New Cross Hospital

On this page

• 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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

We rated effective as requires improvement. This meant people’s outcomes required improvement. The service did not always ensure people’s care was completed in line with national standards or guidelines and the teams did not always work well to support each other.

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.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards. We saw up to date guidelines displayed in most triage and resuscitation areas. However, we saw the resuscitation council UK guidelines in resuscitation room 7 were out of date; they were for 2020 rather than 2025.

The trust's intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected current practice. It had guidance for staff around collaboration with multi-agency teams and for delegation of clinical tasks to ensure the right people delivered evidence-based care and treatment.

Staff gave people clear information about their care and treatment needed to support their physical and mental health.

The service participated in clinical audits which enabled them to show care was being provided in line with national recommendations and best practice. Although we found there were not always action plans to improve compliance.

There was a consultant who was the guidance lead who ensured guidelines were updated in line with national updates. For example, they had recently updated their head injury guideline in line with the National institute for Clinical Excellence (NICE) and their sepsis-six proforma in line with UK Sepsis Trust. We saw guidance was discussed in ED directorate governance meetings and included action plans to achieve compliance.

Evidence showed that the service did not always deliver evidence-based care and treatment. Despite the fact that guidelines were up to date, care was not always delivered in line with these. For example, venous thromboembolism (VTE) risk assessment audits results from August, September and October 2025 showed 56%, 18% and 33% of patients had a completed VTE risk assessment respectively. There was no associated action plan with this.

Members of the psychiatric liaison team completed full bio-psychosocial assessments. This meant they looked at the patient as a whole picture including the biological, psychological, and social support. We reviewed 2 sets of notes for patients who attended with mental health needs and found they had fully completed full bio-psychosocial assessments. Staff worked with partners to avoid admissions. On the day of the inspection, members of staff attended a care and treatment review to consider whether to admit a patient in the department.

The triage process followed evidence-based practice and patients were graded in accordance with the seriousness of their presenting complaint. There was a colour-coded scale on the computer programme to give a visual appearance of those patients who would need more urgent review. The time the patients had been in the department was also colour coded to indicate those waiting longer than the national standard waiting time and gave a visual warning to staff about delayed treatment, particularly when both more high-risk trigger colours were indicated.

The staff were supported to deliver evidence-based care in line with their Royal College of Nursing (RCN) Competency Framework for Emergency Nursing by practice education facilitators. At the time of the inspection, they had all been redeployed to work within the department due to staffing levels.

The service did not always work well across teams and services to support people. Staff worked well together in their own environment but did not always ensure that people were seen in the appropriate environment by the best team. SDEC staff told us, and we saw, inappropriate patients were transferred to SDEC from majors, triage or streaming outside of their criteria. This meant some patients were transferred back down to majors which created a poor patient pathway and created conflict amongst the teams at times.

Staff told us they had to wait hours for some specialities to review their patients. There were interprofessional standards, but they were not adhered to. Patients were not reviewed within 30 minutes as per these standards. Doctors from ED chased their colleagues to review but told us they often had pushback from the teams on the wards and there was a lack of respect. Managers told us they did not review data based on speciality reviews and response times. We raised this with the trust, and they told us they had reinforced the interprofessional standards standard operating procedure and communicated to clinicians. They had also commenced a weekly audit of response times.

Staff mostly followed up radiology concerns. Radiologists reviewed radiology results and communicated the findings to the clinicians involved in their care and any patients who required further treatment were recalled. Audit results showed in October 2025 83% of radiology results were filed and of those unfiled, 5% were viewed which meant 11% were not viewed. This had decreased from August 2025 where 97% were filed and only 1% not viewed from those unfiled. We saw evidence of a patient who had a delay in reporting and no action taken to recall them. We asked the trust to provide assurance that the radiology recall process was robust. They told us any missed findings of significance were acted upon and discussed in the weekly ED incident review meeting. They recognised the need to strengthen oversight to deliver more reliable assurance and from 8 December 2025 a register for all discrepancies and recalls will be in place and a recall audit will be undertaken weekly to ensure discrepancies are reviewed and reported monthly in line with their processes.

The trust worked with the local NHS ambulance trust and a hospital ambulance liaison officer who was based in the department’s emergency ambulance entrance 3 long days a week. They were the link between the ambulances arriving and waiting and the emergency department staff. This was to help ensure the transition of the patient from the ambulance into the emergency department.

