Croydon University Hospital

Updated 16 July 2025

Croydon Health Services NHS Trust provides a comprehensive range of acute hospital and specialist healthcare for a diverse community living in Croydon and South West London.  The trust manages two hospitals with the main one being Croydon University Hospital and Purley War Memorial Hospital.  The trust also manages community services. 

There is a large diverse workforce and a dedicated team of volunteers. It has over 500 beds and offers a range of inpatient and outpatient services. It provides acute medical and surgical services, intensive care, children’s services and maternity care for approximately 1,506,791 people living in South West London area.

We carried out an assessment of urgent and emergency care (UEC), and medical care services at Croydon University Hospital. The assessment was unannounced and carried out on 1 and 2 April 2025 January 2025,  by a team of inspectors and specialist advisors. The assessment focused on a number of quality statements under the Safe, Effective, Caring, Responsive, and Well Led domains. Following the assessment, the UEC service has an overall rating of requires improvement, and medical care services has an overall rating of requires improvement. The rating from UEC and medical care has been combined with ratings of the other services from the last inspections. See our previous reports to get a full picture of all other services at Croydon University Hospital. The overall rating of Croydon University Hospital remains requires improvement.  

Updated 19 February 2025

Medical services provided care and treatment in a number of medical inpatient beds located across at number of wards which are all based at Croydon University Hospital and included older people's care.

We carried out this assessment on 1 and 2 April 2025 as part of our system pathway pressures programme. We assessed 24 quality statements across the key questions Safe, Effective, Caring, Responsive and Well-led and have combined the score for each of these areas to give the rating.

During the assessment, we visited a number of wards and assessment units. We reviewed the environment and staffing levels and looked at care records and prescription records. We spoke with patients and family members, staff of different grades, including nurses, doctors, ward managers, therapists, a domestic assistant, and the senior managers who were responsible for medical services. We reviewed performance information about the trust. We observed how care and treatment was provided.

Whilst the service had improved in a number of places since the last assessment at this assessment we still found breaches of legal regulations. At the last assessment the service was in breach of regulation relating to good governance and this was a continued breach at this assessment. We found eight breaches of the legal regulations in relation safe care and treatment, consent, premises and equipment, medicines management and good governance as well as staffing at this assessment.

The service was working to embed a culture of safety and continuous improvement but systems were not always fully effective. The service worked with people and healthcare partners to establish and maintain safe systems of care; however some systems were less effective especially around discharge processes to ensure continuity of care and ease flow through the care pathway. Staff did not consistently assess the risk to the health and safety of service users or maintain good standards of medicines management. Equipment was not always kept safe and staff did not always apply the Mental Capacity Act 2005 in line with guidance and legislation.

There were areas where the skill mix of staff on wards was not in line with national guidance and levels of training compliance needed to improve. Senior leaders did not always ensure that systems to monitor and improve were effective and there were areas that were still not meeting the fundamental standards of care.

However, care was provided in line with national best practice guidelines and medical services participated in the majority of clinical audits where they were eligible to take part. Staff had a strong understanding of how to keep people safe from abuse or harm and followed good infection control procedures. Staff teams worked well together when assessing people's needs and shared information. Patients told us that staff were caring, kind and respected their wishes. The service was providing person centred care and meeting individual needs for patients who had dementia or required palliative care. There were governance and risk management processes in place and services were working with other organisations and system partners. Improvement plans were being put in place but not fully embedded at the time of the assessment for us to assess the effectiveness.

We have asked the provider for an action plan in response to the concerns found during this assessment.

Updated 19 February 2025

We inspected the Urgent and Emergency Care Service at Croydon University Hospital which included the emergency department and the urgent treatment centre. The emergency department sees around 12500 patients per month and the urgent treatment centre around 5000 per month. Activity in the department had increased by around 11% each year for the preceding few years. It delivers services to a diverse population with a comparatively high proportion of people requiring care and support with their mental health.

Patients experienced long delays in the emergency department though the non-admitted pathway including the urgent treatment centre was much shorter. The crowded department resulted in escalation areas being used. It also meant that there were not always sufficient facilities for people who needed care in the department.

We carried out this assessment on 1 and 2 April 2025 as part of our system pathway pressures programme. We inspected 24 quality statements across the key questions Safe, Effective, Caring, Responsive and Well-led and have combined the score for each of these areas to give the rating.

During the assessment, we visited the emergency department and the urgent treatment centre. We reviewed the environment and staffing levels and looked at care records and prescription records. We spoke with patients and family members, staff of different grades, including nurses, doctors, ward managers, therapists, a domestic assistant, and the senior managers who were responsible for urgent and emergency care services. We reviewed performance information we held about the trust. We observed how care and treatment was provided.

