East Surrey Hospital

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them. 

At our last assessment we rated this key question good. 

At this assessment the rating has remained good. 

We assessed 5 quality statements

This meant people were supported and treated with dignity and respect and involved as partners in their care.  

We have not awarded this service a score for Caring.

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

The service generally treated people with kindness, empathy and compassion. However, operational pressures and the use of non-clinical care environments meant people's privacy and dignity were not always maintained. 

Staff treated patients and their relatives with kindness, compassion and respect. During the inspection, patients consistently spoke positively about the attitude, professionalism and caring nature of staff. Many patients acknowledged the significant pressures within the department and praised staff for remaining supportive and compassionate despite these challenges. Comments included that staff were "excellent", "friendly", "helpful" and "doing their best".

We observed caring and compassionate interactions between staff and patients throughout the inspection. Staff took time to reassure people, explain what was happening and respond to concerns. For example, we observed a doctor kneel beside a patient who was feeling unwell and anxious, providing reassurance and explaining the assessment they needed to undertake. We also observed nursing staff supporting patients, responding sensitively to concerns and ensuring patients felt listened to. One relative told us a nurse had been "lovely and very kind" and had made their family member comfortable during a difficult time.

Patients told us staff generally listened to them and kept them informed about their care and treatment. Most patients felt staff took time to explain investigations and treatment plans and answer questions. Feedback from patient interviews and the National Urgent and Emergency Care Survey 2024 also highlighted positive experiences of staff attitudes, compassion and professionalism.

Volunteers played an important role in supporting patients and relatives. Volunteers received appropriate training and were observed talking with patients, helping reduce feelings of isolation and ensuring patients did not feel forgotten while waiting.

However, the department was operating under significant pressure, which affected people's privacy and dignity. Corridor care was routinely used and some patients were cared for in public areas for prolonged periods, reducing privacy, comfort and dignity. Staff tried to minimise this by providing blankets and using screened areas where possible for personal care and examinations. We also identified concerns regarding privacy during the streaming process, which was undertaken behind the reception desk and did not always provide a confidential environment for patients to discuss sensitive information. Although patients could request a private assessment, this was not routinely offered by staff.

Some patients also raised concerns regarding communication and staff identification. One patient told us they found it difficult to identify staff roles due to the number of different uniforms worn within the department. We also heard one isolated concern regarding a clinician's attitude, with a relative describing them as dismissive.

Despite these challenges, patients overwhelmingly recognised the commitment and compassion demonstrated by staff in a challenging and overcrowded environment.

The service generally treated people as individuals and took account of people's needs, preferences, circumstances and protected characteristics. Staff recognised people's individual needs and sought to adapt care and support accordingly. However, operational pressures and overcrowding sometimes limited the service’s ability to fully meet those needs. 

Staff generally treated patients as individuals and considered their personal circumstances when planning and delivering care and treatment. Patients told us staff listened to them, explained their care and involved them in discussions about investigations and treatment plans. We observed staff taking time to understand patients' wider circumstances, including their home environment, support networks and ability to manage following discharge.

Staff had access to specialist services, including frailty, dementia, learning disability and mental health teams, to provide additional support when required. We observed staff discussing individual needs with patients and relatives and considering the support available to them at home. Staff also worked with safeguarding teams and described taking a "Think Family" approach when assessing and responding to concerns.

The trust had initiatives to support inclusion and awareness of individual needs. The trust participated in the Rainbow Badge initiative to promote inclusion and support the needs of LGBTQ+ patients and staff and the Hidden Disabilities Sunflower Scheme to help staff recognise and respond to the needs of people living with non-visible disabilities and health conditions. Volunteers received dementia awareness training and provided additional support to patients and relatives within the department.

However, delays in assessment and treatment, together with overcrowding, sometimes affected the service’s ability to respond to people's individual needs in a timely way. Some patients and relatives told us they had to repeat information to different members of staff, and some vulnerable patients experienced prolonged waits in environments that were not always appropriate for their needs.

The service promoted people's independence and supported people to have choice and control over their care, treatment and wellbeing. Staff routinely considered people's individual circumstances when planning care and discharge arrangements. However, operational pressures and overcrowding sometimes affected opportunities for meaningful discussions about care and treatment.

Staff recognised the importance of supporting patients to remain as independent as possible and considered people's wider needs when planning care and discharge arrangements. We observed examples of staff discussing patients' home circumstances, available support networks and equipment used to help maintain independence.

The service had access to specialist teams including frailty services, same day emergency care services and community support teams. These services helped avoid unnecessary admissions and supported people to remain independent where safe to do so. Information displayed within the department also promoted services designed to support people at home and reduce avoidable admissions.

