New Cross 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

We rated caring as requires improvement. We looked for evidence that people were always treated with kindness, empathy, and compassion. We checked that people’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

At our last inspection we rated this key question good. At this inspection, the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for, or treated with dignity and respect.

The service was in breach of legal regulation in relation to dignity and respect.

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.

Staff mostly treated patients with kindness and compassion. However, due to crowding in the department and the difficult environment there were some concerns about patient’s privacy being always met. This was recognised by most of the staff who were doing as much as they could to support privacy and dignity for patients.

We found staff were kind and trying their best to provide good care. Staff were mostly discreet when caring for patients. Staff mostly interacted with patients in a respectful way, but they just did not have the time to give them the care they needed all the time. One patient told us “The staff are caring but they are too busy”, and “staff are doing the best they can, but I feel sorry for them” another said, “I wouldn’t change anything, they look after me”.

Staff told us they did not have time to give the patients the care they needed. One member of staff told us they did not feel that all the staff were caring and they would not be happy for their family member to be treated in the department. Another told us “The quality of care is poor as nurses are rushing”.

We observed patients being triaged and this was not done confidentially. Triage doors were left open and other patients were sat outside and could hear everything. We fed this back to the managers who informed staff about their requirements to see patients in a confidential environment; the following day we observed triage and found all doors were closed during consultations.

We saw some examples of good care and had some comments from patients including “staff were so caring” and “they explained everything to me very well and made sure I understood”. However, we also found examples of poor care. We saw a patient who was exposed in ARC by 4 paramedics whilst changing the patient without closing the curtains. We were also told about a verbal complaint as the patient had been told to go to the toilet in an incontinence pad rather than be taken to the toilet by a member of staff. Patients in the ambulance offload areas in majors had examinations behind screens which did not always maintain dignity and the curtains around the trolley spaces did not close.

We saw compliments were discussed in ED governance. Compliments included comments such as “I owe the doctor a huge debt of gratitude and I want to acknowledge their professionalism and skill”, “All staff were pleasant, kept us informed and tried their best – we cannot ask anymore.” And “the receptionist consistently demonstrated professionalism, empathy and patience. They treated every individual with respect and kindness, remaining calm, polite, and caring in all their interactions”. The service received between 2 and 10 compliments monthly.

Patient information was not always kept confidential in conversations. For example, in ambulance offload, ARC and SDEC there were curtains between bedspaces and limited space to have conversations. In ambulance offload, there were 4 extra chairs in the area which were very close together and provided no privacy; patients stayed on these chairs overnight at times. Staff commented how they found it uncomfortable at times to speak to patients when they knew conversations were overheard.

Staff and managers recognised privacy could be an issue at times. There were a few spaces in the department they moved patients into if they needed to perform a procedure or needed a private conversation, but this was not always possible due to the high volume of patients being seen.

There was 1 relatives’ room in ED, 1 relatives’ room in Paediatrics and 2 SWAN relatives’ rooms which were quiet and away from the main corridor where private conversations could be had.

We spoke to a few families in the PED and they were happy with the care despite the long waits in the department. One told us “The whole team was fantastic and very child focused”.

Staff collaborated with other experienced colleagues to provide support for people with mental ill health including children and provided support with emotional wellbeing. Staff understood and respected the individual needs of each patient and showed understanding and a non-judgmental attitude when caring for or discussing patients with mental health needs. A patient we spoke with noted, “Some of the staff have been fantastic.”

Members of the psychiatric liaison team completed full bio-psychosocial assessments to ensure patients received the most appropriate care for their needs.

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.

The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. We saw staff working diligently however the pressures within the department meant they did not have time to respond to people’s immediate needs which meant there were significant shortfalls in care.

Patients we spoke with told us they did not always feel listened to by the team who was looking after them. For example, we spoke with a patient who had fast atrial fibrillation. They required heart monitoring and had not been seen by the nurse, no one had told them the plan of care and were just told there weren’t any monitors. They felt scared and not listened to. There were long waits in the department and not all patients we spoke with were aware of their plan of care. Patients waiting for long periods of time were frustrated and told us they didn’t feel communicated to.

People often spent more than 12 hours in the department and staff supported them with their needs where they could, but this was not always possible. One patient we spoke with noted that they had not been offered a shower in the 72 hours they had been in the department.

The service had hourly checklists for each patient, but these were not completed hourly. They included an hourly task of ‘offered refreshments’. This was not completed in any of the notes we reviewed. Staff told us they did not have time. Patients we spoke with told us they did not always get drinks when they asked. Staff in SDEC told us they completed drinks rounds including the waiting room and there was a supply of water in the waiting room which was kept topped up. Meals were provided for patients who were in the departments, although not in the waiting areas where some patients waited over 12 hours.

