Epsom General 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

At our last assessment we rated this key question requires improvement. At this assessment the rating remained requires improvement. This meant people's needs were not always met. There were no effective systems to identify and flag people with a learning disability, and specialist teams could not access emergency department records. This limited shared understanding of individual needs and reasonable adjustments. Communication with patients and families was inconsistent, with limited updates about care plans, delays and discharge, particularly in the paediatric emergency department where there was no staffed reception desk or electronic waiting time information. Access to care was significantly affected by poor patient flow and capacity pressures. Patients experienced prolonged waits in the emergency department, including long delays after a decision to admit. People with mental health needs were particularly affected, with some patients waiting many hours or days for onward care. Although escalation processes were in place, these did not consistently result in timely transfers. Men and women were placed side by side in SDEC bays for over 72 hours. Patients should not share sleeping areas, or toilet/bathroom facilities, with members of the opposite gender, or pass through opposite-sex areas to reach them.

However, staff treated people with compassion and professionalism, asked about individual needs and made reasonable adjustments when identified. Information was available in different formats and languages, and liaison teams supported people with complex and mental health needs. Patients were able to provide feedback and raise concerns.

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 consistently make sure people were at the centre of their care and treatment choices. There was no system for flagging patients with a learning disability (LD), and specialist teams were unable to access UEC patient systems. We did not see how patients with a learning disability would inform hospital staff about their specific needs and how they could be supported. However, staff we spoke to said they communicated with their patients to ask them what their needs and worries were. Staff we spoke with told us if patients required reasonable adjustments, they would ensure the patient had those adjustments put in place. Staff told us they would note this in their patient record to ensure all staff were aware of the adjustments that were in place.

The SDEC was in breach for mixed sex accommodations. Patients could be bedded in the SDEC for at times in excess of 72 hours and female and male patients were placed side by side in the bays. This impacted privacy, dignity, and the person‑centred nature of care.

Patients were able to access information leaflets or staff could print information from the hospital intranet. The trust provided information leaflets available in languages spoken by patients.

Although specialist teams were unable to access the UEC patient systems, the trust had in-reach services such as the frailty team and palliative care team in the department at specified times.

The environment of the paediatric ED was poorly designed for the patients visiting the department. There was little space to move around and there were limited play resources due to the space. However, patients we spoke with told us the waiting area was calm and clean. Families reported that they were welcomed by a triage nurse and they introduced themselves and had good communication.

Families we spoke with in the paediatric ED said they were not always aware of who they were waiting to see in the department. However, they were generally happy with the care their loved ones received.

We observed staff administering medication to patients in a compassionate and professional manner.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff we spoke with told us there were challenges with updating patients. Patients we spoke with told us they were not given regular verbal updates about their care, including interventions and their rationale.

The responsibility for discharge advice rested with the discharging clinician, with nursing staff providing the advice to the patient. The treating clinician was responsible for ensuring discharge advice was accessible, whether verbally, in writing, or online, and printed copies were provided when patients were discharged to nursing homes. Medication changes were documented for the patient and communicated to the GP in the discharge letter. The clinical record noted that discharge advice was given, although the format of the advice was not specified. However, information was available in different formats, and the trust used language line and visual audio where required.

Information gathered about patients or others was held in secure systems which met data protection legislation requirements. Access to computerised patient records was accessible through a key card. Bank and agency staff on each shift were allocated a key card on each shift by the senior matron.

In the paediatric ED we observed a lack of clear information for families. The department did not have any electronic boards displaying waiting times and there was no receptionist positioned at the reception desk so patients could not obtain regular updates. Without a reception desk position being filled, there was no one to welcome families into the department. Staff we spoke with recognised this was a problem in the department. We saw the triage nurse communicated waiting times to families however when the waiting room became busy, this became less frequent.

