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 did not always ensure people’s care and treatment was effective, as staff did not consistently involve them and maintain up-to-date records. While the service planned and delivered people’s care and treatment in collaboration with them, including their individual needs and preferences, it did not always work well across teams and services to support people. Staff did not always share their assessment of people’s needs during transitions between services. Furthermore, the service did not consistently support people in managing their health and wellbeing, which hindered their ability to maximise their independence. The service also did not always routinely monitor people’s care and treatment to drive continuous improvement. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant people’s outcomes were not good, and people’s feedback confirmed this.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always involved in the assessment of their needs. People gave conflicting feedback about risk assessments. For example, some patients in the "fit to sit" waiting area had not been informed of what the next steps were. 

Although staff addressed some people’s current needs, assessments were not always up to date. We observed staff assessing if patients were in pain during triage, however, they did not record a pain score on the electronic system. 

Assessments were available to consider the person’s health, care, wellbeing, and communication needs. People’s needs could be assessed using a range of assessment tools to ensure their needs were reflected and understood. 

The trust had systems to ensure that staff were up to date with national legislation, evidence-based good practice and required standards. The trust’s intranet contained a comprehensive range of policies and standard operating procedures that reflected current practice. It had guidance for staff around collaboration with multi-agency teams and for delegation of clinical tasks to ensure the right people delivered evidence-based care and treatment. We observed staff accessing policies on the provider's intranet system. We reviewed a random sample of policies during our assessment and observed that polices were up to date and in line with national guidance and best practice.  

People were told about good practice that was relevant to their care and were involved in how this was reflected in their care plan. However, a sample of 3 discharge information/leaflets reviewed were out of date. This included discharge advice leaflets on Burns Injury, Knee Injury and Pretibial Laceration. All three leaflets were published in October 2019 with a review date of Oct 2021.  

There were processes in place to ensure that people’s hydration needs were met in line with current guidance. We observed staff giving water to patients upon request.  

There were sometimes challenges with admitting people to different specialities which impacted patient flow and outcomes. When people were due to move between services, not all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care.  At the time of our assessment, consultants in the ED did not have admitting rights for certain care pathways.

Plans for transition, referral and discharge generally considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. However, due to the lack of contemporaneous assessments, we were not assured that when people received care from a range of different staff, teams or services, it was always co-ordinated effectively.  

Teams in the ED worked well together. Staff held daily handovers in the morning and evening. We observed the morning handover on the second day of our assessment. Staff discussed patient care, concerns, staffing and capacity.  

Staff organised and attended multiple meetings such as bed meetings, a front door working group, London Ambulance Service steering group, Hillingdon Urgent and Emergency Care delivery board (attended by stakeholders), high-intensity user groups, and a meeting with police and other NHS providers. 

Support to make healthier choices to help promote and maintain people’s health and well-being was limited. For example, senior staff reported that alcohol addiction services were something that the trust could improve on. However, patients were referred to other organisations relevant to their needs e.g. drug and alcohol cessation. Post inspection we were informed that the trust worked in partnership with an alcohol addiction service, which supported patients with alcohol withdrawal in the Emergency department. Inpatients were supported by Gastroenterology Assistant Psychologists (GAP).

The service informed us that health promotion was included in clinical consultations. On discharge, patients were sign-posted and given advice on where and when to seek help.  

Patient information in the trust had adopted a digital approach but paper information leaflets were still available upon request. 

There were some approaches to monitoring people’s care and treatment and their outcomes. However, we were not assured that the service effectively used monitoring information to improve outcomes. For example, there was a lack of actions to improve sepsis performance despite poor audit results (see safe section).

Our review of documentation and conversations with staff demonstrated that there was a lack of capacity to complete audits and implement actions in a timely manner. This was sometimes due to a lack of funding.

Audit schedules were set up for 2024-2025 to assess a range of patient care including mandatory audits from the Royal College of Emergency Medicine. There was evidence that actions were identified to improve patient outcomes. Audits were discussed at divisional governance and quality meetings. This included sickle cell anaemia audits and Computerized Tomography (CT) head imaging in head injury audits. Other audits were ongoing such as the Epistaxis (bleeding from the nose) pathway and data collection was still in progress.

The trust developed localised action plans against the Royal College of Emergency Medicine (RCEM) national quality improvement programme for infection prevention and control 2022-2023 and for pain in children 2021-2022. Many of these actions were still ongoing.  

People we spoke with understood their rights around consent to the care and treatment they were offered. People told us staff explained care and treatment options and gained verbal consent before carrying out a physical assessment of their injuries.   

People's capacity and ability to consent was considered, and they, or a person lawfully acting on their behalf, were involved in planning, managing and reviewing their care and treatment. Staff understood their responsibilities regarding the Mental Capacity Act 2005. They knew how best interest meetings were held and decision were made for people who lacked mental capacity in any particular area. 

The consent policy was in date and next due for review in November 2025. 

There were high training completion rates for Mental Capacity Act 2005 (MCA) and Deprivation of Liberty (DoLS). Senior leaders assessed staff knowledge of MCA and DoLS during quality rounds. Results from the June 2024 quality round showed some areas of improvement, however, other areas had declined in comparison to the last quality rounds in September 2023. Showing inconsistency in knowledge