Most staff told us there were good relationships between doctors, consultants, nurses, and paramedics who worked together closely to provide the care to patients with no hierarchy between the different roles. Nurses told us, “Consultants never leave on time, they have a really good relationship with the nurses and they listen to us”. However, some staff felt relationships could be improved between the nursing teams.

Staff told us there could be improvements to the way beds were managed. For example, a doctor in PED told us some of the issues with delays were due to communication between bed managers, ED staff and clinicians and there was no one individual organising the admissions to the ward process and this often-caused delays.

Information was shared between teams to ensure continuity of care. There were handovers at shift changeover for both the medical and nursing teams. The paediatric team attended the main ED handover. This ensured the staff were aware of risks within both departments and the nurse in charge of ED had a good understanding of the staffing and potential risks in PED. We observed both the nursing and medical handovers and found them to contain relevant patient information. We found staff discussed high risk patients within the department and a snapshot of learning points.

There was an ambulance receiving centre (ARC) where rapid assessment and triage was undertaken for patients arriving on an ambulance. The nurses and doctors assigned to ARC worked alongside the ambulance staff to ensure there was safe and effective care for patients who were waiting on the ambulances for long periods of time.

There was a rapid intervention team for admission avoidance. It was based in people’s homes and patients and paramedics could self refer to the service. It was staffed by consultants, ANPs and paramedics.

There was a Child and Adolescent Mental Health Service (CAMHS) available from 8am to 8pm 7 days a week. They stopped taking referrals after 6pm. Staff told us it was a good service.

There was a bed meeting 3 times a day. They worked together to try and ensure there was flow for the patients from the ED into the hospital amongst a significant shortfall of bed capacity. There were often no beds available which caused the long delays in ED. They used a push model to identify patients who could be moved to the wards and create more space in the ED.

There were progress chasers who helped to chase the speciality referrals and make things easier for the staff. We found them to be patient focused and dynamic.

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 did not always routinely monitor people’s care and treatment to continuously improve it. Staff did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. However, changes had been made since the inspection to drive improvement in patient outcomes.

Managers and staff did not use audit results to improve patients’ outcomes. They carried out a programme of repeated audits to check improvement, but actions were not always taken to address shortfalls or communicated effectively to staff. For example, the service completed documentation audits monthly, but results showed little improvement between July, August and September 2025; results were 75.5%, 80.4% and 71.7% respectively. We saw no action plan associated with the audit. The audit was discussed at ED governance in September 2025 and October 2025 but no actions were created to make improvements. We saw documentation was not well completed on our inspection.

We were not assured that all patients at the time of the inspection were reviewed by a consultant prior to discharge if they presented with certain conditions such as non-traumatic chest pain, in line with RCEM standards. The trust told us they had changed to a new system which required the nurse to identify patients that required consultant sign off prior to discharge and request a senior review. The leadership team have submitted a request to change this and were auditing the conditions to ensure there was consultant review prior to discharge. Results of the audit were not shared.

There were not always effective approaches to monitor people’s care, treatment, and their outcomes. This meant continuous improvements were not always made. For example, managers of the ED were not looking at the safety measures or the quality of care for the SDEC. They did not evaluate the length of stays, decision to admit and ‘did not wait’ patients. This meant there was a lack of oversight of the potential issues in SDEC and no analysis of data for learning and improvement. ‘Did not wait’ patients were not followed up by clinicians. Following the inspection, the trust commenced a baseline assessment of organisation and individual attitude to safety using the Manchester Patient Safety Framework to establish the baseline of safety culture. This will form an action plan which will be overseen through progress reports to the quality and safety oversight group. The ED audit programme was to be updated to include “did not wait” patients in SDEC so that follow up of these will be actioned in a timely manner. They also introduced real time reporting which included length of stay on SDEC.

Time critical medications (TCM) were not well managed. We saw results of the TCM QIP from 2023 to 2026. Data from the RCEM TCM Quality Improvement Program between May and September 2025 showed of the 95 patients reviewed, 34 patients who had Parkinsons were not identified as on time critical medicines. The team were working to make improvements to ensure all standards were being adhered to. They displayed posters around the department, provided education resources and teaching, change in practice and worked in partnerships with pharmacists to improve TCM practice in the ED. We saw data for TCM had improved from 2024 to 2025 and time to identify TCM had improved from 2 hours 49 minutes average to 2 hours 30 minutes.

