Ealing Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from avoidable harm, neglect and abuse.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

A culture of learning was embedded throughout the trust. Themes from incidents and concerns about end of life care were identified centrally and shared with the end of life education team and palliative care team. This influenced training and skill sharing. The trust had identified 10 incidents regarding end of life care in the last 18 months and had shared these with the service. Learning included the placement of nasogastric tubes and consulting with relatives regarding lasting power of attorney.

Ward staff we spoke with were aware of what incidents to report and how to report them. They told us learning was shared with them by the end of life education team and palliative care team. There were ward based end of life care champions who shared learning with their teams. Learning from incidents and concerns was also integral to handovers, staff meetings, governance meetings and steering groups. There had been no never events regarding end of life care at the trust in the last 2 years.

The service had a proactive and positive culture of safety. The trust’s clinical lead for end of life care provided examples of learning for medical teams both proactively and following incidents. Examples included bespoke training and working with emergency medicine and acute medical teams on specific end of life care themes. Wider proactive learning took place through end of life and palliative care forums within the North West London Acute Provider Group (APG); a collaborative of 4 London NHS trusts running 12 hospitals. For instance, improving discharge processes and anticipatory medicines management.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different services.

The provider had an internal ‘patient transfer and handover’ policy, which aimed to maintain patient dignity and wellbeing, carry out appropriate clinical assessment and provide optimal care during patient transfers. This included communication of accurate and pertinent health care information to ensure safe delivery of the patient to the receiving area. It clarified the responsibility of divisional and nurse managers and ward teams.

We observed multidisciplinary discussions on wards and in palliative care team meetings where patients were identified as appropriate for fast-track discharge (an urgent, streamlined pathway to get fully funded end-of-life care for people with rapidly deteriorating, terminal illnesses), in line with peoples’ preferred place of death (a specific physical location where a person's life ends). For example, to a nursing home or to home. Discussions included patient and family consent, bed availability and confirmation of funding. We spoke with one patient’s family when they were on the ward and the following day in the hospice. They told us that the process was smooth because of how well teams had worked together. The process we observed demonstrated how teams had worked together to provide good care management and continuity of care. We witnessed telephone calls and updates. We observed Situation, Background, Assessment, and Recommendation (SBAR) conversations regarding the transfer - a structured way of assessing and transferring important information.

The palliative care team were directly involved in completing applications for fast-track discharge, which decreased the time they took to complete. However, this took resources away from ward-based activity and patient contact. The team were completing applications within 24 hours resulting in next-day approvals, compared with delays when completed by other hospital administration and discharge coordination.

The palliative care team at Ealing Hospital had completed 105 fast tracks in the last 12 months, which had taken time away from clinical work. Senior trust leaders we spoke with were aware of this issue and were looking at solutions within current budgets. There was now a full-time discharge coordinator within the Meadow House Hospice team. Staff told us this had improved responsive and effective care for patients. We were told 7 day a week admission to the inpatient unit at Meadow House was being implemented in August 2026 as part of a new model of care and strategy, pending funding approval, which had not been approved at the time of our inspection.

The palliative care team had worked in partnership with neighbouring NHS trusts to develop improved discharge processes for end of life and palliative patients. This included learning from hospital and community perspectives on what needed improving. There was an updated checklist and safer transfer tool on the electronic patient record system, which meant workflows could be easily monitored and reviewed. An improved fast track documentation process was going live on the electronic patient record system the week following our visit.

Guidance to facilitate the safe transfer of dying patients from hospital to their preferred place of care had been drafted and was due for ratification at the end of life care group meeting in August 2026. It provided guidance for staff in managing transfers and discharges of terminally ill patients where there may be a possibility that the patient may die during transfer. The guidance covered all hospital sites within the trust.

There was cross-site working of palliative care clinical nurse specialists (CNS), end of life care practitioners and the spiritual care team. This helped with consistency and continuity of care across the trust. We saw many examples of positive working relationships with ward and hospital teams. The palliative care nursing lead, clinical lead for palliative care (and hospice) and the clinical lead for end of life care all had trust wide roles. Palliative consultants from the hospice, and trust’s hospitals shared an on-call rota. This meant better flow, continuity and coordination of care for patients at the end of their lives.

We saw examples of good communication and teamwork between the palliative care team and hospice teams, both based within the Ealing Hospital campus. For example, one relative told us how grateful they were that their loved one was being transferred to Meadow House Hospice as it was their preferred place of care and preferred place of death. The office space of the palliative care team was shared with the oncology team which enhanced joint working and continuity of care for patients.

An improvement project was undertaken by the trust palliative care team in 2026 on transferring patients at the end of life from hospital. This had now become a wider improvement project within the APG to scope issues that led to complex discharges. To better understand patient and carer experiences, community stakeholders were being consulted such as local services and local authorities.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Palliative care team members and ward staff we spoke with understood what actions to take if they believed someone was at risk of abuse. They understood how to escalate concerns and how to contact the trust safeguarding leads for advice.

The trust’s palliative care team were trained in children’s safeguarding to level 2 and to level 3 for safeguarding adults. The team had achieved a 97% compliance rate for training against a trust compliance rate of 90%.

