Epsom and St Helier University Hospitals NHS Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Requires improvement

Our view of the service

Epsom and St Helier University Hospitals NHS Trust (the trust) provide services to a population of approximately 490,000 people living across south west London and north east Surrey. The trust also provides more specialist services, in particular orthopaedic, renal and level 2 neonatal intensive care to a wider catchment area.

The trust has approximately 892 beds located across 2 acute locations; Epsom General Hospital which is located in Epsom and St Helier Hospital and Queen Mary’s Hospital for Children which is located in Sutton.

The trust has a further 8 locations registered with the CQC: Frimley Park Hospital Renal Unit; Kingston Satellite Dialysis Unit; Leatherhead; Mayday Satellite Unit; Molesey Community Hospital; Dorking Community Hospital; and Sutton Hospital.

In addition to these registered locations, Epsom and St Helier University Hospitals NHS Trust (ESTH) is the host for the South West London Elective Orthopaedic Centre (SWLEOC) which is located on the Epsom General Hospital site. SWLEOC is run in partnership with a number of local trusts and is the largest hip and knee replacement centre in the United Kingdom and is one of the largest in Europe. Additionally, St Helier Hospital is home to the Southwest Thames Renal and Transplantation Unit which provides acute renal care and dialysis and is integrated with the St George’s University Hospital NHS Foundation Trust renal transplantation programme.

The Trust has a turnover of  £809 million and employs over 7200 whole-time equivalent staff, with 500 volunteer staff.

The trust services are commissioned by South West London Integrated Care Board and by Surrey and Sussex Integrated Care Board.

The trust is part of the St George’s, Epsom and St Helier University Hospitals and Health Group, which brings together Epsom and St Helier University Hospitals NHS Trust and St George’s University Hospitals NHS Foundation Trust.

There was significant partnership working with community services, partners and stakeholders across the trust’s areas including Surrey.

We assessed all 8 quality statements under the well-led key question, using our current framework methodology. We reviewed evidence for all quality statements under our Single Assessment Framework. Our well-led review followed assessments of the trust’s front-line services (assessment service groups - ASGs).

We assessed Maternity, Medical Care (including older people’s care), Surgery, and Urgent and Emergency Services at both Epsom General Hospital and St Helier Hospital and Queen Mary's Hospital for Children. We undertook these assessments to ensure we understood a range of services the trust provides before our well-led review. The length of time since our previous inspection and information related to the quality of care triggered the initial assessment of the trust’s services.

People's experience of this service

The Adult Inpatient Survey (2024) showed that the Trust performed broadly in line with other trusts across most measures, with 42 of 46 benchmarked questions rated as “about the same.” This suggests that, overall, patients reported a satisfactory experience of care. However, 4 questions fell outside the expected range, highlighting areas where patient experience was either better or worse than average. Areas identified for improvement included waiting times to be admitted, support with personal care such as washing, and involvement in care conversations.

There was also variation in performance across hospital sites. St Helier Hospital consistently scored lower and benchmarked worse than other trusts in several areas, including waiting times, patient comfort at night, support with washing, communication between staff, discharge information and experiences of kindness and compassion. Epsom Hospital generally performed better than St Helier, although it also scored worse than other trusts in relation to waiting times and clarity about care after discharge.

Some improvements were noted compared to previous survey results. For example, there were better scores for patients feeling able to talk to staff about worries and for perceptions of staffing levels. In addition, survey findings from maternity services showed that the Trust continued to perform “about the same” in most areas, with a small number of questions rated better than expected, particularly those relating to antenatal care, partner involvement and compassionate care. However, performance had declined in some areas compared to the previous year, including pain management during labour.

During our inspection of maternity, medical care, surgery, and urgent and emergency services we spoke with over 100 patients and relatives. They told us their privacy and dignity were sometimes compromised, especially when care was delivered in non-designated clinical areas. We observed Mental Health patients stayed for long periods in unsuitable environments. Despite this, patients and families consistently praised staff for doing their best in challenging circumstances, reporting that staff communicated well, listened to them and treated them with respect. People stated they did not always receive timely care and treatment, but they said they felt safe and knew how to raise concerns or make complaints. Most patients said they understood their treatment plans and felt staff explained information in a way they could follow.

Every patient should be treated with compassion and dignity in a clean, safe environment, and should be able to raise concerns if standards are not met. PLACE assessments provide direct patient feedback to highlight where environments and services can be improved.

Results from the 2025 Patient-Led Assessments of the Care Environment (PLACE) assessments demonstrated that performance across the trust’s sites was mixed. Indicating an inconsistent patient experience and variation in leadership and culture. Epsom General Hospital scored above the national average in all areas, particularly in dementia and disability, while St Helier Hospital scored at or below the national average across all categories.

Overall, the trust scored lowest in Privacy, dignity and wellbeing and Dementia, although both remained above the national average. The lowest score compared to the national average was for food at St Helier Hospital.