Crawley 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

Local leaders were visible, approachable and supportive to staff. There was a positive culture where staff felt they could speak up. There was a culture of continuous improvement and learning shared from incidents. The trust values were demonstrated by staff.

When the service was last inspected and rated, the rating for this key question was requires improvement. At this assessment, the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The department worked in accordance with the trust’s vision and strategy. We found there was a shared vision, strategy and culture, in the department. We spoke with 5 senior staff members. The trust values were safety and quality, one team, dignity and respect and compassion. We saw evidence that staff demonstrated these values.

We were told the trust's strategy was recently refreshed. The strategy was developed through workshops and workstreams that involved stakeholders including divisional deputy directors. The outpatient’s department strategy was part of the trust's surgical strategy and was delivered at East Surrey Hospital, Horsham Hospital and Crawley Hospital sites.

Staff we spoke with were positive about the service; they felt listened to and their opinions valued when their views about extra clinics were considered.

The trust had a clinical strategy, published in 2024, which aimed to play a key role in achieving its objectives to deliver safe healthcare, be a great place to work, be a valued partner, improve health outcomes and be financially sustainable. ​​The trust’s vision was to deliver high-quality, safe and compassionate care to all patients provided through state of the art, innovative surgical services. To achieve this, they would address their infrastructural challenges, whilst also using quality improvement methodology to improve productivity, optimise their pathways, and achieve best practice in line with national recommendations.

We were told and observed that the management of outpatients was fragmented. Whilst outpatients was part of the surgical division, the cancer and diagnosis division ran the booking of the rooms. Plans to unify these and bring outpatients under the cancer and diagnosis division had commenced and hoped to be completed in 2 months' time.

The outpatient’s department was part of the surgical division, which was led by a triumvirate of a divisional chief of surgery, divisional chief nurse and director of operations. Nursing sat within the surgical division and appointment scheduling sat within the cancer and diagnostic division.

There were inclusive leaders within the department who understood the context in which care was delivered. Senior staff enjoyed working for the trust. Compassionate leadership was important to senior leaders, which we observed. The matron for the outpatient’s department was visible and approachable and invited other leaders to visit the department. However, staff felt there could be greater visibility of senior trust managers. We were told one of the department leaders was passionate about staff engagement, psychology safety and freedom to speak up. Staff from outpatient’s departments at the two more remote sites supported each other.

The workforce team completed an engagement exercise and feedback from this was very positive.

The department fostered a positive culture where people felt they could speak up and their voices would be heard. A Freedom to Speak up Guardian was in place. Most staff felt comfortable to raise concerns directly with their managers and staff raised concerns with leaders. One staff member told us they had raised concerns to management in the past about a member of staff who was unpleasant to patients and that the staff member did not return after the complaint was escalated.

Staff’s concerns were taken seriously and investigated.

Staff reported that everyone was treated equally. Staff were supportive of other staff with health-related conditions. Staff asked patients for their preferred pronouns and we heard this had a positive impact on patients. Staff reported feeling proud of working at the trust and felt supported by the management. Staff felt comfortable to raise their concerns with the management.

The trust celebrated different cultural events such as Diwali and Black History Month. There was a diverse workforce that reflected the local population. Staff were proud of the team approach that contributed to keeping patients safe.

Staff at Crawley outpatients did a well-being day, that included giving shoulder massages for staff with musculoskeletal issues.

We were told that the leadership focus was on fairness and improving the culture.

Staff used language line to translate for patients. British sign language was also arranged for patients. Staff recruitment considered the equality, diversity and inclusion policy. There was good support from HR business partners.

There was a diverse workforce that reflected the local population. Staffing shortages were covered by bank staff.

Leaders valued diversity in its workforce and worked towards an inclusive and fair culture by improving equality and equity for staff. Some staff reported through the latest satisfaction survey, that they experienced discrimination, and the majority said this was on the grounds of their ethnic background. However, some staff told us that everyone was treated equally. Staff reported feeling proud of working at the trust and felt supported by managers. Some staff reported that they felt isolated at the Crawley site and senior trusts leaders were not that visible. Senior staff recognised this isolation from the acute site and as a result, a matron with visibility was put in place in 2022.

The latest staff satisfaction results for the outpatient’s department showed that in the last 12 months, some staff had reported experiencing harassment, bullying or abuse at work from managers, other colleagues and patients, relatives and other members of the public. These incidents were not always reported by staff.

Of those reporting that they experienced discrimination, the majority said this was on the grounds of their ethnic background and no one said it was due to their gender, religion or sexual orientation.

Around half of respondents felt the trust acted fairly with regard to career progression / promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age.

There were clear responsibilities, roles, systems of accountability and good governance.

Staff reported having a good working experience, despite the Crawley site being somewhat isolated from the trust’s main site.

