East Surrey 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’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff worked collaboratively to ensure patient assessments were comprehensive and reflected individuals' needs. Joint reviews were completed, reducing the need for people to repeat the same information and supported the development of coordinated care plans. For example, allied health professionals, including occupational therapists and physiotherapists, gathered relevant information such as patients' backgrounds and social histories to inform assessments.

The hospital had specialist teams to review people’s health, care and wellbeing, such as the lung function team who supported wards with the management of patients requiring oxygen therapy. The team assisted with fitting oxygen masks and monitoring patient compliance with their use.

The service used the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) to assess and monitor the risk of pressure ulcer development. The tool was consistent with NHS and NICE recommendations and supported the delivery of evidence-based care. Staff used photographs to monitor areas of pressure damage. These images were taken regularly to support the assessment of healing and to inform and review patient care plans. We reviewed data that showed following a peak in pressure damage in March 2025, performance improved across 2025 – 2026. Multiple tissue viability improvement initiatives were implemented during the year, including targeted ward education, workflow redesign and optimisation of skin assessment processes. These improvements indicated progress in pressure ulcer prevention and management.

Patient records demonstrated patients’ healthcare needs were assessed and managed appropriately. For example, pain was assessed and analgesia administered in response to identified needs. Scoring tools were used to identify deteriorating patients, with appropriate escalation and documentation of actions seen. 

Staff developed care plans that were tailored to the needs identified during assessment. For example, patients had charts displayed at their bedside recording whether they had been supported to sit out of bed or remain in bed for breakfast, lunch, and dinner. This information enabled staff to identify the support required, monitor progress, and determine appropriate next steps in the patient's care and rehabilitation.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.  

People regularly received care, treatment and support that was evidence-based and in line with good practice standards. 

Staff attended regular huddles and meetings where local leaders such as matrons shared updates and feedback. We also observed multidisciplinary teams being involved with patient care. 

The service was involved in the Sentinel Stroke National Audit Programme (SSNAP). This was the national audit for stroke services and measures performance against evidence-based standards of stroke care. The most recent SSNAP assessment showed a decline from grade D to grade E. However, leaders demonstrated a clear understanding of the areas requiring improvement, and had actions monitored through dedicated meetings. We reviewed recent SSNAP meeting minutes and saw that challenges, risks and actions were discussed and monitored. 

Patient flow delays and outliers throughout the service could impact the 4-hour benchmark for stroke patients to access specialist stroke care. These risks were included on the medicine division's risk register, to ensure senior leader oversight and maintain progress against improvement actions.

Practice Development Nurses (PDNs) were visible across ward areas. They encouraged healthcare professionals to develop their skills, providing hands-on support, supervision and learning to promote consistent delivery of safe and effective care. The PDNs had identified opportunities to improve the support provided to patients and subsequently developed and led a focused improvement project to strengthen processes. For example, further training was provided including how to recognise and manage deteriorating patients and how to effectively document assessments. They were undertaking re-audits to evaluate the impact of the focused improvements and the outcome of the changes to better support patients. 

The service had policies and procedures to ensure care and treatment was delivered in line with national guidance and best practice. However, this was not consistently effective. For example, some policies and pathways, such as the medicines emergency inpatient pathway, had not been reviewed within required timescales and no longer fully reflected current practice. This increased the risk of staff providing care that was not in line with the most up-to-date evidence and best practice standards. The service was aware of some of this and were updating documents.

The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Multidisciplinary team (MDT) meetings across the service were not always effective. For example, we observed a medical team meeting where staff were dismissive and spoke over one another. This behaviour was not challenged by other members of the team. Where these behaviours were not challenged, there was a risk that staff would feel unable to contribute openly. This could potentially limit the sharing of information, professional challenge, and collective decision-making needed to support safe and effective patient care.

However, some were effective, such as on Tilgate Ward, where we observed effective team working. MDT meetings included medical staff, respiratory specialist nurses, physiotherapists, occupational therapists, pharmacy staff and members of the discharge team. Staff engaged openly in discussions and contributed to decision making about patient care. Conversations were collaborative, and different professional perspectives were considered when planning patient treatment and discharge.

