Croydon University Hospital

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• 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

This was a focused follow‑up assessment for this service. At our last inspection, we rated this key question as requires improvement. During this assessment, the rating stayed the same. We specifically looked for evidence that the breach relating to safe care and treatment due to crowding in the Emergency Department had improved. Due to ongoing hospital flow pressures, patients did not always receive timely care and treatment in the Emergency Department. Patients experienced prolonged waits for inpatient admission, which resulted in extended stays within the department. During these delays, staff cared for some patients in environments that were not designed for clinical care, which limited timely access to appropriate treatment and further affected patient experience.

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.

We did not look at Person-centred Care during this assessment. The score for this quality statement is based on the previous rating for Responsive.

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.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

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 (ED) when they needed it.

Due to the crowding in the ED, escalation areas were in use. We reviewed performance data for adult attendances in the ED and Urgent Treatment Centre (UTC) and identified several areas where delays posed potential risks to patient safety and experience. Patients experienced prolonged waiting times across multiple stages of their ED journey. Average time to triage for adults frequently exceeded 20 minutes, which meant patients did not always receive timely clinical prioritisation on arrival. In the United Kingdom (UK), the nationally recommended standard for patients to be assessed (triaged) by a clinician is within 15 minutes of arrival at an Emergency Department (ED) or Urgent Treatment Centre (UTC). Although time to triage was variable, the data we reviewed showed periods of improvement. We saw averages reducing to approximately 17–19 minutes in some months, indicating efforts to improve early clinical assessment.

Performance against the 4-hour standard target (Type 1 performance) remained consistently below expected levels, falling to approximately 59%–75%. This showed that many patients waited longer than 4 hours for treatment, admission, or discharge.

Delays following the decision to admit to a bed presented further risks, with over 680–815 patients each month waiting more than 12 hours for admission, equating to around 6.5%–7.5% of admitted patients.

We reviewed data provided by the trust which showed the longest Emergency Department stays were from 34 hours up to over 127 hours (equivalent to more than 5 days) in the most extreme cases. The longest stays were mainly adult patients presenting in mental health crisis, often conveyed by ambulance or police. A consistent number of patients waited more than 12 hours, reflecting delays in accessing appropriate mental health assessment and specialist input. These longer waits meant that some patients in psychological distress remained in an environment which was not designed to meet their therapeutic needs, increasing the risk of deterioration in their mental state and negatively affecting their overall experience.

Overall, the data provided by the trust showed persistent flow challenges, including delays in assessment, bed availability, and onward placement across a wide patient group. However, following the previous inspection and the issuing of the warning notice the service took immediate action to redesign urgent and emergency care pathways and established a Medical Assessment Area (MAA) to increase capacity and support patient flow. It maximised the use of frailty same day emergency care pathways and reframed discharge lounge criteria to enable timely discharge of patients. The service enforced the ED Full Capacity Protocol in line with escalation triggers and introduced on-call huddles to ensure timely identification and escalation of pressures. Senior leaders strengthened site management arrangements, including enhanced bed meetings, to provide oversight and drive improvements in flow.

The trust put into use a revised medical model and reduced the number of chairs in the sub-wait area to better control overcrowding. It lowered the threshold for boarding to ensure patients were moved more quickly from escalation areas to ward-based care. To further manage flow pressures, the trust used additional capacity, including surge areas and the cardiac catheterisation laboratory. They also introduced regular operational touchpoints to monitor demand and take timely action.

The trust strengthened multidisciplinary clinical huddles and introduced additional roles, including a third streaming nurse and a patient care navigator, to support timely assessment and progression of patients. It introduced ward “safari” reviews for patients with extended lengths of stay and introduced executive-level escalation reviews for patients with prolonged admissions. A real-time discharge tracker was embedded within daily operational meetings to monitor progress against discharge targets and reduce delays, including those associated with external system partners.

The service introduced 2 dedicated homelessness/housing officers in the Emergency Department from 16 January to 31 March, providing consistent support 6 days a week. This early intervention model improved staff awareness, strengthened processes, and ensured that housing needs were identified and addressed promptly at the front door. Plans to extend the service into 2026/27 with 7-day coverage showed a commitment to improving patient support.

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.