Wexham Park Hospital

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• 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

We assessed a total of 4 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good.

Our rating for this key question stayed the same. We rated it as good.

We found the service planned and delivered people’s care and treatment in line with legislation and current evidence-based good practice and standards. The service worked effectively across teams and services to support people. Electronic systems were used successfully to share patient’s assessment of needs when they moved between different services. People’s care and treatment was routinely monitored to continuously improve it. The ensured outcomes were positive and consistent, and that they meet both clinical expectations and the expectations of people themselves. The service understood people’s rights around consent and respected these when delivering person-centred care and treatment.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

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

Clinical guidelines and policies used in the department were developed and reviewed in line with National Institute for Health and Care Excellence (NICE), the Royal College of Emergency Medicine (RCEM) and other relevant bodies. Policies and protocols were accessible on the hospital's intranet.

The service had governance processes to ensure national legislation, evidence-based best practice and required standards were reviewed. If needed, local guidance/working practices were updated and communicated, with training, to the emergency department staff.

We observed that national guidelines were referred to during the doctor's handovers, showing they were embedded in the department.

There were a variety of up to date, evidence-based pathways used in the department such as the management of sepsis, asthma, fractured neck of femur (broken hips), stroke and mental health. We found these were understood by staff and were being used effectively to manage patients' care.

The ED had an extensive clinical audit programme that included both national and local audits. Audits were reviewed by the clinical effectiveness and audit committee. Evidence showed, audit was effectively used to highlight where the service was doing well and where improvements were needed. Actions planned where put in place, monitored and reviewed. For example, in April 2023, 27% of elderly care patients were reviewed for frailty when attending ED. After actions had been agreed, with targeted and intense input from the frailty team, the ED reviewed patient's frailty score on almost every eligible patient that entered the departments, despite the high numbers of attendances. Audit results for February 2025 showed an increase in elderly care patients being reviewed with a compliance rate of 96%. The department's performance was now almost three times the national target for this measure.

Patients said they had been offered something to eat and drink. Staff reviewed patient's nutrition and hydration needs had been met during care rounds. We observed patients being offered refreshments by trained volunteers which were available in all areas of the emergency department. We saw catering staff arrive in the morning with a breakfast trolley for the patients that had been in the department overnight.

Water coolers were at various points in the department, including the waiting areas, so patients and visitors had access to water.

There was effective multidisciplinary working in the emergency department (ED). Staff we spoke with, and from interactions seen during the inspection showed us there was good multidisciplinary working across the department.

Staff had access to the information they needed to appropriately assess, plan, and deliver people's care, treatment and support. The trust used an electronic patient record (EPR) throughout the hospital. Therefore, hospital teams completed the same record for each patient. This meant patient information was accessible for all, easy to find and helped facilitate better communication between healthcare professionals. Staff said this had led to a more coordinated and patient-centred approach to care. In addition, other system partners used the same IT system making information sharing more efficient and effective. Feedback from staff was extremely positive regarding the EPR system.

There was a dedicated ED diagnostic imaging team available 24 hours a day, seven days a week. This ensured staff and patients had timely access to tests and results.

The frailty team provided nursing, therapy and medical support to facilitate admission of frail and older patients from ED to the hospital wards, or discharge to a community hospital or to the patient's own home. They were an integral part of the ED team, and the staff spoke highly of the service the frailty team provided. The team included nursing and medical staff, occupational therapists and a pharmacist. The team had excellent links to the local community NHS trusts. These trusts supplied the community services which the patients needed after discharge.

The ED worked closely with the psychiatric liaison team from the local mental health trust. The team provided mental health assessments for patients within the ED environment and provided support for the ED team. The team were based at the hospital which made contacting them straight forward. ED staff were also able to access the child and adolescent mental health services (CAMHS) for young people 24 hours a day 7 days a week. Staff within ED were complementary about these and other supporting agencies they worked closely with. For example, regular partnership in practice meetings took place between ED staff, the local mental health trust, approved mental health professionals (AMHPs), the local ambulance service, police and commissioners.

The ED team could call on the services of specialist teams found in the trust such as the dementia team, the learning disability and the alcohol liaison nurses. ED staff we spoke with told us these teams were responsive and supportive in the help they gave.

The department had members of staff who had special interests and had become ED champions to promote innovation and drive improvements in that area. For example, there were champions in fractured neck of femur, and chemical, biological, radiological and nuclear hazards.

Most referrals from the ED were to the acute medical or surgical specialty teams. Medical staff in ED told us they felt well supported by the rest of the hospital, however, due to high demand and no spaces on the wards meant there were some delays transferring patients out of ED and onto the wards. Although the patient was the responsibility of the specialist team once transferred to their care, the emergency medical team continued to provide clinical support to the patient and monitor them for deterioration when they were in ED.

Some patients depending on their clinical severity would need to be transferred to other acute hospitals for more specialist care. Patient pathways and standard procedures were used to ensure continuity of care for the patient and effective collaborative working between the hospitals.

We were told there was a positive working relationship with the local ambulance service. If needed, the local ambulance trust would provide a hospital ambulance liaison officer to help smooth transition of patients from ambulance crews to hospital teams to support handover delays and improve patient care. During the inspection, we observed good interactions between ED staff and ambulance crews during handovers and when sharing information regarding patients.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service had systems and processes in place to monitor, audit and benchmark the quality of services, and the outcomes for patients receiving care and treatment.

