Northwick Park Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

We have not awarded this service a score for Responsive.

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

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patients at the end of their lives were at the centre of their care and treatment through their end of life care plans and advance care plans. We reviewed 5 patient records. This included care plans and advance care plans, they all included people’s care and treatment choices.

The trust supported teams to meet people’s individualised needs through specialist teams such as the learning disability team, dementia team and drug dependency and alcohol team. The palliative care team gave us examples of how they had worked with each of these teams to provide personalised care and treatment. This included close working with the learning disability team which involved carrying out joint first visits to share expertise and assess individual needs. They also carried out post death and post discharge reviews with the learning disability team for learning and in line with Learning from Lives and Deaths (LeDeR) guidance.

The palliative care team reported they were seeing more patients with learning disability, which had raised awareness. The trust had rolled out the statutory training programme on learning disability and autism which was required learning for all health and social care staff in England, with the face-to-face component completed 18 months ago. The palliative care team had completed the training.

The trust had developed resources to support people with learning disabilities and autistic people. These resources promoted reasonable adjustments and helped ensure safeguarding information was provided in an accessible and inclusive format. There were accessible documents for people with learning difficulties and autism on domestic abuse. Calm Bags were available in the hospital. These were portable kits filled with tools like ear defenders, fidget toys, and grounding items designed to help anyone experiencing sensory overload manage stress and self-regulate.

The palliative care team told us how their caseload was increasingly made up of patients with dementia. The team described working closely with the frailty and dementia team and described many examples of co-working to better meet individual need.

Mental health support was provided by the mental health trust and included a liaison service and crisis support.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Patients being discharged at the end of life were referred to district nursing teams. Staff described the process of going from hospital to home. They told us it was easy to get equipment such as mattresses and syringe pumps to go home. Ward managers and senior nurses had set up a telephone group chat to locate syringe pumps when needed. There was generally good availability of pumps in both the hospital and community.

There was an occupational therapist in the palliative care team who assisted the process and district nurses could also order equipment, with urgent orders delivered within 4 hours.

The clinical lead for end of life care had led on improvements to the processes for getting people home such as with transport, medications and prevention of premature discharge. The hospital palliative care team and end of life leads framed this as a system problem and good communication was seen as key to helping. For instance, picking up the telephone and speaking with local teams and joining up services for the benefit of patients.

The palliative care team were completing fast track discharges which involved completing forms and tasks, speaking to key people in community teams and understanding how to help to make this process smoother for patients and families.

The universal care plan (UCP) was used to exchange information with services. This was a digital service for handovers that shared personal care preferences, medical history and support wishes with emergency services and healthcare professionals without needing to repeat your medical history including recommendations for do not attempt cardiopulmonary resuscitation (DNACPR).

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The palliative care team demonstrated an ethos that promoted providing accurate, relevant information to people and signposting people to the right hospital and community resources whenever possible. This was also true of ward teams caring for people at the end of their lives. We met bereavement, hospice, mortuary and spiritual care teams as well as other medical teams such as ED and critical care outreach. A key part of everyone’s work was using their links and relationships to provide accurate information and get things done for people.

The trust’s intranet contained information to assist hospital teams with advice about palliative and end of life care. The palliative care team signposted staff to these resources which included information about what to expect following death, where they could access further assistance and what was offered by the palliative care team.

The bereavement pack had recently been updated and rebranded to incorporate the purple butterfly project. We found it readily available to pick up in different settings at the hospital such as wards and the viewing area at the mortuary. It provided valuable information for relatives following bereavement. This included: contact details of the bereavement office. A booklet on the next steps such as visiting the mortuary. The bereavement service. The tissue donation service. How to access spiritual care and support. Advice on when the coroner was involved. Registering a death and arranging a funeral. There was a leaflet on how to remove a deceased relative from marketing lists. A guide to understanding probate matters. A leaflet on probate valuations. A leaflet on how to take part in the bereavement survey for the National Audit of Care at the End of Life which included an easy link QR code.

The trust had a reading group who reviewed all literature prior to publication. This was to ensure it was jargon free and in an easy to read format.

On all leaflets and patient information on websites it stated that information was offered in in different languages and formats including large print and Braille, with links and contact details for obtaining further assistance including access to interpreter services.

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

A central trust team flagged any palliative and end of life care related complaints to the palliative care team. The palliative care team carried out a thematic analysis of related complaints. There were 12 complaints in the last 12 months. Two were specific to the palliative care team themselves while 10 were about care received by hospital teams, with the palliative care team having peripheral involvement.

