On each of the days we were onsite, there were approximately 45 patients awaiting admission at 8am. Staff confirmed this was a regular occurrence and long waiting times for a bed following a Decision To Admit (DTA) were common. The longest wait in majors on 2 April was more than 50 hours. The longest wait in the nurse cohort corridor was 9 hours.

The emergency department was largely in line with the regional and national average for patient waiting less than 4 hours from arrival to admission, discharge or transfer. In January 2025, 61% of patients were seen within 4 hours, which is below thel standard of 78%. Staff told us the department met this standard for March 2025.

There were long waits for patients being admitted. Whilst the non-admitted pathway (such as through the urgent treatment centre) performed well, this was not the same for the admitted pathway.

Between February 2024 and January 2025, the percentage of patients waiting between 4 and 12 hours from a decision to admit to admission at the hospital had been consistently much higher than both the regional and national averages in the last 12 months.

Data from NHS England Digital showed that patients who go on to be admitted at the trust experienced much longer waiting times in the ED than the regional and national averages, which has been a consistent trend over the last two years.

On average, in December 2024, admitted patients waited 7 hours longer than the average nationally (13 hours and 48 minutes at the hospital compared with 6 hours 31 minutes nationally).

However,non-admitted patients tended to have shorter waiting times compared to the national and regional average, which has been a consistent trend over the last two years. This indicated that performance in the emergency department was around flow into , around and out of the hospital.

Compared with both the regional and national averages, the percentage of patients who left the emergency department before being seen was considerably lower, which has been a stable trend over the last two years.

Information provided by the trust included an action plan in place to address some of the issues raised in the Getting It Right First Time (GIRFT) data however, the plan was dated to 2020 and most recent GIRFT data was from January 2025. The (GIRFT) programme is a national NHS England programme designed to improve the treatment and care of patients through in-depth review of services, benchmarking, and presenting a data-driven evidence base to support change.

This meant we were not assured that all information available was being used to drive improvement including equity of access.

Due to flow in the hospital patients spent long periods in the department and escalation areas.

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.