Ealing 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

At our last inspection, this well-led was rated as Good. At this assessment, the rating was ‘good', The service fostered a positive culture where people felt they could speak up and their voice would be heard.

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.

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 service scored 71 (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.

The service had a vision and strategy that worked alongside the trust’s overall strategy, Our Way Forward (2023 – 2028). The service’s strategy had been developed in consultation with staff and input from stakeholders. Local leaders escalated issues that impacted on patient safety to the senior divisional leaders and action was taken to improve patient safety. Actions to address issues raised were discussed and monitored via trust-level workstreams including the patient safety group.

We were told the emergency and ambulatory care divisional strategy fed into the trust's four priorities, of which priority one was to "reduce" how often temporary escalation spaces were used, to allow patients to receive "high-quality, safe care in the right place." This was monitored via the flow board.

The trust’s HEART values (Honesty, Equity, Accountability, Respect, and Teamwork) were well communicated and understood by staff at all levels. These were central to how staff worked with each other and the patients they cared for. 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 we spoke with told us they were proud to be in the team and how they all worked together towards common goals. They provided examples of improvement they had seen over the last few years. For example, reducing the waiting time for lower risk patients by greater use of the pathways, directing these patients to alternative services such as their GP, when it was appropriate.

The culture within the department was open, transparent and inclusive, where staff were listened to, felt empowered to identify issues, resolve or be part of the solution. Patients and families not only gave feedback but were listened to and they were sometimes involved in developments. For example, the main themes from staff and patient feedback were regarding waiting times, accessibility and signage, lack of hearing loops at the ED reception.’ We were told action was being taken to address these issues. However, at the time of our visit we were not provided with action plans to demonstrate how and when all issues would be addressed.

Leaders at all levels understood the context in which they delivered care, treatment and support. They did not routinely monitor delivery of care and changes to identify their effectiveness.

Most leaders had the skills, knowledge and experience to lead and perform their roles. The senior divisional leadership team included a Divisional Medical Director, Divisional Head of Nursing and Divisional Director of Operations. They each spent time at each of the three times to promote visibility and accessibility. They understood the pressures in the department and how this could impact on staff. They monitored actions identified to address issues for effectiveness through the daily UEC Sitrep and bed meetings. Progress and effectiveness was reported up to the board through standing committees such as Patient Safety Group.

All staff we spoke with told us they felt local leaders were visible and accessible when needed. Describing their leaders as supportive and encouraging, which led to a positive working environment. Local leaders we spoke with acknowledged the high pressure environment that their staff worked in and the risks of staff burnout.

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

Information about the Freedom to Speak Up (FTSU) guardians, including names and photographs, was displayed on staff computer monitors, with all trust staff having access to the FTSU policy which was available on the intranet. Staff were able to describe how and where to find information about the FTSU guardians and noted that FTSU champion walkarounds were conducted within the service. Staff also reported feeling able to raise concerns when necessary.

Patients, their families, 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 Test. Managers and staff had access to this feedback and used it to make improvements.

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.

There was a clear management structure for the Emergency and Ambulatory Care Division. The triumvirate team had oversight of all 3 locations providing emergency and urgent care services and reported to the board. Under the divisional team sat local leadership with oversight at a location level providing a clear reporting line for staff.

The division had a governance structure showing how local meetings fed into the divisional quality board which reported into the trust board standing committees. There was a clear structure for information to flow from ward to the trust executive team. The governance meetings had set agendas, and covered key areas such as risk, performance, audits, learning from incidents and complaints, training, and safeguarding. We were told data such as the use of TES areas was collected and used to inform changes to monitor their effectiveness and impact. However, we were not provided with evidence to demonstrate this.

Leaders maintained the directorate risk register and knew and understood the risks to the department. The leadership team were able to discuss the top risk and what mitigation had been put in place to try and reduce the risk score. However, mitigating actions were not always evaluated to demonstrate their impact. The risk register was reviewed and updated regularly at the clinical governance meeting. The risks staff identified matched what was on the risk register, for example, staff were concerned by the temporary escalation areas and waiting times for patients. This meant the concerns staff had about the department were reflected on the division’s risk register.

The division held a monthly emergency planning meeting with the trust’s emergency preparedness, resilience and response (EPRR) lead to ensure the department was prepared to respond to a wide range of incidents that could affect patient care. A tabletop exercise was carried out 18 months ago to test the division’s preparedness. The EPRR lead was working with partners including the Hazardous Area Response Team, a division of the local ambulance service to improve how the service responded in an emergency.

The morbidity and mortality meetings were held monthly and the whole clinical team were invited to join the meeting. It was recorded for those who couldn’t attend. There was a standing agenda including a review of patient deaths, patients admitted to the intensive care unit and re-attending patients. Learning points were discussed, and the meeting was minuted.

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 service worked with a range of stakeholders to improve services. They had worked closely with neighbouring mental health trusts to identify areas for development in the pathway for mental health patients accessing the emergency department. This included work with the psychiatric liaison team, who were able to contribute to discussions and policies impacting this patient group in this department, such as the rapid tranquilisation policy and restraint policy.

The department also worked with local charities. For example, a local charity provided warm clothing to ED for patients on discharge who were homeless or suffering financial hardship. This not only provided physical comfort but also restored the patient’s dignity. Another charity provided donations of emergency food parcels, for patients on discharge who were in financial need.

The corporate objectives for 2025/26, included a specific objective for improved alignment with community-based neighbourhood teams, virtual wards. We were told this was currently being scoped and therefore we were unable to assess its impact.

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.

Staff were given opportunities, time and support to develop projects for improvements and innovation. Staff told us they were encouraged to suggest new ideas and ways of working and to implement pilot studies to see if they could improve the service. The service provided examples of initiatives aimed at promoting equitable patient experiences, outcomes, and quality of life. These included the introduction of a dedicated nurse to administer medications, including time-critical medications.

Improvements to the service included staff wellbeing. Leaders encouraged staff to share their appreciation of colleagues through an online platform where staff could leave messages such as highlighting good team working, helping build a positive culture.

The trust was participating in three national Royal College of Emergency Medicine (RCEM) Quality Improvement programmes for 2025: Time Critical Medications, Care of Older People, and Mental Health to help improve care for patients. We were not provided with evidence of the impact these improvement programmes have had.

Local, quality improvement audits included fracture documentation, which identified not all fractures were recognised at the time of reporting. In response to this a new process was introduced that included all imaging being requested under a lead clinician who was then responsible for reviewing, reporting and following up any missed fractures and discussing issues at the ED forum with the aim of improving governance and promoting staff learning.

ED staff provided DVLA fitness-to-drive advice to patients following seizures, strokes, visual impairment, or episodes of loss of consciousness. This is in line with the DVLA guidance relating to the responsibilities of medical professionals. Advice was given to the patients in line with National Institute for Health and Care Excellence (NICE) guidance relating to fitness to drive and this was documented in the patient’s record.

To facilitate seamless service provision the trust were introducing a single point of access for GP's. This meant that when it was set up there would be one point where they could send GP referrals in, and work was ongoing with local GPs to develop a system where overnight the trust would have access to local GP appointments and would be able to re direct patients into these appointments the following day if appropriate. The trust were keen to ensure that there was governance around these appointments to ensure equality of access and the system was not abused. However, during our visit we were not provided with any information of when this initiative would be implemented.

The department had developed revised ED anaphylaxis guidelines, in response to the NICE recommendations relating to the management and treatment of anaphylaxis-related incidents. Plans to raise awareness of these guidelines in the ED, had been implemented. As this was a recent change there was no data on compliance with the guidelines available.