Northwick Park Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant there was good service leadership. Leaders and the culture they created assured the delivery of high-quality care.

We have not awarded this service a score for Well-led.

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

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The end of life care strategy for 2026 to 2029 highlighted its commitment to providing good end of life care, aligned to One Chance to Get it Right, 2014. It highlighted its strengths and challenges and its future focus that included: Developing and implementing a trust-wide policy to embed cultural, social, psychological, and spiritual assessments into care planning, develop a process for all inpatients to have a treatment escalation plan (TEP) completed and conduct quarterly reviews of TEP documentation, Implement the use of care in the last hours and days of life plan across all hospital wards. Leaders told us that ratification of the strategy was on hold because the APG wished to use this strategy as a template for writing its sector wide strategy. This involved each trust adding individual sections and align mutually agreed sector principles. It was anticipated this work will be completed within 2 months of our visit.

The acute hospitals specialist palliative care strategy 2026 was currently in draft form and due for ratification in September 2026. It highlighted a rising demand for the service alongside gaps in staffing to meet that demand. It highlighted continuing the training of key skills to ward staff and how a proactive, sustainable approach was needed to increase workforce confidence, improve consistency and enhance collaboration. Its 5 strategic priorities were: workforce development to implement a 7 day service, standardise referral pathways, further training to staff in palliative care principles, improve metrics to measure quality and place further focus on collaboration across trusts, community and voluntary sectors for better coordinated care and discharge. 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.

Both strategies were aligned to the trust’s HEART values of honesty, equity, accountability, respect and teamwork (HEART). Staff involved with end of life and palliative care told us that the HEART values were useful in conversations with other staff because they spoke of respect and valuing people. We were told that the values raised the profile of providing dignified and respectful care for patients at the end of their life. Managers told us it was a helpful thing to bring into discussions. They were incorporated into staff annual appraisals, and 2 HEART value questions were asked as part of all interview processes.

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.

Executive leads for end of life care were the chief nurse and divisional lead nurse. Palliative care team leaders told us they met with the executive leads regularly to explore challenges the team may have and consider solutions.

The trust palliative care team was led by the nursing lead for palliative and end of life care. The trust’s clinical lead for palliative care was also the clinical lead for the Meadow House Hospice, the medical director for Ealing Hospital and the trust‘s named doctor for adult safeguarding. We spoke with the triumvirate leads for Women’s, Children’s and Clinical Services division within the cancer directorate, which was where the palliative care team sat. In all cases we found leaders held the values of their organisation and the credibility to lead effectively. There was cross site experience and knowledge which raised the profile of collaborative working for the benefit of patients at the end of their life. Leaders understood the challenges the service faced.

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

The Raising Concerns at Work policy set out the trust’s commitment to encourage staff to raise concerns openly as part of normal day-to-day practice and how and where staff could raise concerns, including the national guardian’s office, the Freedom to Speak Up Guardian, NHS whistleblower helpline and other statutory bodies.

Staff had access to a Freedom to Speak Up Guardian who was available should staff need to raise concerns. Staff were aware of who this was and told us they felt they could raise concerns without fear of reprisal. At the time of the inspection the trust reported they had not received any concerns from staff relating to end of life or palliative care.

Staff could also raise concerns through other routes, such as line managers and reported receiving good support from them. Trust leadership for both palliative and end of life care gave us examples of how they had taken forward concerns on the behalf of others, so they reached the right people without staff fear of unfair treatment.

Staff had access to the trust’s intranet pages on raising concerns, whistleblowing and freedom to speak up procedures. They included information on how to speak up and what to expect after speaking up. This included signposting to other external bodies if staff felt their concerns were not adequately addressed by the trust. Data confirmed there were no Freedom to Speak Up concerns raised by staff in relation to end-of-life care at the trust in the last 12 months.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for people who work for them.

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. The trust had a coaching program for mentorship that staff were able to access. All new staff have a mentor and someone to be able to reach out to who was external to their own team.

