Northwick Park Hospital

Updated 26 November 2025

On 15 and 16 July 2025 we carried out an unannounced inspection at Northwick Park Hospital. This assessment looked at urgent and emergency care which we rated as requires improvement. The rating of urgent and emergency care has been combined with the ratings of the other services from our previous inspections. See our previous reports to get a full picture of all the other services at Northwick Park Hospital. This is the first time we have assessed the Urgent Treatment Centre as part of the urgent and emergency care assessment service group as another provider previously ran it.

The rating of Northwick Park hospital has remained the same, requires improvement with breaches of regulation 10, dignity and respect and regulation 12, safe care and treatment.

In our assessment of Urgent and Emergency Care, we found.

People could not always access care, support and treatment when they needed it with some patients waiting over 12 hours in the emergency department.

In temporary escalation areas there was no privacy. Patients did not have access to call bells should they need assistance and staff were not always visible in the areas we visited.

The service did not always assess or manage the risk of infection. Staff did not always wash their hands between patients.

Not all staff had completed safeguarding training, and several staff groups fell below the trust target completion rate of 90%.

Children were not streamed by a paediatric nurse when they arrived in the department leading to some patients with similar injuries being streamed differently.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service always treated people with kindness, empathy and compassion but in some areas did not always respect their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Updated 3 April 2025

We carried out an unannounced assessment of Northwick Park Hospital on 15 and 16 July 2025 in line with our assessment priorities. We assessed the following assessment service group.

Urgent and emergency care

Overall, the service was rated as Requires Improvement.

The emergency department (ED) had previously been inspected in November 2019. At this inspection the urgent treatment centre (UTC) was operated by a different provider. This was the first inspection of the service that included both the emergency department and UTC as a service provided by this trust. At our last inspection the emergency department was rated as requires improvement.

The department had different areas where patients were treated including, urgent treatment centre, majors, minors, resuscitation, rapid assessment unit, and paediatric emergency department. The department was open 24 hours a day 7 days a week to both walk in patients and those arriving by ambulance.

People could not always access care, support and treatment when they needed it with some patients waiting over 12 hours in the department.

Some patients were seen and assessed in temporary escalation areas where there was no privacy, and patients did not have access to call bells should they need assistance and staff were not always visible in the areas we visited.

The service didn’t always work well with people and healthcare partners to establish and maintain safe systems of care. This means we looked for evidence that people were protected from abuse and avoidable harm.

The service did not always assess or manage the risk of infection. Staff did not always wash their hands between patients.

Not all staff had completed safeguarding training, and several staff groups fell below the trust target completion rate of 90%.

Children were not streamed by a paediatric nurse when they arrived in the department, leading to some patients being streamed differently with similar injuries, placing them at risk of not receiving timely treatment.

The service had a shared vision, strategy, and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion and engagement. However, not all staff were aware of the vision, and it was unclear if this had been developed in collaboration with staff.

The service always treated people with kindness, empathy and compassion, however, in some areas their privacy and dignity was not always respected. Staff treated colleagues from other organisations with kindness and respect.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Updated 20 May 2022

Updated 31 August 2018

Our rating of this service stayed the same. We rated it it as requires improvement because:

• Mandatory training completion rates for nursing and medical staff were not meeting the trust target.
• Processes and systems could not always be relied upon to protect children from abuse and harm. Children on the child protection register were not always identified, and arrangements for vulnerable patients between 16 and 18 years were not robust.
• There was a lack of appropriate assessment for children with mental health concerns during nights and weekends, which meant they may stay in hospital longer than necessary.
• Nursing vacancies were high across all areas of the service, with a high turnover rate between January and December 2017. This led to a high proportion of bank and agency staff being used to fill shifts.
• Nutrition and hydration assessments were not always completed. We found gaps in feeding charts and the frequency of patient assessment reviews.
• The pain tool, used by the service to assess and manage pain, was not consistently completed and reviewed.
• The children and young people’s service did not have a nursing lead for patients with a learning disability or mental health concern. Advice was sought from the Children and Adolescent Mental Health Service Monday to Friday, but there was no support at night or weekends.
• The service did not always provide a smooth and timely transition for patients moving between children and adult services. The trust did not have a transition policy and staff felt that guidelines required clarity.
• Bed space capacity during the winter months was not meeting the increasing demand, particularly for patients with higher and more complex needs. The inpatient ward was providing high dependency care although this was not yet funded and there was no designated area.
• Senior leaders of the trust were rarely seen on the children and young people’s wards. Medical staff told us there was no forum for them to raise ideas or concerns with the senior leadership team.
• Audits were regularly undertaken within the service to check that guidelines were being followed. However, robust action plans were not always put in to place when gaps were identified.
• The service did not have a forum for children and young people, and their carers, to provide feedback about the care and treatment received at the hospital.
• Most staff within the children and young people’s service said that communication could be improved. In particular, staff said ward meetings did not always go ahead. Emails with a brief summary were sent out to staff who missed meetings.

