Whipps Cross University 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

The service planned and provided care in a way that met the needs of local people and the communities served. However, the service was not able to ensure that patients did not stay longer than they needed to, due to capacity issues within the rest of the hospital and long delays in accessing assessment, treatment and admission or discharge. The service was inclusive but could not always take account of patients’ individual needs and preferences due to the demand on the service. Patients with mental health problems often spent a long time in the department due to delays in on-going psychiatric treatment. People’s individual needs to have information in an accessible way were identified, recorded, highlighted, and shared. These needs were met and reviewed to support their care and treatment in line with the Accessible Information Standard. People could expect information to be tailored to their individual needs. This included making reasonable adjustments for disabled people, interpreting and translation for people who didn’t speak English as a first language and for deaf people who use British Sign Language. The service had involved patient representatives in the improving signage in the emergency department as well as the drafting of the standard operating procedure for same day emergency care (SDEC). The trust also sought feedback and input from patients on patient information leaflet for SDEC and surgical assessment unit. The leaflets went through an internal review process with the patient review panel. At the time of the inspection, the trust was awaiting their dementia and delirium strategy to be signed off at board level.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Managers and staff were not able to ensure that patients did not stay longer than they needed to, because the demands on the service and challenges with access and flow prevented this from happening. This was due to the number of people using the service, capacity issues within the rest of the hospital, and challenges across the wider health and social care system of north east London . There were long delays in accessing assessment, treatment and admission or discharge, and national targets for ED care were not met.

There were insufficient beds available in the rest of the hospital and in mental health specialist hospitals locally to accommodate all the patients in ED who needed admitting. Throughout most of our inspection, there were up to 30 patients waiting for a bed in the ED. Senior staff stated that the challenges the service faced were difficult to resolve by the hospital alone because of the wider challenges across the health and social care system of north east London. The trust had been engaging with stakeholders across the wider health and social care system as the challenges to access and flow were complex and not within the gift of the hospital to address alone.

The service had 24-hour access to mental health liaison and specialist mental health support which was managed by a local mental health trust. Staff had access to speciality teams who worked across the hospital, services such as the speech and language team (SALT).

People’s care and treatment was not always delivered in a way that met their assessed needs from services or were co-ordinated and responsive. There were long waits for MH beds for young people and adults, leading to long stays in the ED. Whilst there were bed review regular meetings held each day, with representation from across the trust. Escalation triggers regarding bed availability and demands on services, were discussed and assessed in accordance with the risk. However, we did not see effective action which resulted in discharge which would have facilitated sustained flow through the ED.

We did not see any evidence of discussions between managers and the trust’s executive team to identify how many additional beds were needed for patients for the day or night. When demand was in excess of bed spaces, patients remained in the ED overnight and were moved to inpatient beds as and when a bed became available which could at times be multiple days.

Current waiting times for triage and access to a clinician were not displayed in the emergency department waiting room. We asked the trust why this was the case, and we were told that they were having problems implementing an electronic display system. At 8am on the morning of the second day of our inspection the waiting time to be seen by a clinician was in excess of 11 hours and patients were not being kept aware of this waiting time.

The hospital met with the ambulance service on a monthly basis to review ambulance data collaboratively and ensure improvements were made to meet demand. Operational pressure levels were monitored through an electronic system which allowed the service to view hourly demand and locations of conveyances. ED leads and ambulance service leads met fortnightly to discuss demand, flow optimisation and improvement opportunities including handover times. The median total time spent in the ED per patient in the last 12 months was three and a half hours. The average length of stay in same day emergency care (SDEC) was 6 hours in the last 3 months. Managers monitored waiting times and ED performance using a dashboard. Performance was discussed regularly by senior leaders.

People’s individual needs to have information in an accessible way were identified, recorded, highlighted, and shared. These needs were met and reviewed to support their care and treatment in line with the Accessible Information Standard. People could expect information to be tailored to their individual needs. This included making reasonable adjustments for disabled people, interpreting and translation for people who did not speak English as a first language and for deaf people who use British Sign Language. People who have difficulty with reading, writing or using digital services were supported with accessible information.

Staff made reasonable adjustments to help patients access services. There was a 24-hour telephone translation service available for patients and carers and interpreters or signers could also be requested.

Communication services available to patients included, interpreting and translation services which including British sign language 24/7.

The service was inclusive but could not always take account of patients’ individual needs and preferences due to the demand on the service. Patients with mental health problems often spent a long time in the department due to delays in on-going psychiatric treatment.

People we asked knew how to give feedback about their experiences of care and support including how to raise any concerns or issues. The service clearly displayed information about how to raise a concern in patient areas.

Actions following patient feedback included the increase of medical staffing numbers to improve early decision making and drive down waiting times as well as increasing nursing staffing to improve early assessments of patients. In addition, the service had increased food rounds to three times a day, and improvements in the environment of the department such as renovation of the toilet facilities, clearer signage, and improvement of the lighting in the department. The trust had also started a series of workshops for staff of all levels to address compassion features which had been a feature of some patient complaints recently. The trust also had patient panel representatives who attended governance, morbidity and mortality and the pressure ulcer steering groups in order to ensure patient voice was heard in these forums.

It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint. The service had an up-to-date complaints policy which provided guidance on how to manage complaints. Complaints were overseen by the patient advice and liaison service who worked with the department’s managers to resolve and respond to complainants. From December 2023 and April 2024, the emergency department at Whipps Cross University Hospital received 51 formal complaints. Complaints were investigated, learning was identified, and the service apologised to patients when something went wrong. The main themes from the complaints were around waiting times, environment, and communication. Complaints and identified themes were discussed at clinical governance meetings. Friends and family test responses for the month of July showed of the 195 responses, 62.8% of patients felt the care they received the emergency department was good and 25% felt their care was poor. Positive feedback included praise for staff professionalism and competency, helpfulness, emotional and physical support, and compassion. Negative feedback included concerns around waiting times and emotional and physical support.

