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.

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.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We visited 4 wards where patients were receiving end of life care. We saw 4 patients with members of the palliative care team. We reviewed the care records of 5 patients following our ward visits.

All patients were receiving effective care from ward teams and palliative care team members. This included mouth care, malnutrition assessments, catheter care, bowel charts, eating and drinking and pressure area care. Patients who were at the end of life were appropriately cared for through symptom management including medications, pain management, breathlessness management and management of terminal agitation.

Patients looked well cared for and clean, all care plans had been completed and documented. Having witnessed the palliative care team at work with ward teams, we agreed with the comments of ward staff and would compliment their contribution to the delivery of end-of-life care in Northwick Park.

We attended a trust palliative care multidisciplinary team meeting which occurred weekly. This was attended by consultants in palliative medicine, palliative CNSs including senior and triage coordinator and band 4 end of life practitioner. We observed discussions about new referrals, discussions about existing patients on the caseload, in-depth discussions about complex symptom management and advice given by consultants to CNSs. There were discussions around fast track decisions and referrals regarding appropriateness of referrals. There were discussions about patient appropriateness for referral to a hospice, preferred place of care and preferred place of death. Discussions and decisions made were documented. Mental capacity and DNACPR discussions were discussed and documented where appropriate. Referrals to MacMillan psychology support and to the spiritual care team were discussed and made.

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

The trust took part in the National Audit of Care at the End of life (NACEL). The hospital’s performance data from NACEL reports for both 2024 and 2025 (the 2 most recent reports available) demonstrated good performance against most key indicators. For instance, completion of individualised care plan had risen from 82.6% in 2024 to 90.1% in 2025. Ethnicity had been documented in 90.0% of plans in 2024 and 93.8% in 2025. Recognition of expected death had risen from 78.3% to 88.8%. Prescribing of anticipatory medicines had risen from 85.2% to 89.7%.

Other areas showed improvement but with further improvement needed. For instance, communication about hydration which had risen from 52.5% in 2024 to 75.3% in 2025. Completing emotional and psychological assessments had risen from 49.2% to 65.8%.

One of the service’s key performance indicators was providing a 7-day service. Because services were not provided on weekends, this was rated ‘red’ by the service. We had several conversations regarding this with different leaders. Everyone was aware of this lack of provision, and that extra palliative care clinical nurse specialists (CNS) were required to fulfil this.

It had been highlighted to the executive team in reports such as end of year reports and strategy documents. The resourcing of a 7 day a week service remained a challenge for the trust and senior leaders we spoke with were aware of this. It had also been highlighted that the palliative care team lacked administrators and discharge coordinators, which impacted on the amount of time spent away from front line patient work. Time between recognition of a dying patient and death was below both the London and national average. Time taken from referral to the palliative care team and patient review was also below both the London and national average. However, time taken from patient admission to referral to the palliative care team was above both the London and national average.

The palliative care team attended Friday forums which included being regularly updated on good practice guidance and evidence-based care and treatment. Training days for nurses and healthcare assistants organised by the end-of-life education team. This was based on the ‘five key priorities for care of the dying person’, from One Chance to Get it Right, a key source for end of life care published by the Leadership Alliance for the Care of Dying People (LACDP) in the UK. The end-of-life education team worked with ward-based end of life care champions who attended regular meetings and training which they shared with their teams. This meant they were being regularly updated on good practice guidance and evidence-based care and treatment.

There had been trust wide training on the use of a single type of syringe driver, in line with best practice guidelines, in partnership with the manufacturer.

The trust were part of the North West London Acute Provider Group (APG); a collaborative of 4 London NHS trusts running 12 hospitals in total. There were end of life and palliative care forums within the APG which both included keeping abreast of good practice guidance and evidence-based care and treatment. Recent examples were improving discharge processes and anticipatory medicines management.

The trust’s palliative care team had consulted on and drafted the ‘acute hospitals specialist palliative care strategy’, which was due for ratification within a month of our visit. This was based on good practice guidance and evidence-based care and treatment.

We visited patients receiving end of life care with members of the palliative care team and reviewed patient files. Care was being delivered in line with legislation and current evidence-based good practice and standards such as the National Institute for Health and Care Excellence (NICE) NG31, NG 142 and NICE quality standard 13 which define clinical best practice in care of dying adults in the last days of life.

