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

This was a focused follow-up assessment for this service. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

We assessed 5 quality statements for the safe key question.

The service worked well with people and partners to maintain safe systems of care and manage risk. Equipment, facilities and technology supported the delivery of safe care, and the skill mix and number of staff was appropriate to safely meet the needs of patients.

The redesign of the department had created a safe environment where infection prevention and control (IPC) was supported and monitored to address any incidents. Staff adhered to hygiene policies and improved facilities, such as the sink at the Hello Nurse desk, which supported good hygiene practices

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service worked well with people and healthcare partners to maintain safe systems of care. Patients arrived at the department via several routes, by ambulance, GP referral and self-presenting.

Self-presenting patients aged 18 and over could register their attendance using a QR code self-check in system on their mobile device. This allowed patients to enter their details and answer initial triage questions. Patients who did not wish or were unable to use the digital system continued to register at the ED reception. Paediatric patients were directed to the paediatric ED where they were registered and triaged by a paediatric nurse. During our inspection, we did not observe queues to enter the ED, in contrast to the previous inspection in July 2025, when we noted that patients were queuing to register at the ED reception.

The redesign of the front door pathways and facilities, such as the relocated Rapid Assessment Unit (RAU) to the ED front door in September 2025, supported early assessment and streaming processes. The ‘Hello Nurse’, supported by an ENP, carried out initial observations, identified and managed patient redirection to Same Day Emergency Care (SDEC) or other non-ED pathways. Patients meeting defined criteria were directed immediately to triage by the Rapid Assessment and Treatment (RAT) nurse, while others were added to the Urgent Treatment Centre (UTC) triage list and directed to the waiting room. This meant patients were promptly streamed to the most appropriate pathway for their needs. Data showed that between January 2026 and June 2026, this assessment took place within an average of 4 minutes of arrival against a national target of 15 minutes.

The Hello Nurse area had a sink and privacy screens added as part of the redesign. This improved patient dignity and reduced the risk of cross infection as staff were enabled to wash their hands between each patient. Patients were given labels that differentiated them from visitors, so staff were able to monitor for deterioration and prioritise seating for the people with the greatest need, particularly during busy times.

Patients assessed by the hello nurse as being at risk of falls were provided with yellow stickers that allowed staff monitoring the waiting room to identify them, and frailty packs that contained items such as non-slip socks to reduce the risk of falls. Patients identified at higher risk of infection were directed to a dedicated isolation area. This meant the risk of cross infection was reduced.

The service had an established system to support patients who the front door ENP assessed as not requiring ED care, but whose needs would be better met by a GP or pharmacy service. The pathway decided by the ENP was actioned by patient champions who booked allocated GP appointments or directed patients to local pharmacy services. Data showed a 38.7% increase in patients redirected to primary care between December and February (2025-2026). This had assisted in reducing the number of patients attending ED when their needs could be met by a community provider.

The RAT pathways for self-presenting patients had been enhanced following the relocation of RAU as part of the front door redesign. Patients were seen by a team led by a senior clinician, with time-critical tests initiated promptly that enabled streaming to discharge, same-day emergency care (SDEC) or admission. This supported timely investigation and treatment planning, early identification of high-risk patients and rapid referral to specialty teams. Data showed an increase of 7.6% of patients receiving care on a RAT pathway since September 2025.

To improve flow through the ED patients medically fit for discharge were transferred to the discharge lounge. The patients were cared for in this area while they awaited their medication supply to take home and if necessary, while home support and follow up arrangements were organised.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service had clear processes in place to identify higher risk patients on arrival. We observed that posters at the ED entrance and triage process, facilitated staff to identify people who were vulnerable, including those undergoing chemotherapy or who had recently travelled. This supported timely prioritisation and appropriate clinical management of patients.

At times of high patient demand, additional spaces were used to deliver patient care. Patients were cared for in areas such as corridors when necessary. We observed that these spaces were well organised, had staff allocated to each patient, were overseen by a senior nurse, with privacy screens for each patient. Exclusion criteria ensured only patients who could be safely managed in these areas were placed there, such as those not at risk of falls. We saw that staff had access to equipment and electronic record systems within the additional space, meaning staff did not have to leave the area and patients unattended. Information provided to patients explained why these additional areas were being used and was available in multiple languages and formats.

There was a dedicated sepsis treatment room to support timely intervention of patients who had been identified as at risk of, or with symptoms of sepsis. We reviewed 2 patient records where sepsis was suspected, which showed patients received appropriate assessment and treatment. Data showed an improvement in compliance of sepsis screening compared to the previous year, rising from 40% to 90%, however in 2 out of the last 6 months, compliance was 80% which was below the trust’s target. An action plan to address this non-compliance had been developed and implemented. This included targeted sepsis awareness training for new and existing staff and spot checks of documentation. We noted that sepsis documentation was not always completed consistently. We observed that one of the 2 suspected sepsis patient records we reviewed, had sepsis documentation that was incomplete and could contribute to a delay in administering medication. This was escalated to the senior nurse in charge during our inspection and corrected.

