Chelsea and Westminster Hospital

On this page

• 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 looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

Staff provided evidence-based care and treatment in line with current legislation, good practice and standards. Staff worked well across health care disciplines and with other agencies to care for patients. They supported people to live healthier lives. Staff obtained consent before they delivered care, support, or treatment. The service routinely monitored people’s care and treatment and carried out quality improvement projects to improve care.

At our last inspection we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patients were involved in the assessment of their needs. Staff carried out assessments that captured patients first and preferred language, communication needs, disabilities and complex needs, cultural, religious and spiritual requirements. Staff had access to relevant information to assess patient’s needs. This included current and past medical history. Staff also had access to translation services to ensure that patients were involved in their care.

We reviewed 7 care records which were comprehensive. The records showed that staff completed a comprehensive health assessment of patients in a timely manner at, or soon after, admission. Staff completed individual plan of care (IPOC), end of life care agreements for the last hours of life and we saw evidence of establishment of ceilings of care.

All DNACPR records reviewed reflected discussions held with patients and/or their relatives, and the decision was approved by a consultant in line with guidelines. There were treatment escalation plans for each patient in the records reviewed.

We saw from patient records that symptom management assessments were carried out regularly for pain, breathlessness, agitation, nausea and vomiting, and retained secretions. Medicines were prescribed for the management of those symptoms in line with NICE guidance. Communication with families was clearly documented in all patient records reviewed. We saw evidence of chaplaincy staff visits in patient notes.

Staff completed daily care plans and assessments including nutrition assessments, body map, bowel chart/urinary output, and falls assessments among others. There were regular comfort rounds and patient notes reflected review by the SPCT and clinical nurse specialists. This demonstrated that patients individual needs were routinely assessed and care was delivered in line with their needs.

The service used the fast track assessment for NHS continuing healthcare to access appropriate care and support on discharge, either within a person’s home or within a care home, for patients with a rapidly deteriorating condition at the end of life.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff followed policies to plan and deliver care according to best practice and national guidance. Guidelines were developed in line with national guidance, such as the National Institute of Health and Care Excellence (NICE) and ambitions for palliative and end of life care framework.

Clinical guidelines and policies were available on the trust’s intranet, and staff knew how to access them. We reviewed a sample of the hospital’s policies and found they were up-to-date and complied with current national guidance and evidence-based practice.

The service had a dedicated intranet site that provided ward staff with information and guidance regarding end of life care. Specialist palliative care staff had access to the palliative care dashboard on the electronic system. The dashboard provided information about referrals, caseload, demographics and outcomes. It supported routine monitoring of service delivery and provided information about the areas for quality improvement including advance care planning, discharge planning, and outcomes such as preferred place of death.

Our review of patient records showed that patients received care, treatment, and support that was evidence-based and in line with good practice standards. This included individual risk assessments to support holistic patient care. Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. Staff used the malnutrition universal screening tool (MUST) to assess patient’s nutrition and hydration needs. Where necessary, staff referred patients for dietetic input. Patient notes reflected daily comfort rounds, pain assessments, skin integrity assessments and falls risk assessments.

A multidisciplinary team of staff and specialists assessed patients receiving end of life care. This included members of the specialist palliative care team (SPCT), doctors and nurses, cancers specialists and clinical nurse specialists, occupational therapists, physiotherapists, social workers, pharmacists, speech and language therapists, and dieticians.

Staff participated in clinical audit, benchmarking and quality improvement initiatives to monitor patient care outcomes. This included the national audit of care at the end of life (NACEL) and cardiopulmonary resuscitation (CPR) audit. Action plans were implemented following audits to address any areas requiring improvement.

The service monitored documentation of pain review and pain relief through participation in the national audit of care at the end of life (NACEL). Results from the review of documentation between January and December 2025 showed evidence of pain review in 87% of cases compared to the national average of 92%. In every case reviewed, actions to address pain were implemented in 100% of cases compared to the national average of 99%.