We found new breaches of regulation in relation to safeguarding and Mental Capacity Act, safe care and treatment and privacy and dignity. Improvements in governance were not found the service remained in breach of regulation.

Patients’ pathway of care sometimes meant they were cared for in areas that were not designed for patient care including patients requiring support with their mental health. Doctors mandatory training was low and children’s safeguarding training was also below trust target. Staff gave us inconsistent information about how the Mental Capacity Act was followed in the department.

Patients documentation was inconsistently completed with some risk assessments not being completed or acted upon. There were concerns with medicines in the department.

National Early Warning Scores (NEWS 2) were completed regularly and results acted upon. There were the right numbers of competent staff available and we saw staff following infection, prevention and control procedures when carrying out their work. We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

The service carried out regular audits, including monitoring against the emergency care standards. Staff worked in a strong culture of evidence-based practice.

Patients privacy and dignity was not maintained in the department. The crowded nature of the department meant that escalation areas were in use. The use of escalation areas, the majors sub wait area, and the nurse cohort corridor did not offer privacy and dignity. We observed staff offering compassionate care to patients and patients we spoke with were positive about the care they received. However, at times the service did not meet patients individual needs. Staff worked in a high-pressure area that with incidents making their workplace challenging. Most staff were positive about where they worked, and leaders were sighted on the risks to the workforce and the support required. Due to challenges with flow in the hospital patients did not always have access to care and treatment in the emergency department when they needed it. Patients continued to wait long periods for admission. There were examples of long stays in the department whilst patients waited for an appropriate place of care. This included extended periods in environments that were not intended for patient care. There had been mixed culture in the emergency department. Leaders were aware of this and were taking steps to address it. Whilst leaders could describe the vision and strategy for the service, not all staff could and we were not provided with a strategy. Leaders were aware of concerns in the department and whilst they had taken some action, it was insufficient to address the safety and privacy of patients in the department. Governance systems were in place but not always effective.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded. We have also asked the provider for an action plan in response to the concerns found at this assessment.

Updated 7 October 2015

Children’s services at Croydon University Hospital provided effective, caring and responsive support to premature babies, sick children and their families. Patient safety was assured though vigilant monitoring and responding to any deteriorating child.

Staff were required to complete safety related subjects but targets were not always met, particularly within the paediatric medical staff. There were some discrepancies in staffing levels of doctors and nurses due to vacancies, which were managed to ensure patient safety was not compromised.

There was an open and transparent approach to reporting and learning from incidents. Infection prevention and control measures were in place to minimise risks to those who used the service.

Effectiveness of services were geared to reducing emergency readmission rates and delivering the best treatment and care outcomes for children and young people, in accordance with best practice. A multidisciplinary team approach to patient care prevailed, and our observations and feedback from people using the services demonstrated that care was delivered in a kind, compassionate, respectful and friendly manner.

Responsiveness of the service was achieved through close working arrangements with community-based services, which ensured that children could expect to be cared for at home via community nursing services.

The service was well-led and staff spoke positively about providing high quality care that was aligned to the trust-wide vision of ensuring that patients received safe, clean and personal care. Whilst the overall care environment and ambiance of the Rupert Bear Ward and Special Care Baby Unit were tired and in need of refurbishment especially with regard to parent accommodation, the trust had acknowledged this was an area of concern and had developed action plans to improve facilities for babies and sick children.

Updated 11 February 2020

Our rating of this service improved. We rated it as good because:

• Our rating of the service had improved. We rated it as good because the trust had taken note of concerns raised about the critical care service at the previous inspection and made improvements in many areas such as governance, leadership practice and management of risk.
• Staff understood how to protect patients from abuse and the service worked collaboratively with other agencies to do so. Staff underwent training on how to recognise and report abuse and they knew how to apply it.
• Staff completed risk assessments for each patient swiftly and updated the assessments to minimise patient risk.
• There was an effective system in place to ensure policies, protocols and clinical pathways reflected national guidance. Managers checked to make sure staff followed guidance.
• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
• The critical care performance was comparable with other similar units in the Intensive Care National Audit and Research Centre (ICNARC) audits for the period of 2018/19.
• The service made sure staff were competent for their roles. Patients were cared for by staff with the right qualifications, skills and knowledge to provide safe care. As at October 2019, 91% of staff have completed the post-registration critical care course, which was better than the Faculty of Intensive Care Medicine standard of a minimum of 50%.
• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the trust policy and procedures when a patient could not give consent.
• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.
• The critical care service was planned and delivered in a way that met the diverse needs of the local and surrounding population. Patients’ needs and preferences were considered and acted on to ensure services were delivered to meet those needs.
• Staff understood the impact of patients care, treatment or condition to their wellbeing and those close to them. Staff provided emotional support to patients to minimise their distress.
• The trust and service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• There was a culture and focus of continuous learning, innovation and improvement in the service to improve patient outcome
• There were effective systems of governance that looked at quality and performance. Staff understood their roles around governance and there were structures for reposting and sharing information from the department to the division and board and down again.