We were not assured that people did not experience discrimination or inequality. People with additional needs were at times disadvantaged due to the challenges within the department in regard to the length of stay and overcrowding. People could not access care, treatment, and support when they needed to and in a timely way that worked for them. People were experiencing significant delays in the ED. During the period of our on-site assessment there were mental health patients in the ED for up to 72 hours. The longest waiting time for people to see a clinician was consistently up to 12 hours. Children were not triaged within 15 minutes of their arrival in the children’s ED. Services were not designed to make them accessible and timely for people who needed to access care. There were barriers to accessing timely efficient care and these were not always easy for the trust to remove or work around. For example, the trust did not have control of its only front door of access to the ED. A third party was commissioned to stream and triage patients. This was not working well. The environment in children’s ED (CED) was child focussed, contained children specific displays and was visually appealing for children. The waiting room was suitable for children and young people and there was access to refreshments. Staff told us of the challenges they experienced when caring for patients with mental health concerns. Staff described a lack of a dedicated spaces and privacy for mental health patients, concerns about resource constraints and regular struggles to find additional staff to provide one to one or two to one care and the availability beds for mental health patients due to full capacity.

In the last year, an average of 5.8% of patients were seen within 15 minutes. Paediatric patients were not always seen within 15 minutes by a paediatric trained clinician as per the Royal College of Paediatrics and Child Health, Facing the future – standards for paediatric care guidelines. Data provided to us regarding the average time for patients receiving a consultant review in June 2024 was 2 hours 31 minutes. Patients stayed in the ED waiting for a bed within the hospital sometimes in excess of 24 hours. In the last 12 months, 70% of patients were seen within the four hour wait standard which was below the national standard. 27.4% of patients waited between four and 12 hours from the decision to admit until being admitted. In the last 12 months, 4.9% of patients left the emergency department before being seen or treated. In the last 12 months, the emergency saw an average of 12% of patient reattendances which was higher than the national average of 10%. Flow through the hospital needed to be addressed to safely move patients out of the ED in a timely manner once the decision had been made to admit. Following our inspection, we were told that the nurse in charge of the initial assessment and reception area would now have oversight of the patients within the reception area. They would also complete hourly reviews of patients streamed by the urgent treatment centre and patients in triage who were waiting to be seen by a clinician.

The department was open 24 hours a day all year round. Adults and children were cared for including those seeking treatment for mental ill health. The service worked with other healthcare professionals to provide a service for different healthcare needs and serious conditions needing specialist input. Streaming and triage processes were ineffective to assure us that patients were being seen in the correct service (urgent treatment centre or emergency department) and were receiving timely appropriate clinical assessment. Ambulance handovers were not in line with standards for an ambulance handover (clinical handover and offload). Data from the trust showed that in the last 12 months 24% of ambulance handovers were completed within 15 mins each month and 59% exceeded 30 mins. In the last 12 months, there were 122 occasions where patients waited over an hour from ambulance arrival at the emergency department until they were handed over to the emergency department staff. We were told that the average time taken for patients being streamed through the urgent treatment centre, to be seen in the emergency department was 3 hours. However, there was no clinical oversight of patients once they had been triaged, some of which were waiting 14 hours to be seen following their initial triage.

People’s care, treatment and support promoted equality and protected their rights. There was no indication that people experience any inequalities in experience and outcomes. All results and discharge summaries were shared with the patients GP. All the reasonable adjustments were available including hearing loops and interpreters. Staff told us of challenges they experienced when caring for patients with mental health concerns. Staff described a lack of a dedicated spaces and privacy for mental health patients, concerns about resource constraints and regular struggles to find available beds for mental health patients due to full capacity.

The service had involved patient representatives in the improving signage in the emergency department as well as the drafting of the standard operating procedure for same day emergency care (SDEC). The trust also sought feedback and input from patients on patient information leaflet for SDEC and surgical assessment unit. The leaflets went through an internal review process with the patient review panel. At the time of the inspection, the trust was awaiting their dementia and delirium strategy to be signed off at board level. Staff did have access to resources such as posters and a learning disabilities staff information booklet to help support patients. A clinical nurse specialist was also available on site four days a week. A monthly learning disabilities report was produced on a monthly basis and taken through the patient experience forum by the clinical nurse specialist. The trust had implemented the Oliver McGowan mandatory training on learning disability and autism.

The service had systems to manage patients at the end of life. People who may be approaching the end of their life were identified by the service (including those with protected characteristics under the Equality Act and people whose circumstances may make them vulnerable) and the information was shared with all required ED staff.

The emergency department had patient panellists who attended the governance and morbidity and mortality boards. The service was also running a 12 month pilot whereby a family liaison nurse offered health promotion support to reduce ED attendances for children aged 0-15 where there was a focus on children that had attended the ED more than five times over the last 12 months. Support included speaking with parents and asking a series of questions to assess why people chose to attend the emergency department as opposed to their GP etc. The trust hoped to run education programmes to help the local community access appropriate alternative pathways of care. The service had also actively involved patients in the planning and design phases for the outline business case for the Whipps Cross hospital redevelopment plan, meetings for which had begun in 2020 and 2021. Patient involvement was present within the urgent and emergency care working group where they contributed to the plan and design of all aspects of the emergency floor including SDEC.