The Hillingdon Hospital

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found the service provided safe continuity of care, including when people moved between different parts of the service. Staff understood and managed risks. The facilities and equipment met the needs of people and mitigated risks. Staff managed medicines well. We found a service that had made improvements and found no continuing breaches of regulation.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service worked to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different parts of the service.

In response to the concerns we highlighted about the surgical assessment unit (SAU) in July 2024, we found the trust had taken action to establish and maintain safe systems of care and reduce the length of stay on the SAU. The service was being effectively managed and monitored within the hospital’s wider systems and pathways. Patient flow was better organised and understood within SAU. There was better identification of patient need, escalation and support in relation to length of stay.

The SAU was part of the hospital’s same day emergency care (SDEC) pathway which enabled more rapid assessment, diagnosis and treatment of patients. This meant the SAU was part of a wider system of patient flow through the hospital. They attended the daily 8.30am SDEC meeting in ED and daily 8.10am meeting within the surgery department to review SAU patients, understand how many surgical beds were needed and how this could be best accommodated.

The 8am SDEC meeting in ED was attended by multidisciplinary teams and site practitioners which included the flow coordinator for the surgical division. What was going well, what needed to be done better and the pressures of the day ahead were reviewed. Surgical day care, which provided surgical procedures on an outpatient basis, was also part of the SDEC pathway. Patients assessed on the SAU were transferred with a treatment plan to the surgical day care unit. This helped with patient flow in SAU as it moved patients with different needs on from SAU. Low risk patients came to SAU from ED and sat in a chair while they awaited further tests or theatre decisions. This helped reduce crowding in ED and improved patient flow through the hospital.

For patients identified as requiring admission, the process for securing a bed was well-defined. During working hours, the surgical bed manager was responsible for bed requests. Outside of these hours, the clinical site practitioner took responsibility. The trust did not collect data in a format that enabled reporting on length of stay following a 'decision to admit'. We were told this was under review with the SAU team and business intelligence team. However, regular safety huddles identified patients and effectively escalated patients who had been on the unit for 12, 20 and 24 hours.

Data demonstrated there had been significant reductions in patients staying on the SAU for longer than 24 hours, which was now considered an incident because it was a breach of the standard operating procedure. For instance, in August 2024 there were 45 patients staying longer than 24 hours, which was typical for that period. Data for this year (March to October 2025) showed that in March, 14 patients had stayed for longer than 24 hours, April 14 patients, May 7 patients, June and July zero, August 16 patients, September 16 patients and October 15 patients. In all instances, the reason given for the breach was a high influx of patients in the emergency department (ED) impacting on the flow of surgical patients.

Data also demonstrated there had been significant reductions in patients staying on the SAU for longer than 40 hours. In March 2025, there were 4 instances of patients staying longer than 40 hours whereas from May to October 2025, zero patients had remained on the SAU for 40 hours or more.

A safety huddle now occurred on the SAU 5 times a day. It was usually attended by the ward manager and the nurse in charge. Sometimes matron and unit staff were also available. It monitored several quality metrics that included length of stay, the number of patients who were on trolleys, in chairs and the longest wait in a chair. It recorded the number of patients who were waiting for a bed, including those waiting longer than 12 hours and longer than 20 hours and whether this had been escalated. This meant that patient need was now better understood. As well as monitoring how long, each patient had been on the unit for, it also understood their level of risk and clinical priority, which could be better escalated to bed managers as necessary.

Patients who had been on the SAU for longer than 12 hours were escalated to the divisional director of nursing, site practitioners, the discharge planning team and highlighted at bed meetings. We were given examples of other types of issues that had also been escalated, such as the priority for a bed because of individual needs such as dementia or frailty. Staff told us they felt able to escalate issues and that medical teams and the critical care outreach team were responsive to the needs of patients waiting for long periods.

