East Surrey Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At the last assessment we rated this question outstanding.

At this assessment the key question has been changed to requires improvement. 

We assessed 7 quality statements.

This meant people’s needs were not always met through good organisation and delivery.

We have not awarded this service a score for Responsive.

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

The service did not always make sure people were at the centre of their care and treatment choices or consistently respond to changes in people's needs in a timely way. 

Staff generally considered people's individual needs, preferences and circumstances when planning and delivering care. We observed staff discussing patients' home circumstances, support networks and discharge arrangements, and considering what support people would need following discharge. Specialist teams including frailty, mental health, safeguarding, dementia and learning disability services were available to provide additional support when required.

The service had made some adjustments to support people living with dementia and cognitive impairment, including dementia-friendly signage and access to staff with dementia and learning disability expertise. Staff had access to training and specialist support to help them understand and meet the needs of people with learning disabilities, autistic people and people living with dementia.

The service worked with external agencies and community services to support people with complex needs. For example, the children and young people emergency department worked with Child and Adolescent Mental Health Services, the Hope Service and a Barnardo's family support project to support children, young people and families.

Patients attending with mental health needs benefitted from support from the psychiatric liaison team, and daily multidisciplinary meetings were held to review patients waiting for mental health beds and discuss discharge planning and ongoing care needs. We observed examples of multidisciplinary discussions where the patient's individual circumstances and needs were central to decision-making. The 2024 Urgent and Emergency Care Survey showed the department would score within the top 20% of trusts for patients being informed about what would happen following their first assessment. However, the department was scored within the middle 60% of trusts for explaining why tests were needed in a way people could understand.

However, operational pressures, overcrowding and delays affected the service's ability to consistently provide care which reflected people's needs and preferences. Some patients, including people with mental health needs, learning disabilities and autism, experienced prolonged stays in environments that were not appropriate for their needs. Children and young people (CYP) with mental health needs could also experience extended waits for onward care and support. In addition, there was no dedicated play specialist within the CYP emergency department to support children during prolonged waits or periods of distress.

The service generally understood the diverse health and care needs of people and their local communities. However, delays in accessing onward care, specialist services and mental health placements meant people did not always experience joined-up, flexible and continuous care.

The service worked closely with a range of internal and external teams to support patient care. We observed the daily clinical decision unit and multidisciplinary review meetings for people with mental health needs. This meeting effectively brought together medical staff, nursing staff, therapists, safeguarding teams, discharge teams and psychiatric liaison teams to coordinate care, assess risks and plan ongoing treatment and discharge arrangements.

The emergency department had access to specialist teams including frailty services, same day emergency care services (SDEC), psychiatric liaison teams, safeguarding services and community providers. The service also had an enhanced frailty pathway which was developed with external stakeholders. This pathway supported early identification and specialist assessment of people living with frailty. It involved comprehensive geriatric assessment and advance care planning, with the aim of providing care in the most appropriate setting and avoiding unnecessary overnight admission where clinically appropriate. Staff told us these teams were generally responsive and supported patient flow and discharge planning.

The psychiatric liaison team worked alongside emergency department staff and attended daily meetings to review patients awaiting mental health assessment or admission. There were information sharing arrangements and liaison staff had access to the electronic patient record.

Staff across children and you people (CYP) emergency medicine, paediatrics and anaesthetics worked well together clinically and supported each other when managing unwell children. Joint simulation training and shared clinical input helped maintain coordinated care. However, continuity of care across the wider CYP pathway was less effective. Children requiring a higher level of care did not always have timely access to an appropriate care setting and some remained in the emergency department for prolonged periods whilst awaiting retrieval, specialist input or onward transfer. This reflected gaps in the wider pathway, including the absence of local paediatric high dependency provision, delays in accessing onward services and limited capacity across the wider system.

More widely, continuity of care was affected by delays accessing inpatient beds, specialist services and mental health placements. Patients frequently remained in the emergency department after clinical decisions had been made because there was nowhere suitable for them to move to. Delays were particularly significant for some patients awaiting mental health beds, with 1 patient waiting over 600 hours (25 days) for transfer. These delays affected people's ability to access the right care in the right place at the right time and negatively impacted continuity of care and patient experience.

The service generally supplied appropriate, accurate and up-to-date information. However, information was not always provided in a way that met people's individual needs.