However, we also found areas for improvement:

• Medicines were not always in date or within the use by date. However, staff followed systems and processes when safely prescribing, recording and storing medicines.
• The service provided mandatory training in key skills to all staff and made sure everyone completed it. However, we identified some areas where staff had not completed it, such as information governance and resuscitation trainings.
• There were systems and processes to control and prevent the spread of infection and the department was visibly clean, tidy and free of any odours. However, the service did not control infection risk well and staff did not always adhere to good infection control practice.
• There was no system in place to ensure equipment was regularly serviced. We found four pieces of equipment that were overdue for servicing.
   
• Although, the service met the ICS standard on the access to a follow-up clinic for patients discharged from the intensive care unit however there was lack of psychological and multi-disciplinary input at the follow-up clinic.
   
• Patients experienced delayed discharge from the service. In 2018/19, 8.7% of patients experienced a delayed discharge of over eight hours, which was worse than national average (4.5%) and similar unit (6.8%).

Updated 11 February 2020

We previously inspected diagnostic imaging jointly with outpatients so we cannot compare our new ratings directly with previous ratings. We rated it as requires improvement because :

Most staff were unable to show us training records demonstrating us they had received training to use the machines and carry out the procedures they were doing.

• Managers were aware of the lack of a comprehensive local induction for new staff members and were actively working on a new induction pack, however this meant new staff were not being inducted thoroughly and could miss important information as there was no record of what they had and hadn’t been trained to do.
• We were not assured all incidents were being reported and investigated thoroughly. Staff told us they did not always have the time to report all incidents and the department manager told us they were struggling to use the software.
• Department audits were not all formally logged and therefore their use and the validity of the data they produced was limited, as methodologies were not approved.
• The friends and family test was not broken down enough for the diagnostic imaging department to get their results. This meant that although the department was asking patients for their feedback managers were not receiving this information to act upon.
• We had concerns over the governance systems and how information and documentation was shared with staff within the department, including the robustness of the risk register. Many staff were not aware certain protocols and procedures were available to them to refer to. This meant they may have been unknowingly working outside of protocols they were not aware of.
• Clinical leaders did not have the time and resources to fully work through all the issues the department was facing and had been highlighted in reports written by their Radiation Protection Advisor (RPA) in 2018 and 2019. The reports both highlighted 15 of the same problems, demonstrating these had not been acted upon in 2018.
• Printed patient information was not available in languages other than English. With such a diverse multi-cultural population this could mean some patients were missing out on vital information as they were unable to read or understand English.

However:

• Staff carried out risk assessments and administered contrast safely in line with the patient group direction (PGD).
• Staff tailored their care to fit the patient’s needs and used a multidisciplinary approach when necessary.
• Many services were open seven days a week and superintendent radiographers in places which were not open seven days a week had the authority to open longer if they needed to. The impact of this was demonstrated in the fact that the department consistently achieved its six week wait time target and had consistently achieved this more often than the England average.

Updated 21 February 2018

Our overall rating of this service improved. We rated it as good because:

• The SPCT were competent, knowledgeable and responded to patients and their loved ones’ needs. The team had completed mandatory training.
• The SPCT worked as an integrated team with hospital and local hospice to promote continuity and consistency in patient care. The team also participated in local and national audits to share information.
• Staff knew what incidents to report and how to report them and managers were involved in investigating incidents and shared any lessons learned.
• The team held daily meetings, attended ward rounds and multidisciplinary team meetings across the hospital specialties, in order to provide knowledge, support and input into patients’ end of life care.
• Medicines were managed and prescribed appropriately and equipment was available to patients at the end of their life and equipment was well maintained.
• Palliative and end of life care was provided on many wards at the hospital and all staff were caring and committed to meeting patients’ needs.
• Palliative and end of life care services was provided by dedicated, caring and compassionate staff across the hospital. We observed care was planned and delivered in a way which took account of people’s wishes.

