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 of leadership, culture, governance and improvement arrangements that supported safe, person-centred care for children and young people.

At the last inspection, we rated this key question as requires improvement. At this assessment, the rating improved to good. This meant children and young people’s needs were met through organised and well-led services.

Leaders had the skills, knowledge and experience to oversee the service. Staff described leaders as visible and approachable, and said they felt able to raise concerns and contribute to service development.

The service had a vision and strategy aligned with the wider trust priorities. Staff understood the service’s goals and described a culture that supported teamwork, equality, diversity and inclusion.

Governance arrangements included defined roles, responsibilities and lines of accountability. Leaders reviewed information about risk, performance, incidents, quality and outcomes through established meetings and reporting processes.

Staff used team meetings, safety huddles, debriefs, newsletters and other communication routes to share information and learning. The service used audit findings, feedback, incidents and risk registers to identify areas for improvement and monitor actions.

The service worked with partner organisations and community services to support joined-up care. Leaders and staff described improvement work, staff development and learning from incidents, complaints, audits and feedback.

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 service had a vision for what it wanted to achieve and a strategy to turn it into action. This vision reflected the overarching trust’s aims and objectives. The vision was quality at heart, represented by HEART symbol (quality at our heart), it encompassed the following five attributes; honesty, equity, accountability, respect and teamwork, which shaped the culture and guided staff behaviour.

Children and young people’s (CYP) services had undergone notable strategic and environmental improvements since the last inspection in 2018. The new paediatric strategy set a clear direction for developing and strengthening care, that had brought all inpatient children’s services onto one site to improve continuity and oversight.

The CYP strategy was linked to the hospital’s 2023–2028 strategy, which set out plans to deliver high‑quality, timely and equitable care, develop and support the workforce, celebrate excellence, strengthen professional pride, and build a culture of continuous quality improvement. It also aimed to provide responsive non‑clinical services like cleaning, maintenance, security and building management, and work in partnership with local people and organisations to improve community health. Staff we spoke with understood the service’s goals and how their roles contributed to achieving them, and they remained focused on meeting the needs of children and young people.

Children and young people, their families and staff were able to raise concerns without fear, reflecting an open and supportive culture. Staff consistently reported feeling respected, valued and included. Relationships across all grades of staff were positive, with strong teamwork and collaboration. Staff described feeling motivated about the future and confident in planned improvements to the service.

Leaders supported staff development and progression. We saw examples of staff working towards advanced clinical and non-clinical roles. Staff we spoke with gave examples of teaching and learning programmes and conferences they had attended as part of their continuous professional development.

The service displayed patient feedback and outputs from the patient engagement program of “you said – we did” on their notice board, and staff spoke positively about this. They said patient feedback was encouraging and felt their hard work was recognised by parents and families of children and young people.

Leaders told us the service structure supported effective engagement with teams to deliver the shared vision. This approach had led to improved outcomes, including bespoke solutions for complex discharges, improved teamwork, reduced delays and helped families experience smoother, safer and better‑coordinated care.

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.

There was a clear management structure which staff understood and were able to identify their leaders. Staff were given the opportunity to develop leadership qualities and develop in their roles. Senior nurse leaders, managers and all staff knew their job roles and understood the accountability requirements of the role.

The service was overseen by capable managers who had clearly defined roles and responsibilities. They demonstrated the experience and capacity needed to deliver safe, sustainable care and how to manage risk well. This leadership approach of the service supported safe and well organised services and had led to improved staff confidence.

Leaders we spoke with understood the priorities and challenges facing the service, including staffing pressures. Staff told us leaders were visible and approachable, and patients and families also gave positive feedback about leadership presence.

Many staff we spoke with had opportunities to undertake further qualifications and develop or extend their roles within the service. Some staff were actively involved in partnership and working groups, contributing to initiatives aimed at reducing costs or improving clinical and operational practice, for example the consultant program at the GP surgeries, whereby consultants held clinics at the GP surgeries. The aim of this project was to work in partnership with GPs, increase their confidence to manage these children in the community and to build effective working relationships.