Staff used nationally recognised tools to identify specific risks and take the appropriate action. For example, the national early warning score (NEWS) and paediatric early warning score (PEWS) were used to identify deteriorating patients. All 6 patient records we reviewed, included evidence that PEWS or NEWS had been completed. However, skin assessments to identify the risk of pressure damage were not always documented in patient records. For example, 2 of the 4 patient records, for patients who should have had a skin assessment had not been completed. This placed these patients at risk of pressure damage.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment supported safe care and treatment. The main waiting area was bright, clean and equipped with wipe clean chairs. Staff maintained clear lines of site across the space, supported by floor walkers observing patients for signs of deterioration. This ensured patients who became unwell while waiting were identified and escalated quickly.

A separate paediatric waiting area was accessible only via card entry, providing a controlled and secure space for children and young people. We saw that the area had been expanded since the previous inspection, which improved staff oversight from the nurses’ station. Staff had identified that parts of the room were not fully visible and had acted by installing a mirror to reflect obstructed areas. The door to the triage nurse’s room was kept open when not in use to provide additional oversight. Older children were encouraged to wait in a designated section, with age-appropriate information displayed. This contributed to a calmer and more suitable environment for different age groups.

In escalation spaces such as corridors, staff took steps to maintain patients’ privacy and dignity. Each patient space had a privacy screen, and patients had access to dedicated toilets, washing facilities and over bed tables to support mealtimes. A privacy and dignity room located in the escalation spaces provided an area for consultations or for patients to change clothes. These measures helped to reduce the impact of being cared for in these areas.

We saw that equipment throughout the department was clean, labelled with I am clean stickers, fit for purpose and regularly tested. Data received showed monthly fire safety audits were completed with 100% compliance. Rooms and bays had curtains and doors to maintain privacy. Staff huddles and handovers were held where conversations could not be overheard, protecting confidentiality.

To meet the needs of mental health patients, there were 4 ligature light rooms to support patients with mental health needs., These rooms were fitted with CCTV, to provide additional oversight of patient and support staff. Signage in the room made patients, relatives and staff aware that CCTV was in place. We observed that 2 of the 4 rooms had ensuite toilet and shower facilities. We were told that the design of the rooms meant that, when necessary, these rooms could also be used for other patients as they included medical equipment stored safely in cupboards when not in use.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service had staffing arrangements in place to support safe care and treatment. The planned nursing staff numbers across ED and paediatric ED were met on average 97% of the time between May 2026 and July 2026. Bank staff were used to ensure planned staffing levels were met. Roles were clearly defined and required competencies for each role were documented to ensure staff had the required skills.

Nursing and support staff were allocated to escalation spaces, ensuring consistent oversight. The service used trust bank staff and did not use agency staff meaning all staff had undertaken trust mandatory training. Mandatory training data demonstrated that the 90% trust compliance target was achieved in most areas, except for fire safety (68.81%) and basic life support (85.32%). Compliance with these courses was reviewed at monthly mandatory training meetings. There were agreed actions to address this non-compliance which were monitored.

Security staff were contracted, with shifts routinely covered by the same people meaning they were known to the department. Staff and leaders told us they were viewed as a part of the ED team. This approach supported continuity and effective team working.

Staff and leaders, we spoke with described a culture of good teamwork in the department. We observed the site manager working closely with the senior nurses and the flow coordinator to effectively prioritise discharges. We saw evidence of experienced staff members, which supported consistency and shared understanding of ED processes.

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

The service had systems in place to maintain effective infection, prevention and control (IPC). We saw that clinical and waiting areas were visibly clean, well maintained and free from clutter. We observed staff cleaning equipment between patient use in line with trust policy. I am clean stickers were applied to show when items had been cleaned.

Hand gel dispensers were accessible throughout the department, including at entrances, clinical bays and in escalation spaces. Staff were observed using hand gel consistently, and posters reminded patients and visitors to do the same. Personal Protective Equipment (PPE) was readily available and generally used and disposed of appropriately. However, we noted one example of disposable gloves and aprons not being worn by staff treating a potentially infectious patient. This could lead to cross contamination.

Processes were in place to identify and manage patients with potential infection risks. Staff asked screening questions at triage, including whether the patient had recently travelled overseas, to ensure patients were placed in appropriate areas. A dedicated isolation space was available and staff followed clear escalation pathways when infection risks were identified.

Environmental audits were completed daily, and data seen showed 98% compliance with cleaning standards above the trust target of 95%. Where issues were identified, actions were recorded and monitored by the ED matron who told us that findings from overnight checks had led to a review of cleaning shift patterns to support increased night cover. We observed that clinical waste was disposed of correctly, sharps bins were used and labelled appropriately.

The department had monitoring systems in place and leaders used audit findings to drive improvement. Audit results and any actions required fed into a trust wide action plan that was reviewed monthly by trust leaders. The IPC Code of Practice audit report for March and April 2026 showed 87% compliance against a target of 95%. An action plan had been developed and implemented to address non-compliance. This included introducing spot checks and updating IPC information available to staff. The report also included good practice that had been identified, including correct use of isolation spaces and access to hand hygiene products. Hand hygiene audits for May and June 2026 demonstrated 85% compliance, and leaders had implemented an ongoing action plan that included the provision of staff training. During our visit, we observed staff were bare below the elbow, washed their hands or used hand gel.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.