Data was collected, analysed and tracked over time to understand how the department was performing against key performance indicators, NHS standards, the Royal College of Emergency medicine (RCEM) standards and locally derived standards. Managers and staff carried out a comprehensive programme of repeated audits to check improvement over time. Data was reviewed and discussed by the relevant focussed departmental groups and committees which would then feed into the wider hospital and trust meetings, for example the clinical effectiveness and audit committee.

The service used internal audit to improve patient care and safety. This identified areas where care processes could be optimised, leading to better outcomes and reduced risks for patients. For example, issues locating patients when being cared for in the corridor. The service had implemented a simple system of numbering the beds and the use of audio headsets for staff to communicate more quickly.

The service participated in national audits such as those identified by the RCEM. The results were used to benchmark and compare with other trusts nationally. The department used quality improvement programmes, with action plans, when improvements were needed. We reviewed changes the department had made from the 2023/2024 RCEM audits for mental health (self-harm), care of older people and time critical medications all demonstrated improved care, treatment and outcomes for patients in these areas.

The service took part in the urgent and emergency care survey 2024, a patient experience survey conducted by the Care Quality Commission (CQC) in England. Its aim was to assess patient experiences in emergency departments (ED) including wait times, communication, and overall quality of care. The service performed the same as the England average for the majority of questions. They performed somewhat better than expected for doctors and nurses listening to what patients had to say, for providing help for patients to take medication for pre-existing medical conditions. However, performed somewhat worse than the England average, for patients being able to understand the information they were given about how to care for their condition at home. The response rate was 28% which was comparable to the national response rate of 29%.

The service participated in Getting it Right First Time (GIRFT) a national initiative by NHS England to help emergency departments (ED) in England improve their performance. GIRFT uses data to identify areas for improvement and track progress, ensuring that interventions are data-driven and effective. Emergency departments can also benchmark themselves against other emergency departments in England. Data from January 2025 showed that the service was under pressure in relation to demand. The service saw a higher number of patients aged 75 years and over, and attendance rates were above the England average for the local population. Patients spent considerably longer waiting for treatment, and waiting for admission, transfer or discharge than compared to other EDs in England. The service recognised these issues and had a frailty team working out of the department to support elderly patients and were trying to work with the wider hospital to improve flow.

Key performance indicators were used to track the departments performance, for example time to triage, length of time in the department, and percentage of patients seen by a clinician within 90 minutes of arrival. Where performance was not optimum, the department would look to see if there were reasons and what they service could do to improve performance. For example, additional consultants and nurses were rostered on Monday's and Tuesday's, as these were shown to be busier days in the department.

The service had a good understanding of their local community and how they used health and care services. Leaders actively contributed to discussions with the wider health and care system on how services could be improved for their local community.

The service had up-to-date policies and procedures regarding consent and the Mental Capacity Act 2005, Mental Capacity Act (MCA), mental health awareness and Deprivation of Liberty safeguards DOLs. The Mental Capacity Act and Deprivation of Liberty safeguards (DoLS) was not part of the trust’s mandatory training, however, was included as part of the safeguarding level 3 adult training. Nursing staff were 96% compliant with this training and medical staff were 78% which was lower than the trust target of 85%. The service had sourced additional training from the local mental health NHS trust for their staff to gain greater understanding.

Staff understood the importance of consent when delivering care to patients. We observed staff seeking consent from patients prior to examination and treatment. In the majority of cases this was implied consent and not documented. When patients did not have capacity to consent, staff followed legislation and guidance and made decisions in their best interests. This was documented on the electronic patient record. DoLs were not completed by the emergency department team.

Staff working with children and young people showed a good understanding on gaining consent in children and young people and when to apply the Gillick competency. They were aware of the legal guidelines which meant children under the age of 16 were able to give their own consent if they demonstrated sufficient maturity and intelligence to do so, often referred to as being Gillick competent. Staff were aware that should a child not be considered “Gillick competent”, consent would be sought from the child’s parent or guardian. Staff could also describe the scenarios in which an individual would be deemed to have parental responsibility.

A mental health assessment tool was completed at triage when there was a risk of lack of capacity. This risk rated patient’s mental health status and gave recommendations of next steps depending on status. This included safe areas in the department patients could be nursed, timeliness of observations and supervision requirements. The formal mental capacity of a patient was assessed by medical staff or the psychiatric liaison team using the formal mental capacity assessment tool.

Staff were clear how they could access the on-site psychiatric liaison team and the child and adolescent mental health service (CAMHS) 24 hours a day, 7 days a week if needed. In addition, the emergency department (ED) had two dual qualified mental health nurses they could call on for advice. Any patient who presented with a mental health condition were referred to one of these teams.

Staff we spoke with were aware of Mental Health Act holding power and section 136 requirements. Section 136 is an emergency power which allows patients to be taken to a place of safety from a public place, if the police considers the patient is suffering from mental illness and in need of immediate care. Patients admitted to ED under section 136 had to be escorted by two police officer at all times whilst the patient was in the department receiving emergency medical treatment. We observed this happening during the inspection. The ED had a dedicated mental health room, where individuals apprehended by the police under section 136 of the mental health act, could be safely assessed and cared for in a safe environment. Patients would be transferred to the local mental health trust once it was deemed medically safe to do so and there was availability.

ED staff were not routinely trained in restraint. We were told if restraint of a patient was required the team would call the trust’s security team, who were trained in restraint, or the police. If needed, the ED had policies and procedures on the use of rapid tranquillisation and sedation for patients.