We heard from staff about a strong and varied programme in support of equality, diversity and inclusion that included messages of support from leaders. There was an annual festival with invited external speakers. Staff told us there were lots of opportunities to participate. There were themed months in support of and celebrating diversity such as LGBTQ+ and southeast Asian heritage. Staff told us there were always lots of examples around the trust of celebrations such as recognising religious festivals along with education and information.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There was a deliberate separation of end of life and palliative care within the trust to enable a better understanding of the difference between providing a palliative and end of life care service. This included belonging to different directorates. However, services were also integrated. For instance, the lead nurse for the palliative care team was also the lead nurse for end of life care. Clinical leads for both palliative care and end of life care worked closely with clinical directors regarding both palliative and end of life care across the hospital. Palliative care teams had both palliative CNSs and end of life care assistant working in them.

The palliative care team sat within the cancer directorate, which belonged to the Women’s, Children’s and Clinical Services division. End of life care belonged to the Corporate Services division. Most activity was reported into the cancer care group monthly divisional management governance meetings. Minutes of the monthly divisional management meeting from June 2026 were provided. They demonstrated monitoring of performance, quality and safety and was attended by divisional leads including representation from a palliative and end of life services.

The annual activity report for the acute hospital’s specialist 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 the last 10 years. Clinical outcome indicators were used to demonstrate high levels of dependency and complexity which were triaged and prioritised. Service development areas included implementing the acute hospitals specialist palliative care strategy, further alignment with palliative colleagues across the APG and improve access to occupational therapy services to Ealing Hospital. Continuing priority of education activity was also highlighted.

The service’s risk register was reviewed at the monthly directorate meeting for updates on progress and actions. It contained palliative and end of life care items. The risks recorded were: 7 day working, estates at Meadow House Hospice, administrative support and working to 2 electronic patient record systems Meadow House.

Currently, administrative support pulled together performance metrics from several sources that were then shared in performance reports. The palliative care team leaders were working with the trust’s IT team to build a dashboard that would bring together all their performance metrics into one place. This amounted to 30 metrics which would enable the team to better monitor and respond to the quality of care, treatment and support given to patients and families. It would allow the palliative care team to better monitor information such as source of referral, time of referral from referral to being seen, what areas of the hospital were not referring, how long patients remained on the caseload. The IT project sourced all its information from different locations within the electronic patient record. To date 2 progress meetings had taken place with IT to clarify future tasks and monitor progress with current work stages.

The trust quality account 2025 to 2026 report set out key achievements, performance and priorities including in end of life care. It included performance of the end of life education team, expanding the purple butterfly scheme and performance and participation in the national audit of care at the end of life (NACEL).

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

We noted many examples of collaborative and partnership working with palliative and end of life care services. There was an ethos amongst trust teams to work in wider networks for the benefit of patients at the end of life and their families.

For instance, within the North West London Acute Provider Group (APG); a collaborative of 4 London NHS trusts running 12 hospitals, there were both palliative and end of life forums demonstrating an outward facing focus on improving processes and practices.

We heard from bereavement teams and mortuary teams about how they worked to establish links with community services and minority groups to enable good care following the death of loved ones.

The hospital’s palliative care team had a culture of promoting good communication with teams around the hospital and in the community by taking a positive approach to speaking to people for the benefit of patients. This meant they had forged good working relationships. We heard about how they worked to make discharge arrangements work for patients and families in challenging circumstances.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contribute to safe, effective practice and research.

Both members of the palliative care team and the trust lead for end of life care were involved in various trust quality improvement initiatives to improve the quality of care for patients at the end of their lives and their relatives.

One of the workstreams of the Acute Provider Group (APG) end of life care working group was improving end of life care documentation on electronic patient record within the group of 4 London NHS trusts. We were also provided with examples of individual learning carried out in partnership with other hospitals within the group.

Improvement work had taken place in the use of treatment escalation plans (TEP) in urology. The end of life care clinical lead had reached out to urology to understand its implementation across the trust. A working group of critical care consultants, urology team members, specialist palliative care nurses and ward managers had jointly drafted recommendations.

Following some trust wide learning, a policy had been produced to provide guidance on improving the process for people who might die in transit and getting home safely. This was being shared wider for implementation within the APG.

One of the palliative consultants was working with the haematology team to improve end of life and palliative care for patients. A member of the palliative care team also worked in the transformation team which had increased the presence of end of life care within the work.

Improved fast track documentation was going live on the electronic patient record the week after our visit. This meant the palliative care team and supporting administrative systems in the hospital would be able to better locate information to populate the many sections that required completion and assist in completing applications within tight timeframes.