New Cross 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

We rated responsive as requires improvement. We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of the legal regulations relating to safe care and treatment due to long waits, crowding and lack of flow in the department.

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 mostly made sure people were at the centre of their care and treatment choices. People understood their condition, care and treatment options. Most patients were aware what they were waiting for in the ED. A few patients we spoke with were unaware of the next stage of their care. This was mostly patients who were told they were waiting for a bed to become available in the hospital, but they had no idea where or when this would be. 

The department had access to designated specialty leads, for example, for frailty, and trauma. The service were further supported by in-reach services to support person-centred care, for example, for cardiology, tissue viability and learning disabilities.

Staff made sure most patients living with mental health conditions, learning disabilities and dementia, received the necessary care to meet all their needs. Communication ‘flags’ were present on the patient information system which highlighted if a patient required further support or required reasonable adjustments. The triage nurse or HCA would be alerted to any of these needs prior to calling the patients for review. This ensured any patient with specific needs could be managed in an appropriate way that considers their needs from a communication perspective. However, we did see in SDEC there was a carer who could not find their relative with dementia in the waiting area.

Data showed 99% of staff all had learning disability and autism training.

Staff had support from the hospital’s vulnerabilities team who supported people with specialist needs. The team attended emergency department when they saw a patient was admitted who had vulnerabilities. We saw in the PED there were 2 sensory rooms. We saw a patient who had autism was moved into one of these rooms, alongside their parents, as they were unable to cope with the noisy waiting room and this really helped to settle the patient.

There was a frailty team who supported the ED daily from 8am to 8pm. They reviewed the patient list within the department first thing and transferred appropriate patients up to their ward. Staff told us every morning a few patients were moved to the frailty unit and the team were helpful. They attended the department twice a day minimum to identify appropriate patients.

The PED did not have a play specialist. However, staff could request support from the play specialist on the children’s ward, typically this would be to help support a child with additional needs or challenging behaviour.

Staff were aware of Recommended Summary Plans for Emergency Care and Treatment (ReSPECT) forms and their role in supporting patients requests in terms of their care. We saw ReSPECT forms were available in a few patients notes we checked.

Staff tried to ensure patients with a long length of stay in the department were moved onto a hospital bed with a pressure relieving mattress, where needed. We were told there often were not enough beds to do this for all patients who needed it. We saw some patients received regular skin integrity checks, but not all had this completed hourly as per their checklist due to time constraints.

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 mostly supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The main waiting room had automated up to date information regarding waiting times that was relevant to them displayed on a large screen.

The service had a streaming nurse 10am until 10pm 5 days a week who has allocated to the waiting room to help guide patients to the right department. When needed, they escorted patients to the correct areas. When they were not there, patients went straight to the reception desk. We fed back following this inspection that this process meant not all patients were streamed appropriately and did not always know where they were going. Following the inspection, the service put in runners into the waiting room to assist patients with where they needed to go and ensure the streaming nurse could remain in the waiting room.

All patients who were discharged from the ED had a letter sent to their GP which showed the care received and any updated medication on it. Patients were verbally told this information and could request a copy of the discharge letter if required.

The PED had information posters displayed, all with a QR code so it could be viewed on a mobile phone.

The trust had a drug and alcohol liaison team who provided input and support to the department.

Information about patient care was shared between shifts and departments. ED staff completed situation, background, assessment, recommendation (SBAR) handovers when moving a patient to a ward area. This ensured good continuity of care. There was a handover between staff in the department at the beginning and end of each shift. This included highlighting patient risks and any safety aspects of care. Throughout the day staff approach the nurse in charge and the consultant in charge to discuss any patients they had or needed support with.

There were lots of information leaflets for patients on a range of different subjects, but they were not available in languages for patients who did not speak English as their first language visible in the department. Staff could access a telephone or face to face interpreter for people whose first language was not English, including people who used British Sign Language. Staff told us they did not access interpreters very often.

There was a newly implemented electronic patient record for managing patients records within the department. Staff had received training on this and felt it had improved their processes.

