Ealing Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last inspection we rated responsive as Requires improvement. At this assessment, the ratings remained unchanged. This meant patient were not getting care and treatment in a timely way to meet their needs. There were significant delays in patient receiving care due to high demand, over-capacity across the hospital for beds leading to poor flow and crowding leading to long and unacceptable delays for patient.

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.This means we looked for evidence that the service met people’s needs.

This service scored 57 (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 made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The electronic patient records (EPR) was accessible to all staff involved in the patient’s care. Staff told us when they identified patients with additional needs such as risk of falls, this was recorded in their record and care planned to meet these needs. The EPR included a flag system to alert staff to specific needs including dementia and learning disabilities. The system also flagged if any patients were at risk of sepsis and would not allow staff to proceed with documentation until the alerts had been acknowledged and addressed.

The ED staff were able to access support from the frailty team, dementia and LD nurses to ensure the patient’s needs were met. Staff we spoke with were able to describe how they would access these specialist services and gave examples of when they had done so. We were told the ED also had lead nurses, who had additional skills and knowledge in the management of specific patients such as mental health patients. They provided support to staff ensuring person-centred care was delivered and the individual’s needs were met.

Staff we spoke with were able to explain how they had used the specific learning disability (LD) training they had completed to deliver person centred care. We saw that LD sensory boxes had been introduced in the department, these aim to distract the patients while they waited to be seen and treated. Following our inspection the trust shared the admission policy and discharge checklist for patients with learning difficulties and confirmed they used patient passports for these patients to ensure their specific needs were met.

We observed that ‘call for concern’ posters were visible throughout the department. This provided patients and their families with information on the actions they could take and who they could speak with if they were worried about their care. This assisted patients and their families to raise concerns in a timely manner if they felt their specific needs were not being met. We were not provided with data of how frequently this process had been used by patients and their families.

Patients had access to food and drink, that met their individual cultural and religious needs. We observed that food menus were provided in a range of formats, including picture menus. During our visit we observed food orders being taken, with support being provided to those individuals who required it.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service did not always supply appropriate, accurate and up-to-date information. However, information was available in a range of languages to individual needs.

There were an excessive number of signs throughout the area, with some notices outdated while others remained relevant. Some signs related to clinical areas that were no longer in use. This increased the risk of patients getting confused and lost. For example, one sign next to an alarm stated it was an alarm for the mental health room, the signage had arrows that pointed the wrong way and directed patients in the wrong direction. We were told that a project was due to commence the week following our inspection, which would review all signs and replace signs that were no longer required or directed patients to the wrong area.

There was no information about waiting times displayed in the waiting areas. Therefore, it was unclear to patients how long they could expect to wait to be seen.

CCTV was observed but it was noted that not all CCTV signage informing patients and visitors of the CCTV was clearly visible in all areas.

We were told that to improve the accessibility to the trust website the trust had accessed themselves using a specific tool to identify areas for improvement. The Trust’s website was available in 106 different languages, ensuring essential information was accessible to meet individual's needs. We were told pharmacy information leaflets could be accessed in other languages via an online resource, these were requested by patients on an individual basis. We were told this approach was taken rather than leaflets being printed out in different languages, to ensure the most up to date information was provided. Information was not always available in alternative formats, such as Braille, easy read, we saw a pictorial friend and family test scoring sheets, but staff told us these were not used.

Staff had access to a range of interpreting facilities including language Line, ability to book face to face interpreters. The trust was in the process of rolling out iPads to clinical teams to support the use of Card Medic, a digital translation tool. We were told staff who spoke different languages were used to communicate with patients experiencing language barriers, about their care and treatment. Family members or friends would also be used either face-to-face or on the telephone, to interpret for patients who did not speak or who had limited spoken English. This is not in line with NHS England (NHSE) guidance that professional interpreters should be offered when language is a barrier to care, with family or friends not used as interpreters, especially in sensitive situations like consent, trauma, and safeguarding.

Staff stated they took this approach to provide ‘continuity of care’. They stated that there were instances when timely access to certain languages was difficult to obtain if the appropriate interpreters were not available within the local community. However, staff confirmed formal interpretation services such as language line, were available and staff were able to explain the processes for accessing these services. A member of staff reported using an automated tool to help translate. National Institute for Clinical Excellence (NICE) best practice guidance emphasises the need for accurate and impartial communication, recommending the avoidance of automated tools.