The trust had been going through recent leadership changes. An external review had recently been completed but the outcome was not yet known. The Associate Chief Nurse for Workforce and Education had reviewed how many nursing hours were required for the outpatient department; this found the department to be under-established. They were able to manage the staffing with the use of bank staff but would not be able to support expansion of the department.

The outpatient’s transformation work had commenced. Staff oversight was to move to another division. Although this change had been agreed in principle, no substantive work had been done to facilitate this.

There was a divisional board, which held weekly management meetings, where risks and governance were discussed. The purpose of the board was to ensure local accountability for performance and risk management, through regular review of its governance processes and oversight and review of local risk registers, incidents, complaints and clinical audit. Complaints and incident data was used for maintaining and improving patient safety. It helped in identifying risks, driving improvements, and fostering a culture of learning and accountability.

Minutes of meetings reviewed showed good attendance by key personnel and relevant topics discussed including, incidents, risks, complaints and learning.

There was a good range of accurate and timely data and information available to understand performance and quality and improvements were made as needed.The surgical division had recently started a key performance indicator meeting once a month.

There was a cross site senior nurse leaders meeting each month that also included training. There was a weekly matron meeting, where topics such as quality, audits and medication safety were discussed. The remoteness of the location was recognised by all staff we spoke with. Nursing huddles for all matrons had been introduced, taking place every other weekday for 15 minutes where risks and concerns were discussed.

All patient records were electronic, with secure access to the system. The cancer and diagnostics division dealt with booking and scheduling of appointments, patient initiated follow up and did not attend rates. There was a task and finish group about to be set up to address this transfer of division. ​​​​​​​

There was a range of data and information available to understand performance and quality and improvements were made as needed.The surgical division had recently started a key performance indicator meeting once a month.

For the various specialities at the outpatients at Crawley Hospital, the total waiting list size in November 2024 was 50,024. The average referral to treatment (RTT) 18 week waiting time was 17.9 weeks and the number of patients waiting over 52 weeks was 579. In the NHS, RTT is a process that ensures patients have the right to access certain consultant-led services within maximum waiting times, as outlined in the NHS Constitution.This included a standard that 92% of patients waiting for elective (non-urgent) treatment should wait no longer than 18 weeks from referral to their first treatment.

The surgical division's performance report for 2024/25 was reviewed. The trust was not meeting the breast cancer pathway 62-day RTT standard. The NHS RTT (Referral to Treatment) Breast Cancer Pathway 62-day standard, aims to ensure people with suspected breast cancer receive a diagnosis and begin treatment within 62 days of an urgent referral. This pathway focuses on both speed of diagnosis and initiation of treatment.

The NHS Faster Diagnosis Standard (FDS) aims to ensure that patients with suspected cancer receive a diagnosis or have cancer ruled out within 28 days of an urgent referral from their GP. The trust implemented a breast one-stop service in October 2024, which had reduced time to diagnosis. From this, the plan was to continue to write '24-day' deadline on the multi-disciplinary (MDT) document for each patient and clarify if a patient was on ‘Complex Pathway’ on the MDT document. The trust was working on an improvement project promoting one-stop breast clinics.

We do not have evidence to score in this area.

A senior nurse told us the outpatients department did not need to collaborate with other agencies on the same site as it was self-sufficient.

Staff were increasingly collaborative with other stakeholders such as NHS England (NHSE), for example, with regards to the development of the division's clinical strategy. Regional contacts from NHSE visited the department. Teamwork between the two organisations was used, and staff were in support of the mutual support.

Partners had no specific feedback on this area.

The trust used independent health providers to assist with capacity gaps.

The department previously had a full resuscitation trolley, but this was reviewed and removed. We heard that medical emergencies did not occur frequently, but if there were, there were 2 emergency resuscitation ‘grab bags’ available and staff would call 999. The bags contained the vital items required in the event of a medical emergency and were smaller than the previously used trollies which would facilitate quick transportation to the patient.

Staff collaborated with main hospital site on staffing and equipment. Staff no longer wore lanyards due to infection control.

Senior staff described the quality of care as good. The trust received an Allied Health Professionals (AHP) award as well as a Daisy recognition award, for nurses.

There was a messaging programme for staff which helped to improve communication.

The trust's 28-day performance for breast cancer was the lowest compared to its local peers in May 2024. Subsequently, an improvement team completed rapid improvement work. This included a one stop shop led by a clinical nurse specialist. Since the developments, in October 2024 some backlog remained for breast ultrasound, but additional sessions were put in place to reduce the waiting list.

There was data to improve equity in experience and outcomes to tackle inequalities. We saw a risk stratification for the surveillance endoscopy patients, which aimed to look at risk factors to support and compliment clinical stratification. The factors used included people with a learning disability, deprivation, ethnicity, age, waiting time and attendance at accident and emergency.