Patient information was discussed at monthly directorate governance meetings. We reviewed 2 sets of minutes and found updated patient information leaflets were discussed in line with new guidelines being produced.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People could give feedback about their experiences of care and support including raising any concerns or issues. We saw information in the waiting rooms about how to complain about the care. They had recently introduced the ‘mystery patient scheme’ where patients could scan a QR code and provide anonymous feedback. Themes from this included staff attitude and waiting times. Each individual feedback was sent to the area daily for their review from the mystery patient questions. The patient experience team attended the area monthly to provide verbal feedback on patient overall feedback themes. Managers told us they had put on communication training for staff and challenged poor behaviours. There was a dashboard in development which will be launched in 2026 which will contain detail around patient feedback.

The trust’s website provided clear information about how to make an online, written, or verbal complaint and how quickly people could expect a response. There was information in the form of “tell us what you think” posters in the waiting room in different languages.

Learning from complaints and concerns was seen as an opportunity for improvement. All formal complaints were discussed in clinical governance meetings, and we saw completed action plans for formal complaints. For example, 1 complaint action included bespoke end of life training to be given, another was sharing learning with the team regarding the importance of compassionate communication with patients. All the action plans we reviewed showed actions were complete.

Within the last 12 months, the service had received 130 formal complaints, only 3 of these were for PED. This is the equivalent to 0.09% of attendances resulting in a formal complaint. Staff told us patients mostly complained about lack of communication, and long waiting times. This was due to the increase in demand from patients and meant the pressures within the department were higher and there was less time to communicate well with all the patients and less space for patients to be in.

Staff understood the policy on complaints and knew how to handle them. Managers investigated complaints and identified themes. The themes were shared with staff as a ‘word cloud’. If a complaint theme was continuous, it would then be raised as a risk. The governance team produced a monthly assurance report. This detailed the complaints received and looked at themes found. We saw lessons learned were created for complaints. Complaints were graded and reviewed at governance meetings.

There was support for patients who had complex needs to coordinate the care required. For example, during our inspection there was a patient who had learning disabilities and a multiagency meeting was held to ensure the best care was provided for the patient.

We reviewed five duty of candour letters including a case for PED. They all involved learning and apologies to the patients or relatives for the incident which had happened and they told them what had been actioned because of the incident.

The service did not make sure that people could access the care, support and treatment they needed when they needed it.

Patients did not receive an initial assessment within 15 minutes of arriving in the department in line with the national standard. There were long waiting times for patients to be triaged. During the inspection we observed, there were 222 patients in the department, 7 were being held outside on ambulances, the longest had been outside 5 hours and 10 minutes. The longest patient had been in the department was on SDEC and they had been there for 57 hours and 54 minutes. There was a 2-hour 7-minute wait to be triaged. On average between 1 October and 30 November 2025 in the day, the average wait for triage was 51 minutes and at night 40 minutes. The service also recorded the maximum waiting time and on 39 out of 61 days this was above 200 minutes in the day. On 1 occasion the longest waiting time was 518 minutes. At times throughout each day there were waiting times of 0-2 minutes, but most patients waited significantly longer than the national standard of 15 minutes.

There were no observations completed for patients whilst they were waiting to be triaged or clinical oversight of these patients. We were told overnight the wait for triage increased and there were 3 to 4 hour waits for triage. The service had recognised there were failures in triage and deployed more senior staff to assess in triage but did not always ensure times were in line with national guidance.

We raised this with the trust, and they added in an additional HCA to support with key tasks in the waiting room such as observations and ECGs. The streaming nurse role had been enhanced to include observation taking which aligned with RCEM prioritisation standards.

We saw most children and young people (CYP) attending emergency care settings had a clinical assessment undertaken within 15 minutes.

We saw evidence that patients who arrived with chest pain were waiting long periods without an electrocardiogram (ECG) being completed or observations taken. We reviewed five sets of notes where patients had attended with chest pain and found only 1 had an ECG within 15 minutes of arrival in line with their pathway. We raised this with the trust who increased the resource allocated to triage which they hoped would drive compliance with this pathway. They implemented a daily audit to track the effectiveness of the chest pain pathway.

Staff in triage all had the appropriate training to ensure they could recognise critically ill patients. These patients were prioritised according to acuity using a recognised triaging system.