We observed handovers where no clear framework was used. This meant important information about people’s needs, preferences and risks may not have been shared effectively between staff. Clear responsibilities and roles were not known. Due to the lack of accountability and oversight, not all staff joined the meeting when it started, therefore information was missed by those who joined later. We raised this at the time of the inspection due to concerns raised. The involved teams were reminded by executive leaders the same day about effective handover processes.

Staff told us certain specialities and clinical areas were hard to refer to, as they did not review or accept their patients in a timely manner, causing delays. For example, staff told us the Acute Medical Unit (AMU) had a patient with a neck stoma who was awaiting a discharge planning meeting and should have been on a specialist ward. However, the receiving ward declined the patient, impacting flow in AMU. It also suggested the patient was not in the most suitable care setting available. 

Despite these challenges, people generally benefited from coordinated care through referrals to relevant internal and external specialist services. This included access to tissue viability nurses, district nurses and other healthcare professionals, ensuring people received the support required to maintain their health and achieve the best possible outcomes.

Staff told us each service had leads attend monthly leadership and governance meetings to review performance, quality and patient safety. For the stroke service, attendees included the lead consultant, Sentinel Stroke National Audit Programme (SSNAP) lead, ward manager and matron. The meetings reviewed concerns, with separate monthly meetings dedicated to SSNAP performance. 

Ward staff spoke highly of the teamwork within their immediate ward teams, highlighting the strong support they provided to one another.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

People were supported to live healthier lives through access to a range of specialist healthcare professionals, including occupational therapists, physiotherapists and dietitians. The service provided a choice of menus that met people's individual dietary needs and preferences, including healthy eating options.

People were encouraged and supported to monitor and manage their health conditions. Specialist healthcare professionals provided advice, treatment and education to help people maintain and improve their health and quality of life. For example, respiratory clinical nurse specialists worked with people to manage their symptoms and improve their wellbeing. While diabetes specialist nurses provided tailored support for those living with diabetes.

Staff monitored people's needs and responded appropriately to changes in their condition, supporting them to maintain and improve their health. Handover documents identified when clinical observations and blood monitoring checks were required, ensuring timely assessment and intervention where needed.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff understood how to use the electronic patient record system. They were able to navigate the system to find results and required documents. Staff undertook regular clinical assessments of patients to monitor their health. 

The service used performance dashboards to monitor ward performance. There was a central audit system being used which supported quality assurance. However, this tool was still being embedded and the service acknowledged where further monitoring was required to gain better outcomes from data. 

The service participated in a range of national audits, including the National Audit of Dementia and the National Respiratory Audit Programme. Leaders used the findings from these audits to identify areas for improvement and developed action plans. These set out objectives, timescales and identified leads responsible for completing actions. This demonstrated a commitment to use national benchmarking to support quality improvement and improve patient outcomes.

Staff recognised tools to improve the detection and response to clinical deterioration in patients. Staff were aware of how to escalate clinical concerns and felt confident to do so. 

Despite operational challenges, staff informed us they were delivering care as best they could in the current circumstances. People we spoke with were generally satisfied with the care they received, indicating that staff continued to meet people’s needs and maintain a positive care experience.

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

Staff took practical steps to enable people to make their own decisions. This included ensuring people understood the information shared. One staff member explained they changed how they asked questions to ensure the person understood. They also shared they would ask people’s next of kin for family discussions and support were required. 

Staff reported they knew of pathways and processes to follow for people who had impaired capacity. They were aware of different meetings which included consent meetings, best interest decision meetings and family meetings.

Staff described supporting a person with a learning disability who had been on the ward for several months. As the patient had no family to advocate on their behalf, staff arranged for an independent mental capacity advocate to provide support and representation in decision-making, to support the patient’s care and discharge planning.

We observed a ward staff meeting where an individual who lacked capacity was discussed. The discussion was respectful and person-centred, with the team considering which family members were best placed to represent the person's views and interests. Staff recognised the individual may have capacity to make some decisions and should be involved in discussions wherever possible. Appropriate multidisciplinary team involvement was considered to support balanced decision-making.

Security staff attended each ward daily to obtain updates on patients subject to Deprivation of Liberty Safeguards and those identified as being at risk of absconding. This process enabled security staff to familiarise themselves with the individuals, so that, in the event a patient left the ward without authorisation, they would be able to identify and respond more effectively.