The Hillingdon 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

The service had a clear vision and strategy focused on high-quality, compassionate care, supported by well-known values among staff. Middle management was approachable and supportive, creating a positive and inclusive work environment where staff felt comfortable raising concerns.

The service promoted equality, diversity, and inclusion, with various initiatives and networks supporting diverse staff groups. Strong governance structures were in place, with regular meetings to review performance, manage risks, and ensure accountability.

The service actively engaged with local partners to provide integrated care, and a culture of continuous learning and improvement was evident through regular training, audits, and reviews.

However, not all staff were aware of the broader trust vision and strategy, indicating a need for improved communication and alignment with strategic goals. Senior leadership was not visible enough on the wards, which affected staff morale and hindered the timely identification of frontline issues. Awareness of the Freedom to Speak Up (FTSU) guardian was limited, suggesting a need for better promotion of this role to ensure staff knew how to raise concerns.

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.

Leaders established a clear and shared vision for the service; however, the assessment revealed that not all staff members across the service were fully aware of or understood the vision, values, and strategic goals. While the trust made efforts to communicate these, further engagement and communication initiatives were necessary to ensure all staff recognised how their roles contributed to achieving the trust’s objectives.

The vision, values, and strategy had been developed through a structured planning process that involved stakeholders such as service users, staff, and external partners. Staff were familiar with the core values (CARES); however, there was a gap in staff knowledge regarding the strategic goals. Although collaboration existed, enhanced dissemination and engagement methods were needed to better involve staff at all levels in the strategic planning process.

The culture within the service was positive, promoting openness, compassion, and a commitment to listening to staff and patients. There was a focus on building trust and fostering improvement. Staff demonstrated a strong understanding of equality, diversity, and human rights, which was reflected in their compassionate care approach. The service actively promoted these values and addressed any identified workforce inequalities.

Leaders and staff were aware of the risks associated with delivering the strategy, including local factors such as the challenges of managing a backlog of incident investigations. Action plans were in place to address these risks, such as prioritising high-risk cases and allocating resources. Improved communication of these action plans and progress updates to all staff members could have strengthened understanding and support for the strategy. 

The leadership team demonstrated capability, knowledge, and a strong commitment to providing compassionate care. Middle management, such as ward managers and matrons, were frequently described by staff as approachable, supportive, and responsive to their needs. Staff felt comfortable raising issues and appreciated that management made efforts to accommodate personal circumstances, such as adjustments for childcare needs. Regular ward meetings provided staff with opportunities to discuss concerns and collaborate on solutions, reinforcing a positive working environment.

Despite this, the visibility of senior leadership was limited. Staff reported that they rarely saw senior leaders on the wards, which created a sense of disconnect between frontline staff and the higher levels of the organisation. This absence could have hindered efforts to foster trust and ensure consistent communication of the trust’s vision and values. The divisional leadership structure was also incomplete at the time of assessment, as there was no divisional director of nursing in post, with the role temporarily covered by other senior leads. The trust had recruited to the post, and the new director of nursing commenced in August 2024.

While the leadership team had the necessary skills and experience to lead effectively, ensuring a consistent presence and engagement with all levels of staff would have strengthened alignment with organisational goals. Senior leaders were crucial in demonstrating inclusive behaviours and modelling the values of the trust, thereby enhancing staff engagement and understanding of their roles in achieving the trust’s objectives.

The service had a system in place to support staff in raising concerns, including the appointment of a Freedom to Speak Up (FTSU) guardian. Staff indicated that the culture around raising concerns had improved since the last inspection, and they expressed feeling more comfortable and supported when reporting issues. The presence of the FTSU guardian was intended to provide staff with a resource for voicing their concerns confidentially and without fear of repercussions.

Despite these structures, the assessment found that staff awareness of the FTSU guardian was limited. Many staff members were not aware of who the FTSU guardian was, and there were no visible posters or materials promoting the guardian’s role and function around the unit. These findings suggested that while the role existed, there was limited visibility and knowledge among staff regarding this support mechanism.

The trust demonstrated a strong commitment to promoting equality, diversity, and inclusion (EDI) within its workforce, supported by a dedicated EDI lead and team. The trust developed a comprehensive action plan for 2024/25, outlining specific actions aimed at increasing career progression opportunities for Black and Minority Ethnic (BME) staff and other protected groups, with measurable outcomes to monitor progress. The inclusion of ‘Equity’ as a core value within the trust’s CARES values further underscored its dedication to building an inclusive and fair working environment.

Staff were actively encouraged to participate in the trust’s EDI agenda through various initiatives. These included becoming EDI champions, joining reciprocal mentoring schemes, participating as interview panel experts to ensure fairness, and engaging with the multiple staff networks available. The trust supported numerous staff networks, including those for multicultural staff, LGBTQ+ allies, disabled employees (Able 4 All), international nurses, and women. These networks provided staff with platforms to share experiences, develop skills, and contribute to a culture of inclusivity and support.

The trust also maintained a dedicated EDI webpage on its intranet, offering a wide range of resources for staff, including a ‘Diversity and Inclusion Good Practice Points’ communication toolkit designed for healthcare professionals. This resource aimed to foster shared learning and help staff deliver personal, respectful services to the diverse patient community the trust serves.

Additionally, the trust actively promoted EDI through events, workshops, and social activities, such as Diversity and Inclusion workshops, celebrations of International Women’s Day, LGBTQ+ Month, and themed cultural events in the canteen. These activities highlighted the trust’s approach to celebrating diversity and building an inclusive workplace culture.