Staff consistently told us they felt valued in their roles and able to contribute to service development. We also noted that some senior staff had been with the service for a long time, which supported continuity of care for patients and contributed to a stable, experienced, and consistent workforce.

Staff told us ward managers and senior nurse leaders were supportive, and they could speak to them regarding any concerns they had.

The service promoted a culture where staff felt able to speak up and were confident, they would be listened to. Systems and processes were in place to support staff in raising concerns, for example the service had a whistleblowing policy for staff to follow.

The trust had an established Freedom to Speak up process where staff could raise concerns if not addressed through the line management route. Staff were aware of this service. There was freedom to speak up champions within the children’s service and staff knew who they were and how to contact them. Clinical staff we spoke with, told us they had not raised any recent concerns with the freedom to speak up guardians.

Staff were encouraged to speak up within the CYP service as part of an open and supportive learning culture. Staff told us there was a culture of speaking up, they felt safe and supported in doing so without fear of any repercussion. Staff gave us examples where they had raised concerns with their managers. We were told these were treated sensitively and seriously, and managers worked with the member of staff to resolve the concern. Staff we spoke with were happy with the outcome and felt comfortable to raise concerns again.

The service valued diversity in its workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. The service had a diverse staff team and staff felt there was good teamwork and a positive culture around equality, diversity and inclusion.

There was a commitment to supporting equality, diversity and inclusion (EDI) through peer-to-peer networks. These included staff networks such as an ethnic minority staff group, disability networks, LGBTQ+ groups, as well as support from the freedom to speak up team and chaplains.

The trust completed EDI reports, including the headline reports for the Workforce Race Equality Standard and the Workforce Disability Equality Standard, we had not asked nor been provided with the EDI report.

The trust supported work‑based learner programmes and international recruitment of nurses and medical staff to strengthen diversity across the workforce, including within the CYP service. An up‑to‑date Equality, Diversity and Inclusion (EDI) policy was in place and aligned with the trust’s wider CYP EDI programme. Staff completed equality, diversity and human rights training, with an average compliance rate of 95%, meeting the trust’s target. The trust had a diverse ethnic workforce, with 68% of staff identifying as Black, Asian or from a minority ethnic background, making it the most diverse trust in the country. This diversity was also reflected within the CYP staffing group. Overall, this demonstrated a strong organisational commitment to inclusion, representation and equitable workforce practices.

Staff told us they had opportunities to apply for new roles, take part in improvement projects and to undertake external studies through an open application process. The service acted to prevent and address bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act and those from excluded and marginalised groups. Staff felt everyone was treated fairly and that they would be able to report behaviour or attitudes which were negative in style. Staff with disabilities and caring responsibilities were offered reasonable adjustments such as flexible working arrangements to support them to carry out their roles well. Leaders acted to improve where there were any disparities in the experience of staff with protected equality characteristics in line with their equality and inclusion strategy. Leaders took steps to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work, and throughout their employment, this was done through ethical recruitment programme implemented by the trust.

Leaders had a clear governance structure with defined roles, responsibilities and lines of accountability. Managers at all levels understood their individual and collective responsibilities, and governance arrangements were used effectively to oversee safety, quality and operational performance. This ensured a coordinated and consistent approach to managing risk and maintaining high standards of care for children and young people.

Leadership teams acted on reliable and timely information about risk, performance and outcomes. Information was shared securely when appropriate, and staff had access to integrated and easy‑to‑use systems that supported decision‑making and improvement. Data was submitted promptly to external organisations as required, for example data was submitted to the national outlier programme.

Governance processes operated through a structured programme of committees and meetings, where leaders reviewed clinical indicators, incidents, risks and quality metrics. Performance data was analysed and benchmarked against other CYP services, and action plans were developed and monitored where improvements were needed, this included an action plan on reduction of medication error.