However:

• All areas within the children and young people’s service were visibly clean, and we found infection control protocols were adhered to.
• Paediatric early warning scores were routinely recorded to identify patients that may be deteriorating.
• We saw evidence of good multidisciplinary working throughout all areas of the children and young people’s service. Psychosocial and complex case meetings discussed the social and psychological wellbeing of patients.
• We observed compassionate care being provided across all areas of the children and young people’s service by nursing and medical staff.
• Children and their carers felt fully involved in their care and treatment. Doctors and nurses explained procedures in a relaxed and child friendly manner.
• Transitional care was provided on the neonatal ward, enabling mothers to stay with their baby whilst receiving hospital care, and preparing for discharge.
• The service had won a national patient experience network award for its’ use of technology and actively engaging with adolescent users of the diabetes services. This had led to a reduction in patient non-attendance at the diabetes clinics.

Updated 25 March 2019

• We have not reviewed the rating for this service because of the limited focus of this inspection. The rating therefore remains good overall.

Updated 21 June 2016

We found the specialist palliative care team (SPCT) to be passionate about ensuring patients and people close to them received safe, effective and good quality care in a timely manner.

The patients and relatives spoke positively about their interactions with the teams involved in their care.

The trust had responded to the withdrawal of the Liverpool Care Pathway. The trust used a holistic document which was in line with the five priorities of care, was called the ‘Last Days of Life Care Agreement' (LDLCA). However, this document was not compulsory to use across the hospital leading to difficulties in following some care plans.

Patients’ records and care plans were regularly updated, matched the needs of the patient and were relevant to EOLC.

There were some concerns raised by specialist staff and from our observations about whether all generalist nurses, doctors and consultants had the expertise to recognise dying; and had the skills to have difficult conversations about planning care for those at the end of their life.

The SPCT were focussed on raising staff awareness around EOLC. However they said that this should be a trust wide responsibility.

The trust had recently run a pilot training scheme for staff on the elderly care wards. However this is not yet part of mandatory training.

Staff were aware of their responsibility in raising concerns and reporting incidents.They were keen to report any incidents in relation to palliative and EOLC in order to drive improvement.

There were few complaints in relation to EOLC and staff told us they preferred to deal with concerns or issues at the time to try to deal with it prior to it becoming a formal complaint.All staff understood their role and responsibility to raise any safeguarding concerns.

We found that leadership of the SPCT was good at a local level, and all staff reported being supported by their line managers. The SPCT were able to communicate the trust's vision. However they were not always able to explain how this was going to be met. Cross site working was in its infancy and staff expressed a difficulty in doing more due to the difficulties in physically getting between the hospitals in the trust.

Updated 24 December 2021

Updated 21 June 2016

Outpatients and diagnostic imagingservices at Northwick Park Hospital did not consistently offer appointments within defined target times.

There was a system in place to highlight which patients had waited longest and should be prioritised for the first available appointments. The trust had attempted to reduce the backlog of patients waiting for appointments, but financial constraints meant that additional clinics had been stopped.

We found that management of risks associated with emergency situations in some areas within the outpatient services including haematology had not been appropriately recognised, assessed or managed.

We found that there were regular shortages of nursing staff of up to 20% in the outpatients departments.

We found the method for tracking medical records was not reliable. Notes were stored in the medical records department and were collected by medical records staff in preparation for outpatient clinics. Staff were not always aware of or have access to the incident reporting system through Datix.

We found limited evidence of the effectiveness of outpatient services and at times staff were not always caring or respectful of patients.

The services had begun to integrate across the three hospital sites following the merger in 2014, but there was more work needed.

We saw good evidence of how diagnostic services respond to patients’ needs and how outpatients track the progress of patients on the waiting lists for appointments.

Updated 20 May 2022