Northwick Park Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At the last assessment, we rated this key question as requires improvement. At this assessment, the overall rating of safe at Northwick Park Hospital had improved and was rated as good. This meant people were safe and protected from avoidable harm.

The service had appropriate staffing levels, and a suitable skill mix to deliver safe, high‑quality care. This was supported by extensive specialist input from NHS clinicians.

The service worked closely with patients and partners to maintain safe systems and ensure continuity of care. Staff understood how to report incidents, felt confident to raise concerns and described an open, no‑blame culture.

The service supported people to understand and manage risks in a holistic way. Equipment and technology were well maintained, and infection risks were consistently assessed, managed and controlled. Medicines and treatments were managed safely and were aligned with people’s needs and preferences.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive safety culture that was based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Learning was used to identify and embed good practice; for example, the service educator held lunchtime bite‑size teaching sessions on the ward to support staff, and staff could suggest topics and teaching sessions to be provided by the education team.

Staff held daily safety huddles and handovers. During staff huddles, incidents were routinely discussed. We observed staff discussing an incident that had been reported using the Patient Safety Incident Response Framework (PSIRF). The outcome of the investigation was shared with the team, and feedback was given on changes to be implemented from the learning.

Staff told us that incidents were discussed openly and described the approach to incidents as a ‘no blame’ culture. We reviewed three patient safety incident investigations (PSII), which included identified areas for improvement, safety actions and evidence that actions had been completed.

The CYP service followed the NHS England Patient Safety Incident Response Framework (PSIRF), which set out the service’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents and issues for the purpose of learning and improving patient safety. Staff had access to the incident reporting policies and procedures through the trust’s intranet. CYP leadership kept a log of National Patient Safety Alerts and shared this with staff and actioned as appropriate. We saw evidence that information had been shared with staff.

The paediatric service used the Trust’s Datix incident‑reporting system to record and manage incidents. Over the previous 12 months, the service reported 195 incidents, including 11 near misses. All incidents were reviewed by the paediatric team and monitored through the Trust’s regular governance processes. The highest reporting categories were Implementation of care and abuse. Incidents recorded under implementation of care included issues relating to workforce, communication, and operational processes. The service had implemented ongoing actions to address these areas, as outlined in its action plan.

Staff reported that they had completed their yearly mandatory training, the training data log confirmed this was the case. Staff mandatory training was monitored by line managers to ensure completion; the trust reported 98% completion rate against the trust target of 95%. Staff had allocated time for mandatory training and within this allocated training time, staff had the opportunity to choose from a range of courses to enhance their skills. The service offered funding for professional development and career progression for staff based on merit. For example, a band 5 nurse informed us of the course she had been funded to undertake to develop her CYP knowledge and skills.

The CYP service held regular mortality and morbidity (MM) meetings across all specialities, reflecting a strategic culture of learning and clinical governance. We reviewed minutes of meetings and terms of reference for MM meetings which demonstrated a programme of reviews, well‑documented records detailing morbidity cases, contributing factors, and outcomes, with standardised classification used to assess the severity of complications. Themes emerging from the reviews included post‑operative complications such as bleeding, infections, and respiratory depressions, all of which had been managed appropriately.

The CYP team produced a monthly newsletter which included learning from incidents and clinical audit reviews. Learning from incidents, complaints, and concerns was also shared through teaching sessions on the ward facilitated by the practice educator.

All staff understood their responsibility to be open and honest with patients and their families when things went wrong. Staff were able to give examples of duty of candour being applied and demonstrated a good understanding of when this duty was required. They understood that this included offering an apology and completing an investigation into the incident if appropriate.

The service worked with children, young people and their families as well as healthcare partners to establish and maintain safe systems of care, with arrangements to monitor and manage safety. Staff supported continuity of care, including when children and young people moved between different specialities, for example children. Children and young people and their families participated in discharge planning, and records and handovers showed arrangements to support safety and continuity of care.

The service’s referral and admission processes included key information to help determine whether the child or young person’s needs could be safely met by the service or if an alternative service was required. Handovers included patient needs and arrangements for ongoing care.