Meadow House staff and palliative medical staff completed level 2 and 3 adult and children’s safeguarding training depending on their roles. The team had achieved a 96% compliance level against a trust compliance rate of 90%.

There was a positive, proactive culture within the trust which included safeguarding patients who were palliative or at the end of life. For instance, relatives of patients who were at the end of life we spoke with, told us how their loved ones’ best interests and wellbeing was protected by ward teams and palliative care team members through good care management at what was a difficult time for them. The trust’s clinical lead for end of life care was also the trust named doctor for adult safeguarding. This helped to raise the profile of safeguarding end of life patients across the trust.

The trust had rolled out a campaign and toolkit for recognising and supporting earlier identification of domestic abuse and vulnerability. This included a conference and publicity campaign.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The Acute Physical Deterioration and Suspected Sepsis in Adults policy was used to promote a systematic approach to safe patient care during deterioration and included use of assessment tools, good communication and appropriate escalation.

Ward teams could escalate patients to the palliative care team, who accepted urgent and non-urgent referrals. Referrals could be done verbally then followed up with referral on the electronic patient record. The electronic patient record included an assessment of need and risk which was shared with the palliative care team. The palliative care team had a dedicated CNS to triage all referrals which were assessed within two hours and prioritised based on risk, patient need and could be seen the same day.

Risks were assessed and regularly reviewed. The palliative care team and ward staff were reporting, reviewing and acting on identified risks. They understood how to escalate care for the deteriorating patient. Staff used a nationally recognised tool to identify deteriorating patients (National Early Warning Score 2). Our review of patient records showed ward staff used this tool effectively to support safe care.

Ward teams were supported to manage risks to patients receiving end of life care by the palliative care team who visited wards and reviewed patients. There was an end of life education lead and practice educator who led a training programme for nurses and healthcare assistants which included how to manage and escalate risk. There were end of life care champions on wards who were supported by both to deliver safe and effective care.

We attended handovers and multidisciplinary meetings on wards, within the palliative care team and at the hospice. We found patients were being appropriately reviewed. Risks were assessed with decisions documented and referrals made for needs-based treatment and care.

The end of life care clinical guideline principles were available on the trust intranet. They directed medical staff to a link on the electronic patient record to complete the Last Days of Life Care Agreement (LDLCA). Each of the LDLCA sections required completion and sign off from either a registrar or consultant and followed the 5 priorities for care of the dying person with prompts to assist the advance care planning conversation.

We visited 5 wards where there were patients receiving end of life care. We saw 5 patients with members of the palliative care team. We reviewed the care records of all 5 patients following our ward visits. This included patients who were acutely unwell and rapidly deteriorating. Risks were being assessed, monitored and acted on. This included frailty, risk of malnutrition, allergies, skin care, deep vein thrombosis and pulmonary embolism. We found Situation, Background, Assessment, and Recommendation (SBAR) assessments had been completed for safe transfer between care settings and wards. We found good symptom management for the patients.

We observed patient care on the inpatient unit at Meadow House Hospice and reviewed the records of 5 patients. We found all care plans had been completed and safe care was being delivered with dignity in mind.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

We visited 5 wards at Ealing Hospital and the inpatient unit at Meadow House Hospice. We observed ward and clinical environments where patients were receiving end of life care to be in a reasonable state of repair. They were tidy, cupboards were locked where appropriate. They were free from clutter with call bells to hand. Personal protective equipment such as gloves, aprons were available and used appropriately.

Single rooms were offered for end of life care where possible unless patients or families prefer a bay bed. We met patients who had been moved from a bedded bay to a single room for patient privacy and dignity.

At the time of our visit Meadow House was currently undergoing essential maintenance to the exterior. The chief executive had visited to support estates improvements. Family visitors’ rooms were available. The garden was well maintained and well used by patients and families at the time of our visit. It offered well-presented areas which had been subdivided for privacy and reflection.

There was both piped oxygen and small cylinders delivery by nasal cannula or simple face mask. Oxygen cylinders were securely stored and upright. There were fire safety no smoking signs and regular checks of cylinders and gauges.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs.

The Ealing Hospital palliative care team were funded for 2.3 whole time equivalent clinical nurse specialists (CNS).  There was a 0.8 whole time equivalent palliative consultant and the trust clinical lead for palliative care provided additional cover. The team were also supported by the trust’s clinical lead for end of life care who was also the medical director for Ealing Hospital. The team worked 5 days a week as current resources were not sufficient to provide a 7 day service.

There was no administrative support or discharge coordinator support for the team. The trust palliative care teams had consulted on and drafted the ‘acute hospitals specialist palliative care strategy’, which was currently in draft form. It had been shared with senior leaders and was due for ratification within a month of our visit. One of the pillars of the strategy was the resourcing of the team to fund a seven day a week service which meant 2.5 more CNSs. It proposed the funding of an occupational therapist and discharge coordinator. This would increase their presence on hospital wards and allow the team to support more teams, including by increased attendance at multidisciplinary team meetings.