At the time of our visit there was no assistive technology or facilities to support those with hearing loss or other forms of sensory impairment observed within the UEC services, including the main reception. We did observe a member of the reception staff making efforts to ensure a hearing-impaired patient understood what was being communicated to them by leaving the reception desk and standing in close proximity to the patient when they spoke. Following our visit, we were informed that as part of ‘project welcome’ a hearing loop was now in place at the main reception.

Information governance systems included confidentiality of patient records. Records were stored electronically and only accessible to staff via a log in. Throughout the inspection all computers we observed were locked when they were unattended.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

There was signage throughout the service regarding how to make a complaint, which included information on how to get in touch with the Patient Liaison Services (PALs) and make a formal complaint.

Patients we spoke with had not been explicitly informed about the complaints process, but most were able to identify how they would access this information if needed. Information about making a complaint could be found on the trust’s website and on posters within the ED. None of the patients we spoke with expressed concerns about the care they had received.

Complaints were responded to in line with the trust’s complaints’ policy. The nurses we spoke with knew about the complaints process and were able to describe it and how learning from complaints was shared. Complaints were an agenda item on the daily nursing handovers, and were included in the ED newsletter that was shown on a large screen during the handover and disseminated to staff via email.

National surveys for the NHS were carried out periodically. In November 2024 the urgent and emergency care survey 2024 showed the trust was performing at a similar standard when compared to other trusts. The trust scored 9.4 out of 10, with 10 being the best possible score, by patients for feeling informed by staff about what would happen after the first assessment. However, they scored 2.8 out of 10 for receiving information on waiting times. This lack of information on waiting times, was supported by what we saw during the inspection. We were not provided with trust information to show how this issue was being addressed.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The service did not always make sure patients could access timely care, support and treatment when they needed it. Improvements had been implemented such as streaming patients away from the Emergency Department (ED), supported by protocols outlining care pathways and the reconfiguration of services. However, the department remained crowded at times due to both increased patient numbers, and the delays of identifying and transferring patients to the ward beds from ED. We were told the department could request that patients arriving by ambulance were diverted to a neighbouring hospital for a period of time to enable the department to move patients out to wards and address overcrowding issues. We were told safety rounds, had been introduced and took place 6 times a day, to mitigate the risk of patients that might deteriorate in the waiting room. However, patients were not routinely given updates on likely waiting times.

The use of TES areas and the length of stay for mental health patients with physical health issues were both on the departments and the trust’s risk registers, and both were graded at the highest level of risk with a recognition of all the risk factors for patients. The information provided showed that the length of stay for some patients, especially medical patients, awaiting beds exceeded the NHS recommendations with examples provided of some patients waiting more than 19 hours.

The department was not meeting the national standard for patients who arrive to hospital by ambulance being registered, handed over and transferred off the ambulance trolley within 15 minutes of the ambulance arriving at the ED. Over the last 4 months, the performance statistics for ambulance handover times within 30-60 minutes were within the England average of 16-20% There were fewer handovers taking longer than 60 minutes when compared to the national average of 5-15%.

The service considered the needs of people with different protected characteristics and made reasonable adjustments to ensure people’s individual needs could be met. Staff we spoke with were aware of the resources and teams available to support patients with additional communication needs. For example, the learning disability team could advise and support staff. Some staff were aware that some patients would have a communication passport. One member of staff described how the team would aim to meet the requirements in the communication passport.

The executive team recognised that flow throughout the hospital was having a negative impact on the service and a Flow Programme Board was established in May 2025 with the aim of improving this. There were 4 programmes of work being delivered including wider work around admission avoidance and the introduction of virtual wards. As these were new initiatives their impact had not yet been seen,

Department staff attended bed meetings and surge meetings throughout the day, so the wider hospital teams were aware of the pressures on the department and to escalate patients who urgently needed to be admitted to a ward area. We attended the site meeting and found that performance from the previous day was discussed including themes from patient breaches. Information was escalated when issues at the bed meeting could not be resolved.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

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