The NACEL audit showed that 77% of bereaved relatives reported that they felt the dying person was given enough pain relief which was similar to the national average of 78%. An action plan was developed to emphasise the importance of assessing pain and recording pain assessments in end of life care education and training.

Staff recorded pain assessments and administration of pain relief in records reviewed during our assessment.

The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff worked across health care disciplines and with other agencies when required to care for patients. We saw that information was appropriately shared with community teams such as GPs and local hospices.

Staff had access to information needed to appropriately assess, plan and deliver people’s care, treatment and support. The trust used an electronic record system accessible to all relevant staff. This helped facilitate better communication between healthcare professionals.

The SPCT maintained close working relationships with medical, nursing and therapy staff on in-patient wards. The SPCT worked across trust locations with the intensive care unit (ICU), acute medicine unit and oncology to develop treatment escalation plans.

The service worked with cancer teams to support patients with incurable cancer diagnosis. For example, the SPCT had implemented an enhanced supportive care service for patients with lung cancer. This service supported patients at the early stages of their diagnosis through treatment thereby enhancing their life expectancy and avoiding emergency admissions.

Oncology and palliative care teams worked in a coordinated and integrated way, including through shared multidisciplinary team meetings, joint ward rounds and aligned outpatient pathways. Chelsea and Westminster Hospital had been recognised by the European Society for Medical Oncology (ESMO) as an ESMO Designated Centre of Integrated Oncology and Palliative Care. This is an accreditation awarded to centres demonstrating established integration between oncology and palliative care services.

The service held weekly multidisciplinary team (MDTs) meetings to discuss patients and improve their care. Staff told us nursing staff, allied health professionals and consultants attended these meetings. In addition, members of the SPCT attended weekly cancer specific MDTs including lung MDT, enhanced care MDT and ICU MDT. There were monthly palliative care and hepatology MDTs for patients with advanced liver disease.

The trust held quarterly EOLC steering group meetings attended by staff across different disciplines and specialities including representatives from cancer charities and local hospices. Staff discussed audit results, training, incidents and complaints.

Individual wards and specialities held MDTs to address the needs of specific patient groups. For example, Ron Johnson ward, (an oncology and HIV specialist ward) cared for patients with cancer and advanced HIV. Staff worked together with the psychiatry liaison nurse, HIV community nurse, occupational therapists, physiotherapists, dietitians, doctors, nurses and discharge liaison nurses to linked patients with relevant organisations to address their specific needs. Staff informed us that some patients who were experiencing homelessness had been taken from the streets and brought to the hospital because they are unwell.

Plans for transition, referral and discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. When people were due to move between services, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care.

The SPCT was actively involved in training staff across specialities and disciplines. This included EOLC simulation study days, training of EOLC ambassadors and syringe driver training. The service also provided bespoke EOLC training tailored towards international medical graduates and surgical staff.

The service worked with the chaplaincy, community teams, hospices, primary care and the bereavement team to provide emotional support to patients and ensure continuity of care.

The trust had a clinical decision support group (CDSG), which included a group of senior clinical and non-clinical staff at the trust who could be asked to consider challenging decisions around the care of individual patients, including those patients reaching end of life. The group could be convened on any day of the week, usually within an hour. The CDSG was initially set up before the first COVID surge and had continued subsequently as it is seen as being of benefit to clinical teams.

All staff we spoke with were positive about effective team working across teams, external organisations and community teams. There was a positive culture across services and staff felt able to provide patients with effective care and treatment.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives, for example, through participation in smoking cessation schemes, healthy eating advice, and screening for cancer. Staff provided relevant information leaflets and signposted people to local organisations that offered wellbeing workshops and classes to help people living with cancer.

The trust had multiple sexual health clinics which provided intramuscular injections every 8 weeks for people living with HIV. This also helped them to be discreet about their status without having to carry HIV medication around.