Not all patients received a full clinical assessment within an hour of arrival into the department. During the inspection, at 7am there was an 11 hour wait to be seen initially by a clinician in majors and 12 hour wait in SDEC. This improved and later in the date there was a 3 hour 6-minute wait to be seen. On average in November 2025 patients waited 9 hours and 45 minutes. Staff told us they often had abusive patients due to the long waits. Staff told us long waits built up overnight due to poor medical staffing. They had a poor skill mix of doctors resulting in a junior workforce and lack of ability to make senior decisions. Consultants often had to step down into registrar positions to cover the nights to ensure safety for the patients. We saw limited action was taken when waiting times were not met.

Ambulance handovers did not always occur within 15 minutes. However, all patients who arrived by ambulance were brought into ARC for an ‘eyeball’ assessment by the nurse in charge. This meant they could bring in any patients who were at risk of deterioration promptly. On 26 November 2025 at 1pm, there were 9 ambulances waiting outside. We spoke to a paramedic who had been waiting for 1 hour with a severely disabled non-verbal patient who had a chest infection. They told us the staff were working to get them seen in ARC. NHS England had brought out the 45-minute ambulance handover time standard. Data showed the service was better than England average for ambulance handover over 30 minutes from May 2025 to July 2025 and then it increased and in September 2025 it was 32.2% whereas national average was 26%.

The hospital were using a variation of a model developed at a hospital in Bristol to help to relieve pressure on the ED, and to share the risk across specialities. The hospital had started a “push model” where patients were sent up from the ED to the wards before a bed was available. The patient had to be low risk and a low national early warning score. We saw patients moved at 7am to release the pressure in the ED using the push model.

Some measures in the department were better than the national average. For example, the percentage of patients who were discharged, admitted, or transferred within 4 hours of arrival was consistently higher than the national average. Data from January 2025 to September 2025 showed they were consistently above 70% whereas the national average was 55.1%. However, this did not translate to what we found on inspection as waiting times were consistently high in November 2025. The mean time in ED for admitted patients was consistently better than national average between 6.5 hours and 4.1 hours in 2025. The national mean time was 8.3 hours.

The inability to review and admit patients in a timely way increased crowding and reduced flow in the department. NHS priorities and operational planning guidance set a revised and temporary standard that 78% of patients should be admitted, transferred, or discharged within 4 hours of arrival in the emergency department. This was temporarily reduced from the 95% NHS constitutional standard. Data showed that in November 2025 62.6% of patients spent 4 hours or less in ED. They were consistently better than the national and regional averages throughout 2025.

Data showed patients who waited over 12 hours in the department after decision to admit (DTA) had increased since August 2025 where only 2.9% of patients waited over 12 hours after DTA which was better than both the national and regional average. In November 2025, 20% of patients waited over 12 hours after DTA. This was worse than the national and regional average.

The service streamed less urgent patients to their urgent treatment centre or SDEC based on a set criteria; both of which were open 24 hours a day 7 days a week. We saw these criteria was not always followed which meant patients were not always in the best department to receive the care safely that they needed.

The SDEC saw a high volume of patients. It helped with capacity constraints for the ED, but the unit was often full and did not have enough space to take all the patients who were diverted there from ED. We found multiple examples of patients who were inappropriately transferred to SDEC and were not within the criteria. SDEC was used to accommodate the volume of patients in the ED rather than for its intended purpose. It became very overcrowded and there were very long waits to be seen, and this contributed to a poor patient experience, high waits and increased frustration from staff and patients. For example, during the inspection the longest a patient had been in SDEC was 57 hours and 54 minutes.

Patients were not always seen within 30 minutes of referral to specialist teams. There were agreed internal professional standards, but these were not always adhered to. We were told there was a lack of respect between specialities and the staff in ED often got push back from the ward staff resulting in delays in reviews. Managers told us they did not review the data for speciality referrals at the time of inspection so were not sure if some specialities took longer than others or what the average time for a speciality review was. Following the inspection, the trust had reissued the professional standards and started to audit the speciality reviews.

The trust had a frailty service, virtual ward and other initiatives that aimed to keep people out of the ED and therefore reduced demand on the service, but this was not always the case due to high volumes of patients.

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.