If a patient was long staying in the SAU, the ward manager, the matron or the divisional director of nursing would now go to see the patient, apologise for their length of wait and explain the current situation. There was also a letter given to patients that explained what was happening and what they could expect in relation to good patient care. It sought to reassure people by stating that the right individual care would be provided and that any clinical risks would be properly escalated. It assured people that their privacy and dignity would be maintained that there was access to hot food and washing and showering facilities as required.

Since our last visit, the trust had revised its standard operating procedure (SOP) for the SAU. It clarified referral pathways, clinical criteria for transfer to the SAU, exclusion criteria, length of stay and escalation pathways. It clarified that patients were not to return to the SAU following surgical procedures. If patients returned to SAU post procedure an incident report was raised because this was now considered a breach of protocol. Breaches were monitored in the monthly local clinical governance meetings for surgery. Data showed there was 1 return in February, 2 in March and 1 in May 2025. Between January and October 2025 there were no other instances of patients returning to SAU post procedure.

Staff told us that improved systems had meant they were able to provide better care to patients. We were told that not having to manage returns from theatres had helped to take pressure off the unit, and that better patient flow within the emergency and surgery departments had reduced the length of time patients stayed on the SAU. The discharge lounge for surgical beds had also really helped. However, staff also told us that although overall length of stay had been reduced on surgical wards, more decisions on discharges would help them further. We were told there were sometimes delays from pharmacy and delays with arranging care at home.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

In response to the concerns we highlighted about the surgical assessment unit (SAU) in July 2024, we found the trust had taken action to manage patient risk and provide safe treatment. We found the SAU was providing appropriate and supportive care.

There were 5 safety huddles a day with the purpose of identifying patient risk and escalating for action. They were attended by the ward manager and the nurse in charge. Sometimes the matron and unit staff were also available. During safety huddles staff checked that risk assessments and care plans were up to date. They reported how many patients were in the SAU, how many were on trolleys, how many were in recliner chairs and what was the current longest wait in a chair. Staff checked whether any patients were awaiting consultant review and if there were any clinical safety concerns. During the huddles staff also checked whether hot food had been offered and whether patient hygiene needs had been met. The safety huddles were now completed on a digital recording system. Data showed huddles were taking place, being correctly recorded and issues effectively escalated.

When the huddle identified risk there were several ways this could be escalated for action depending on the risk. It included to the ward manager, matron, divisional director of nursing and surgical teams. We were given examples of issues that had been escalated such as the need for discharge, the need for a bed and individual needs such as learning disability, dementia and frailty. Staff told us they felt able to escalate patient risk to the divisional medical teams and the critical care outreach team who were described as supportive.

Longer staying patients and those at risk were assessed using the national early warning score 2, a standardised risk assessment which identified those at risk of deterioration (NEWS2). Patients with a NEWS2 score of 3 (medium risk) who had not been stabilised, were at risk of deterioration or with a score of 4 plus (higher risk) were excluded from the unit. This was defined in the revised standard operating procedure.

The SAU were now escalating long staying patients for a hospital bed to be provided on the unit. This meant that although patients remained on the SAU, they were in a cubicle and in a hospital bed with an appropriate mattress as opposed to a trolley and a trolley mattress. We were shown an example of this while we were on the unit.

Air mattresses were available for patients at risk of pressure damage. Assessment for all patients included a skin check and body mapping for patients assessed as at risk. Staff told us they were able to manage complex wounds and that patients could be referred to the tissue viability nurses. Hospital acquired pressure ulcers were rare on the SAU because patients did not generally spend long periods of time on the unit. Data for July, August and September 2025 showed low levels of harm. There were zero pressure ulcers and 2 slips or falls without injury during this period.

Patients’ route into the SAU was from either their GP, the emergency department (ED) or the urgent treatment centre. Patients referred from their GP were assessed by one of the speciality medical teams (depending on their presenting condition) for assessment, diagnostic tests and further treatment.

