East Surrey 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 looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

At this inspection we found the service was in breach of legal regulation in relation to good governance. This was because the service did not always operate effective governance systems or maintain confidentiality of patients records.  

In response to the governance concerns, the trust submitted an action plan which set out actions to strengthen governance and operational management within the Acute Medical Unit. These included enhanced executive and clinical oversight of patient flow and escalation processes, increased monitoring through operational dashboards, strengthened review of critical capacity escalation beds. These actions were proposed after the inspection and therefore did not influence the findings of the assessment. 

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 had a vision and strategy and understood the challenges and the needs of people and their communities. However, they were not always effectively communicated or consistently received across the service. 

The trust shared their vision and strategy on their website and through internal communications. The vision was to pursue perfection in the delivery of safe, high-quality healthcare which put people of their communities first. There were divisional strategies to support departments. The medicine divisions aim included supporting service flow and improving patient and staff experience.

Staff had mixed views on the culture within the service. Some staff felt there was insufficient regular two-way communication with leaders, which made it challenging for changes to be understood. This perception was mirrored more widely across the service, with staff at all levels, including those on wards and in senior leadership roles, reporting that concerns they raised were not always acknowledged through feedback or visible action. While other staff reported a positive atmosphere, where they worked as part of a supportive and collaborative team that did not emphasise hierarchy.

Some staff reported the culture had improved since there were changes in senior leadership, reflecting a more positive and inclusive working environment.

The 2025 staff survey results reflected many of these concerns. Compared with the wider organisation, staff within acute medicine reported lower morale and wellbeing, alongside reduced confidence that concerns would be addressed. While staff remained committed to delivering high-quality patient care, many did not feel sufficiently supported by the organisation. The survey did highlight positive local team cultures in some areas, characterised by strong teamwork and approachable managers. However, ongoing workload and staffing pressures continue to impact morale and contribute to burnout.

Staff expressed they were doing their best and their desire to provide high-quality care. However, with patients being so unwell, the current environment and pressures, it was felt to be challenging to achieve.

Although leaders generally demonstrated commitment to the service and understood many of the operational challenges it faced, leadership was not consistently effective across the division. Leaders were not always accessible and responsive and did not always provide consistent oversight and direction to support delivery of high-quality care. 

The medicine division was led by a divisional director, divisional chief nurse and chief of medicine, who worked together as a triumvirate (three-person leadership team) to lead the medical division. Leaders at departmental level were known to staff and were visible within the service. However, staff feedback indicated some divisional leaders were not always accessible when support was required. Staff reported experiences of their emails to leaders being unanswered, leaving them without the guidance required to address specific concerns. Delays in addressing concerns could impact the effectiveness of workforce oversight and increase the risk of staff undertaking duties without the necessary guidance and support. This could potentially affect the quality and safety of patient care.

Staff described local leaders as approachable and supportive, and leaders showed empathy towards the pressures experienced across the division. However, this did not consistently translate into timely support or effective action when staff required guidance to address operational or workforce issues.

Leaders understood the services they managed. However, staff told us there was a lack of understanding between the divisional teams and structures. This created a disconnect between strategic oversight and operational delivery, resulting in misunderstandings about how processes worked in practice and how the service was experienced by staff and patients. 

There had been several changes within the divisional senior leadership in recent years. This disrupted the progression and continuity of projects. For example, business cases that had already been developed, were halted due to funding changes. This did not provide staff with a clear and consistent direction for service development.

Leaders knew their teams and were supportive of how hard everyone was working. Staff spoke positively of local leaders. Many leaders spoke with passion and conviction about their work and the hospital's role within the community. Conversation consistently reflected a strong emotional connection to the teams and organisation, demonstrated by comments such as, “This hospital means the world to me,” and “I could not be any prouder of the nurses”.  

The leadership team understood the concerns with service flow and the division's strategy to adapt in response. The team were proud of the progress in strengthening front-door services, including the expansion of same day emergency care services and the development of the frailty unit. The leadership team recognised the difficult position staff were in and how staff were doing the best they could with what they had been given. The leadership team would visit operational areas weekly to provide support and assurance. 

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The trust had an effective contract with a guardian service since July 2025. This service provided a support system to guide advocacy for staff. 

The trust had a Speaking Up (raising concerns) policy, and staff were aware of the freedom to speak up (FTSU) Guardians and how to contact them. Most staff felt confident to raise concerns with their line manager without fear of negative consequences. 

Between July 2025 and March 2026, 19 concerns had been raised to the FTSU Guardian. Themes from these cases included patient safety, staffing levels, systemic structural issues, worker wellbeing and management concerns.

Patients and carers had opportunities to provide feedback on the service they received in a manner that reflected their individual needs. This included providing feedback by friends and family tests, verbal communication with staff on the wards and through complaint processes. 

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service had a diverse range of staff and international recruited staff felt welcomed and supported by the service. Staff told us they felt supported by managers and colleagues and were able to provide examples of times they were individually supported. We were told of circumstances in which flexible working and reasonable adjustments were implemented, to help promote and maintain a positive work-life balance. 

Some staff we spoke with shared they had not experienced discrimination. However, there was an awareness that some staff members had been exposed to unacceptable behaviours. It was reported this was usually from patients who were confused or when there were heightened emotions involved. 

The 2025 staff survey indicated the organisation had strong teamwork and respect, and low levels of internal harassment and discrimination.

