The Hillingdon Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service demonstrated a strong commitment to effectively assessing and meeting patients' health, care, and wellbeing needs. Multidisciplinary teams (MDTs) were a notable strength, with doctors, nurses, and allied health professionals collaborating seamlessly to provide comprehensive and holistic care. Patients reported feeling well-supported and informed about their care, highlighting the dedication of staff to involve them in decision-making processes. The service ensured that patient assessments, such as pre- and post-operative observations, blood glucose monitoring, and urinary catheter checks, were conducted thoroughly, contributing to well-coordinated and effective care planning.

The service actively participated in national and local audits, demonstrating its commitment to continuous improvement and adherence to best practices. This proactive approach aimed to ensure that care was consistently aligned with the latest national standards and evidence-based practices.

The service supported patients in leading healthier lives, with physiotherapists, dieticians, and doctors working closely to promote mobility, nutritional health, and overall wellbeing. Patients valued the post-operative information and guidance provided, which helped them manage their recovery and prepare for life after hospital care. The service also demonstrated a structured approach to monitoring and improving patient outcomes. Clear and structured processes were in place for obtaining and respecting patient consent, which staff consistently followed in line with national guidance.

This service scored 62 (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 did not consistently ensure timely assessments for patients, particularly in the Surgical Assessment Unit (SAU), where the model of care required doctors to work across multiple areas, which at times led to delays in reviewing patients. This issue, also identified in the previous inspection, resulted in delays in doctor reviews, impacting the timeliness of care planning and the overall quality of patient care. These delays highlighted systemic challenges in the allocation of medical staff and the efficiency of scheduling processes, which require improvement to ensure patient needs are met promptly.

Despite these challenges, the service demonstrated a strong commitment to effectively assessing and reviewing patients’ health, care, and wellbeing needs. Patients generally reported feeling supported, listened to, and involved in the assessment process. Clinical staff conducted a variety of assessments, such as pre- and post-operative observations, blood glucose monitoring, and urinary catheter checks, ensuring that patient needs were accurately identified and addressed. Regular surgical ward rounds, involving various specialist doctors, further ensured that care plans were consistently reviewed and adjusted to meet patients' evolving needs.

The service provided care and treatment based on national guidance and evidence-based practice. Hillingdon Hospital’s surgery core service planned and delivered care in alignment with clinical guidelines. Staff demonstrated knowledge of these guidelines, and patients reported receiving support that adhered to best practice standards.

The service actively participated in various national and local audits to monitor and enhance care delivery. Notable audits included the National Emergency Laparotomy Audit (NELA) and the Bowel Cancer Audit (NBOCAP), which were mandatory national audits aimed at improving surgical outcomes. Locally, the service conducted audits such as the Prolonged Fasting Audit and the Perioperative Temperature Management Audit. These local audits highlighted areas for improvement, such as managing patient temperature during surgery and minimising fasting times to prevent patient discomfort and complications. When improvements could be made to align with national guidance, staff acted promptly to implement them. For example, when pre-operative fasting audits identified that starvation times exceeded the recommended durations, the service reviewed and updated its guidelines to improve patient care in line with evidence-based practices.

Inconsistencies were noted in implementing certain protocols, particularly around Venous Thromboembolism (VTE) risk assessments. Although audits were conducted, findings indicated that full adherence to VTE protocols was not consistently achieved, suggesting a need for further training and monitoring. This issue, identified in the previous inspection, emphasised the importance of continuous audits and staff education to ensure compliance with clinical guidelines.

The service undertook audits specific to surgical safety, including the WHO Surgical Safety Checklist and local audits of the surgical site infection protocols, to enhance patient outcomes. These audits aimed to identify potential risks and verify the application of safety protocols, ensuring alignment with national standards.

The service demonstrated effective multidisciplinary teamwork across teams and services to support patient care. Staff, including doctors, nurses, and allied health professionals, collaborated well, ensuring comprehensive and holistic assessments of patients’ needs. This collaborative approach was particularly evident during ward rounds and handovers, where specialists from various disciplines, such as orthopaedics, urology, and trauma, participated in assessing and planning patient care. Resident doctors reported feeling well-supported within these multidisciplinary teams (MDTs), reflecting a positive culture of teamwork and communication.

Staff had access to the hospital’s electronic health record system, which facilitated the sharing of patient information necessary for planning and delivering care. Although the trust had rolled out the new electronic patient record system and provided fixed and mobile computer access across surgical areas, some staff told us they experienced difficulties accessing enough working devices at peak times. These challenges, which were also highlighted in the previous inspection, affected timely access to information and occasionally hindered efficient teamworking.

The service managed patient transitions between services effectively. The assessment team observed various speciality teams, including nursing and allied health professionals, working together to assess patient readiness for discharge. Staff ensured that all necessary assessments, referrals, and care plans were communicated during handovers and ward rounds to maintain continuity of care. Despite the challenges with the electronic system, the MDT approach was a clear strength, ensuring that patients received well-coordinated and effective care across different services.