Children and young people and their families were involved in discussions about surgical risks and anaesthesia‑related complications. We observed a pre‑operative assessment where a parent was given information about the risks associated with general anaesthesia to support decision‑making. The service worked with children and young people, staff, and healthcare partners to maintain safe systems of care. Staff reported relationships with colleagues across different specialties and external healthcare providers, which supported communication and multidisciplinary discussions.

Staff held daily safety huddles and handovers. We observed a morning handover attended by staff from relevant teams, such as pharmacy. Topics discussed included patient‑specific concerns, such as deterioration in the theatre recovery area, clinical observations, arrangements for onward discharge or transfer, safeguarding considerations, and relevant test results. Additional support services for children and young people were also discussed; one young person was receiving input from a dietician.

The CYP service held daily meetings to review flow within the service and escalated any child or young person who faced delays in discharges. Managers told us this helped coordinate patient flow within the hospital through multidisciplinary collaboration. Clinical staff involved relevant healthcare specialties to support continuity of care, both within the hospital and post‑discharge.

Clinical staff assessed, monitored and responded to the nutrition and hydration needs of children and young people using documented assessment and monitoring processes. We reviewed five care records and found that nutrition and hydration charts were completed during the admissions reviewed. The charts included information about intake and actions taken and gave staff information to support clinical decision‑making. The records showed staff used this information to plan care, monitor progress and escalate concerns when required.

A review of care records also showed that daily interventions over a 24‑hour period were completed, this included risk assessments, vital signs and assessments of deterioration. The records were clear and well documented. We noted that clinical staff used this information to identify risks and to respond to changes in the child or young person’s condition.

The documentation we reviewed showed staff followed established processes to support continuity of care. Information was recorded in a way that supported handovers, multidisciplinary communication and ongoing monitoring. This approach ensured every staff member involved had the information they needed to provide safe, coordinated treatment

There was evidence of systems in place to support young people from the age of 13 years in their transition to adult services. The transition from child to adult services was planned to support continuity of care. Staff prepared children, young people and their families in advance by working with them to understand their individual needs, preferences and future care arrangements. Personalised transition plans were co‑produced with input from relevant professionals, including social workers, health professionals and adult service providers.

The leadership of the CYP service worked closely with patients, families and healthcare partners to ensure children and young people were protected from harm, neglect, abuse and discrimination. Staff understood their safeguarding responsibilities and were able to describe how they would take appropriate action when concerns were raised. They were supported by accessible safeguarding policies, which were available to all staff via the intranet.

Managers reviewed all staff safeguarding training to ensure the correct level of safeguarding training was completed and added to individual online learning records. Staff received targeted communication reminding them to complete their mandatory safeguarding training and encouraging timely completion. Data provided by the service showed excellent compliance with safeguarding training. Most staff groups had a compliance rate of 100%, which exceeded the service target of 85%. For children and young people’s safeguarding training (levels 1 and 2) the average compliance across all staff groups was 98%. The safeguarding leads had completed level 4 safeguarding training along with two other senior staff members. Average compliance across all staff groups for Mental Capacity Act, DoLS and preventing radicalisation training was 100%.

The trust had a safeguarding CYP at risk policy. This provided staff with guidance on how to identify possible abuse and the processes to follow if they needed to raise a safeguarding concern. The policy was in date and reflected current legislation and national guidance. Access to the wards was secure via a door buzzer system and staff carried electronic passes to enter the wards and CYP areas.

Staff knew how to identify children at risk of, or suffering, significant harm and worked with other agencies to protect them. Learning from specific cases of safeguarding was discussed and disseminated throughout the CYP service and to the wider trust. There was a designated CYP safeguarding leads. Staff told us they could escalate concerns to them and seek advice if they had any concerns. Staff explained how they would escalate safeguarding concerns and told us the procedure they would follow to make a safeguarding referral. Staff gave an example when they had suspected abuse and how they had referred to and worked with external agencies to keep the child safe.

