The Care Quality Commission
  • Hospital
  • NHS hospital

Central Middlesex Hospital

Overall: Good read more about inspection ratings

Acton Lane, Park Royal, London, NW10 7NS (020) 8965 5733

Provided and run by:
London North West University Healthcare NHS Trust

Important: This service was previously managed by a different provider - see old profile

All Inspections

During an assessment of Urgent and emergency services

The urgent treatment centre (UTC) operated 7 days a week, between the hours 8am and midnight. Outside of these hours people would be treated at Accident and Emergency departments at neighboring hospitals. Between July 2024 and June 2025 there were 46,173 attendances to the UTC. The UTC only treated people with minor injuries and illnesses who self presented ,or were referrals from 111. They did not accept any people bought in by ambulance.

This is the first time we have assessed the UTC under the assessment group (ASG) of Urgent and Emergency Care, as it was previously run by a primary care provider. We have rated it as good.

In our assessment of Urgent and Emergency Care, we found the service had a positive culture of safety, built on openness and honesty. Staff listened to concerns, investigated incidents, and learned lessons to improve practice. They worked closely with patients and healthcare partners to maintain safe systems of care and ensured continuity when people moved between services.

Teams collaborated effectively so individuals only needed to tell their story once, with assessments shared across services. Care and treatment were routinely monitored to drive improvement, with outcomes that met both clinical standards and patient expectations.

People were treated with kindness, compassion and respect for their privacy and dignity. Staff supported each other and colleagues from other organisations with the same approach. The service also promoted staff wellbeing to enable the delivery of person-centred care.

Patients could easily share feedback or complaints, were involved in decisions about their care, and were told what had changed as a result. Access to care, treatment and support was timely and well managed.

Leaders at all levels were inclusive, skilled and credible. They understood the service context, embodied organisational values, and led with integrity and openness. Staff felt confident to speak up, knowing their voices would be heard.

However, the service did not always manage infection risks effectively. It did not consistently detect or control the risk of spread, nor always share concerns with the right agencies promptly.

During an assessment of the hospital overall

Central Middlesex Hospital provides a range of NHS hospital services. This assessment looked at urgent and emergency care, which we rated as good. The rating of urgent and emergency care has been combined with the ratings of the other services from the last assessments. See our previous reports to get a full picture of all the other services at Central Middlesex Hospital. This is the first time we have assessed the urgent treatment centre under the assessment group (ASG) of urgent and emergency care, as it was previously run by a primary care provider. The rating of Central Middlesex Hospital has improved to good. In our assessment of urgent and emergency care, we found

  • The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.
  • 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 across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
  • The service routinely monitored 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 people themselves.
  • The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.
  • The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.
  • The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.
  • The service made sure that people could access the care, support and treatment they needed when they needed it.
  • 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.
  • The service fostered a positive culture where people felt they could speak up and their voice would be heard.

However, 

  • The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

02 July to 15 August 2019

During a routine inspection

Our rating of services went down. We rated it them as requires improvement because:

  • Staff had limited understanding of the practical application of care for patients with deprived liberties.
  • There was limited interaction or stimulation for patients with dementia or cognitive impairment. The ward spaces were not dementia friendly.
  • Children and young people services and medical care services did not have a clear vision or strategy.
  • Flow out of the service was poor. There was a significant population of medically fit patients who could not be discharged due to difficulties in arranging care and support in the community.
  • The senior leadership team recognised the sometimes poor relationship between its staff and local authority staff, but there had been no action to address this.
  • Some staff did not always formally report incidents and, in particular, near misses.
  • Records of mandatory training for medical staff were poor and unreliable.
  • Compliance rates for mandatory training and safeguarding training were below trust targets.
  • Managers did not always effectively appraise all staff’s work performance.
  • Nurse vacancy rates were high in surgical services.
  • Waiting times from referral to treatment were not always in line with national standards in surgical services.
  • We did not see any evidence of improvement following the previous rating of requires improvement in children and young people services.
  • The children and young people service did not control infection risk well. We found the Rainbow Unit untidy, we could not be assured that children’s toys were regularly cleaned and there was of a lack of infection prevention information for children.
  • There were facilities for disabled and baby changing in the Rainbow unit but staff told us they believed that the Rainbow unit was shut.
  • Staff we spoke with in Recovery Stage One told us that children were cared for in a mixed four bedded recovery bay with adults
  • Staff did not use a nationally recognised tool to identify deteriorating patients, such as Paediatric Early Warning Signs (PEWS) or a validated acuity score system to assess patients.
  • We were not assured that the children and young people service was fully geared up to deal with a paediatric emergency. For example, there was no separate paediatric resuscitation trolley in pre-assessment Area One. The trust subsequently told us that there was a grab bag.
  • We were told that not all medical staff had European Paediatric Life Support (EPLS) or Advanced Paediatric Life Support (APLS) training.
  • There was no paediatrician available on-site at the hospital. Staff had to refer to the consultant of the day or week, who was based at a different hospital in the trust. Some staff were not aware of this arrangement.
  • Records were clear, but sometimes children were seen with an incomplete set of records. Following the inspection, the trust told us, in the event that a child was seen with a temporary set of notes at pre-operative assessment (POA), the complete record was requested straight away from the clerks.
  • Storage of medicines complied with national guidelines. However, fridge temperature monitoring in the recovery ward was not recorded and we could see no evidence that temperatures were being monitored. However, fridge monitoring in ACAD paediatrics was recorded.