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

At our last assessment, we rated this key question as requires improvement. At this assessment the rating has changed to good.

The service provided care and treatment based on national guidance and evidence of effectiveness. National Institute for Health and Care Excellence (NICE) guidance was routinely discussed and reviewed at clinical governance and team meetings. Leaders told us NICE guidance was followed during pre‑assessment and throughout the care pathway. Staff used up‑to‑date policies to plan and deliver high‑quality care in line with best practice. The trust had a policy in place for implementing NICE guidance and quality standards.

Leaders supported joined up working across teams. The service used clinical outcomes, audit findings and performance data to identify areas for improvement and develop action plans when required.

Children, young people and their families were actively involved in pre‑operative assessments. Staff communicated clearly about risks, treatment options and expected outcomes. Assessment processes supported staff to identify and respond to individual health, wellbeing and communication needs. Families were encouraged and supported to be involved in their child’s care.

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 children, and young people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff told us that children and young people received an initial consultation to identify their care needs, preferences and care pathway. Children and young people undergoing surgery were also provided with information about their procedure as part of this process.

We reviewed patient records and noted that care planning was holistic and took account of all identified needs, for example those with learning disabilities, epilepsy, and gastroenterological conditions. The electronic patient record clearly detailed the multidisciplinary teams involved in each patient’s care and the actions being taken to meet their individual needs. Children and young people and their families said they were confident their individual needs had been appropriately assessed and they fully understood the assessment process.

The service had effective procedures for patients in need of mental health support. There were established partnerships with local mental health teams and support services. We saw minutes from departmental meetings where self-harm amongst children and young people had been discussed. For example, types of self-harm injuries had been discussed, the need for a multidisciplinary (MDT) approach and the latest guidance and learning. Clinical staff had a good understating of the needs of children with attention hyperactivity deficit disorder (ADHD) and how the condition presented. The needs of children and young people were captured at pre-assessment and reasonable adjustments were made. For example, placing a child at the end of a ward where it was quieter.

Staff effectively communicated with children and young people and their families to meet their needs. For example, we observed a member of staff communicating patiently, kindly and compassionately with a patient presenting with a mental health condition. Staff discussed patient’s individual needs with them, and they were involved in how their care and treatment was planned.

Staff assessed and acted on risks to children and young people of avoidable harm and worked with other specially trained professionals to support their needs. We reviewed patient records and saw evidence of input from the therapy teams. Staff could add flags to patient records to identify patients with additional needs or who might require additional support. This included alert flags for patients with allergies, mental health needs, learning disability and autism.

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

Care and treatment were provided in line with National Institute for Health and Care Excellence (NICE) guidance. NICE guidance was routinely discussed and reviewed at clinical governance and team meetings. The lead paediatric consultant told us that NICE guidance was followed during pre-assessment, and staff used up to date guidelines to plan and deliver high-quality care. During the inspection, we found that clinical practice reflected national guidance and established good‑practice principles.

The trust had a policy in place for implementing NICE guidance and quality standards, this ensured care was delivered in line with the most recent guidance. The CYP service leaders monitored the effectiveness of care and treatment through ongoing local and national audit activities; the audit showed the trust was improving. Regular reviews of performance and outcome data were undertaken to ensure the service continued to meet the needs of children and young people. This included benchmarking and peer‑review processes with other NHS hospital trusts, with which the service compared favourably.

The policies we reviewed included creation and review dates and referenced current national guidance. Systems were in place to communicate policy updates through meetings and management newsletters, and notice boards displayed up‑to‑date information for staff. Policies and processes reflected changes to Royal College guidance and National Institute for Health and Care Excellence (NICE) standards.

In the five care records we reviewed, all children and young people had appropriate care plans and risk assessments. Patients waiting for surgery were not kept nil by mouth longer than necessary, and intravenous fluids were used to support pre‑operative optimisation for emergency cases when required. Staff completed fluid and nutrition charts accurately, and this information informed care planning and delivery. A nationally recognised screening tool was used to identify children and young people at risk of malnutrition, and care plans were adjusted accordingly. Those requiring special diets for clinical reasons were assessed by a dietitian, provided with appropriate meals during admission, and given dietary advice on discharge.

The service worked well across teams and services to support children and young people. Staff shared information effectively so that children, young people and families did not need to repeat their story when moving between services.

Staff held regular MDT meetings and told us there were positive working relationships across teams. We observed good communication and collaboration between staff from different professions and grades who were involved in the care and treatment of children and young people.

Information was shared during shift handovers, safety huddles and bed meetings. Staff also used daily huddles to identify risks, review patients requiring close monitoring and discuss safeguarding concerns. We observed a safety huddle and handover meetings, which were well attended and supported shared decision making.

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide high quality care. Staff reported healthy working relations across staff groups including between medical and nursing teams. We saw and heard examples of effective team working which was based on mutual respect and trust.

Regular MDT, reviews, clinical planning meetings and ward rounds were held for some specialities such as cardiothoracic surgery. Staff held regular MDT meetings when required, to discuss treatment options for individual patients and improve their care and treatment option.

