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 undertook a focused follow-up assessment of the urgent and emergency care service on 22 July 2026. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good. The service has made improvements and is no longer in breach of regulations.

The service had improved systems and processes to support patient safety, staffing and infection prevention and control (IPC). The service had a stable and committed workforce, with continued investment in staff development and support. Staff worked collaboratively to identify and manage risks.

At the time of inspection, the department was under redevelopment which included creating additional clinical spaces to increase capacity and improve visibility of patients.

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service had effective arrangements in place to manage the emergency department (ED) activity and maintain patient flow. Established pathways and multidisciplinary working enabled patients to be assessed promptly and directed to the most appropriate service, supporting timely treatment, care and discharge. For example, the number of patients referred to the Clinical Decisions Unit (CDU) for ongoing assessment and management increased between January and June 2026, with 836 patients referred in June 2026. The service’s CDU provided short term care for patients requiring a stay of 24 hours or less, with daily consultant review each morning to determine whether patients needed to be admitted or could be discharged. This facility assisted with patient flow through the ED and allowed those patients who required monitoring before a decision was made to admit them or if they could be discharged, to have this monitoring commenced in a timely manner.

The service had introduced an ambulance pathway with a dedicated seated area for patients requiring treatment and observation without needing a trolley. This pathway promoted timely handover of patients from the ambulance staff to ED staff and the commencement of treatment. At the time of our inspection the rapid assessment and treatment (RAT) area, a front door clinical model used in emergency departments to provide early assessment was being redesigned and work was planned to commence 24 July 2026. Plans included a 6 bedded handover area and a nurses’ station to improve staff visibility of patients. As part of the wider ambulance pathway redevelopment, a glass wall will be installed to provide staff with a clearer line of sight across the area supporting the safe and effective management of patient flow. We were told this work was due to be completed in October 2026.

During times when capacity of the department could not meet patient demand, the service opened temporary escalation space (TES) areas to help maintain flow in the department. Staff used regular huddles to plan additional staffing for the TES areas to ensure patients were managed safely and appropriately. A nurse and healthcare assistant (HCA) were allocated to have oversight of this area, with the HCA remaining in the area at all times to provide continuous observation.

The service had established a chest pain pathway to support early assessment and treatment, enabling patients to be cared for in a dedicated area where electrocardiograms (ECGs) were recorded and reviewed promptly by the assigned staff on site. Staff were available to provide observations and provide treatment.

The service had implemented a mental health pathway providing access to triage by the mental health practitioner at the front door from 8am to 8pm.The service saw around 8 mental health patients each day, with some patients receiving early intervention and being discharged directly from ED, while others were referred to community or inpatient mental health services. As part of the ongoing improvements within the department, the service had plans to introduce a dedicated mental health assessment room to support more timely assessments of mental health patients and improve patient flow. In addition, there were plans for the development of a mental health walk-in centre to provide an alternative pathway for appropriate patients. Timescale of when this will take place was not confirmed during the inspection.

The service had improved multidisciplinary working by relocating the complex patient and high intensity user team into the department. Feedback from staff indicated that this had improved collaborative working and enabled the team to access and update individual care plans more proactively.

The service had developed a separate paediatric pathway. Children attending the urgent treatment centre waited and were cared for in a dedicated paediatric waiting area and assessment room with age-appropriate information displayed. This meant children did not need to wait alongside adults or be transferred through the adult waiting area. The hospital did not have a paediatric ED, therefore any children requiring emergency care were stabilised in the resuscitation area before being transferred to an appropriate paediatric service at a neighbouring hospital. These arrangements demonstrated a focus on improving patient flow, early assessment and continuity of care.

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

The service demonstrated a strong focus on involving patients, relatives and staff in identifying risks and shaping improvements to the service. Feedback from patients and staff showed there had been noticeable changes to the waiting environment, including increased seating, improved signage and clearer information about waiting times. In the main waiting area, a whiteboard was manually updated every 2 hours by administrative staff to ensure patients remained updated. There were plans in place to automate the wait times based on admission statistics however at the time of the inspection this had not yet been implemented. The service had engaged with staff throughout the redevelopment of the emergency department. They had been involved in discussions to understand what worked well within the department and what changes would improve the experience for both patients and staff.

Translation iPads, supporting more than 100 languages were available to translate information and help patients understand and participate in their care. The service also intend to introduce British sign language (BSL) functionality however we were not informed about when this would take place. Information about chaperones was clearly displayed, informing patients how they could request a chaperone if required. Patients and carers told us that they felt well informed about their treatment plans and understood the reasons for any delays.

A staff huddle we observed during the assessment demonstrated that staff were encouraged to contribute to discussions about the service. An overview of the emergency department and urgent treatment care (UTC) activity was provided, with risks reviewed collaboratively and potential solutions considered.