We saw that not all staff had visible name badges. We were at the nurse’s desk in ED and saw 12 members of staff in the department who did not have a name badge on within a 5 minute period. We also spent time in triage and found staff did not always introduce themselves to the patients.

The service completed a friends and family test monthly. Results were overall positive. Across all months, positive ratings made up the majority with ‘very good’ consistently accounting for the largest share.

In September 2025, 65% of patients would recommend the service. Results slowly declined from July 2025 to September 2025. Pain management and post-discharge communication scored consistently low. July showed a relatively stronger performance in questions about kindness, confident and communication about the patient’s condition.

The service had additional ideas to strengthen the plan relating to volunteer support and enhancing patient experience which included comfort packs, visible volunteer identification, feedback loop for staff, link into equality and inclusion and produce a patient information leaflet to explain why waits happen and how to raise concerns; we saw this patient leaflet in draft form.

Staff mostly responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress. We found patient call bells were answered promptly and despite the long waits in the department, patients felt the care was good.

We had mostly positive feedback from patients who recognised the difficult environment staff were working within. Some patients told us communication could be poor at times when they were not sure what was happening. One patient told us they felt like they had been “dumped in a room and left”. Others told us staff had “gone out of their way to help” and they felt listened to.

We saw the care patients received in the resuscitation area was prompt, responsive and well-coordinated.

The paediatric ED had a ‘help yourself’ kit bag with a selection of useful items including toiletries, ear plugs, and socks.

The service cared about staff, but more could have been done to promote the wellbeing of their staff and support and enable staff to deliver person-centred care.

People did not always receive safe, effective and person-centred care as the service did not always meet the wellbeing needs of staff. Staff told us they often did not have time for breaks. One staff told us the previous week they had 2 out of their 8 breaks across the previous week.

The staff completed an annual staff survey. The most recent was completed in 2024 and the department compared to the trust overall, were worse in every single question; there were 73 responses. The service created an action plan and the focus for ED was ‘we are recognised and rewarded’. Staff members were approached to become champions to harness the support in the department. They launched a suggestion box in the key staff rest areas where staff could anonymously say ‘just one thing’. Suggestions were collated and fed back to staff via “you said, we did” initiative. There were monthly ‘Matron surgeries’ in place. These aimed to provide staff with the opportunity to meet with a Matron to discuss any concerns, observations or suggestions for improvement within the department in a safe and professional environment.

Staff told us they mostly felt they could give feedback, but action was not always taken if they did. There were not regular team meetings and due to how busy they were it was hard to fit these in. However, there had been some managerial changes within the department and team meetings were being reinstated at the time of our inspection. This was to ensure all staff had a voice and were able to have open discussions about ways to improve the service.

Staff told us the culture was mostly good and there was great teamwork between all staffing groups. Staff described the team as a “fabulous nursing team with supportive consultants” and “fantastic teamwork”. However, there were areas where there could be improvement. We were told relationships were mostly good between the nurses but there were some tensions. There was a disconnect between some of the nursing staff across the bands and this created a poor working culture at times. One member of staff told us they were “scared of escalating issues” and another told us, “bullying happens a lot and some staff just get away with it” and another said it was a hard place to work and they were often “treading on egg shells”. Improvements were needed to strengthen these relationships to ensure staff were enabled to do their job well and to be well at work.

Staff were mostly supported if they are struggling at work. The Trust had a policy and offers suitable support to women going through the menopause although a few staff were unaware of this support available.

Emergency Nurse Practitioners staffed the see and treat rooms and they told us they often did not feel safe. These rooms were out of the way and patients sat closest to the doors. They told us they had done a number of incident reports about security, but nothing had been done.

Staff told us the environment was difficult due to an increase in aggression and agitation from patients waiting a long time to be seen. One staff member told us “We are used to dealing with verbal abuse as patients wait long times”. The main waiting room and some corridors in the department displayed large images of children who depicted children of hospital workers in no abuse to staff posters. They included phrases next to the children such as “there is no excuse for abuse – please be kind to my mum” to try and reduce violence towards hospital staff. But more needed to be done to reduce the abuse staff received. Data showed 97.2% of staff had completed conflict resolution training.

The service had food brought in by consultants every Thursday which the staff valued, and staff told us they celebrated each other’s birthdays.

The consultants had a weekly wellbeing meeting on teams including medical ED consultants; staff told us this was beneficial.