THE test results are in, the diagnosis has been given and, though it is far from out of the woods, inspectors say there is definite cause for optimism at Croydon University Hospital.
The Care Quality Commission (CQC) has delivered its verdict on the hospital following a comprehensive assessment of all its services.
The inspection team that visited the hospital in September found there were areas of care which required "significant improvement".
Its report, published today, said priority needed to be given to staffing levels in older people's wards and that too many elderly patients were being discharged in the evenings.
The 20-strong panel of doctors, nurses, managers and trained members of the public called for reduced waiting times for outpatients and said the hospital's rundown A&E department was putting patients at risk.
They also raised "serious concerns" about the attached urgent care centre, run by a private company, which sees people when they first arrive at the hospital.
But they praised recent improvements brought about by dedicated staff and a senior leadership team which is beginning to move Croydon Health Services in the right direction.
Matthew Trainer, CQC director for London, said: "This report highlights reasons to be optimistic about the future of the hospital.
"We've been impressed by what we have seen from the new management team and we were struck by the commitment and enthusiasm of the staff.
"We have seen some promising signs but the report makes clear there are areas of improvement which must be made before it can be considered a good hospital.
"What I will say is that we have been in and out of Croydon over the last couple of years and this was probably the most positive visit yet."
John Goulston, the trust's chief executive, said the report should give people "confidence" about the quality of care at the hospital.
Croydon was among the first four hospitals to face the CQC's tough new two-day inspection process after being identified as 'high-risk' under the revised criteria.
It was chosen also because its patient experience scores in 2012/13 were among the worst in the country.
The report said the A&E must be improved.
"While staff employed by Croydon University Hospital were well-motivated and tried hard to make the arrangement work, the department has high staff vacancies and the environment in A&E made it hard for staff to deliver good care," it said.
While the inspection team accepted staffing levels were being addressed in certain areas as the result of a major recruitment drive, funded by operating a deficit budget, it raised concerns about older people's wards.
"These wards were busy, and both staff and patients recognised that care was poor because of a lack of enough staff with the right mix of skills," the report said.
It also found that, in August, 244 non-elective patients over the age of 65 were discharged between 6pm and 9pm. Some were only dressed in their nightclothes, which was "not warm or dignified".
The inspection team, led by Professor Edward Baker from Oxford University Hospitals NHS Trust, said older patients must only be allowed home at appropriate times.
The CQC said the overall level of care in the hospital was "mixed", praising the trust's recently refurbished maternity unit, but describing the inpatient ward for children as "cramped".
The Critical Care Unit was also said to be overcrowded and over-reliant on bank (agency) staff at weekends and nights.
Despite areas of improvement, poor patient experience was "still a theme across the trust", it added.
Part of the team's concern focused on the condition of outpatient facilities, where waiting lists were poorly managed and patients were forced to stand due to a lack of chairs.
Some of the panel's harshest criticism was reserved for the A&E which, it said, is not "well designed or maintained".
The report said: "It was cramped and lacked lines of sight between staff and patients. The observation ward was very crowded. Vacancy levels were high."
This week the trust submitted a business case for a new A&E department, costing £17 million, to the NHS Development Authority. The current unit was built in the 1970s and designed for 70,000 people a year. It currently sees 130,000.
If funding is secured building work could start as early as next spring.
The CQC, while recognising widespread evidence of progress, said the trust faces a "significant challenge" to improve care and change the "culture" of the organisation.
But it praised the awareness and initiative of staff, and said standards were being raised in some areas.
Mr Goulston said: "What this report should do is give the people of Croydon some confidence about the quality of care and the service that is being provided at the hospital.
"Maternity, children's services, surgery and the acute medical unit – which cover a large part of the hospital – they all got very good reports.
"Clearly there are other areas where we need to make improvements but the good thing is they don't come as a surprise. We know those services must get better."
The stricter, more-wide ranging inspections were prompted by the shocking revelations at scandal hit Mid Staffordshire and Sir Bruce Keogh's review of 14 trusts with high mortality rates.
Croydon will eventually be given an Ofsted-style rating when the hospital is re-inspected around next September.THE GOOD - The trust was praised for:
- Sustained improvements to maternity services, an area previously criticised by the CQC
- The care of people with dementia in A&E, as the first trust to have a 'dementia zone'
- The new acute medical unit
- The chronic obstructive pulmonary disease clinic, which is "working well" to prevent avoidable respiratory admissions
- The palliative care team, which is carrying out good joint working with a local hospice
- Leadership team making improvements
- Staff are committed and enthusiastic THE BAD – The trust was told it MUST take action to improve:
- Arrangements between A&E and the privately-run Urgent Care Centre
- Staffing levels to provide care in older people's wards
- Reduce discharges in the evening, especially for older people, and make sure people are properly dressed before they go home
- Improve outpatients to reduce waits, ensure there is enough seating and tell people why they are waiting and for how long
- Improve care plans to make sure they involve people and reflect their needs