The safeguarding team consisted of a named nurse, doctor and nurse advisors who were available Monday to Friday. Each ward that we visited had a named link nurse for safeguarding who provided training and support to the team working in the ward. Staff we spoke with knew the name of safeguarding children’s link nurse on their ward. We observed medical and nursing staff routinely discuss safeguarding concerns or children and young people who had a child protection plan at daily safety briefing meetings and multidisciplinary meetings on each of the wards we visited. We were told by the management team that the service had a commitment to taking action to keep children and young people safe from abuse and neglect.

The CYP safeguarding team told us that safeguarding concerns were escalated and dealt with quickly and included working collaboratively with partners. For example, children or young people with suicidal ideation were referred to the in‑house psychology service and staff liaised with GPs and specialist services to inform them of this concern.

The service worked with children, young people and their families to understand and manage risks by thinking holistically. Staff provided care that was safe, supportive and enabled children and young people to do the things that mattered to them. Staff completed risk assessments during the child or young person’s pre‑operative assessment, on admission and reviewed these regularly throughout the admission.

The service had systems and processes in place to recognise and escalate deteriorating patients. Staff used the National Paediatric Early Warning System (NPEWS) to identify children and young people at risk of deterioration and escalated concerns appropriately. There was a clear policy to guide staff on managing deteriorating patients. All clinical staff, including paediatric nurse practitioners, were trained in intermediate life support. This training supported staff to meet the needs of children and young people in an emergency, as timely and appropriate action was taken. Practice educators provided training sessions for staff on incident reporting, escalation of deteriorating patients, other topics of interest and ward‑based audits. This ensured staff were appropriately trained to identify and act if a child or young person deteriorated.

The service worked with children, young people, their families and other NHS providers to understand and manage children and young person’s risks. Staff provided care that was safe, supportive and enabled people to do the things that mattered to them. We reviewed records and noted that care plans, safeguarding information and risk assessments were completed, the records also detailed mental health support provided to children and young people in need of a mental health assessment with evidence of psychiatric and psychologist support where required. We were told there was good multidisciplinary team working both with internal trust teams and external support agencies.

Ward rounds and daily handovers took place to support patient care and risk reviews. We observed a weekly multidisciplinary meeting and heard that family involvement was considered. Staff told us that family involvement in the care of their child or young people was encouraged and families were actively involved in ward rounds. We saw some families present during ward rounds and they confirmed they were informed and involved in their child’s care. We reviewed feedback from the parent and staff survey undertaken in 2024, it showed that parents were encouraged to attend ward rounds, were always supported to feel part of the team and be involved in managing risks. We noted that staff were confident in supporting children and young people and their families, and this showed the staff knew what they were doing in terms of patients care and treatment.

The service identified and managed risks within the care environment. Equipment, facilities and technology supported care delivery. Environmental risk assessments were completed for CYP areas and wards. Where risks, such as falls, were identified, records showed mitigating actions were developed and implemented. Access to wards and CYP areas was controlled through a door buzzer system, with staff managing entry to reduce the risk of unauthorised access.

The environment was designed for children and young people and aligned with relevant guidance. Clinical areas included age-appropriate artwork, colour schemes intended to support children and young people, and cubicle layouts that supported care delivery. The service had introduced changes to support children’s experience, including a dedicated play team, a paediatric mental health facility and a children’s council, which provided a route for children and young people to contribute feedback. Planned improvements included the development of an outdoor healing garden and renovation of the sensory room on Jack’s Place ward to support children with sensory needs.

Call bells were available at patients’ bedsides and in cubicles, enabling children, young people and families to call for assistance when required. During the visit, staff responded in a timely manner to call bells in the wards.

Infection prevention and control measures were in place. Staff followed infection control processes, including bare below the elbow practice. Clinical areas visited were visibly clean. The flooring, including skirtings and edgings, were compliant with Health Building Notes 00/10, which supported cleaning.