Information was available throughout the department to support patients and relatives. This included information leaflets, electronic waiting-time screens and information about services available within the hospital and wider community. The service had a patient communication and information policy and access to translation and interpreting services. 

The trust’s website provided information about the emergency department, how to access services and alternative healthcare options available within the community. The website included several accessibility functions, including language translation tools, dyslexia-friendly fonts, adjustable text sizes and contrast settings to support people with different communication and information needs. The trust also had a policy describing how patient information should be produced and maintained to ensure it was accurate, accessible and compliant with the Accessible Information Standard.

Patients generally told us staff explained their care and treatment and answered questions. We observed staff taking time to explain investigations, treatment plans and discharge arrangements. The service also provided information for patients being cared for in corridor areas through a dedicated leaflet explaining the reasons for corridor care, what support patients could expect and how to raise concerns.

Staff could access translation services and a diverse workforce often helped support communication with people whose first language was not English. Information could be translated into alternative formats where required. Information on how to raise concerns or make a complaint was available through the organisation's website, including easy-read resources and complaint information available in translated formats.

However, not all information was consistently accessible. Most leaflets available within the department were in English, and information regarding Martha's Rule was not displayed within the emergency department. We found examples where communication needs were not always met in the most appropriate way. For example, staff described practical difficulties accessing approved interpreting services within some areas of the department, which could affect privacy and confidentiality. We also identified an example where a patient with hearing impairment experienced delays accessing appropriate communication support. Some patients reported confusion regarding staff roles because of the number of different uniform colours worn within the department.

The service usually listened to people and involved them in decisions about their care, treatment and support. However, while the service gathered feedback from people, opportunities for patients and relatives to influence service development and improvement were limited.

Patients generally told us staff listened to them and involved them in discussions about their care and treatment. We observed staff explaining treatment options, answering questions and involving patients and relatives in decisions about ongoing care and discharge arrangements. Most patients told us staff were approachable and that they felt able to raise concerns or ask questions. These findings were broadly consistent with the 2024 Urgent and Emergency Care Survey, which showed the department would perform within the top 20% of trusts for several aspects of communication and involvement, including staff listening to patients, explaining treatment and discussing concerns and anxieties.

The service had systems to gather feedback from patients and relatives, including the Friends and Family Test, complaints, Patient Advice and Liaison Service (PALS) enquiries and patient experience surveys. Feedback was reviewed through governance processes and used to identify themes and areas for improvement. The service had identified waiting times, communication, pain management, nutrition and hydration as recurring themes and had implemented actions in response. Actions taken included the introduction of information boards and posters advising patients how to request pain relief whilst waiting and providing additional information about delays and waiting times. Patient feedback and complaints continued to be reviewed through regular patient experience reports. However, the service had not completed a full review of complaint themes for the most recent reporting period. 

The service received compliments from patients and relatives and used these to recognise staff contributions and share positive feedback. Patient experience information was reviewed through divisional and urgent and emergency care governance structures.

However, information about how to raise concerns or make a complaint was not prominently displayed within patient areas and learning from complaints was not routinely shared with patients. In addition, there was limited evidence that patients and relatives were informed about changes made as a result of feedback and complaints.

The emergency department did not have a dedicated patient forum or patient representatives involved in departmental governance or operational meetings. Some patients also reported uncertainty regarding treatment plans and delays, particularly when experiencing prolonged waits in waiting rooms and corridor environments.

The service did not make sure that people could access the care, support and treatment they needed when they needed it.

The emergency department was open 24 hours a day and accepted patients regardless of residency status. The service had access to specialist services including frailty, same day emergency care, safeguarding and psychiatric liaison teams, and staff worked closely with community and specialist providers to support patients with complex needs.

However, sustained overcrowding, high demand and limited inpatient capacity significantly affected access to care. Patients experienced delays in triage, assessment, treatment and admission. As a result of overcrowding and poor flow through the hospital, patients were frequently cared for in waiting areas, escalation areas, corridors and other spaces not designed for patient care. Many remained in these environments for prolonged periods, sometimes for days, whilst awaiting clinical assessment or an inpatient bed. In February 2026, the trust reported that an average of 35 patients each day received care in corridor settings.

The impact of these pressures was not experienced equally across all patient groups. Patients with mental health needs experienced some of the greatest barriers in accessing timely and appropriate care. Whilst 14% of patients attending the emergency department waited more than 12 hours, this increased to 38% for patients attending with a primary mental health condition. These patients also experienced prolonged stays within the emergency department and clinical decision unit, with an average length of stay of 36 hours. Delays in accessing specialist mental health assessments, inpatient beds and onward support meant patients with mental health needs were disproportionately affected by system pressures and did not consistently receive timely access to the right care in the right setting.

