The Hillingdon Hospital

Updated 7 January 2026

The Hillingdon Hospital is an acute NHS hospital run by The Hillingdon Hospitals NHS Foundation Trust. The trust has two locations: The Hillingdon Hospital and Mount Vernon Hospital.

This was a focused inspection of Surgery and Urgent and Emergency Care at The Hillingdon Hospital. The areas of focus were within the safe and well led domains.

Updated 7 October 2025

We inspected the key questions of safe and well led on 7 October 2025. Our visit focused on care provided in the surgical assessment unit and medicines management on Kennedy Ward. The surgical assessment unit is also known as the Wilson Unit. It is comprised of 2 consultation rooms, a waiting area with 6 chairs, a large bay area containing 7 recliner chairs, 5 cubicles for patient trolleys or beds and 1 self-contained ensuite room for isolation when required. Kennedy Ward is a surgical ward, caring for patients following surgical procedures. Our team comprised of a medicine’s optimisation inspector and a lead inspector. We spoke with a total of 8 members of staff. We reviewed patient records and documentation concerned with the functioning and management of the service while on site and were provided with documentation we requested after our visit. We reviewed electronic prescribing and medicines administration records for 8 patients.

This was a focused inspection following up on concerns we identified during our visit in July 2024. As a result of these concerns, we issued a warning notice in August 2024. This was because the trust was failing to comply with requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a service that had made improvements and found no continuing breaches of regulation.

Updated 7 October 2025

Hillingdon Hospital is a hospital in Hillingdon, London. It is one of two hospitals run by The Hillingdon Hospitals NHS Foundation Trust, the other being Mount Vernon Hospital.

This was a focused inspection of The Hillingdon Hospital following up on concerns we identified during our visit on 23 and 24 July 2024. As a result of these concerns, we issued a warning notice on 6 August 2024. This was because the trust was failing to comply with requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the service had made improvements and there were no continuing breaches of regulation.

We carried out a focused assessment on the 07 October 2025 to assess the improvements the trust had made. We looked at the adult emergency department (ED), the paediatric ED and, the Urgent Treatment Centre (UTC). We spoke to consultants, matrons, junior doctors, junior nurses, and health care assistants (HCA’s) as well as service users.  

Overall, the service was rated as requires improvement, at this inspection we identified a breach of regulation 10, dignity and respect.

There was no mental health ‘ligature light’ room or cubicle in the paediatric emergency department in which to provide care for children and young people with mental health conditions. While risks were mitigated for children and young people this continued to sometimes place children and young people at risk of potential self-harm.

There was a recently implemented standard operating procedure for the care of patients in temporary escalation spaces (TES). However, patients cared for in these areas did not always have their privacy and dignity maintained.

Patients were streamed on arrival at the department and directed to the most appropriate area to meet their needs. This had positively impacted on flow through the department.

Paediatric patients who attended the ED were now assessed by a paediatric trained nurse.

There were governance structures in place that included reporting and escalation processes.

Updated 18 January 2023

Updated 24 July 2018

• There was an open and constructive culture of sharing and learning from incidents.
• Safeguarding knowledge and processes had improved. Staff understood their responsibilities and how to keep patients safe.
• Medicines were stored and managed appropriately; patients received the correct doses at the right times.
• The effectiveness of care and treatment was monitored and improvements were made as a result.
• Nutrition and hydration needs were met as a result of effective monitoring.
• Patients’ pain was managed and monitored well.
• There was a multidisciplinary approach to patient care and staff worked well together to deliver an effective service.
• Staff cared for patients with compassion and ensured that dignity and privacy were respected.
• There was good emotional support for patients and their families and carers.
• Patients and those close to them were supported to understand their care and treatment and were involved in making decisions.
• The department delivered a broad range of services including speciality and one-stop clinics.
• There was timely access to services and good flow through the department.
• There was a positive, ‘can do’ culture in the department and staff were proud to work there.
• There had been an improvement since the previous report in staff feeling listened to and supported by their managers.
• There were processes for engaging staff in news and developments in the department including newsletters and meetings.

