- NHS hospital
East Surrey Hospital
Assessment report published 4 November 2026
Contents
Ratings - Urgent and emergency services
Our view of the service
Date of Assessment: 09–10 March 2026
We carried out this assessment due to increased concerns in the emergency department and as part of the CQC winter pressures programme. We assessed 32 quality statements across the safe, effective, caring, responsive and well-led key questions. We found the quality of care had declined.
At the last assessment in October 2018 the service was rated as good and there were no breaches of regulation.
At this assessment we rated the service as requires improvement. We found 4 breaches of the regulations in regulation in safe care and treatment, premises and equipment, good governance, and staffing.
At this assessment we found the service was operating under sustained and significant operational pressure. Overcrowding, poor patient flow and delays accessing onward care had become embedded challenges within the department and adversely affected the delivery of safe, effective and responsive care. Patients were routinely cared for in inappropriate environments, including corridors and waiting areas, often for prolonged periods. Systems to assess, monitor and respond to patient risk were not consistently effective, which resulted in delays to triage, assessment, treatment and the recognition of deterioration. Medicines were not always managed safely, and medicines management systems did not consistently support the safe delivery of care. Staffing levels, skill mix, deployment and the environment did not consistently support the safe delivery of care. As a result, patients, particularly those with mental health needs, children and other vulnerable groups, were exposed to increased risks and did not always receive care in environments that met their needs. We found the service did not consistently deliver timely, effective or person-centred care. Delays in accessing assessment, treatment, inpatient beds and specialist services affected patient outcomes, continuity of care and patient experience. Whilst leaders understood the challenges affecting the service and there were governance arrangements to monitor quality, safety and performance, several longstanding concerns relating to patient flow, corridor care, capacity pressures and wider system demand remained unresolved. The service routinely identified, monitored and escalated risks. However, it was unable to consistently demonstrate that actions taken resulted in sustained improvement or timely resolution of longstanding concerns. Whilst leaders understood the challenges affecting the service, some leaders did not feel fully involved in decisions affecting the department and lacked confidence that concerns raised through organisational processes would consistently result in meaningful change.
However, staff remained committed to delivering good care despite the significant pressures they faced. Patients consistently spoke positively about the kindness, compassion and professionalism of staff. Staff worked collaboratively across teams and with partner organisations to support patient care and demonstrated a strong commitment to safeguarding, learning and improvement. Departmental leaders were visible and supportive, and staff described a positive team culture despite the challenging environment. There were effective systems to support safeguarding, incident reporting, risk monitoring, patient feedback and partnership working, and leaders demonstrated a good understanding of the challenges affecting the service and the actions required to improve care.
Following this assessment, CQC issued a Section 29A Warning Notice to the trust due to concerns about the timeliness of patient assessment and treatment, the oversight and safety of patients cared for in waiting areas and corridors, the provision of emergency care for children and young people and people experiencing mental ill health, and weaknesses in governance arrangements supporting the delivery of safe care. The trust responded with an improvement action plan which included immediate actions to address these risks, alongside longer-term actions to improve patient flow, governance, staffing and operational oversight.
The Warning Notice focused on concerns requiring urgent action to reduce the risk of harm to patients. The full assessment considered a broader range of evidence across all quality statements and regulatory requirements. This identified areas where the service was not consistently meeting the fundamental standards and resulted in breaches of Regulations 12, 15, 17 and 18. We have therefore requested that the trust submit an action plan setting out the actions it will take to address these identified breaches.
People's experience of this service
People who used the service consistently praised the kindness, compassion and professionalism of staff. Patients and relatives told us staff were caring, supportive and worked hard to provide good care despite the significant pressures within the department. Many people recognised how busy the department was and expressed appreciation for the way staff remained calm, respectful and reassuring.
Most patients felt listened to and told us staff explained their care and treatment in a way they could understand. People described staff responding with kindness when they were worried, distressed or uncomfortable, and valued the support provided by volunteers within the department.
However, people's experiences were affected by overcrowding, delays and the use of corridor care. Some patients experienced long waits and uncertainty regarding timescales for investigations, treatment or admission, while others felt their privacy, dignity and comfort were compromised by being cared for in public or non-clinical environments.
Despite these challenges, patients overwhelmingly recognised the commitment and dedication of staff and understood that many of the issues affecting their experience were related to pressures on the service rather than the attitude or behaviour of staff.