We observed some children coming into the paediatric ED with GP referral letters. These patients were seen by the paediatric team. Patients were either reviewed by ED doctors or referred directly to paediatric doctors. This system was understood by the nursing and medical team. However, when speaking to family members, it was clear this information was not communicated to families.

The department was challenging to navigate around and patients we spoke with required directions.

The trust made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The department had regular huddles to share patient information across teams and services. Staff met at 0745 and 1945 for a verbal handover which included information about allocations in the department, current issues, teaching if there was anything urgent, top tips and any changes that may have happened recently. The department then had a nursing handover with their patients.

Patients were able to provide feedback on their experience of the emergency department through recognised mechanisms, although the range of available methods was unclear. Staff protected patients who raised concerns or complaints from discrimination and harassment. Patients and carers had opportunities to give feedback on the trust they received in a manner that reflected their individual needs. Friends and Family feedback was reported to be available, and we saw the results for the adult inpatient survey 2024. This told us patient experience could have improved with staff taking into account a patients’ dietary needs, the long waiting times before admission and the wait to obtain a bed. Patients also said there was room for improvement to be given assistance to help them wash and give enough information about care and treatment on the virtual ward. However some of the positive points noted in the survey included discussions about what patients would need after leaving hospital and what medicines they needed to take home and patients obtaining food outside of meal times.

Learning from complaints and incidents was shared with staff. Incident learning was disseminated through paper-based feedback, which supported staff awareness of themes and areas for improvement.

Staff demonstrated an understanding of the complaints policy and reported confidence in how to handle concerns raised by patients or relatives. Feedback indicated that staff were aware of the appropriate processes and escalation routes

The trust did not always make sure that people could access the care, support and treatment they needed when they needed it. People could not always access care, treatment and support in a timely way due to capacity constraints and poor patient flow across the hospital. Although the trust operated in line with the Operational Pressures Escalation Levels (OPEL) and the continuous flow policy, these arrangements did not achieve their intended outcomes within the emergency department. During our inspection, we saw patients experiencing prolonged waits in the department, including long delays after the decision to admit had been made, before they were transferred to ward areas.

People using the trust and their relatives told us they experienced long waiting times while in the emergency department. They said there was a lack of clear communication about expected waiting times for admission to wards, which caused uncertainty and made it difficult for them to manage their expectations during their stay.

Despite staff telling us patients were initially assessed within 15 minutes and that delays were escalated to the nurse in charge, medical team or relevant specialty, this was not always reflected in people’s experience. While staff reported that mental health patients were usually seen within one hour depending on risk, ongoing delays in patient flow meant these patients could still remain in the department for extended periods. In October 2025, for example, the team recorded that they had responded to 112 out of 113 emergency referrals within one hour.

Staff told us there were no delays in ambulance handovers and said the ambulance offload area was monitored by staff. However, ongoing capacity pressures within the hospital meant that timely movement of patients from the emergency department to inpatient wards was not consistently achieved.

People with mental health needs often spent more than 12 hours in the department.

On the day of our inspection, 2 patients had spent more than 100 hours in the department following a decision to admit as an inpatient.

NHSE released experimental national data on the time patients with mental health needs waited in emergency departments. This showed that in October 2025 65 out of 190 (34%) patients attending the emergency department with mental health needs spent more than 24 hours there. This was the second highest in the country.

Psychiatric liaison members of staff completed assessments in parallel to emergency department members of staff, although some members of the emergency department staff felt this did not always happen. Psychiatric liaison members of staff sometimes waited for the person being medically cleared when this was not needed.

The department and psychiatric liaison team had clear processes to escalate when a person requiring an inpatient mental health admission remained in the department. These included escalating to senior managers when a person had been in the department more than 12 hours. The paediatric matron held daily escalation meetings with social services and the CAMHS team. The paediatric liaison team worked closely with CAMHS and other community services. This helped them avoid admitting a young person when it was not required.

The integrated care board (ICB) led on developing plans for high intensity users. The psychiatric liaison team contributed to these multi-agency plans.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.