Northwick Park Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work. This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The team had access to the full range of specialists required to meet the needs of patients in the service. Including social workers, pharmacists, speech and language therapists, the frailty team, high intensity user team and registered mental health nurses.

The trust had an agreement in place with the neighbouring mental health trust to provide psychiatric and mental health support to patients in the emergency department. This enabled staff to protect the rights of patients subject to the Mental Health Act and followed the Code of Practice. At handover meetings, staff referred to the psychological and emotional needs of patients, their relatives, and carers. The notes we reviewed for mental health patients demonstrated that they had had a review by a member of the psychiatric team and a plan had been developed.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. The compliance rate for medical staff receiving their appraisals in July 2025 was 94.6%, this had not dropped below the 90% trust standard for the last 12 months. Appraisals were included in mandatory training for other staff groups. At the time of the inspection 93.75% of nursing staff had received an appraisal in the last 12 months.

Policies and guidelines were stored electronically and accessible to all staff. We reviewed over 10 policies and found they were in date and referred to national guidelines. They were based on best practice from the National Institute for Health and Care Excellence (NICE) and the Royal College of Emergency Medicine (RCEM). Staff we spoke with knew how to access policies and were told about updates in newsletters and at team meetings.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff we spoke with told us about additional training they had received which enhanced their skills. University accredited training was available for staff and advertised on a staff notice board. Training included ‘recognition and management of the seriously ill child’.

The service was included in trust wide audits including GIRFT (getting it right first time). Action taken as a result of these audits included the implementation of a new standard operating procedure and patient pathway for patients living with Cauda Equina Syndrome, a spinal condition needing emergency treatment. This included protecting imaging slots available to patients and meant patients could access diagnostic testing rapidly improving outcomes for patients.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary team (MDT) meetings. There were systems in place for cross site MDT meetings to discuss patients including, the transfer of care and safeguarding concerns. This meant a patient attending an urgent care centre (UTC) who might require a higher level of care, could be discussed with clinicians in the emergency department and a pathway agreed.

Staff shared information about patients at effective handover meetings. Nursing and medical handovers were informative and comprehensive. Patients with additional needs were highlighted and arrangements made, for example we observed discussions around patients who required one to one care.

Staff in the emergency department and UTC could easily transfer patients between the services. Staff told us this process had improved since the UTC became part of the trust. The team worked closely together, and UTC staff told us they were able to ask for support from clinical staff in the ED if they needed to ensure patients received the safest possible care.

The service worked well with other providers when patients needed further support. The service used a referral system to access support from a mental health provider and the child and adolescent mental health services (CAMHS) visited the department daily to review patients. The service attended fortnightly meetings with the NHS ambulance provider. These meetings were minuted which showed ideas for improvements were discussed and what actions had been taken, for example returning of trolleys to ambulance crews once a patient had been moved into a hospital bed.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. Staff recorded patient observations using the national early warning score (NEWS) tool for adults and paediatric early warning score (PEWS) for children. Staff we spoke with understood the importance of recording observations which helped determine if a patient’s health was deteriorating. In the 10 sets of patients notes we reviewed, we saw NEWS scores were calculated correctly and documented and in two cases care was escalated and the patient was treated with IV antibiotics in line with the trust’s sepsis policy.

The department ensured patients received care in the most appropriate service and had a range of agreements with local tertiary centres. For example, the ED was not a major trauma centre, to ensure these patients received timely care from the most appropriate service there was a major trauma transfer that covered all age groups in place. This supported staff to communicate and transfer the patient to the most appropriate local major trauma centre.

The service introduced a dedicated sepsis room in May 2024, an area where any patient who was extremely unwell with suspected sepsis could begin immediate treatment. According to the National Institute for Health and Care Excellence (NICE) sepsis guidelines, intravenous antibiotics should be administered within 1 hour of arrival to hospital for patients with suspected severe sepsis. Following the implementation of the sepsis room, compliance with this standard significantly improved. For example, in July 2024, only 24% of patients received antibiotics within 1 hour; by July 2025, this figure had risen to 89%.

The department referred approximately 300 patients a day for imaging. Audits were carried out to check for discrepancies in reporting the images. Any discrepancies found were presented at the mortality and morbidity meetings to share learning with others.

The service carried out audits of patients’ notes reviewing whether notes, forms and risk assessments had been completed. Each month trends were identified showing areas for improvement. Over the 6-month period February 2025 and July 2025, data showed a up and down trend indicating there were instances of improvement and decline. Action was taken to improve this. A monthly poster was created called the ‘Big 4’. This listed the 4 risks in the department and completing documentation became a standing item. The service launched a ‘perfect week’ which was an initiative for nurses and healthcare assistants to reinforce basic care for patients and implement learning from the outcome of complaints and audits. This included completing a checklist of documentation recorded.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff used a recommended summary plan for emergency care and treatment (ReSPECT) forms to record patient’s preferences for their care. We were told doctors of any grade could complete the form, but it needed to be ratified by a registrar or consultant. During our review of the patients EPR, we did not see any examples where it had been necessary for the form to be ratified by a registrar or consultant. ReSPECT forms were stored in the electronic patient record. This did not automatically open or flag when staff accessed patients’ notes and staff had to proactively look for this. This meant staff could miss any recorded preferences.

Staff took all practical steps to enable patients to make their own decisions. During triage consent was gained and recorded in their patient record. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. In the patient records we reviewed, we found that consent had been correctly recorded.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. The registered mental health nurses were available to support staff acting in the patient’s best interest. Staff received training in the Mental Capacity Act as part of their mandatory training.

Staff in the paediatric emergency department told us they used different tools, such as the Gillick competency assessment, when assessing children’s capacity to consent and understand their care and treatment.

Patients with capacity could self-discharge from the department. Patients were required to complete a form to document this, and this was stored in their patient record.