Leaders within the trust took steps to ensure the fair and equitable treatment of all staff members, with policies in place to prevent bullying, harassment, and discrimination, particularly for staff with protected characteristics under the Equality Act. The assessment noted ongoing efforts to monitor and address any disparities in staff experiences, and measures aimed at removing bias from employment practices, such as fair recruitment procedures and flexible working arrangements, were evident.

Furthermore, the trust provided reasonable adjustments for disabled staff to support them in their roles, demonstrating a proactive approach to creating an accessible and supportive working environment. The trust’s ongoing engagement with staff, including those from protected groups, ensured that their voices were heard and that their input shaped services and improvements within the organisation. This inclusive approach was reflected in the trust's commitment to aligning its workforce representation with the demographics of the population it serves, fostering a sense of empowerment and confidence among staff that their concerns and ideas would lead to positive changes

The service had established clear governance structures and systems of accountability. Regular governance meetings were held, attended by appropriate personnel, including divisional directors, nursing management, and clinical leads. These meetings were documented, with minutes showing detailed discussions on current and future performance, risks, and quality management. The service maintained a risk register to monitor key risks, each assigned a score and a responsible lead. Risks were actively reviewed and updated during governance meetings, ensuring that the service had continuous oversight of issues that could have potentially affected the quality of care.

Governance processes also included reviewing incidents, patient safety alerts, and outcomes of clinical audits. Information from these processes was used to update the risk register and inform quality improvement initiatives. Data and updates on the risk register showed active management of issues, with examples such as the identification and monitoring of specific risks within surgery, urology, and other specialities. Incidents and risks were categorised, and actions were assigned to responsible staff for follow-up, ensuring that issues were managed in line with governance protocols.

During the governance meetings, audits and performance metrics were also discussed. Clinical audit programmes were organised and adjusted for the upcoming period, incorporating national quality accounts and areas identified from previous audits, incidents, and patient safety data. Staff responsible for these audits were identified, and the programme included elements specific to various specialities within surgery. Information shared in these meetings demonstrated an organised approach to clinical governance, ensuring that audits and other quality measures were structured and implemented consistently.

Governance reports included summaries of incidents across departments, highlighting categories such as admission-related incidents and medication errors. Learning points from incidents, including those escalated to service managers and clinical leads, were reviewed and shared. For example, an incident involving a translation service not being available was discussed, and actions were outlined for addressing similar issues in the future.

The governance structure supported data sharing and quality assurance processes compliant with statutory and regulatory requirements. Clinical staff participated in reviews and audits, with resident doctors and other healthcare professionals involved in contributing to clinical audits. Meeting notes showed that there were ongoing updates on issues such as surgical site infections (SSI) and policies related to vascular care, demonstrating the service’s commitment to aligning with quality frameworks and standards.

While the service had a structured approach to managing performance and risks, the assessment highlighted that some previously identified issues, such as those related to capacity and access, were still in progress. Plans were in place to address these, and the governance system ensured that these issues remained on the agenda for continuous monitoring and action. In addition, the governance of the medicines management processes needed to improve to strengthen oversight of self-administration protocols and ensure compliance with safe administration practices. Enhanced monitoring and review mechanisms were necessary to address any inconsistencies and to ensure that all medication procedures adhered to the highest safety standards

The service demonstrated a strong understanding of its responsibility to collaborate and work in partnership with other services, communities, and stakeholders to provide seamless care. The service actively engaged with local health and social care partners, as well as other relevant agencies, to enhance service delivery and share learning. Regular meetings and communication with external partners reflected a commitment to integrated care and collaboration aimed at improving patient outcomes.

Leaders and staff engaged openly with a range of stakeholders, including patients, equality groups, the public, and local organisations, to plan and manage services effectively. These engagements facilitated the sharing of best practices and learning, contributing to continuous improvements within the service. For instance, the governance meetings included discussions on collaborations with external bodies such as social care partners, emphasising a collaborative approach that aimed to ensure joined-up care for patients.

This commitment to partnership working supported the service's efforts to deliver integrated services that addressed the diverse needs of its patient population. By maintaining transparent and open communication with key organisations, the surgery service was able to implement new initiatives and explore ideas, contributing to ongoing improvements in service delivery and patient care.

The assessment found that several issues identified in previous inspections remained unresolved. Despite the presence of governance structures and processes for monitoring risks and performance, some key challenges, such as those related to capacity, access, and flow, persisted. The service leadership was aware of these ongoing issues, but actions to address them had not been implemented in a timely manner, and plans for improvements were still in development without imminent changes.

Additionally, while the service had mechanisms in place for learning from incidents and reviewing patient safety alerts, the effectiveness of these measures in bringing about prompt improvements was limited, as some previously highlighted risks remained current. Several incidents remained open, with some overdue for investigation. This suggested that while the service had systems in place for learning from incidents, the effectiveness of these measures was hindered by delays in the resolution and closure of these cases. These open incidents reflected a gap between identifying issues and implementing effective solutions to mitigate risks and improve patient safety promptly.

However, the service demonstrated a focus on learning, improvement, and innovation, with staff having access to ongoing training and development opportunities to maintain the delivery of safe and effective care. Regular audits, as well as mortality and morbidity meetings, were conducted to review patient outcomes and identify areas for improvement. These sessions facilitated the implementation of changes aimed at enhancing the quality of care. The culture of continuous learning was evident, reflecting the service's commitment to maintaining high standards and fostering innovation within the service.