New Cross Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We rated well-led as requires improvement. We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question good. At this assessment, the rating has changed to requires improvement. This meant there were shortfalls in service leadership and improvement was needed to the governance systems. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to the governance of the service.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

The service did not have a clear shared vision or strategy. Staff did not always understand the challenges and the needs of people and their communities.

There was no individual strategy, vision or values for the department. There were no plans to document a strategy for the department at the time of the inspection. The service used the trust values.

Most staff and leaders demonstrated a positive, and compassionate listening culture that promoted trust and understanding between them, but it was not always focused on learning and improvement. Some staff told us that the culture was good, that all staff roles worked well together. However, other staff told us the culture was poor, and the staff did not all work well together. We were told SDEC felt like they were not part of ED and it was “them and us”. We were told staff ignored the referral criteria into SDEC and this put patients at risk. For example, they sent a mental health patient to SDEC who had to be sedated, and they had to move all patients in the waiting room downstairs for their safety. Other staff told us there was a divide between the senior and junior nurses and there was conflict and a lack of respect for each other’s roles.

The department was often overwhelmed with patients and there was not always enough staff to carry out all the required tasks in a timely manner. Some staff did not feel this was always supported by the managers and they did not always ensure there were enough staff on shift to enable them to deliver good care. They felt upset that patients were in the department for hours. However, resident doctors spoke positively of their training experiences and said their consultants were very approachable.

The leaders had the skills and abilities to run the service, although were struggling with the demands of the overstretched department with little support from the wider trust. The senior leadership team consisted of the matron, clinical lead and group manager; they had a new group manager due to start the beginning of December 2025. They met weekly, informally, to discuss the department and actions needed. However, we found there was a lack of awareness around issues that we had found within the department. Leaders had also told us about several issues they were aware of and there was a lack of action to implement change to improve outcomes for patients.

We were told the group manager role had changed a lot recently and this lack of stability caused anxiety amongst the team. The matron was new to the role but had been in the department previously as a band 7 and had a weekly matron meeting for support.

There was a monthly meeting between the band 7 nurses and the consultants. They discussed day to day running of the department, staffing issues, performance metrics and any incidents.

Staff completed an annual survey about the workplace. The most recent survey showed the ED scored below the organisation level for every single question. There was a question about compassionate leadership which scored 6 compared to 6.9 overall for the organisation.

We found the ED team had good levels of operational knowledge to lead the department in pressurised circumstances, but this did not always make a difference. One staff member told us, “Seniors respond well to crowding in the department”. There were lead consultants who supported the leadership team in different roles. For example, there was a guidelines lead. Consultants met every Monday and decided their message of the week to be delivered to staff.

There was a lead advanced clinical practitioner who oversaw the ACPs. We were told the communication could be improved and there were no team meetings.

Leaders were supportive of their staff and caring about the service. Leaders were aware of how the ED environment and pressures in the workplace affected the welfare of their staff. We were told they supported the staff who worked hard and tried to ease the pressures of working in such a busy environment. However, some staff told us staffing shortages could be overlooked and shifts were regularly short staffed. There were daily escalations on bed meetings, divisional matron meetings but staff did not always feel the impact of these meetings.

There was a team of band 7 nurses who managed and ran the department supported by the matron. Some staff told us they were approachable whilst other staff told us they were not; this caused a divide at times between the nursing staff. The managers were visible in the department. There were mostly 2 or 3 band 7s on each day and they were all assigned to work clinically. Staff told us their immediate managers were “really supportive as they have worked in the department and understand the pressure”. However, they had found it unstable with a lot of manager changes.

There were not always enough senior doctors to lead the departments overnight. This led to delays in patient care and long waits to be seen. For example, on 26 November 2025 at 7am, there was a 12 hour wait to be seen. Staff told us this was because there were only 2 senior doctors on overnight and the more junior resident doctors had to run everything by them as decision makers, and this caused delays in both SDEC and majors.

Following our feedback to the trust and our letter of intent, the trust leadership team implemented leadership safety walkarounds of the ED and SDEC to ensure key elements of the feedback were addressed and actions sustained. Audit results were also reviewed daily by the ED and SDEC senior leadership teams.

