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

Staff did not always feel they could speak up and that their voice would be heard. The service lacked clear responsibilities, roles, systems of accountability, and good governance. Staff did not act on the best information about risk, performance, and outcomes, or share this securely with others when appropriate. The service understood their duty to collaborate and work in partnership. Staff shared information and learning with partners and collaborated for improvement. The service did not always focus on continuous learning, innovation, and improvement across the organisation and local system. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant there were some improvements in service leadership and culture and in the delivery of care.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders ensured there was a shared vision and strategy. Staff and leaders ensured that the vision, values and strategy have been developed through a structured planning process in collaboration with people who used the service, staff and external partners. The trust’s vision was ''to deliver the best possible care for all who need our services''. The trust hoped to achieve this vision with a focus on quality, people, performance, finance, partnerships and strategic programmes. There were also 6 goals to help deliver the vision: 

1. Have a rating of good across all services and for well-led.  
2. Deliver the 4 pillars of their people strategy and have staff recommending the trust as a place to work.  
3. Deliver right care at the right time for patients.  
4. Live with means, and support financially sustainable system. 
5. Help lead care within the Hillingdon system. 
6. Lead delivery of a series of high profile complex programmed which support the organisations long term plans.  

The trusts values were: Communication, attitude, responsibility, equity and safety. Stakeholders commented while junior staff communicated effectively with stakeholders, management communication was poor, with emails going unanswered. 

Senior ED staff informed us they were working together with the UTC to improve services, particularly streaming for walk in patients in the UTC. They spoke about improvements on acuity calls and making sure sick patients were promptly treated. 

Staff informed us they worked well together with other staff. They believed staff were generally fantastic to work with and some staff felt they were like family. They felt they worked in a positive environment.  

The January 2022 Clinical Services Strategy outlined the need to decrease patient reliance on emergency care.  This was to be achieved by case-managing high-risk patients, implementing same-day emergency care and frailty pathways, and better integrating community and social care to facilitate timely discharges.  The service design for the new Hillingdon Hospital was informed by lessons learned during the COVID-19 pandemic.  This included separating COVID and non-COVID staff and patient flows, as well as providing distinct patient access points. 

However, there was evidence that staff within the ED and UTC had not been listened to when raising concerns and improvement suggestions about staffing, patient flow and admittance rights.

This demonstrated that more needed to be done to ensure the goals of the vision were realised across all services.

Staff said that leaders in the department were open, transparent and approachable. Senior ED staff said they were listened to by the divisional team and said they were approachable.  

Leadership was sustained through safe, effective and inclusive recruitment and succession planning. Leaders go through an appropriate selection, assessment and interview process and recruitment checks before getting appointed into roles, ensuring they meet the personal specification criteria to perform the role effectively.  The ED matron noted that there was a new MH steering group directly reporting to Board level. We did not see assurances that leaders were suitable to their role and were only provided with job descriptions of each senior role. The Fit and proper person policy was in date and next due for review in March 2027. 

However, we found Leaders had not taken effective action to address concerns raised following our previous inspection in 2018. This included concerns around infection prevention and control, clinical oversight of waiting areas, medicines management and provisions for mental health patients. 

Most staff spoke positively about their experience of working for the trust. Staff said that their colleagues were very supportive. Staff also commented on the strong sense of team they had with other staff working in the ED. 

The trust was currently developing a succession planning options paper. This included recommendations for the approach/framework and resources. Other policies and initiatives were planned to address talent management and succession planning but not embedded.

There was a culture of speaking up where staff actively raised concerns. Although staff felt confident to raise concerns, the staff we spoke with did not feel confident about actions taken to address issues raised.  

Staff and leaders promoted staff empowerment to drive improvement. Staff were encouraged to raise concerns. The trust had a Freedom to Speak Up (FTSU) Guardian with whom staff could raise concerns with about any issues.  

The FTSU Guardian was supported by 21 FTSU champions. Some of the work carried out included, podcasts, site walkabouts, presentations to senior staff, FTSU promotion, FTSU quality rounds and attendances at London regional FTSU network meetings and conferences.  