However:

• The department had not implemented a seven day service.
• There were limited examples of the department supporting patients to manage their own health.
• Staff did not receive formal training provision for learning disabilities and the service relied on support from external partners or the trust’s learning disability link nurse.
• Some areas where children were seen in adult outpatients were not child friendly.
• Parents reported delays in seeing the dietitian.
• There was limited engagement with patients and those close to them to gather their input in improving the service.

Updated 24 July 2018

• We rated safe, responsive and well-led as requires improvement, and effective and caring as good.

• The rating for effective improved since the last inspection; the rating for each of the other key questions remained the same.

• The senior management team had not taken note of all of the concerns raised at the previous inspection and only made improvements in the areas of 24 hours consultant cover, healthcare assistant recruitment, partial improvement of the ventilation system and submission of the Intensive Care National Audit and Research Centre (ICNARC) data.

• There were no formal morbidity and mortality meetings. Learning from any clinical case presentations was not shared with the wider directorate, or fed back to the board through any identifiable governance structure.

• At the time of inspection, the unit was unable to provide optimal care for patients requiring isolation facilities such as positive and negative air pressure management. There was increased risk of cross infection, as at the time of our inspection; the ITU environment was not compliant with recommended building (HBN04-02) standards and heating and ventilation for health sector building (HTM 03-01) standards. We found inconsistencies in hand hygiene practice amongst staff, in particular during ward rounds. There was dust on some equipment and high surfaces. This remained an area of concern from the time of the last inspection.

• We found inconsistencies in the daily checks of the difficult airway/ intubation trolley in the located in the unit. Nursing staff equipment competencies for some key pieces of equipment had not been rechecked since 2015 and were now overdue.

• In the ITU, oxygen was not prescribed on the patient prescription chart as per the trust policy on the prescribing and administration of oxygen in adults.

• In February 2018, the nursing vacancy rate was 16%. Staff informed us that due to increased bed pressures recently, there had been many occasions when the supernumerary nurse would cover the short staffed/unfilled shifts. There was no 24-hour cover provided by the critical care outreach team (CCOT). This was an area of concern at the last inspection.

• The unit did not use any sepsis screening tool and there was no separate policy for sepsis management in place. Although the outreach team told us that sepsis was part of the deteriorating patient policy. All junior staff we spoke with were not aware where to find information on sepsis management and if there was trust lead for sepsis.

• The unit was not meeting the Core Standards for Intensive Care Units recommendation of having a practice nurse educator, who dedicated two-thirds of their time to this role. This was an area of concern at the last inspection and we found no improvement in regards to this provision.

• The unit had made no progress in relation to the facilities for patients and relatives. There was only one patient toilet in the unit and no bath or shower facilities. Since the last inspection, there had been limited improvement in the facilities on the unit for relatives and visitors.

• Capacity and flow was one of the key areas of concerns for the unit. According to ICNARC data covering April 2016 to March 2017, the percentage of bed days occupied by patients with discharge delayed more than 8 hours and 24 hour was higher compared to other similar unit.

• We found that divisional and executive team were not visible and rarely visited the unit. The staff told us that there was little support for the critical care unit within the trust; they felt isolated and disjointed from the division. At the time of the last inspection, we found that there was no evidence of strong critical care leadership to challenge or influence the future direction of the service. At this inspection, we found there was still lack of any consensus regarding cohesive future direction of the service.

• There was a lack of an effective governance structure driven by the unit leadership team. Not all the junior staff we spoke with could articulate the department governance arrangements and how it fed into the divisional governance structure. Not all risks identified by us during the inspection were reflected on the risk register. In addition to this, many risks identified at the last inspection were still outstanding.

• Staff struggled to locate clinical guidelines quickly as the trust intranet search engine was not user friendly.