However:

• Whilst Do Not Attempt Resuscitation (DNACPR) were in place for patients and clearly identified on the electronic patient record (EPR), ward staff were not able to show us the completed forms. SPCT were able to access the forms easily.
• The consultant cover was .5 whole time equivalent (WTE) which is 1.5 WTE short of national guidelines. A business case had been submitted for additional consultants.
• Staff across the service understood how to protect patients from harm and abuse. However, they were not correctly assessing patients’ with regards to their capacity to make decisions about their care. Staff had training on safeguarding, the Mental Capacity Act, and Deprivation of Liberty Safeguards (DoLS), but we found areas of concern with regards to the Mental Capacity Act (2005) and the completion of DoLS application. The trust did not ensure that staff complied with its policy on Deprivation of Liberties Safeguards (DoLS).

Updated 22 February 2023

Updated 21 February 2018

Our rating of this service improved. We rated it as good because:

• Staff had completed mandatory training and they were supported with their professional development.
• There was good compliance with infection prevention and control practices.
• There were sufficient staff to care for patients and a matron had been appointed since our last inspection.
• Patients were positive about the care they received and told us they were involved in decisions about their care.
• Clinics were well organised and waiting times were within national standards for many conditions including cancer.
• A new dedicated cardiology department had been opened.

However:

• Not all staff were aware and had access to the risk registers.
• There was a backlog of some GP letters which the trust planned to clear by December 2017.
• Some staff at Purley War Memorial Hospital had some concerns about security.

Updated 21 February 2018

Our rating of this service improved. We rated it as good because:

• Since our last inspection the governance framework had greatly improved. A clear responsibility and accountability framework had been established. There was a systematic programme of clinical and internal audit, which was used to monitor quality and patient safety.
• Leaders had the skills, knowledge and experience to effectively manage teams within surgery services.
• There was a much improved and robust system for mortality and morbidity monitoring. There were good structures to govern mortality and morbidity and regular meetings took place to ensure regular oversight and scrutiny.
• Mandatory training rates had improved since our last inspection. There were detailed action plans in place with oversight to monitor core skills training.
• There was a better culture for the reporting and investigation of incidents. Staff received feedback on actions taken from serious incidents and there was shared learning in each surgical divisions clinical governance meetings. However, staff did not always receive feedback on low level incidents they had reported.
• Risk assessments were carried out regularly and in line with guidance. Staff understood their responsibilities and actions required in identifying patients at risk from deterioration, harm, and abuse.
• There were effective processes to ensure all relevant staff had the information they needed to provide care and treatment.
• The service routinely monitored and collected data to ensure safety and effectiveness. There was involvement in relevant local and national audits. Quality and safety was monitored and used to identify where improvement was needed, and actions were taken as a result, working together with external stakeholders.
• All policies and procedures were regularly reviewed and up to date.
• Staff provided care and treatment based on national guidance.
• Staff worked together as a team for the benefit of patients. Doctors, nurses, and other healthcare professionals supported each other to provide care and treated patients with compassion, treating them with dignity and respect.

However:

• There were still issues with old equipment and staff reported that the equipment replacement programme was running at a slow pace. Staff were still ‘firefighting’ with old equipment and this had an impact on their working environment.
• Although there was a theatre refurbishment project in place, staff told us the trust was not taking intermediate action in rectifying minor repairs.
• Much improvement had been made with clinical governance structures and leadership; however, consultants felt there was a widening gap in communication between themselves and the senior team. More work was required to establish good working relationships between the two teams.
• The surgical assessment unit (SAU) was still not being used for its intended purpose. We visited the SAU on two occasions during our inspection, and found it to be empty on both. Staff told us that the SAU was often used as an escalation area from the emergency department (ED) and to create additional bed capacity in the hospital.
• Some staff did not adhere to the trusts policy and guidance on the use of personal protective equipment (PPE), to prevent the spread of infection. We saw staff wearing jewellery not in line with trust policy and not all staff wore over gowns when leaving theatres to enter the main hospital. We saw personal staff bags were brought into the main theatres and anaesthetic rooms.
• Staff had noticed an increase in inpatients with mental health issues. This placed immense pressure on the demands of staff. Staff wanted better supportive systems in place to help them. Staff told us they required more specialist help and training to ease the pressures they faced.
• There had been minimal change to ensure patients did not become dehydrated before surgery. Nurses on admission told us anaesthetists did not have a standard approach with allowing patients to drink small amounts of clear fluids up to two hours before surgery. As a result, nursing staff said they often had to tackle patient complaints.