Central Middlesex 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 that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities. This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service. This key question has been rated good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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.

Leaders had a clear shared vision and strategy that guided the trust and its services. The trust’s strategy, Our Way Forward (2023–2028), focused on working closely with NHS and social care partners, building on lessons from the Covid-19 pandemic, and responding to current and future challenges. It aimed to deliver high-quality, timely, and equitable care while supporting staff to provide safe, compassionate services.

The trust’s HEART values (Honesty, Equity, Accountability, Respect, and Teamwork) were central to how staff worked and were well communicated and understood. During the assessment, all staff we spoke with were aware of the trust’s values and strategy and could give examples of how they applied them in their work, such as speaking up about concerns, supporting colleagues, and treating people fairly. Staff also had opportunities to take part in discussions about service strategies, especially when changes were being made, and could explain how their work contributed to delivering high-quality care.

Leaders had developed an improvement plan for the urgent treatment centre to maintain high standards while supporting capacity and flow across the trust. Staff confirmed they understood the plan and were actively following it, helping to improve efficiency, patient experience, and team working within the service.

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.

Leaders in the service had the skills, knowledge, and experience required for their roles. They demonstrated a clear understanding of the service they managed and could explain how their teams worked to deliver high-quality care, including managing patient flow and maintaining safe staffing levels. Leaders were visible and approachable, regularly engaging with staff in the department, attending team huddles, and supporting problem-solving in real time.

Staff reported that accessible leadership encouraged open communication and made them feel supported in raising concerns or suggesting improvements. Leadership development opportunities were available and actively promoted, enabling staff to take on new responsibilities and lead projects such as audits, which contributed to service improvements and monitoring of quality standards.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff could describe how concerns were reported, investigated, and followed up, with feedback shared through various forums. Leaders maintained an open-door policy and were actively engaged in supporting and addressing staff concerns.

The trust’s Freedom to Speak Up (FTSU) Guardian worked independently to promote a positive speaking-up culture, providing confidential advice and support to staff regarding patient safety or concerns about how issues were managed. The department also had a FTSU champion, who was well-known to staff, with a poster displayed in the staff room explaining the policy and how to raise concerns.

Patients and carers had opportunities to provide feedback on the service in ways that reflected their individual needs, including through surveys such as Friends and Family. Managers and staff had access to this feedback and used it to make improvements.

We did not look at Workforce equality, diversity and inclusion during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service formed part of the trust’s emergency and ambulatory care division. Although a smaller service focused on patients with minor injuries and illnesses, governance structures ensured the service was fully integrated within the wider trust. Leaders and staff were included in trust-wide meetings, reporting structures, and decision-making forums, ensuring service delivery, patient safety, and staff development aligned with wider organisational standards.

As part of governance arrangements, the service took part in regular trust-wide meetings during busy periods and, when needed, supported other emergency departments within the trust by receiving some of their patients with minor injuries and illness. This helped to ease pressure and ensured patients continued to receive timely, high-quality care across the trust.

There were monthly local and divisional governance meetings that followed a set agenda. These meetings included discussions on learning from serious incidents or complaints, the risk register, performance, national and local clinical guidance, policies and procedures, audit results, safeguarding, and training. There were also divisional and trust-wide meetings that reviewed a range of data and audit results to identify good practice and areas that needed improvement.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The trust worked with commissioners and stakeholders and the local health and social care system and there were positive relationships. We saw evidence of regular meetings with other stakeholders to discuss pathways and any areas of concern. There was a desire to develop a shared understanding of the challenges in the system and identify ways to improve.

There had been ongoing trust level quality reviews of emergency care, where information was shared to encourage collaboration across departments and providers to improve quality, effectiveness and safety for patients using the service.

There was evidence of engagement with staff and stakeholders and patients to develop pathways and improved care for patients with certain conditions, including diabetic care.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Improvement programmes for urgent and emergency care were implemented trust-wide to ensure consistency and to raise standards across all three sites. The trust was also participating in three national RCEM Quality Improvement programmes for 2025: Time Critical Medications, Care of Older People, and Mental Health.

Leaders were able to describe areas of improvement that had already been achieved. For example, the trust introduced the MISSED mnemonic to support the prompt identification and administration of time-critical medications on arrival. This includes medications for movement disorders, immune disorders, diabetes, steroids, epilepsy, and direct oral anticoagulants, with the initiative aimed at improving the timeliness of these treatments.

The trust had also undertaken focused improvement work in relation to sickle cell care. This included a “Sickle Cell Perfect Week” initiative, which culminated in a positive peer review carried out by a local patient-led sickle cell working group. As a result, emergency department standard operating procedures for the care of people living with sickle cell disease had been improved and were effectively communicated to staff.

The department was involved in education and research activities, including thematic reviews of patient cases, which were presented to the wider team to support learning and improve patient outcomes.

Leaders and staff described a recent trust-wide focus on staff wellbeing within emergency care, recognising the physical, mental and emotional pressures faced by those working in the emergency department. This commitment had led to practical improvements, such as enhanced staff break facilities and the provision of tea and coffee, creating more supportive rest spaces. Leaders and colleagues were also encouraged to share appreciation and gratitude, with initiatives such as the Digital Heart card, the Greatix system and staff awards helping to build a positive and supportive culture.