The SDEC pathway was not effective. We raised this with the trust who put immediate measures in place. They reconfigured the department to ensure a clearer pathway for ED and Medical patients in the SDEC to improve flow. We saw patients were prescribed venous thromboembolism (VTE) prophylaxis within 14 hours of hospital admission, but VTE risk assessments were not completed prior to the medication being prescribed. The VTE policy stated a risk assessment must be completed within 4 hours of admission. It was not clear when this started as patients waited for long periods of time in ED which increased their risks. However, their long stay pathway stated that patients in the department for more than 12 hours must have a VTE risk assessment and prophylaxis if required. In all notes we reviewed where patients were over 12 hours, there were no completed risk assessments, but prophylaxis was prescribed. The service looked at lower limb immobilisation VTE risk assessment compliance. Results from August, September and October 2025 were 56%, 18% and 33%, respectively. There was no associated action plan with this. The service also completed a long stay audit in January 2025 which looked at VTE completion if a patient stayed longer than 14 hours. Results showed 1 out of 23 patients received a risk assessment within the timeframe. There was no action plan with the audit to improve compliance.

Staff did not always act promptly when patients had suspected sepsis. There was a consultant who was the lead for sepsis and completed monthly audits. They told us compliance had improved since they could see up-to-date NEWS2 scores on the computer system. Sepsis leads completed a monthly audit of patients who were diagnosed and treated for sepsis. Results had improved from August 2025 where only 50% of patients were given antibiotics within the first hour to 72% in October 2025. In October 2025, the results had reduced since September 2025. There was no action plan associated with the audit, but the outcome of this audit was presented to the medical staff and emailed to all staff in the department. There was a deteriorating patient group from the department who met bi-monthly. They discussed the audits and fed these back to their peers. There was a project for improving the urine output monitoring and documentation element of the sepsis pathway by May 2026 which had started in September 2025.

Patients pain relief was not monitored in line with their own local standards of every hour. Staff asked patients about their pain and patients we spoke with told us staff gave them pain relief when asked. The service had an hourly checklist which asked the patients their pain score. We found this was not completed hourly, but when it was done, pain scores were completed.

Staff did not always meet patients’ nutrition and hydration needs. Some patients we spoke with had not been offered drinks or food, and they had been in the department for over 12 hours. However, others we spoke to told us they had been offered hot food and there had been regular drinks rounds. Staff in SDEC told us they did drinks rounds to all SDEC patients and relatives, including those in the waiting room. In ED food was offered to patients in majors who had been there over 8 hours and were in a cubicle. They had hot lunches and sandwiches for dinner. There were no drinks rounds; these were ad hoc by the nurses and HCA’s when they had time. Patients in ARC had access to sandwiches and biscuits when required.

Data for patients who left before being seen for August and September 2025 was 3% This was better than the national average.

The service participated in the RCEM quality improvement programme (QIP). The QIP had clear projects outlined for improving patient safety and experience in emergency department in line with RCEM standards. These included projects around care of the older people and time critical medicines.

The care of the older adult QIP commenced in 2023 and lasted into 2026. They looked at 3 key standards against the national average. Data showed they performed better than national average on most of the key standards. Areas for improvement were identified including improving the usage of clinical frailty scores. We saw this was not completed in 1 triage assessment we observed but did not look at this specifically in other notes to confirm if this was consistently not completed.

The service had started a home leave QIP to understand if patients who were sent home on the home leave pathway understood what was involved. This meant they were sent home and brought back in for treatment when required. They had conducted a survey with patients which concluded there was a lot of confusion around home leave. They were looking into ways to improve the pathway. We saw a patient leaflet which had been developed to inform patients about the process.

The service participated in a QIP to transition radiology requests to an online system. Data showed following this there was a reduction in duplicate requests, faster turnaround times and improved communication.

The service participated in a trauma QIP which aimed to improve outcomes for patients who had sustained trauma associated time delay by reducing the time from arrival in resuscitation to the trauma scan being completed against the gold standard of 30 minutes which is recommended by NICE guidelines. They completed 3 intervention cycles which included different education and communication around the standard. Results showed there were significant improvements in time to requesting trauma scan from the first intervention and overall had improved to around 30 minutes in May 2025. The QIP was ongoing at the time of the inspection.

The service participated in the Getting It Right First Time (GIRFT) program for emergency medicine. Data showed monthly patient outcome data including areas to be addressed which was updated and compared to their local regional trusts. There was an associated action plan to improve outcomes for patients in the department which was updated monthly. However, leaders did not have much insight into GIRFT and they told us they tried to follow it, but it was not monitored at the time of our inspection.

