Central Middlesex 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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This is the first assessment for this service. This key question has been rated good. This meant patient’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.

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

Staff assessed and met patient’s needs for hydration, and jugs of water were available in the department. As patients were not typically in the UTC for longer than four hours, food provision was not required. Where patients had specialist nutrition or hydration needs, staff ensured these were met.

Staff followed up-to-date policies to plan and deliver high-quality care in line with national guidance. Policies and treatment guidelines were stored electronically and accessible to all staff. They were based on best practice from the National Institute for Health and Care Excellence (NICE) and the Royal College of Emergency Medicine (RCEM) and were regularly reviewed and updated. Staff protected the rights of people subject to the Mental Health Act and followed the Code of Practice.

The team had access to a full range of specialists to meet the needs of patients using the service. In addition to doctors and nurses, staff could access support and advice from mental health teams, occupational therapists, social workers, pharmacists, speech and language therapists, dieticians, and various community services, with referral pathways in place where needed.

Staff were experienced, qualified, and had the skills and knowledge required to meet the needs of the patient group. All clinical staff were either qualified ENPs or GPs, trained in both adult and paediatric emergency care, in line with the function of the UTC.

All medical and administrative staff (100%) had received an appraisal within the last 12 months. For nursing staff, appraisal rates were 85%, which was slightly below the trust target of 90%. However, this shortfall related to 1 member of staff who was on long-term sickness leave. We saw their appraisal had been scheduled to be completed on their return.

Managers identified the learning needs of staff and provided opportunities for them to develop their skills and knowledge. For example, we saw that UTC-specific training was delivered to staff in small groups, enabling all staff to participate while ensuring shifts remained fully covered.

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.

When patients moved between services, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care. Staff worked well across the team and with other services to support people. Advice and referrals were sought appropriately. For example, we saw advice was sought from an emergency department when a patient’s condition had deteriorated, and effective communication maintained until the patient was transferred to that department.

We saw that any patient with a learning disability that presented to the UTC was immediately flagged to the learning disability team so that they could follow up with the patient either during or after their presentation.

We saw systems and processes in place for multidisciplinary cross site discussions regarding people highlighted as having safeguarding concerns, and those that frequently reattended to the emergency services across the trust.

We saw appropriate community referrals made for patients who may require further treatment or follow-up in the community, such as to the mental health team or local GP services. Discharge summaries and documentation were shared appropriately, which ensured that patients received the necessary support after leaving the service.

We did not look at Supporting people to live healthier lives during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.

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 consistently met the national emergency waiting time outcomes, with over 95% of patients being seen and discharged or care transferred to other facilities within 4 hours.

Staff participated in clinical audit, benchmarking, and quality improvement initiatives. The service’s audit programme included audits such as a monthly review of clinical notes and a daily review of x-ray outcomes. The review of clinical notes assessed documentation such as medical and medication history, presenting complaint, physical and mental health, red flags, allergies, safeguarding, and safety-netting. Results consistently scored above the trust target of 90%. Where an individual clinician did not achieve 100%, action was taken, starting with an initial discussion with the clinician.

Daily x-ray checks were undertaken to ensure no fractures were missed. The service performed well in this area. In the rare event that a fracture was not identified, the Urgent Treatment Centre (UTC) team contacted the clinician involved to ensure any learning was undertaken and the patient appropriately followed up.

The service was included in trust wide audits including GIRFT (getting it right first time). The trust was aware of population factors that may contribute to trust wide poor emergency department performance, and leaders told us they were addressing flow constraints and inpatient capacity to improving trust wide performance against national targets. Service leaders told us that meetings were held daily to determine if patients with minor injuries and illness at emergency departments within the trust could be treated at the UTC, to reduce the wait time and increase capacity and flow.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff gained consent from patients for their care and treatment during triage in line with legislation and guidance and this was clearly recorded in patient records.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patient’s consent. They supported patients who lacked capacity to make their own decisions or when experiencing mental ill health. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care, including young people.