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

The palliative care team worked across the trust, building good working relationships with clinical teams to improve outcomes for patients receiving end of life care. For example, staff on wards we visited told us about their helpfulness and we observed these good relationships around the hospital. Ward based end of life care champions were supported by practice educators who had helped to build a network among teams.

Staff told us how the trust lead for spiritual care had built good responsive relationships with teams within the hospital which had improved access to spiritual care for patients. We also spoke with the bereavement team and mortuary technicians. We found there were good working relationships across the hospital and trust, built for the benefit of good patient care and for supporting families.

The nurse lead for palliative and end of life care, trust clinical lead for palliative care and the trust clinical lead for end of life care worked with clinical directors across the hospital. This included establishing relationships with teams such as gastroenterology, haematology and the emergency department. Good links with frailty consultants and care of older people teams had meant a better understanding of end of life care for patients. For example, due to collaborative working there was now a guideline to accompany the urgent care plan for palliative care specific to frailty and care of the elderly.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

During our observation of care and treatment, attending handovers and multidisciplinary meetings where patient care was reviewed and reviewing patient files, we found that the care and treatment provided to people at the end of their lives was focussed on supporting patients with hydration and nutrition, mouthcare and symptom control such as pain management. This meant people were supported to live healthier lives where possible.

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

There was an annual activity report produced by the palliative care team which reported on outcome criteria such as preferred place of care and outcome data from palliative care team input. This was shared within divisional leads and reported up to the executive team for assurance and monitoring.

The annual activity report for the trust palliative care team, April 2025 – March 2026, reported on clinical activity, service development and staff education. It reported on a 4% increase in activity in the last year and a doubling over 10 years. Clinical outcome indicators were used to demonstrate high levels of dependency and complexity which were triaged and prioritised.

Mortality and morbidity (M&M) review meetings were attended by the trust clinical lead for end of life care. M&M meetings are clinical forums where healthcare professionals review outcomes involving patient deaths. They include learning and highlighting good practice at the end of life.

The outcomes from deaths in the emergency department (ED) audit had been completed for April and May 2026. It showed that out of 262 people who died in hospital, 12% died in ED. It included analyses of time between arrival and verification. The results were presented at the end of life care group meeting in May 2026. Learning was identified as: continue to improve and update the universal care plan and the collaborative working with the ambulance service and improve slow recognition of dying in frail elderly patients.

We were provided with data showing the increasing number of palliative care team referrals over the last 10 years. This showed that in 2025, 2042 referrals were received compared to 1317 in 2015. The palliative care team told us that they had additionally seen an increasing number of referrals due to rising frailty rates and other long-term conditions. Financial constraints meant that staffing had not increased to meet these demands.

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

The palliative care team were able to give us several examples where they had worked to obtained informed consent and deprivation of liberty in challenging situations. These included with complex family relationships, the advance care plan and expectations and understanding about rights and consent. This included family meetings, where they made sure everyone understood the same thing regarding their loved ones’ wishes at the end of their life.

The palliative care team and end of life lead had recently provided training to medical staff around communication, consent and best interests. It included better understanding about Lasting Power of Attorney following an incident regarding nasogastric feeding. There had also been teaching sessions for ward staff on mental capacity and second opinions, where patients lacked capacity in relation to working with patients and families.

The trust had responded to a national report regarding blanket DNACPR decisions applied to people with learning disability and autism. This included carrying out DNACPR audits and producing guidelines. An audit of DNACPR and treatment escalation plans (TEP) took place in November 2025, with the stated aim to give assurance that practice was in accordance with policy. 515 cases were sampled and showed 49% of the communication with family section had no documentation compared to 46% in 2023. Results were broken down to wards for targeted improvement. An action plan had been produced with stated aims and target dates for completion. It stated that further training was now taking place including at induction for better completion and to ensure that staff were aware of the policy. It proposed better guidance on how to complete areas of the document. It also advised having a medical end of life champion on each ward to ensure correct, timely and full documentation of TEP and DNACPR forms with regular spot checks and feedback to the teams.

The trust supported teams to meet the Deprivation of Liberty Safeguards through a dedicated team. The palliative care team told us they received good support from this resource.

The 5 patient records we reviewed including review of DNACPR forms, had all been fully completed, including discussions with patients and their relatives. Demonstrating discussions and decision had been documented.