The raising concerns/speaking up/(whistleblowing) policy and procedure policy was in date and due for review in July 2025. Aligned to guidance from NHSE and the National Guardian Office (NGO). 

Leaders took action to continually review and improve the culture of the organisation in the context of Equality, Diversity and Inclusion (EDI). EDI was a priority for the trust in 2024 - 2025. The Inclusion lead and inclusion team could be contacted by staff. Staff could get involved in Trust’s EDI agenda by becoming an EDI champion, taking part in the reciprocal mentoring scheme, and joining staff EDI networks.  Staff had access to multiple networks.

Leaders took steps to ensure that some staff and leaders were representative of the population of people using the service. The trust workforce was made up of 54.6% Black, Asian and Minority ethnicity (BAME) and 42.7% white and 2.7% unknown. There was an under representation of BAME staff in clinical posts at band 7 and above and non-clinical posts at band 3 and above.

The staff survey was conducted between September and December each year. Themes included strong engagement, compassion and inclusivity, a voice that counts, and teamwork. Areas of improvement included staff feeling safe and healthy, recognition and reward, and morale. The trust responded to this staff survey by setting a goal to deliver the four pillars of the trust people strategy at a divisional level that included, looking after our people, belonging in our trust, new ways of working and delivering care, and growing for the future. The ED did not carry out a local staff survey a new pulse survey will be introduced in the next few months.

We were not assured there were effective structures, processes and systems of accountability to support the delivery of the strategy and good quality, sustainable services that continuously improve. After our assessment, we issued a S29A warning notice as we found that the trust was not doing all that was reasonably practical to mitigate the risks to service users in the ED, we observed delays in treatment which could put patients at risk of deterioration and or irreversible harm

We saw two risk registers for ED, one on the day of the inspection and a revised version as part of our data request. The risk register did not sufficiently address some of the issues identified during our inspection. This included medicines management and mental health provisions.  

Staff generally understood their roles and responsibilities. We saw high attendance in clinical governance and quality meetings for both ED and UTC chaired by consultants and doctors. Discussing and addressing key areas of risk, incidents, safeguarding and infection control. However, there was limited discussion about audits to improve care and review of existing action plans.

The service had business continuity plans in place for various scenarios. For example, there were downtime procedure packs in the event of an IT outage. The business continuity plan was due for formal review in July 2025.  

Emergency planning resilience and response (EPRR) policy was reviewed by the accountable emergency officer in July 2024. There were multiple policies in place to manage risks and emergencies including fuel disruption, evacuation, heatwaves, and mass prophylaxis. 

Staff and leaders engaged with people, communities and partners to share learning with each other that results in continuous improvements to the service. They used these networks to identify new or innovative ideas that led to better outcomes for people. The service worked with other organisations for the benefit of service users. This included charities for the elderly, refuge for victims of domestic violence and professional networks amongst others. 

Staff and leaders had a good understanding of how to make improvements happen. The approach was consistent and included measuring outcomes and impact. For example, communications were shared after a violent and aggressive event in UTC to staff and increased security measures were put in place to protect staff. However, we saw that whilst events were investigated, learning was not embedded into practice and repeated errors occurred. This included poor management of sharp bins, cleanliness, and uniform adherence.   

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.

Leaders encouraged staff to speak up with ideas for improvement and innovation and actively invest time to listen and engage. There was a strong sense of trust between leadership and staff within the ED and UTC. For example, the service had introduced the acuity call and response team as a means of treating seriously ill patients promptly. Streaming staff could put out an acuity call for patients to be seen promptly by an ED doctor and nurse. 

There were processes to ensure that learning happened when things went wrong and to learn from examples of good practice. Leaders encouraged reflection and collective problem-solving. Continuous Quality Improvement projects were ongoing or completed. These projects included pathway referral, urinalysis and prolonged stay for patients suffering with mental health. Each project had a start and expected finish date, changes had been implemented, and improvements were made.