The team provided a service to a 350-bed hospital. In recent years the team had seen an increasing number of referrals due to rising frailty and other long-term conditions. Financial restraints had limited the funding available for team expansion. We were told the palliative care team were pragmatic about what they needed to cover with the resources available and worked to provide a good service within current parameters.

The Meadow House Hospice inpatient unit team consisted of a unit manager, 5 senior staff nurses, 14 staff nurses and 4 healthcare assistants. There was always a senior staff nurse on duty at night. There were 15 inpatient beds. However, there were currently 13 beds open due to nurse staffing and long-term sickness. The work undertaken by clinical teams was supported by multidisciplinary input including a dedicated psychology team, clinical nurse educator, 2 full-time occupational therapists, 2 full-time physiotherapists and 2 assistant therapists, a discharge coordinator and administrator.

There was a trust wide out of hours on-call service provided by 6 palliative consultants who jointly covered 3 trust sites and the hospice, providing continuous medical care outside of regular working hours.

The nursing lead for palliative and end of life care led all palliative care teams at the trust. CNSs did cross site working for consistency, good teamwork and sharing of resources when there were gaps. There was a trust clinical lead for palliative care who was also the clinical lead for the hospice.

A trust wide end of life education lead and practice educator had been in post for 2 years. They had organised a range of training programmes that included core end of life training based on the ‘five key priorities for care of the dying person’ with learning outcomes. The annual report produced by the end of life education team stated that between April 2025 and March 2026, there had been 697 attendances at end of life themed training events across 38 education sessions, including 18 full training days for core end of life care attended by 284 nurses. 52 healthcare assistants (HCA) had attended 8 end of life core training days. The education team contributed to the trust’s preceptorship programme for nurses, HCAs and allied health professionals. The team also ran scheduled courses and ad hoc training sessions. The report stated that across the trust, targeted sessions were attended by 90 registered nurses and healthcare assistants. The team had organised syringe pump training sessions in collaboration with a representative of the pump manufacturer and was attended by 40 nurses across 6 sessions.

Education had been delivered to a range of medical staff through the postgraduate education programme and bespoke departmental sessions. Training was also delivered to resident doctors across the trust. Sessions included communication issues at end of life, recognising dying and next steps, symptom control and prescribing at end of life. The team were also continuing to roll out the Purple Butterfly Initiative training across the trust. The initiative provided companionship, comfort and emotional support to patients who were dying and to their families, promoting dignity and personalised care.

The end of life education team worked with ward-based end of life care champions who attended regular meetings and training sessions which were shared with their teams.

There were consultant and medical education initiatives which had raised the profile of end of life care within the trust by reaching into more departments and specialities such as trauma and orthopaedics, oral and maxillofacial surgery.

A trust wide team produced a compliance report on mandatory training every two weeks to monitor compliance. There was a trust compliance level of 90% and the palliative care team achieved a 97% compliance rate. Meadow House had a 96% compliance rate.

The palliative care team and Meadow House Hospice had a 100% appraisal rate. Appraisals identified additional training for clinical nurse specialists and met requirements of postgraduate training. There was also in-house training for CNSs. This included a Friday forum every fortnight at Meadow House, which included a case focus and updates as learning.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All clinical areas and wards we visited including the hospice were visibly clean, tidy and free from clutter. Equipment was clean and in order with cleaning noted stickers dated mostly with today’s date.

We observed staff on wards caring for end of life patients followed infection control principles. Personal protective equipment (PPE) including gloves and aprons were available and used appropriately. We observed that hand gels were available and that handwashing was carried out. Staff met the key requirements of the hospital infection prevention and control policy of being bare below the elbows.

Meadow House Hospice infection prevention and control compliance was checked monthly. The report for 12 months up to July 2026 stated that hand hygiene and hand hygiene observation audits showed 100% for 11 of the 12 months of the year.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

End of life care was supported by the pharmacy team. A specific interest pharmacist had supported the writing of guidelines, such as on the use of synthetic opioids and anticipatory medicines.

Safe prescribing was in place and authorised by appropriately qualified prescribers. Doctor and non-medical prescribers followed national and local guidance. Anticipatory medications for end of life care were prescribed appropriately and available when clinically indicated and in line with guidance.

We observed safe storage and security of medications. Temperature monitoring was undertaken and recorded. Controlled drugs (CD) were kept in compliant and locked storage, prescribed and documented correctly. Access to controlled drugs and medicines restricted to authorised staff only. CD registers were maintained. On wards where end of life patients were cared for, we observed stock balances were checked regularly twice a day.

Staff administering medicines were trained, authorised and competent. Medicines administration records were legible, complete and accurate. Patients were supported to self-administer where appropriate, with policy and standard operating procedure in place. Patients and families were involved in medicines management where possible and appropriate. Information about medications was provided in an understandable format where appropriate.

A digital medication management and dispensing system was used to securely track medications. Governance arrangements included audits and maintaining of CD management.

Medical gases in Meadow House Hospice were used primarily for comfort focused care, symptom relief and basic clinical support to relieve breathlessness.