A review of patient records - demonstrated that patients received appropriate treatment. A dedicated sepsis treatment room was available to support timely intervention of patients presenting with sepsis. Compliance data for provision of sepsis treatment showed a significant improvement compared with the previous year, increasing from 42% to 93% compliance with the sepsis care bundle, indicating that patients with sepsis were receiving antibiotics quicker and treatment was being delivered more consistently. Audit data showed that sepsis compliance had also improved, reaching 92% in December 2025 and ranging between 78% and 93% during 2026, demonstrating continued focus on adherence to sepsis standards.

The service had made environmental improvements designed to enhance patient safety, privacy, dignity and experience. Work continued to take place to improve the environment and facilities in the department. During the assessment, we observed work being undertaken. This work was undertaken in a safe and controlled manner, with areas screened off appropriately and information signs telling patients what was happening.

The service had taken steps to improve safety for patients who may be at risk of self-harm. Refurbished ligature light toilets and shower facilities were available within the department demonstrating consideration of the needs of patients at risk and the provision of a safe environment. The refurbishment included the introduction of a mental health assessment room which was due to be operational within the next 2 months. This meant patients attending with mental health concerns would be triaged quickly without having to wait in the main waiting room and referrals would be made to for other services if required. However, we were unable to assess the impact of this new assessment room has it had not been implemented at the time of our visit

The department had improved facilities to support privacy and dignity. The refurbished relatives and family room provided an appropriate private environment for staff to communicate with relatives when delivering sensitive information or breaking bad news.

Wider environmental developments and improvements remained ongoing. Some flooring had already been replaced within the department, with further areas planned as part of the redevelopment plan. Building work had already commenced in the UTC assessment rooms. Plans for the main entrance included the redevelopment of the reception area and the introduction of a QR code that would enable patients to self-check-in. Timescale of when this will take place was not confirmed during the inspection.

The environment and equipment we observed were visibly clean and in good physical condition. Most of the flooring in the UTC had recently been replaced, and the remainder of the UTC would be replaced as part of the redesign of the department.

The data received from the service showed that all required risk assessments were completed and up to date and fire safety was also 100% compliant between July 2025 and July 2026. Rooms and bays observed had curtains and doors to maintain privacy and staff meetings are held where conversations could not be overheard, protecting confidentiality.

As the work remained ongoing and some planned improvements had not yet been implemented, it was not possible to assess their full impact on patient safety and experience at the time of the inspection.

The service had a stable and engaged workforce. Staff described strong teamwork and a sense of pride in working within the department. Staff and leaders that we spoke with demonstrated a commitment to their roles and to providing safe, high-quality patient care.

The service had strengthened its mental health staffing provision. A full-time registered mental health nurse and two registered mental health nurses had been recruited into substantive roles support staff and contribute to policy development. Mental health nurses were available from 8am to 8pm to support early assessment and triage of patients presenting with mental health needs. We observed a mental health nurse providing care to a patient, a role previously undertaken by one of the department’s general nurses. This ensured patients received appropriate specialist nursing support

The data provided showed that the service had improved staff competency in areas such as assessment and triage. The training data demonstrated that all 9 band 7 nursing staff and 25 of 26 band 6 nursing staff had completed triage training and had been assessed as competent to undertake triage independently. All medical leads had completed advanced paediatric life support (APLS) training and overall training compliance remained around the 90% target with the service demonstrating a continued commitment to further improving compliance through governance.

The service had systems in place to support infection prevention and control (IPC) and actively monitor compliance. Hand hygiene audit data between April 2026 and June 2026 ranged from 85% to 89%, with compliance improving to 88% in June 2026 from 85% in May 2026. The service used monthly audits to identify and address areas for improvement. IPC leads worked collaboratively with the matron, IPC team and team leaders to support ongoing improvement through monitoring, feedback and staff engagement.

IPC was a standing agenda item on the at annual team days and was reinforced through staff huddles, team meetings and wider staff communications when issues arose. Hand hygiene results were discussed weekly at the emergency department meetings with the multidisciplinary team to share learning and progress on actions. The daily matron’s checklists included IPC, with actions and escalations identified where standards were not met. This demonstrated the service’s commitment to maintaining and monitoring IPC compliance.

Monthly hand hygiene audits included all staff working within the department. Compliance over the previous 6 months ranged between 75% to 90%. Where compliance reduced, the service increased the frequency of audits and sourced additional support and training from the IPC team to improve compliance.

The service had identified that some staff were not confident to challenge visiting professionals about hand hygiene when they observed non-compliance with hand washing policies. To address this the service had provided staff with additional training sessions to develop skills in challenging poor practice. This demonstrated the service’s commitment to promoting a positive IPC culture and empowering staff to maintain standards.

During the assessment, cleaning standards and IPC practice were observed to be effectively managed. We observed the matron completing a daily spot check and used a digital hygiene monitoring system to record completed cleaning, with the next inspection automatically scheduled, supporting effective oversight. During the assessment, Personal Protective Equipment (PPE) was readily available and used appropriately. We observed staff were bare below the elbow, washed their hands or used hand gel in between patients and their hair was above the neckline, in line with the hospital’s policies. Clinical waste was disposed of correctly and sharps bins were labelled appropriately and not over full. Separate bins were also available within the waiting area clearly labelled for purpose.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.