The SAU was a multidisciplinary team led unit. Consultants were on call from the 4 specialties within the trust division of planned care. They were gynaecology, surgery, orthopaedic and urology and the SAU team worked with all 4. Patients were prioritised by their clinical condition and are initially assessed by resident doctors in liaison with consultant within 4 hours for diagnostic tests and treatment. Decision making by the consultant in relation to admission, theatres or discharge was an ongoing process over a 24-hour period.

Staff told us that hydration was often a high patient need for the SAU. To manage hydration the unit practiced ‘sip until send’ for nil by mouth patients waiting for theatre. We were told that assessments often showed frailty, and patients may have already faced long waits before arriving at SAU. Staff told us that pain management was a high priority which was escalated to the specialty teams. We were told an advanced nurse practitioner (nurse prescriber) was currently being considered for the SAU. This would mean that prescriptions for pain management could begin sooner and meet patient need quicker. It would also enable nurses to make decisions and discharge patients more efficiently.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

In response to the concerns we highlighted about the surgical assessment unit (SAU) in July 2024, we found the trust had improved facilities for patients, including washing facilities, the availability of hospital beds and access to hot food. We found the trust had taken action to manage risks by reducing the length of time people stayed on the SAU.

We observed that the SAU was comprised of 2 consultation rooms with consultation trolleys, a waiting area with 6 chairs, a large bay area containing 7 recliner chairs each with individual privacy curtains, 5 cubicles with individual privacy curtains for trolleys or beds and 1 self-contained ensuite room for isolation when required. The unit was calm and uncluttered.

The 7 recliner chairs within the large bay area had been replaced in July 2025. They offered a more comfortable stay because they were better cushioned for comfort. Their recliner function was patient operated by a handheld remote control. Each space had a curtain for privacy and dignity.

The 5 cubicle spaces and 1 self-contained ensuite room, could each accommodate either a patient trolley or a hospital bed. Beds were available on request. This meant that based on the individual patient risk assessment, especially when decision to admit had been made, patients could be given a hospital bed prior to transfer within the hospital.

Following our inspection in July 2024, the trust stated that hot food had always been available to patients and that staff on the unit had now received reminders about how to order meals for patients.

On this visit, we found menu request folders were available on the SAU along with contact details of the patient dining department and how to order snacks out of hours. We found that whether food had been provided/offered to patients was now a prompt at the safety huddle, especially for those who had been on the unit for a while. We found that hot meals were available because staff offered menus to people. In the morning the kitchen team brought sandwiches to the SAU which were also offered to patients. There were hot drink making facilities for tea. At night there was a ‘snack box’ which included sandwiches which staff knew to offer.

Following our inspection in July 2024 the estates team assessed the feasibility of installing a second shower on the SAU (in addition to the ensuite patient bedroom). However, it found that as with much of the hospital estate, space limitations were a challenge which required removing clinical space. To mitigate this, long staying patients were now offered a shower on the unit when the ensuite room was available or offered one at the closest available ward (Franklin Ward). Patients were also offered a bedside wash. The safety huddle, which occurred 5 times a day, checked on whether patient hygiene needs had been met. Staff told us the SAU’s processes and function was very different to when we visited in July 2024. We were told that people were not remaining in the unit for as long and were not going without a shower or wash. Staff told us most patients chose to have a wash at their bedside.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines were stored safely and securely, and emergency medicines were easily accessible.

We reviewed patient records on an electronic prescribing and medicines administration (ePMA) system that was in place. Records reviewed showed clear documentation of medicines administration, including route of administration. Medicines were administered on time, including time critical medicines such as those for Parkinson’s disease. Declined doses were accurately documented on ePMA.

There was a process in place to ensure that venous thromboembolism risk assessments were completed, and we saw evidence that these were completed in line with recommendations. Patients were able to self-administer medicine where appropriate and there was a policy in place to support this. Antimicrobial agents prescribing followed local guidelines. We saw in patient records that antimicrobials had clear indications, course length and review dates.

We saw evidence of clear communication and recommendations to staff to improve patient safety. Incidents were reported and any follow-up actions were appropriately recorded, Staff told us that medicines incidents were discussed regularly, and learning was shared trust wide.