The service demonstrated a commitment to supporting patients in managing their health and wellbeing, aiming to maximise independence, choice, and control. A multidisciplinary approach was evident, with physiotherapists, dieticians, and doctors actively involved in promoting mobility, nutritional health, and overall wellbeing.

During the inspection, physiotherapists were observed supporting patients to mobilise on the wards, encouraging physical activity as part of their recovery process.

Patients reported receiving a significant amount of post-operative information, including leaflets that provided practical guidance on managing their conditions post-discharge. This information was valued by patients, as it helped them prepare for life after hospital care and supported them in maintaining healthier lifestyles. The service also provided tailored support based on individual patient needs upon admission, ensuring that each patient’s health was assessed, and appropriate advice was given to promote healthier living. This proactive approach aimed to reduce the risk of readmission and enhance overall recovery outcomes through education and practical support.

The service demonstrated a commitment to monitoring and improving patient outcomes. The service held regular mortality and morbidity meetings to review patient cases, identify areas of suboptimal care, and implement lessons learned to improve future care delivery. These meetings generated detailed reports that highlighted cases requiring attention, showcased examples of good practice, and outlined specific actions for improvement. This structured approach reflected the service’s dedication to continuous improvement and enhancing patient safety and care quality.

The service compliance with cancer treatment standards showed strong performance in some areas, particularly in relation to the faster diagnosis standard (FDS), where breast, children/CTYA, and skin pathways achieved high compliance rates, ensuring timely access to initial consultations for these patients. However, compliance in gynaecology, colorectal, and urology pathways was below the expected standard, with rates as low as 64%, indicating the need for targeted improvements to ensure timely initial assessments and follow-up care for patients on these pathways. Variability was also evident in the 62-day standard, though the service showed generally strong compliance with the 31-day cancer pathway. Low patient volumes in certain specialties and frequent referrals to other facilities made it difficult to assess specific performance levels across individual specialties. Nevertheless, the service demonstrated an improvement in cancer performance, related to the FDS, when compared to 2022 and 2023.

The service had established time-bound targets to reduce waiting times and improve patient flow across its services. A key objective was to eliminate 52-week waits across all specialties (except in high-demand areas such as ENT and Trauma Orthopaedics) by September 2024. In addition, the Trust aimed for a 10% reduction in 0-17 week waits across all specialties by March 2025. For cancer care, the Trust set ambitious targets to achieve a 70% treatment rate within the 62-day cancer wait standard and a 77% compliance rate with the FDS by March 2025.

Despite these efforts, the referral to treatment (RTT) dashboard indicated ongoing challenges, with long wait times exceeding trajectory targets. At the time of the inspection, the trust reported 17 patients waiting over 65 weeks and 3 patients over 78 weeks, which it attributed in part to mutual aid support provided to other trusts within the North West London sector. The number of patients waiting 52 weeks or longer remained static or showed only slight declines, reflecting difficulty in achieving the planned reduction in long waits (April to July 2024). Although the total number of patients waiting over 52 weeks in 2024 (up to August 2024) was lower than in 2022 and 2023, substantial wait times persisted across categories like 40, 27, 18, and 16 weeks, particularly in the 27 and 40-week categories, highlighting ongoing difficulties in reducing wait times to clinically acceptable thresholds. Data suggested challenges in meeting RTT recovery plans.

The service participated in several national and local audits to monitor the effectiveness of care and treatment. Examples included the National Emergency Laparotomy Audit (NELA) and the Bowel Cancer Audit (NBOCAP), which assessed surgical outcomes and compliance with national standards. Locally, audits such as the Pre-operative Fasting Audit and the Perioperative Temperature Management Audit aimed to ensure care aligned with best practices and identified areas for improvement. Staff and managers used the findings from these audits to implement changes. The service also ensured that audit results were shared with staff during team meetings to promote understanding and facilitate the implementation of necessary changes. Continuous re-auditing was conducted to monitor the effectiveness of these interventions and track progress over time.

The service had clear and structured processes in place for obtaining and respecting patient consent, which staff consistently followed in line with national guidance. Staff supported patients in making informed decisions about their care and treatment, ensuring that consent was obtained appropriately and in line with legislation. Patients were informed about their rights, and staff took time to explain procedures thoroughly, providing all necessary information regarding the nature of the treatment and any associated risks. This approach ensured that patients could make informed choices and demonstrated respect for patient autonomy.

Staff were observed using consent forms correctly, clearly recording consent in patients’ records to document that patients fully understood the proposed treatment. When patients lacked the capacity to consent, staff followed the Mental Capacity Act 2005 guidelines, conducting capacity assessments and involving relevant parties, such as family members or advocates, in the decision-making process. This ensured that decisions were made in the best interests of the patient, taking into account their wishes, culture, and traditions.

Nursing and clinical staff received training in the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) and kept up to date with relevant legislation and policies. Staff were knowledgeable about how and when to assess a patient’s capacity to make decisions about their care, and they knew how to support patients experiencing mental ill health. Where patients were unable to give consent, staff implemented DoLS appropriately, ensuring that the documentation was completed in line with approved guidelines.

The service also monitored the use of DoLS to ensure compliance and made sure staff knew how to access policies and seek advice when needed