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

We found the service had clear responsibilities, systems of accountability and good governance. They used these to manage and deliver good quality treatment and support. We found a service that had made improvements and found no continuing breaches of regulation. However, the trust were aware there was room for further improvement to refine flow into and out of the SAU.

We found the service had good governance. However, the ratings of other quality statements in well led that we rated in 2024, meant it remained as requires improvement.

This service scored 61 (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 Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

In response to the concerns we highlighted about the surgical assessment unit (SAU) in July 2024, we found the trust had improved systems of accountability and good governance to better support the work of the unit. However, the trust were aware there was room for further improvement to refine flow into and out of the SAU.

At ward level, systems of accountability meant the SAU better understood how long patients were staying on the unit, what the individual risks were and how to mitigate these. The SAU safety huddle occurred 5 times a day which monitored and managed issues about length of stay and patient risk. Patient safety, clinical need and bed management was now understood from a more integrated and supportive perspective. There were escalation processes for how multidisciplinary and medical teams within the trust’s planned care division responded to the clinical needs of patients on the SAU. The unit was supported by a surgical matron, the divisional director of nursing, flow coordinators and bed managers to who risks were also escalated. Staff told us they felt supported by the nursing structure, ward manager, matron, divisional director of nursing and chief nurse.

The standard operating procedure (SOP) for the SAU had been reviewed since our visit in July 2024. It clarified referral pathways and responsibilities of the multidisciplinary teams. It clarified admission criteria and that patients should not return to the SAU following surgical procedures and should stay for no longer than 24 hours. It clarified arrangements for personal care facilities and food for patients. It stated that patients must be in a hospital bed overnight which would be monitored through safety huddles and reports to the divisional board for surgery. The service demonstrated they were working to this new standard operating procedure, and breaches were being reported as incidents.

A ‘deep dive’ of the SAU’s work had been undertaken in June 2025. It looked at service performance and quality against the trust’s strategic objectives. It demonstrated that the unit had a good understanding of its quality, risks and how to further improve. The unit had achieved a gold accreditation from the trust due to its good work. The closing summary stated “We are proud of our SAU-SDEC unit and our staff. We strive to be the best ward in the trust. We have good MDT working and this is reflected in both our vacancy, turnover rate and our recent gold accreditation”.

The resultant action plan showed work on further quality improvement in 7 work streams. They included better understanding of referrals data, patient activity coding for income assurance, better recording of patient numbers hour by hour, improving data capture regarding how long patients waited to see a doctor and implementing a new discharge template in collaboration with a neighbouring trust’s good practice. All objectives were SMART objectives; specific, measurable; attainable; relevant; timely with identified named leads. Three workstreams were completed and 4 were ongoing.

There were systems to monitor the quality, effectiveness and safety of the SAU. Regular audits monitored the cleanliness and hygiene of the environment, ambient temperatures and resuscitation equipment. Weekly ‘quick question assessments’ (QQAs) focused on environmental safety and infection control. Audits were conducted on urinary catheter compliance, peripheral venous access device (cannula) compliance, isolation, nursing environmental compliance, medicines management, pressure ulcers and falls. Audits for the previous 3 months (July, August and September) showed safe care and low levels of harm. For instance, there were zero pressure ulcers and 2 slips or falls without injury. There were a total of 11 urinary catheters fitted over the period and 17 cannula insertions which showed good rates of compliance with practice and documentation.

The ‘big 5’ was a monthly learning initiative based on themes drawn from incidents, complaints, quality initiatives and live issues for the SAU. It was a way of sharing up to date information with staff and assisted learning and improvement. Five minutes were allocated to the ‘big 5’ during each staff handover for review, evaluation and discussion. Themes for June, July, August and September included pressure area care, teamwork, documentation, pain management and working to the trust’s values. A laminated poster was displayed in the staff room each month, with small bullet point reminders about good and safe care. Each theme had a designated champion to carry out quality spot checks.

The SAU held monthly team meetings. We saw minutes for July, August, and September 2025, which were also distributed to the team. They showed good attendance and regular themes being discussed: learning from incidents, patient flow, training and development, audit outcomes and monthly nursing indicators. It also reported the outcome of friends and family feedback, which was very positive but sometimes voiced dissatisfaction with doctors. It also reported that sickness rates remained high.

The Planned Care Division, Finance, Performance and Improvement Review meetings showed varying levels of how it monitored SAU improvement. For instance, prior to our visit we were provided with the minutes for April and May 2025, which reported on incidents and the number of patients staying longer than 24 hours, along with the average length of stay and the reasons for long stays. Following this inspection visit we requested the minutes for June, July, August and September. We were provided with June and September’s minutes. There was significantly less mention of the SAU; reporting on nursing assessment indicators such as for pressure damage and falls, compliance with a quarterly IPC audit and in passing, when reporting on 4-hour performance in ED.

The SAU was part of the trust’s planned care division along with women and children, surgery, orthopaedics and urology. The SAU team worked with all 4 specialities and attended their governance meetings. Principally, the SAU reported into the divisional board for surgery. We reviewed the individual specialty governance meetings for the planned care division: surgery, orthopaedics and urology for August and September 2025.

Main themes for the SAU were discussed in the surgery governance minutes. This included reporting on patients waiting for long periods without being seen by doctors, causing delays in patient care and dissatisfaction. The chair suggested looking into nurse prescribers and practitioners, which would enable nurses on SAU to improve flow, begin prescribing earlier and make decisions regarding discharge. September’s meeting discussed better understanding of which specialties were slowing SAU flow. A divisional director reported they had begun this process by meeting with ED. To move this forward, they were awaiting data collection and case studies. It was reported there were variations on what staff understood to be the current pathway.

Orthopaedics governance minutes discussed quality improvement initiatives to address documentation gaps and patient flow issues with both ED and SAU. The SAU raised concerns about orthopaedic patients being admitted without timely documentation or drug charts, leading to delays and poor patient experience, and requested this was fed back to junior staff to improve this process.

We requested the minutes from the Planned Care divisional board for July, August, September 2025. The trust told us that the meetings were large and divided into 2 groups which alternated, meaning the part that reported on surgery, critical care, and theatres took place every other month. We found no mention of the work of the SAU in these minutes.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.