The service did not always foster a positive culture where most people felt they could speak up and their voice would be heard. A few members of staff told us they did not feel they could speak up and felt concerns were not acted upon. Where staff did not feel they could do this, there were ways they could anonymously raise concerns. However, we found most staff and leaders acted with openness and transparency. Staff told us they were encouraged to raise concerns with their managers, although they were not always acted upon. There were staff feedback boxes in the staff room so staff could give leaders anonymised feedback if they wanted to.

Not all staff members felt they could speak up in the department. A few staff members told us there were some challenges, and not all staff felt supported or felt able to voice concerns. One staff member told us, “I am afraid to speak up as I am concerned it will come back on me”. Some staff told us they had raised concerns but had been ignored by the team leaders. However, most staff we spoke to were positive about the support and leadership of the service. They told us the service had an open culture where patients, their families and staff could raise concerns without fear.

The staff completed an annual survey. The most recent survey showed they were worse than the organisation average for both raising concerns and having a voice that counts.

The freedom to speak up service was advertised across the hospital to encourage staff to share their concerns. Staff had shared 13 concerns between 1 December 2024 and 1 December 2025. The highest complaint themes were regarding patient quality and safety, feedback on policies and procedures and staff safety in relation to staffing levels.

Patients, their families and carers were provided with information to explain how they could raise a concern on the trust website.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service did not have clear responsibilities, roles, systems of accountability and good governance. Staff did not act on the best information about risk, performance and outcomes to improve patient outcomes and care.

There was a good range of accurate and timely data and information available to understand performance and quality, but improvements were not always made as needed. Managers we spoke with had limited knowledge of outcome data for SDEC, they were unaware that patients did not receive ECG’s within 15 minutes if they presented with chest pain, they had limited knowledge around action plans in place to improve RCEM standards, they had not looked to improve the long waits and the impact this was having on departments such as SDEC, and there was lack of action regarding the risks within the waiting room despite all staff telling us this was their biggest risk.

The senior leadership team acted promptly and put many actions into place to improve outcomes for patients following the feedback we gave them after the inspection. They were sourcing external support from the national urgent and emergency care team to review all the actions they had put into place.

Although there had been improvements with the creation of additional services since our previous inspection, such as the ARC, the ED was not able to provide services to meet the needs and rising demand of the local population. Services had evolved, patient numbers had increased, but the service did not always meet demand. This resulted in patients waiting for long periods of time to be seen in the department and to be moved out of the department into a hospital ward. The waiting area was often crowded along with all other areas of the department. Senior managers analysed capacity and demand daily and capacity concerns were high on the risk register but mitigations were only making limited inroads to improve flow and waiting times for patients in the department. More was needed to be done to improve care for patients. The increased demand meant the staff were not always able to ensure all patients were safe and well cared for. Due to the lack of time, and staff resources, patients were not assessed in line with national guidelines, having their care delivered on time, and risks were not always assessed in a timely manner.

Patients were not always on the correct pathways in ED, and they were not always used appropriately. We found patients were transferred to SDEC inappropriately against their admission criteria. We raised this with the trust and they put in an audit to monitor how the criteria were being followed.

There were long delays in triage which the service had recognised prior to our inspection by putting in a band 7 to triage and created a triage steering group. Minutes and actions were not captured at this meeting for us to review. Further work was needed in triage to improve the safety for patients.

However, there were structures, processes, and systems of accountability to support the delivery of the service. The service had a meeting structure which gave senior leaders and managers regular opportunities to discuss operational issues. Leaders were clear on the links to trust-wide groups and committees to escalate risks and issues. Staff did not have regular team meetings which meant they were not clear on all of the risks and issues within the department.

The quality and safety of the service was discussed at directorate governance meetings. We reviewed 2 sets of governance meeting minutes.

There were other meetings such as the weekly incident and complaint meetings used to drive improvement. The outcome of departmental meetings fed into divisional meetings, which fed into board level committees and meetings. There were paediatric mortality meetings and mortality reviews were discussed in consultant meetings. This was also an agenda item at governance monthly. The clinical lead told us they had a lead for mortality and were aiming to start up separate mortality meetings.

There were clear processes for reviewing and answering complaints made about the service by patients and their families. The complaints were shared at a regular governance meeting and assigned to named individuals for investigation and responding to the person who made the complaint. However, themes and trends about complaints were not always shared with staff so learning could be shared across the staff group. Most staff we spoke with could not tell us changes that had been made following complaints.