The palliative care team’s weekly meetings reviewed any open complaints and timelines of responses. The team contributed to learning about all aspects of complaints related to palliative and end of life care which were shared with the end of life education team and incorporated in to learning streams such as handovers, staff meetings, governance meetings and steering groups.

The quarterly end of life steering group meeting discussed any complaints or incidents regarding end of life care and what learning there was to share for wider learning. They also collated positive feedback from the trust, including Meadow House Hospice, which was shared with the divisional governance team. This included recognising individual and team success.

The service made sure that people could access the care, support and treatment they needed when they needed it.

Palliative care services in the trust were available from 8am to 5pm Monday to Friday. The service was not currently providing a weekend service. The trust palliative care teams had consulted on and drafted the ‘acute hospitals specialist palliative care strategy’, which was currently in draft form. It had been shared with senior leaders and was due for ratification within a month of our visit. One of the pillars of the strategy was team resourcing to fund a 7 day a week service. Leaders told us that the strategy would be presented to the trust and a business case completed to address the expansion of the specialist palliative care team to provide a 7 day a week face-to-face service.

Nurses and healthcare assistants were supported to provide care to end of life care by the regular contact and assistance they received from the palliative care team and from the training programme rolled out by the end of life education team. There were end of life care champions on wards who were supported by both to deliver end of life care.

There was a trust wide on-call service was provided by 6 palliative consultants covering 3 trust sites and Meadow House Hospice which meant patients could access support and treatment when they needed it.

During weekdays the palliative care team had a dedicated CNS to triage all referrals within two hours. The team accepted urgent referrals and patients could be seen the same day. Ward teams could escalate patients to the palliative care team verbally for expediency and later followed up with referral on the electronic patient record.

The trust told us they did not routinely collect data on the percentage of referrals seen within 24 hours. They had been working with the trust’s IT team to create a dashboard of data that would be able to draw better information from the electronic patient record.

However, data collected as part of the NACEL audit, reported that the time taken from patient admission to referral to the palliative care team was above both the London and national average. We were told the program of education and training around the trust had raised the profile of end of life care which had helped to improvement, but there was still work to do. Time taken from referral to the palliative care team to patient review was below both the London and national average.

Access to the spiritual and pastoral care team was restricted by the number of posts currently funded and because the team was not reflective of the religious make up of the local community. Both issues had been addressed by the spiritual and pastoral care team lead, which had been supported by the trust. At the time of our visit, funding and adverts for additional posts had been approved.

The mortuary service was available from Monday to Friday 8am to 5pm. The mortuary teams were available on call out of hours for urgent faith deaths requiring rapid burial or release. They described the process they followed and the extensive links they had with local faith communities and medical examiner.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The trust understood it’s local community demographic and were proud that its workforce reflected the local populations it served. For instance, 68% of staff were from black, Asian and minority ethnic backgrounds and representative of the London boroughs they served. Teams at the hospital told us staff were more involved because they belonged to the local community which also helped with languages and understanding the cultural identity of patients.

We heard from mortuary technicians about their knowledge of local faith-based communities and how they had worked with them for the benefit of patients’ relatives. We heard from the spiritual and pastoral care lead about the work they had done to be representative of the population they served. The bereavement pack had recently been updated and was readily available to pick up in different settings around the hospital. It provided valuable information for relatives following bereavement which included contact details of local bereavement and counselling services that were specific to the local community such as Jewish, Asian and Muslim.

We were given examples of recent work carried out engaging with hard to reach groups. For instance, the mortuary team had been supported by their departmental leads to facilitate a good service to local travellers.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The palliative care team, hospice team and ward teams involved patients and their families in advance care planning; a process of thinking about and recording personal preferences for future medical and personal care and how patients wished to be treated if they lost the ability to speak or make decisions for yourself.

Assessments had been fully completed for do not attempt cardiopulmonary resuscitation (DNACPR); a decision made between doctors and patients and families about future scenarios for resuscitation. Ensuring agreed decisions were acted on.

Treatment escalation plans had been documented on the electronic patient record regarding future treatment based on current health. This ensured individual needs and wishes were met.

The universal care plan (UCP) had been fully completed with patients. The UCP was a digital service for handovers of care that shared personal future care preferences, medical history and support wishes with emergency services and healthcare professionals, ensuring patients received consistent, tailored care without needing to repeat medical histories or preferences.