Waste management arrangements were in place. Clinical waste, including sharps, were segregated and disposed of in line with the trust’s sharps policy. Staff told us equipment was available to support care delivery; they knew where to locate equipment and had received training in the use of equipment used in CYP wards and theatres. Staff reported faulty equipment through the medical devices’ team and told us replacement equipment was provided when required.

Resuscitation equipment was available and accessible. The checklists reviewed showed equipment was stocked, checked, signed and dated to confirm it was ready to use. The service had a resuscitation officer and paediatric advanced nurse practitioner who provided support, training and guidance to staff. This ensured all staff felt supported and were competent to respond to medical emergencies.

CYP services were delivered across inpatient, outpatient, children’s emergency department and peri-operative areas. These included Jack Place ward, Rainbow ward, the paediatric oncology shared care unit, paediatric outpatients, the paediatric and adolescent emergency department, and a paediatric recovery unit. These areas supported care for children and young people with a range of medical, surgical, mental health and oncology needs. Staff worked with inpatient wards to support continuity of care and escalation when required.

The service made sure there were enough qualified, skilled and experienced staff to provide safe care that met people’s individual needs.

Children, young people and their families who used the service told us there were enough staff on the wards and that they provided safe care and treatment. They told us staff communicated well and interacted with them in a respectful and professional manner. They said staff were responsive to their needs. Nursing staff told us there were enough CYP nurses to provide safe care and treatment. They told us their workload was manageable and they received good support from managers. Nursing staff were positive about their learning and development opportunities and said managers supported them to develop their knowledge, skills and experience through conferences, courses and study days, for example, a band 5 nurse was supported to complete a specialist children’s nurse course, while other nurses were supported to develop into leadership roles.

There was a daily bed meeting where staffing levels and needs in particular areas were discussed. Where bank staff were needed, the service used staff who were familiar with the ward. Managers checked staff were trained and competent to administer intravenous medications, ensuring only trained competent staff administered medicines. Staffing for the day was discussed to ensure this met the patients’ needs and safe staffing requirements. Staff we spoke with told us they were sometimes asked to work in different CYP areas if there were staff shortages. They were happy to do this and were only asked to move to wards where they had knowledge and experience of the wards. The nurse in charge of each ward or unit reviewed staffing levels daily, considering patient numbers, acuity, clinical urgency and the level of nursing care required. Any shortfall in staffing was escalated to the lead nurse and head of nursing at daily bed meetings and, where necessary, staff were requested from other areas to help.

Staff completed mandatory training through eLearning programmes relevant to their role. Training targets for mandatory training, including infection prevention and control, information governance, manual handling, intermediate life support and consent, were met. Data demonstrated that 98% of CYP staff had completed their mandatory training, which was above the trust’s target of 90%. Clinical staff received support, supervision and development through monthly one‑to‑one meetings and daily and weekly reflective practice, providing staff opportunities to reflect on their practice, identify learning opportunities and deliver high standards of care.

The service was committed to developing a skilled workforce that was able to provide safe care and treatment. The practice education team supported staff development by delivering training sessions, supporting new staff and responding to training requests. Educational leads provided support, and most staff told us they had appropriate access to education leads and felt supported in their roles. However, some staff felt that due to shortages in some areas, education leads were covering clinical roles and therefore staff had reduced support.

Staff received training that was appropriate and relevant to their roles and were given protected time to complete the training. Staff told us they had opportunities for career development and were able to attend additional training courses to gain further qualifications. Staff also confirmed they received appraisals and had development plans in place.

Staff were able to identify leaders and managers within the service and the roles they held within the organisation. Staff could name the safeguarding and clinical speciality leads and the heads of departments, as well as their own direct managers. Ward and theatre staff names were displayed on ward corridors for the information of patients, visitors and other non‑surgical staff members. Children and young people and their families told us there were enough staff on the wards. They said staff communicated well, were professional and friendly and responded promptly to their needs.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All clinical areas we visited were visibly clean. Families and young people told us they were satisfied with cleanliness and had no concerns about infection prevention and control (IPC). Patient survey data from January 2025 to January 2026 showed a consistently high satisfaction with cleanliness, with 100% of responses rated as excellent or very good.