Shift changes and handovers included all necessary key information to keep patients safe. We attended staff handovers during the onsite inspection and found all the key information needed to keep children and young people safe was shared. The handover shared information using a format which described the situation, background, assessment, recommendation (SBAR) for each patient. Information was shared between teams and services to ensure continuity of care.

Children and young people transitioning to adult services were assessed in line with relevant NICE guidance, terms of reference (TOR) and the trust’s standard operating procedures (SOP’s). There was evidence of systems and processes in place to support young people from the age of 13 as they prepared to transition to adult services. The trust had clear processes to identify and support children and young people who required additional help, specialist intervention or structured planning for transition to adult services. There was joint working with the medical teams taking over the young person’s care, this facilitated a smooth transition to the adult services and managed expectation of what and how services would be delivered. Families of the young person were actively involved in the transition discussions and decisions.

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

Staff took part in projects across the CYP services to promote health and wellbeing. Information promoting healthy lifestyles was available on wards and in the children’s and young people’s outpatient department (OPD).

Staff assessed each child or young person’s health on admission and provided support based on individual needs. Full assessments were completed, and referrals to dietitians or speech and language therapists were made when required. Children and young people along with their families, received appropriate advice about diet, healthy living, nutrition and hydration during admission and at discharge.

Families told us they received good support from staff, including verbal and written information about healthier living and lifestyle choices. They said routine advice was provided before and after surgery. A range of information leaflets was available, offering specific guidance on managing after medical or surgical interventions/procedures, as well as general health information displayed on wards and in the outpatient department.

The service routinely monitored children and young 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 children and young people themselves.

The service monitored care and treatment through clinical audits to support continuous improvement. Staff used clinical audit and outcome monitoring to ensure care was effective and met clinical and patient expectations. The CYP service had a quarterly audit programme as part of the trust’s annual audit schedule. The service submitted data to national audit programmes, which enabled benchmarking against other organisations and identification of outliers. The audit results showed the trust was performing within the national standards.

The CYP service demonstrated a high-volume, high‑acuity clinical workload, with activity levels consistent with a large, complex children’s healthcare provider. In the last 12 months, the service-maintained oversight of 6,873 patients on its treatment list, reflecting sustained demand across all care pathways. Outpatient activity remained the primary point of contact for children and young people, with 33,699 new appointments and 25,197 follow‑up consultations delivered. Surgical activity was significant, with 3,181 paediatric patients undergoing surgical procedures, indicating a broad range of planned and urgent interventions.

CYP inpatient services continued to experience high volume of admissions. There were 8296 children admission in the last year, and the emergency department saw 49,818 children admitted, demonstrating consistently high unscheduled care demand. The increase in inpatient admission for children, showed that more children required hospital‑based care, indicating rising demand and potentially higher clinical acuity within the paediatric service. We noted the service was a busy and responsive to the need of children and young people with activity levels that ensured safe, effective, and well‑led care for children and young people.

The trust was identified as a negative outlier for blood glucose control in children and young people with Type 1 diabetes. In the 2024–2025, the National Paediatric Diabetic Audit (NPDA), the hospital’s completion of key healthcare checks was slightly below the national average but within the expected range. However, some of the results fell outside the expected range, indicating poorer blood glucose control compared with similar paediatric diabetes services nationally. The service had already developed and implemented an action plan for this key indicator.

The trust took part in the National Epilepsy12 audit, which measures the quality of care for children and young people with seizures and epilepsy in England and Wales. In the 2024 audit with the report published in 2025. The trust was positive outlier for the proportion of children and young people who received input from an Epilepsy Specialist Nurse (ESN) within their first year of care. The trust was also within the expected range for referral to paediatric neurology. This indicated good performance by the trust in meeting the National Epilepsy12 target.

The service told children, young people and their families about their rights around consent and respected these when delivering person-centred care and treatment. Staff gained consent for care and treatment in line with legislation and guidance. Plans of care were discussed as routine practice and where possible families were involved in discussions.

Children, young people and their families were given clear verbal and written explanations of procedures, including risks and benefits. We observed staff taking time to explain treatments and ensure understanding before consent was obtained. Staff gained verbal consent for treatments and documented written consent where required. When children and young people or their families were unable to give consent, decisions were made in their best interests, taking account of wishes, culture and traditions.

Parents and carers that we spoke with confirmed risks of procedures had been explained clearly and consent had been discussed and forms had been signed. Staff spoke with the children and young people before any care and treatment was started. They ensured that children, young people and their families understood what was to happen next. Staff obtained consent in line with legislation and trust policy. Staff understood that some children were able to give their own valid consent, this occurred when staff assessed them as mature enough to fully understand what they were being asked.

Staff followed structured processes for obtaining consent and adhered to national guidance. They demonstrated an understanding of Gillick competence and Fraser guidelines which covered the legislation relating to consent for children and how these were applied these in practice.

Staff were aware of Martha’s Rule and the escalation pathway for families of children and young people who had concerns about a child or young person’s condition. The pathway gave families a process to request a second clinical review. There was evidence of this been used by families of children and young people.