The governance team had weekly meetings where possible with senior nurses and consultants to review incidents including falls and highlight any immediate learning or action for sharing with the wider team.

Regular audits were completed to assess and monitor the quality of care but results were not always fed back to staff to make improvements. This meant audit results did not always show improvements month after month.

The service did not complete audits for mental health. Members of staff we spoke with could not identify any mental health audits that had been completed. The 2025-26 quality accounts noted that local and national audits on adolescent mental health had been completed, but the department did not participate in this RCEM audit.

During the inspection, managers told us they tried to follow the Getting It Right First Time (GIRFT) program for emergency medicine, but it was not monitored at the time of the inspection. However, data sent following the inspection 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. There was a lack of insight from the leaders around this.

Risks we found on inspection were not all on the risk register. We found there to be a risk within the waiting room where there were long triage waits and no oversight of the waiting room. Staff all told us this was a risk, but this was not recorded on the risk register. There were 15 risks on the ED register which had their rating calculated as ‘risk after actions’ and only 1 was amber scoring at 9, all others were either yellow or green which were considered low risk. The highest scoring risk was ‘if there were increased numbers of high acuity patients attending ED through the front door and due to challenges with the department from staffing shortages and lack of flow in the hospital there was an inability to triage and treat in a timely manner.’

We were not assured that managers graded the risks within the department as high enough. For example, the risks to medical staffing which caused long delays to treatment overnight were scored as 2 (green), and ambulances offloading after 45 minutes was scored as a 3 (green). Both caused significant delays to patients, and the department were not meeting national standards on both which meant the risks to patients were higher and not well mitigated.

There was 1 risk relating to paediatric ED on the risk register. The risk was ‘if ED paediatrics are not able to increase capacity and flex the space in ED then nursing staffing levels and flow in ED paediatrics will be impacted on”. To mitigate this risk they had fully recruited and had a 0.5 vacancy in March 2025 and were budgeted for 4 nurses on a day and at night. However, at the time of inspection staffing levels were poor and at times ran at 2 nurses in the department; this was not covered by this risk and had not been reviewed since July 2025.

The urgent treatment centre had 3 risks on their risk register. Their highest risk was related to verbal and physical abuse to staff. Mitigations were in place to reduce the risk.

There was a monthly risk meeting where the risk register was discussed, and any new risks were added. Any outstanding risks or changes were discussed in the directorate governance meetings. Minutes were not taken for this meeting.

There was a monthly band 7 nursing meeting where any concerns or themes were highlighted for sharing with the wider team.

The trust had child and adolescent mental health service (CAMHS) and mental health oversight groups.

We found the trust board and leaders very responsive. They took the feedback from the inspection seriously and put in immediate actions to rectify safety issues that we found. They provided assurances that these would be monitored effectively, and were anticipating that improvements should be seen. The division reports to Quality Safety Oversight Group (QSOG) monthly and following the revisions to the department after our inspection, the enhanced ED safety metrics, actions, and improvements will be included which will then feed into the Chairs escalation report to the Trust board via the Quality Committee.

The Quality Committee of the Board told us they would convene an extraordinary meeting to specifically discuss the level of assurance provided by the performance measures, quality dashboard, and compliance with audits, in December 2025. The relevant data will subsequently flow routinely to the Quality Committee of the Board for assurance.

The service had a green ED initiative to move radiology requests to an online system. They found there was an annual saving of around 54,000 sheets of paper and reduction in emissions per year.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for people. Staff shared information and learning with partners and collaborated for improvement. Information was shared across the trust through different meetings such as safeguarding, quality assurance and governance but we found learning did not always happen.

The service worked closely with the local NHS ambulance trust and staff to ensure joined-up care. Managers spoke with the local ambulance trust managers when needed and reviewed any incidents that had been raised.

The service ensured they gathered staff voices by using a friends and family survey. Following the inspection, they told us they had introduced a new survey into the SDEC as they had an increase in complaints in this area. They introduced a new patient feedback survey from both ED and SDEC using the patient experience team and volunteers from 4 December 2025 to ensure they were hearing the patient voice and learning from their experiences.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.