Many patients told us staff explained what was happening and involved them in discussions about their care and treatment. Several patients said they felt informed about planned investigations, test results and next steps in their care. However, this was not consistently reflected in all patient experiences, particularly where delays and overcrowding affected communication and opportunities for discussion.

We observed a detailed conversation between a nurse and a patient regarding how they would manage safely at home. The discussion included consideration of home equipment, support from family members, actions to take if problems developed and who to contact for support. This promoted independence and enabled the patient to have greater control over decisions affecting their care.

However, opportunities for people to exercise choice and control were sometimes affected by delays and overcrowding. Some patients reported uncertainty regarding treatment plans or timescales for investigations and admission. The use of corridors and public areas also reduced privacy and opportunities for meaningful discussions about care and treatment.

While operational pressures and overcrowding sometimes affected opportunities for people to exercise choice and control, staff generally involved people in decisions about their care and supported them to maintain their independence wherever possible.

The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. Although staff were committed to meeting people's needs, operational pressures, delays and overcrowding affected their ability to do so consistently.

Staff demonstrated a commitment to responding to people's immediate needs and were often observed providing reassurance, support and practical assistance to patients and relatives. Throughout the inspection we observed staff checking on patients, responding to requests for help and providing emotional support.

We observed examples of staff recognising and responding to patients' needs. This included a nurse responding promptly when a patient became concerned about their intravenous infusion, providing reassurance and arranging for treatment to continue. We also observed staff supporting patients with toileting needs, checking on comfort and wellbeing, and ensuring a patient living with dementia had access to their call bell should they require assistance.

Patients generally felt staff wanted to help them and were doing everything they could under difficult circumstances. Several patients told us staff listened to them, explained what was happening and offered reassurance. One patient said staff had offered food and drinks while they waited for treatment. Volunteers also supported patients by providing companionship, speaking with relatives and helping meet non-clinical needs.

The service had access to specialist support services including frailty, dementia, learning disability and mental health teams, enabling staff to seek additional support when patients had specific needs. We also observed staff considering patients' wider circumstances, including support available at home and arrangements following discharge.

However, significant capacity pressures affected the service's ability to consistently respond to people's needs in a timely way. Patients described delays in receiving pain relief, ongoing review and treatment. Some patients reported waiting prolonged periods in waiting areas and corridors while feeling uncomfortable or distressed. Delays and uncertainty regarding treatment plans contributed to increased anxiety for some patients and relatives.

The environment also impacted patients' comfort and wellbeing. Patients cared for in corridors described noise, bright lights, lack of privacy and difficulty resting. Some patients waiting for admission or treatment remained in these environments for extended periods.

Although staff were caring and responsive when available, the pressures associated with overcrowding, patient flow and capacity meant people's immediate needs were not always met promptly.

The service cared about and promoted the wellbeing of staff and supported them to deliver compassionate care in a challenging environment.

Staff working in the service had access to a range of wellbeing initiatives and support services. These included occupational health services, an employee assistance programme, counselling support, health and wellbeing champions, menopause support forums, women's networks and LGBTQ+ staff networks. A dedicated wellbeing lead coordinated many of these initiatives and supported staff through periods of change and challenge.

The emergency department (ED) leadership team recognised the emotional impact of working within a busy emergency department and had arrangements in place to support staff following difficult and distressing incidents. Following a series of traumatic deaths within a short period, staff were offered hot and cold debriefs, Professional Nurse Advocate support and externally facilitated psychological support sessions. Staff told us these sessions provided an opportunity to reflect on events, share experiences and access emotional support.

The ED leadership team used debriefs to support staff wellbeing and learning following significant incidents. Staff described these as valuable opportunities to discuss events and receive support from colleagues and leaders. Staff also told us they felt able to access additional support through counselling services and wellbeing programmes when required.

The service recognised and celebrated the contribution of staff and volunteers through initiatives such as SASH Star awards, long service awards, thank you messages and staff engagement events. Information about wellbeing support was available to staff, and there was a dedicated staff room and wellbeing information displayed within the department.

Staff spoke positively about the support available to them from colleagues and immediate managers. They consistently described the team as supportive, with several staff telling us the department felt "like a family". Staff gave examples of colleagues supporting one another during busy periods and following challenging incidents. We also heard examples of staff being encouraged to pursue education and development opportunities.

However, staff continued to work in a highly pressured environment. Some staff told us they worried that the volume of patients attending the department increased the risk of things being missed, and staff working in children and young people services reported they were not always able to take breaks during particularly busy shifts. Despite these challenges, staff remained positive about the support available to them and the teamwork within the department.