There was a new matron who had started to have team meetings. They had recently had a band 7 team meeting. They sent important updates by email but staff we spoke with could not remember recent audit results and changes that needed to be made. The band 6 in charge on SDEC completed a spot check of five sets of notes daily and spoke to staff if there were shortfalls in the documentation. They told us there were shortfalls daily due to time constraints and staffing levels.

The service acted on some feedback from staff. For example, patients had long waits in SDEC which had caused an increase in aggression, particularly overnight. Managers had therefore limited the number of patients who could be in SDEC overnight. They were also having a meeting in December with the patient experience team to come up with an action plan to make improvements as they had seen a high number of complaints regarding the environment and waiting times in SDEC.

The pharmacist had been involved in quality improvement work to demonstrate the importance of a pharmacist in the ED and how it improved outcomes for patients. This had led to a pharmacist being assigned to the ED Monday to Friday.

Staff knew the actions to follow when a patient left the department. The trust’s missing patient policy had been updated in October 2025. It provided staff with a flowchart to follow in line with the Right Care Right Person guidance, including a due diligence form on when to contact the police.

All ACPs had 20% of their job plans allocated to supervised professional activities. There was a lead nurse for research within the organisation, who supported nursing research in urgent and emergency care. Active research was ongoing in the PED.

The paediatric and ED main teams discussed regular attenders to the department at the High Intensity User group. The department’s unplanned reattendance rate within 7 days which included any readmissions within 7 days of departure had slowly increased throughout the year and ranged between 6.7% in March 2025 and 8.1% in November 2025. However, this was still better than the national average which remained around 9% throughout the year.

The service was significantly worse than national average for ambulance handovers taking over 60 minutes. The service monitored the ambulance handover times. We looked at data from April to November 2025 and saw the average handover time increased each month. In April 2025 it was 30 minutes and by November it was 1 hour 6 minutes. The service performed significantly better than the national average between September and November 2025 for the percentage of ambulances taking 30 to 60 minutes to handover. However, they performed significantly worse than national average for handovers taking over 60 minutes. Data showed in November 2025 29.7% of ambulances took over 60 minutes to handover. This was significantly higher than the national average; the regional average was 22% and the national average was 7.7%.

The average time to initial assessment ranged between 20 to 46 minutes and fluctuated across the months.

Patients spent on average 318 minutes in the department across the last 12 months. Since September 2025 it was higher than this at 376 minutes and had reduced slightly by November 2025 to 348 minutes. Data was mostly better than the regional times.

Some patients waited over 12 hours following a decision to be admitted (DTA) to the hospital. We saw this was higher in the winter months than the summer. In August 2025 they had 180 DTA’s over 12 hours, whereas in November 2025 there were 637. The percentage of patients spending 12 hours or more in ED after decision to admit was worse than national average, whereas in the middle half of the year it was better. In November 2025, 20.1% of patients spent over 12 hours in the department from decision to admit, the national average was 12.8%.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff displayed appropriate knowledge and understanding of mental health and mental capacity issues. They understood how and when to assess whether a patient had the mental capacity to make decisions about their care. Training data did not show that staff completed training for mental capacity act or consent.

We observed staff gaining consent from patients in line with legislation and guidance in relation to care and treatment and saw this was documented in all records we looked at.

There was a clear pathway for patients on a Section 136 order. They followed ‘right care right person.’ The Police contacted the mental health team and discussed whether the Section 136 was warranted. Black Country Mental Health team had an urgent care response team which was staffed by a band 7. The mental health team told us they thought that the communication and response has improved. Although ED staff told us the Section 136 did not work well and patients were not always managed well in the department. The ED was used as a ‘place of safety’ 6 times in October 2025 and twice in September 2025.

Security staff were used for the safety of patients. We observed security restraining a patient during our inspection. Security members of staff had received a 2-day training course in restraint. Security staff completed body maps following any restraint, and this was audited.

Staff had protocols for administering rapid tranquilisation and guidance was available for this.

Staff supported children and their families in decision making about their care and treatment. Staff understood the process to assess whether a child had the maturity and competence to make their own decisions and give consent to any care or treatment.

There was a Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) action plan which was up to date. This included actions such as ‘trust wide MCA compliance audit’ and ‘to understand staff barriers to undertaking mental capacity assessments’. Completion dates were January 2026 and on track for completion.