However:

• Staff demonstrated an awareness of safeguarding procedures and how to recognise if someone was at risk, or had been exposed to abuse. There was a clear and effective process to ensure that potential safeguarding concerns were escalated.
• The service used safety monitoring results well. The unit now monitored incidents of falls, pressure ulcers, venous thromboembolism (VTE), central venous catheter infections and catheter associated urinary tract infections (UTIs). This information was displayed in both the staff room and on noticeboards within the unit. This had improved since the last inspection.

• The unit had made progress with regard to consultant cover and now had a separate on-call rota.

• Since the last inspection, the unit had made improvement and was now contributing data to the Intensive Care National Audit and Research Centre (ICNARC).

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• At a local level, there was clear leadership for both medical and nursing staff. The lead consultant and unit manager worked closely together. They were both visible in the department and junior clinical staff described them as approachable and supportive.

• We saw collaborative working between clinicians. Junior doctors and nurses felt supported, with regular supervision. We saw that the medical team worked well together, with consultants being available for junior doctors to discuss patients and to give advice where needed.

Updated 24 July 2018

• We rated safe, effective, caring, responsive and well-led as good.
• The ratings of safe, effective, responsive and well-led improved since the last inspection. The rating for caring remained the same.
• Since our last inspection there had been a focus on the trust wide understanding and development of end of life acre. There was now a strategy and governance programme in end of life care with a clear structure of leadership and accountability.
• Appropriate measures were in place to keep patients safe from avoidable harm. Record keeping had improved.
• There were specialised end of life care advanced care plans in place and risk assessments had been adapted for patients at the end of their lives.
• Team working was strong and the development of staff within the specialist palliative care team had strengthened governance structures. There was a non-executive director in place that sat on the board and had end of life care oversight.
• Patients were provided with compassionate and person-centred care, which took account of their individual differences and needs. There was multi-disciplinary input to ensure that patients received a holistic and individualised care plan.
• The specialist palliative care team had developed end of end training within the trust and worked well with external agencies in order to coordinate care for each patient.

However:

• There was not always evidence that the appropriate mental capacity assessments had been carried out where this was noted in the patients DNACPR form.
• There was no end of life champion on each ward and the SPCT team did not take oversight for the training of staff in syringe pumps.
• The bereavement service had limited opening hours and inappropriate waiting areas for bereaved family members.

Updated 14 February 2024

Updated 24 July 2018

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

• We rated safe and well-led as requires improvement, and responsive and caring as good. We do not rate effective for this core service.

• The rating for responsive improved since the last inspection; the rating for safe went down and the rating for each of the other key questions remained the same.
• We were not assured that the laser service met the Medicines and Healthcare Products Regulatory Agency safety standards
• The laser service did not have a laser protection advisor in place since the start of the laser service in 2012, although the trust was making suitable arrangements at the time of the inspection there still was no one officially in post.
• We were not assured the department had adequate governance procedures for the laser service as set by the Medicines and Healthcare Products Regulatory Agency safety standards. Risks associated with laser practice were not present on any trust risk register.
• Staff did not always maintain appropriate records of patients’ care and treatment. Records were not always clear, up-to-date and available to all staff providing care.
• The service did not have suitable premises and there was a large backlog of estates maintenance.
• The service provided mandatory training in key skills to all staff.
• The service did not actively monitor the effectiveness of care and treatment and use this information to improve the service.
• The department had managers with the right skills to run the service; however senior nurses felt that their managerial duties were at times excessive of their role.
• The service had a vision for what it wanted to achieve, however we were not assured it had workable plans to turn it into action.
• The service had limited engagement with patients and staff to plan and manage appropriate services.
• The service had systems for identifying risks and planning to eliminate them, however the services active risks were of an excessive age.

However:

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so; however some compliance with some training failed to meet trust targets.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff involved patients and those close to them in decisions about their care and treatment.
• The trust planned and provided services in a way that met the needs of local people.
• People could access the service when they needed it. Waiting times from referral to treatment were in line with good practice.
• The service took account of patients’ individual needs.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
• The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.