Children and young people also experienced barriers in accessing appropriate care. Some waited prolonged periods for specialist mental health support, inpatient beds or transfer to more appropriate services. Performance within the children and young people’s (CYP) emergency department had deteriorated, with only 70% of children spending less than four hours in the department and 6% waiting more than 12 hours in February 2026. Capacity constraints and delays accessing specialist services also affected people with additional vulnerabilities.

Alternative pathways intended to improve access were not always able to mitigate these pressures. Same day emergency care services continued to support admission avoidance, but capacity was affected by wider system pressures. The trust also reported that around half of patients streamed to GP services were subsequently reviewed by emergency department clinicians because of limited capacity within alternative services.

The proportion of patients waiting more than 12 hours remained higher than the national position, with local performance showing around 14% of patients waiting more than 12 hours compared with approximately 1 in 10 patients nationally. As a result, equitable access to care, treatment and appropriate care environments was not consistently achieved.

The service recognised people who were more likely to experience inequality in their care, treatment and outcomes. However, equitable experiences and outcomes were not consistently achieved for all groups of people.

The service had processes to support people with additional needs and protected characteristics. Staff could access translation and interpreting services, safeguarding teams, learning disability support, psychiatric liaison services and community organisations. However, some staff told us there could be delays accessing interpretation services, which sometimes created barriers to communication.

The service also participated in initiatives aimed at reducing health inequalities, including the Barnardo's Family Support Pilot, which supported children and families experiencing wider social, emotional and health challenges.

The service used safeguarding information, equality impact assessments and population health information to better understand local need and identify groups who may be more vulnerable to poorer outcomes. Staff demonstrated awareness of issues affecting vulnerable groups, including people experiencing homelessness, domestic abuse, social deprivation, mental health needs and low health literacy. This information informed targeted initiatives, including the Barnardo's Family Support Pilot, which helped children and families overcome barriers to accessing healthcare and wider support services and provided support for people affected by issues such as domestic abuse, financial hardship, neurodevelopmental needs and social deprivation.

However, some groups experienced poorer experiences and outcomes than others. Patients with mental health needs frequently experienced prolonged stays in the emergency department whilst awaiting specialist assessment, treatment or admission. Children and young people with mental health needs, autistic patients and those requiring specialist environments were not always cared for in settings that met their needs. Delays in accessing interpretation and communication support services created barriers for some patients whose first language was not English or who required additional communication support.

While the service recognised health inequalities and introduced initiatives to address them, including the Barnardo's Family Support Pilot and a targeted health inequalities programme which used multilingual information, peer support and follow-up pathways to improve access to care for underserved groups, it was not yet routinely analysing emergency department performance, experience and outcomes by deprivation, ethnicity or protected characteristics. This limited the service's ability to fully understand the experiences and outcomes of different patient groups and assess the impact of actions taken to reduce inequalities. Ongoing capacity pressures, limited availability of some specialist services and delays in accessing onward care disproportionately affected some groups of patients, meaning equitable experiences and outcomes were not consistently achieved.

People were supported to consider important life changes and future care needs. Staff worked with specialist teams and other services to help people make informed decisions about their care, including at the end of their life, whenever this was appropriate and possible within the emergency department setting.

The emergency department operated within a dynamic and often pressured environment, which did not always lend itself to detailed conversations about future care planning. However, staff recognised the importance of responding sensitively to people approaching the end of their life and worked with specialist teams to ensure patients received appropriate support. Where patients were identified as being at the end of life, staff sought to facilitate timely admission to the most appropriate ward and involved relevant healthcare professionals in decisions about ongoing care and treatment.

Staff had access to support from specialist teams and wider trust services, including chaplaincy services, to support patients and their families during periods of significant illness, bereavement or end-of-life care. Staff described working collaboratively with other teams to ensure people's wishes and care needs were communicated appropriately and considered as part of decision-making.

The service also demonstrated a commitment to understanding and planning for the future needs of local populations. Information from safeguarding activity, equality impact assessments and population health work was used to identify groups at greater risk of poorer outcomes and inform initiatives designed to improve access to care and reduce health inequalities, including targeted support for children, families and underserved communities.