The trust monitored workforce equality through the Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) and produced annual reports and action plans to address identified areas of concern. Workforce equality issues were reviewed through established governance arrangements. The trust had also established a range of staff networks and forums to support inclusion and staff engagement, including the Administration Professionals Forum, Cultural Inclusion Champions Network, LGBTQ+ Network, Men's Health Network, SASH Ability Network and Women's Network.

The 2025 WRES findings demonstrated some improvement across a number of indicators. However, staff from black and minority ethnic backgrounds remained more likely to experience harassment, bullying or abuse from patients, relatives and members of the public than white staff. Staff from black and minority ethnic backgrounds were also less likely to report equal opportunities for career progression and promotion.

The 2025 WDES findings demonstrated disabled staff reported poorer workplace experiences than non-disabled staff across a range of indicators, including bullying and harassment, career progression, staff engagement, wellbeing and feeling pressured to attend work when unwell. However, we observed a recurring agenda item for ‘EDI Issues’ at divisional leadership meetings, which demonstrated the divisions dedication to an inclusive and fair culture.

The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance and risk processes were not consistently and sufficiently effective. There were governance structures in place, with lines of accountability from wards and departments, clinical divisions through to the trust board. However, these structures were not always effective. 

While governance arrangements enabled risks to be identified and documented, staff did not always recognise or experience the resulting actions and organisational response. As a result, there was a risk that concerns were not escalated consistently, staff engagement with governance processes was reduced, and opportunities to drive sustainable improvements in quality and safety were missed.

Data collection was not always accurate. Leaders recognised information technology (IT) reporting systems did not consistently support digital intelligence needs. For example, a leader told us systems used to collect and analyse data required further development to provide stronger oversight of the quality and safety of care. Staff did not continuously escalate concerns if issues were not resolved. This limited oversight of risks and performance, and reduced opportunities to identify trends, drive improvements, and support effective decision-making. Leaders acknowledged these issues and reported improvement measures were being embedded, this included the introduction of a discharge and governance group in late 2025. These arrangements were still being embedded, and their full impact was not yet evident.

Staff told us leadership meeting minutes were not always documented or shared appropriately. Staff reported meeting minutes were produced by colleagues who were not at the meetings where the content was discussed. This could result in key information being missed and action not being taken in response. 

The divisional leadership held weekly meetings with minutes taken. However, discussions regarding concerns could also take place outside of the formal forums and were not always documented. Other leaders reported specific divisional reports were not routinely provided and therefore reviewed, and they would generally only become aware of matters escalated to the executive team through verbal communication. This impacted timely oversight of risks and trend identified in their clinical areas. They also stated that feedback following escalation was rarely received, limiting visibility of outcomes and organisational learning. 

Across several wards, staff had left their smartcard passes unattended in mobile computer workstations. This presented a security risk, as a patient or member of the public could remove the pass and gain unauthorised access. While some computers had locked screens, several computers were left open on patient records. This meant patient identifiable information could be easily accessed and represented a potential breach of data protection requirements.

Risks were routinely reviewed and monitored through established governance forums, ensuring appropriate oversight and escalation where required. The medical division held its own risk register. The register aligned with information shared with us and with data we had seen. For example, the register included timely admissions to the stroke unit, to meet the 4-hour standard. However, while the register identified concerns relating to evacuation delays due to layout, and overcrowding within the Emergency Department, we did not see equivalent information provided for the wider division. For example, critical capacity escalation bed use across the hospital. 

The service had plans for emergencies. For example, where a hospital zone was being closed, the fire team worked with clinical teams to undertake physical practical sessions, such as evacuations. 

The service did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Staff did not always have an understanding of the roles and responsibilities of colleagues in other teams and described working in silos. Information was not always shared effectively through divisional structures and processes, which reduced opportunities for partnership working and affected the organisation's ability to coordinate care and services effectively. These issues created barriers to develop strong internal relationships and to improve outcomes for people using services.

The service worked with external partners including charities and community-based services to support people to leave the hospital safely and reduce gaps in care. This included arrangements to support people with transport home, services to help people settle back into their home environment, post-discharge welfare calls, and short-term support while longer-term care arrangements were established. Staff delivering these services told us they had received appropriate training and had completed Disclosure and Barring Service (DBS) checks. These partnerships helped promote improved outcomes for people following discharge and flow through the hospital.

The service liaised directly with social care services and local authority teams across Surrey and Sussex to arrange packages of care and other community support, facilitating safe and timely discharge. This integrated approach enabled people to access the services they needed through a single point of coordination, promoting positive outcomes and supporting people to remain independent at home where appropriate.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. 

Staff were supported to develop projects and make improvements that fostered their professional development and contributed to ongoing service improvement. The service had effective systems in place to support innovation and quality improvement. For example, staff developed an initiative to support people who had entered the hospital as an emergency and were unprepared to stay. Staff liaised with charity shops to obtain clothes for patients who otherwise would not have any available. This encouraged a sense of normalcy for people who would otherwise remain in hospital clothing when discharged.

The service had made multiple digital improvements following the introduction of the Electronic Patient Record (EPR). Following an EPR review, the trust introduced clinician-led care pathways to improve visibility of patient risks, progress and actions. This strengthened timely intervention, multidisciplinary working and consistency of care, leading to improved outcomes, reduced variation and greater staff confidence. Learning was embedded through pathway refinement and wider sharing across digital networks.

The Tissue Viability Nurse team was reviewing champion/link nurse roles. This would ensure that specific staff received regular training and could effectively disseminate knowledge and best practice updates to the wider team, helping to better manage pressure ulcers.