URGENT action is called for to deal with delayed discharges at the Royal Surrey County Hospital, in a report issued this week.
The hospital was put under the microscope of the Commission for Health Improvement (CHI), an independent body set up to help the NHS monitor and improve clinical care across England and Wales.
The delayed discharges, says the report, cause problems in the accident and emergency department, leading to cancelled operations and placement of patients on inappropriate wards.
The report says that on some occasions, because of bed shortages, patients were found to have been receiving their care in A & E for four days.
The A & E department, it says, functions like a ward, where the food trolley and drug rounds take place because of the length of time patients have been there. That arrangement, said the report, was "unsatisfactory."
And staff interviewed said that medical patients admitted to surgical wards caused concern, with some patients waiting for four days to be seen by a doctor.
The NHS trust also has problems recruiting staff, mainly nurses, due to low levels of unemployment and the high cost of living in the area.
Other problem areas include a high turnover of ancillary and maintenance staff and cleaners.
The CHI has also called for the implementation of a whistle-blowing policy to allow staff to report areas which they are not happy with, and a radical overhaul in the the hospital's overall management structure and accountability arrangements.
Among other concerns were occasions when the CHI team witnessed patients suffering "a lack of privacy and dignity".
The CHI also found that car parking facilities at the trust "poor, expensive and disorganised."
But there was high praise for the excellent children's area in Royal Surrey's day surgery unit.
"The bright, air-conditioned cubicles decorated with posters of cartoon characters provide a friendly and comforting environment for children," said the report.
And the CHI's report of its routine assessment, known as a clinical governance review, also praised the Fountain Centre, a relaxing and therapeutic treatment area for patients and staff.
The centre is jointly managed by the trust, Surrey Social Services and the Fountain Centre charitable trust and provides support, information and complimentary therapies to cancer patients and their families.
CHI chief executive Dr Peter Homa said: "CHI exists to promote quality improvement throughout the NHS so that patients receive the care and treatment they need and deserve.
"The report identifies the strengths at Royal Surrey County Hospitals NHS Trust and the trust is already working on an action plan to tackle areas of concern. The implementation of this plan should result in improvements in care for patients at Royal Surrey."
Royal Surrey chief executive, Jeff Faulkner, confirms this view, stating that the action plan has been agreed, with 65 separate actions points to address the issues raised by the CHI review.
Mr Faulkner said: "The CHI review process and recommendations have been received very positively within the trust as a whole and staff found the experience valuable and helpful.
"There is a real commitment within the trust to make changes to enhance care for both patients and staff."
Referring to the central complaint over delayed discharges, Mr Faulkner said: "The hospital is well aware of the impact of delayed discharges on patient care and many initiatives are taking place within the whole health economy linking very closely with social services to improve the situation both on a day to day basis and strategically. The resolution of the unacceptable situation in A & E is recognised by the trust board as a priority."