Staff we spoke with understood their IPC responsibilities and were knowledgeable about the trust’s guidance and how to access support. They had access to training, shared learning and policies relating to IPC, including aseptic non‑touch technique, hand hygiene and waste management. These policies were in date and in line with national guidance. Staff said they could access the IPC team easily when required, and the team provided guidance, training and support as needed.

We observed staff following hand hygiene and personal protective equipment (PPE) protocols. Children and young people with infections were cared for in side rooms, with appropriate signage and protective measures in place to reduce the risk of cross‑contamination. Staff were observed washing their hands before contact with a child or young person and again once treatment had finished. There was good identification of possible infection risks and staff took appropriate safety precautions. Staff used PPE and stored waste safely. This included wearing aprons, gloves and masks when required. Antibacterial hand gel was available for visitors and staff, and visitors and people using the service had access to handwashing facilities. The wards had appropriate storage space for clinical waste, with a locked door, and waste containers were emptied daily.

There was a good standard of cleaning. All areas and equipment were visibly clean, and equipment was clearly labelled with an ‘I am clean’ sticker, with a date showing when it had last been cleaned. Cleaning schedules clearly identified when rooms and equipment were due to be cleaned, and these were up to date. Cleaning rotas were easily accessible in all the CYP areas.

The service demonstrated effective processes for monitoring IPC. These included annual audits, monthly local audits and quarterly corporate audits. Audit data showed compliance with IPC standards. The service had a schedule IPC audit, with a different area audited on each monthly audit cycle. Between January 2025 and January 2026 all CYP areas were audited, with an overall compliance rate of 98%. Action plans with specific completion dates were implemented following the audits.

The service had systems for the safe storage, administration and management of medicines, ensuring compliance with relevant legislation and best practice guidelines. Medicines were stored securely, with controlled drugs locked away with restricted access. Controlled drug checks were undertaken and documented, ensuring medicines remained in date and stock balances were accurate.

Children, young people and their families were actively involved in medicine‑related decisions, providing informed consent and adherence to treatment plans. One parent told us they were included in discussions about their child’s medication and described staff as kind and thorough in explaining treatment plans.

Emergency medicines, including those required for resuscitation, were managed in line with Resuscitation Council (UK) guidance. Safety checks were recorded daily, ensuring medicines and equipment remained ready for use in an emergency.

Medicines were stored safely in line with national guidance. Medicine storage room temperatures were monitored by nurses on the wards to ensure medicines were stored at the correct temperatures to maintain effectiveness.

Controlled drugs were stored safely and securely with access restricted to authorised staff. Checks were undertaken and recorded twice a day by two staff, showing medicines were within date and stock balances were accurate, and a review of these checks showed they were consistently completed. There was a clear process for reviewing and documenting antibiotic prescriptions, ensuring appropriate use and review dates for ongoing treatment. Pharmacists monitored antibiotics requiring close observation and liaised with the microbiology team to address any concerns.

Staff completed medicines management training and annual assessments were undertaken to ensure they remained competent. Medicines audits were completed regularly, and actions identified for example missed doses were communicated with the ward and followed up by senior staff. Medicines reconciliation processes were effective. Staff had access to shared systems and ensured medicines were accurately reviewed and recorded prior to admission.

Children’s care plans were detailed and included symptom management processes, enabling staff to provide consistent, safe and effective care. Clinical staff demonstrated a clear understanding of incident reporting procedures, and medicines‑related incidents were discussed at monthly medicines management meetings. Learning was shared through team briefs, newsletters, meeting minutes and safety huddles to support continuous improvement. The service had systems to ensure staff knew about safety alerts and incidents. We saw that reported incidents were monitored, reviewed and, where required, changes to practice were implemented.

Staff told us a pharmacist was available to support CYP wards and was responsive to CYP medicine queries. Pharmacists were also contactable out of hours via an on‑call service. Staff understood how to access relevant local medicines policies, procedures and guidelines.