Meeting minutes showed that governance meetings were well attended and followed consistent agendas covering quality, safety, incidents, policy updates and changes in clinical practice. Leaders ensured information from these meetings was shared with staff through team meetings, email briefings, newsletters, handovers and daily safety huddles. Safety huddles were used to identify immediate risks and ensure staff were aware of emerging concerns.

Risks were clearly recorded on a formal risk register, which was regularly reviewed and updated. Each risk had defined mitigating actions and clear ownership. Examples included equipment issues, implementation of new e‑learning systems, potential loss to follow‑up due to manual data entry, and risks associated with refurbishment works. These arrangements supported proactive risk management and timely action on emerging issues.

The service reviewed hospital data for learning from deaths, and every child death had a formal review. The patient safety panel met monthly to identify actions and share learning across departments and the wider trust.

Audit processes were used to monitor quality and drive improvement, and leaders ensured action plans were implemented and tracked. Staff could access accurate performance information in clear formats, enabling them to understand trends, make decisions and contribute to improvement activity.

Information systems were secure, integrated and fit for purpose. Staff handled patient‑identifiable information correctly, and no data breaches were reported. Leaders ensured accurate information was shared with CYP staff through multiple communication channels, including newsletters, daily huddles, team meetings, emails, information boards and new colleague forums.

The service had business continuity arrangements in place for major incidents such as fire, flood and power failure. These plans supported service resilience and ensured continuity of safe care during unexpected events.

The CYP service understood its responsibility to work in partnership with other organisations to support joined‑up care. Leaders shared information and learning with partners to improve services and strengthen collaborative working.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for people.

Staff told us about partnership working with other CYP stakeholders across the community to support children and their families in their ongoing medical treatment. For example, social services worked with the hospital to support children’s social needs. Specialist teams worked closely with partner agencies to ensure that services worked seamlessly. For example, the local GP practices could call CYP consultant for direct advice through the advice and guidance scheme.

There were recognised partnership working arrangements in place with other local services. The CYP team were active participants in the regional networks for sharing of best practice and learning from other CYP services within the region.

The service maintained strong and well‑established partnerships with local NHS trusts and community healthcare providers. These relationships enabled coordinated and joined‑up care, helping children and young people to remain safe and supported well within their community. There was an effective collaboration with different services across the wider trust’s, this collaboration further strengthened continuity of care where pathways overlapped.

The CYP service demonstrated a strong focus on continuous learning, innovation and improvement across the organisation and wider system. Leaders encouraged creative approaches to delivering equality of experience, outcomes and quality of life for children, young people and families. Staff were committed to continually learning and improving services. There were processes in place to identify and share learning from incidents and good practice at local, organisational and national levels. Several staff we spoke with had a good understanding of quality improvement methods and had been trained in this area of work.

Leaders encouraged innovation and participation in research. Staff were actively involved in research and innovation projects at local and national level. The service worked with external partners to support service development and embed evidence‑based practice. This collaborative approach strengthened the quality, safety and effectiveness of care.

The service had a programme of innovative projects to drive improvements and provided staff with regular updates and outcomes. For example, the patient safety team led projects to proactively improve the design and use of PEWS, including the embedding of Martha’s Rule principles. There was project to reduce the number of patients who did not attend for appointments to improve service efficiencies.

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.

Areas we visited displayed posters giving details of the quality improvement work for the area. This allowed staff to give feedback on improvements and understand changes being made to their wards. Staff were supported to have the time to develop their skills around improvement and innovation and to pursue areas of interest in the service.

To address the challenges within the CYP services, several initiatives had been introduced to support staff, improve communication, and drive service improvement. Monthly staff meetings were established to provide updates on the staffing, incident reporting, and risk management. A monthly newsletter was launched to keep teams informed about the current position and the actions being taken to improve services. CYP leadership provided weekly oversight and support to divisional colleagues to help drive and sustain service improvements.