The Hillingdon Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People's care and treatment was not always delivered in a way that met their assessed needs that was co-ordinated and responsive. The service did not always facilitate easy sharing of feedback, ideas, or complaints about care, treatment, and support. Staff did not always involve people in decisions about their care or inform them of changes. The service did not always ensure people could access needed care, support, and treatment promptly. Staff and leaders did not consistently record information about those most likely to experience inequality. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people's needs were not consistently met through organisation and delivery.

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.

The ED service demonstrated a commitment to person-centred care. However, people did not always receive timely care and support due to significant delays in the Emergency Department. The ED was very busy during our assessment which meant staff were not able to respond to needs promptly and to ensure that patients were involved in decisions about their care and treatment.

Patients we spoke with had limited understanding of their conditions and the options available to them. Patients were not regularly involved in care planning and decision-making processes (please see safe and effective sections for further detail).

There was some involvement of multidisciplinary teams, including doctors, nurses, dieticians, and physiotherapists, to facilitate comprehensive care planning that responded to the individual needs of patients.

People’s care and treatment was not always delivered in a way that met their assessed needs nor were they always co-ordinated and responsive. There were long waits for MH beds for young people and adults, leading to long stays in the ED or children’s paediatric ward. (Average LOS for MH patients over last 6 months varied between 9-14 hours for adults, and 7-14 hours for young people. Longest LOS over this period ranged from 24 – 72 hours for young people and 51-69 hours for adults). This was largely due to waits for a bed or placement/care package. 

Senior staff informed us the service had reinstated support to minimise the attendance of High Intensity User (HIU) groups. HIU groups consist of patients that attended the ED frequently. It was too early to demonstrate if changes had the expected outcomes.

The main ED waiting area was moderately spacious with sufficient seating arrangements. People in the waiting area had access to vending facilities and various information posted about chaperone services, ailments and symptoms.   

The paediatric ED waiting area had a child friendly ambience. Child friendly information was posted about various ailments and symptoms. People in the waiting area had access to a water dispenser and children’s books.   

Staff had some training in supporting patients with autism and noted that they would avoid acute admissions for people with autism as this was often not the right environment for such patients. Staff noted that they had support from Learning Disability (LD) teams between 9-5 daily. Training modules covered basic LD and autism. 

Staff expressed concerns about patients being in the ED for over 24 hours without access to facilities such as showers. 

People’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared. These needs were met and reviewed to support their care and treatment in line with the Accessible Information Standard. People could expect information to be tailored to their individual needs. This included making reasonable adjustments for disabled people, interpreting and translation for people who didn’t speak English as a first language and for deaf people who use British Sign Language. People who have difficulty with reading, writing or using digital services were supported with accessible information. Communication services available to patients included, interpreting and translation services which including British sign language 24/7. A hospital communication book was available for patients with a learning disability, hearing impairment, injury, or illness that affected communication and autistic people. The interpreting and translation service policy was in date and due for review in August 2025. The trust was currently planning a pilot of real-time digital translation in ED. The confidential and data protection policy was in date and next due for review in May 2027.

Information about people that was collected and shared met data protection legislation requirements. The confidential and data protection policy was in date and next due for review in May 2027. 

People knew how to give feedback about their experiences of care and support including how to raise any concerns or issues. Friends and family feedback was gathered electronically via instant messaging once the patient had left the department. Between 1 April 2024 and June 2024, 2,006 reviews were collected. In June 2024, 655 results were received and showed results of 258 ‘very good’ responses.  

 Patient comments in paediatric ED included: 

• ‘’I understand the NHS is over stretched but a smile and being friendly does cost anything, the customer service is very poor there is a lack of communication’’. 
• ‘’We were seen quickly, all tests done and out in 4hours which is amazing. Hospital was clean. Staff were all really professional and friendly. I was dreading turning up on a Saturday after referred by out of hours GP but was pleasantly surprised how quick it was’’. 

Patient comments in UTC: 

• ‘’Really friendly reception staff at the UTC, I was triaged very quickly, and the sit wasn’t long at all despite it being near midnight on Good Friday’’. 
• ‘’The waiting time was so long for my child with a possible broken bone and in pain’’. 

 Patient comments in ED: 

• ‘’I was treated with care and attention. I was kept informed of all procedures. Although the ED was busy, I was looked after well. Cannot fault’’.  

Senior staff informed us that main themes around complaints involved communication, staff interactions with people and waiting times. Between July 2023 and June 2024, 15 complaints were received in UTC. For the same period 82 complaints were received in ED. Top themes in both areas included clinical care from medical staff, and the attitude from nursing staff.  The complaints policy was in date and next due for review in August 2025. We viewed the trusts responses to complaints and found, each complaint had a written apology, an investigation into the concerns and what actions had been taken to improve the service. 

People could not always access care, treatment, and support when they needed to and in a way that worked for them. People were experiencing significant delays in the ED. During the period of our on-site assessment, there were mental health patients in the ED for up to 52 hours. The longest wait for other people in the ED was 19 hours.  

Children were triaged within 15 minutes of their arrival in the paediatric ED. However, there were delays in children being seen by speciality doctors. On our inspection, children were waiting for over four hours in the paediatric ED. The average time for children to see a doctor was 2.28 hours. Staff expressed concerns about long waiting times and the impact on service users. Staff informed us of an incident earlier in the year where a child waited in the paediatric ED for 6 days waiting for the Child and Adolescent Mental Health Service. These extended wait times for specialist care in paediatric EDs are a recognized national concern. 

Services were not designed to make them accessible and timely for people who were most likely to have difficulty accessing care. When there were barriers, these were not removed. ED consultants did not have admitting rights. The ED was at full capacity during the time of our inspection. Patients were being treated on corridors and there was heavy police presence due to the significant number of patients brought in under the Mental Health Act.   

Between April and June 2024,51.38% of patients exceeded the 4-hour wait time. Where patients should have been admitted to the hospital, transferred to another provider or discharged within four hours. The UTC recorded a 2% breach in the 4-hour wait time in the same reporting period.  

The Trust's patient advice and liaison service provided phone support and guidance on accessing services for those unable to use digital resources. The ED had reduced waiting times for ambulances and delivered 85% compliance with 30-minute handovers between January and June 2024.  

There were systems to support people to receive the most appropriate care and treatment for them. For example, the service had a Paediatric Ambulatory Treatment of Children at Home (PATCH) team which included one band 7 paediatric nurse and 3 band 6 paediatric nurses. This team looked after children in the child’s own home providing assessment and treatment for children in their own home setting. The service had secured additional funding to introduce Advance Clinical Practitioners (ACP) into the role.  

The EDs ability to provide equitable experiences and outcomes was sometimes hampered by systemic issues such as overcrowding, patient acuity, and staffing challenges. These issues could lead to disparities in the quality of care and patient experiences, as evidenced by long waiting times and incomplete assessments.

People did not experience digital exclusion as they were booked in via the reception team. All results and discharge summaries were shared with the patient’s GP.  

Digital and hard copies of the summaries, patient information, and Friends and Family Test feedback were available to patients upon request.  

Clinicians had multiple referral options for patients post-discharge.

People who may be approaching the end of their life were identified (including those with protected characteristics under the Equality Act and people whose circumstances may make them vulnerable). This information was appropriately shared with other services and staff. The service had systems to manage patients at the end of life. Staff had completed end of life training to manage such patients. The service worked closely with the end of life team and the bereavement team to support patients. 

People were supported to make informed choices about their care and plan their future care while they had the capacity to do so. When people wanted to express their wishes about cardiopulmonary resuscitation, they were supported to do so and were able to change their mind if they chose.