Occupational therapy staff assisted the SPCT to assess and manage patient functional and mobility needs. This involved assessing people’s ability to participate in activities of daily living safely and independently. The trust had implemented “move to improve” as a ward level improvement initiative to encourage routine mobilisation, with a particular focus on patients sitting out for meals. The trust aimed to improve routine mobilisation by encouraging people to get out of their bed to sit in a chair or at a dining table for meals.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service had completed several quality improvement projects in the last 12 months of our inspection. A significant proportion of the quality improvement projects were delivered through education programs including simulation-based training for nurses and doctors. Targeted initiatives included the international medical graduate induction program and surgical simulation training which addressed identified gaps in skills and experience, supporting safer and more consistent end-of-life care delivery.

The service carried out a local audit in March 2025 to review records completed by staff following patient death. A local audit of confirmation of death on the trust electronic system showed that 97.5% of notes (on Chelsea and Westminster Hospital site) had been completed to reflect the confirmation of death. This showed that the forms were well embedded within the trust.

Results from the NACEL audit (2025) showed that the service scored the same or above the national average for 6 out of 9 standards including proportion of deaths expected by clinical staff, proportion of bereaved people who rated the care as good or excellent, proportion of people with individualised care plans, availability of palliative care services, proportion of clinical notes with evidence of communication about hydration, and proportion of clinical notes with evidence the patient had participated in personalised care and support planning and conversations. The service was slightly lower than the national average for 3 out of 9 standards including the proportion of bereaved people who agreed the patient received sufficient pain relief (77% compared to national average of 78%), proportion of clinical notes with assessment of the spiritual, religious and cultural needs (43% compared to national average of 49%), and proportion of people who died with their ethnicity documented (86% compared to national average of 89%).

The service implemented an action plan with a responsible lead for each action, for the standards where it achieved lower than the national average. This included sharing findings with staff, multifaith chaplaincy service, patient experience team, and the equality, diversity and inclusion champions. The action plan also included staff training, raising staff awareness about relevant policies, and liaising with the digital team to explore how ethnicity was recorded on the electronic system. The action plan is monitored through the central NACEL Data and Improvement tool, which is updated on a quarterly basis. Actions were only closed once there was assurance the actions had had the required impact and the metrics in the Data and Improvement tool demonstrated sufficient improvement

The trust carried out an audit in 2024 to review decision making, discussion and documentation of cardiopulmonary resuscitation (CPR) and treatment escalation plans (TEP) for adult in patients. The trust required 100% compliance against all standards. Results showed 100% of patients had their capacity assessed and documented prior to making a CPR or TEP decision. In 100% of ‘no CPR’ cases, the decisions were accompanied by a TEP. In 100% of cases learning disability was not documented as sole reason for ‘no CPR’ decision in line with trust guidelines. CPR documentation was completed by a speciality year 3 registrar or above in 97% of cases.

However, the service achieved lower scores for the timeliness of consultant review compared to previous years. Consultant review was completed within 48 hours in 79% of cases compared to 96% in 2023 and 90% in 2022. For patients recorded has having capacity with a TEP and ‘not for CPR’, 85% of records documented a discussion with the patient or appropriate reasons for no discussion. For patients without capacity and ‘not for CPR’, 82% had a documented discussion with the next of kin.

Following the CPR audit, the trust implemented an action plan to update forms on the electronic patient record system, review policies, and implement a simulation course to support surgical trainees. We saw evidence of effective documentation of CPR and TEP in patient records during our inspection. The trust had also implemented a bespoke EOLC training program for surgical residents. However, we could not identify an action plan to ensure consultant review was completed within 48 hours.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

People understood their rights around consent to the care and treatment they were offered. People told us staff explained care and treatment options and gained verbal consent for physical assessments.

Staff we spoke with understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act (MHA) and Mental Capacity Act (MCA) 2005, and they knew who to contact for advice. Records reviewed showed staff completed mental capacity assessments where relevant.

Staff could describe and knew how to access the policy and obtain accurate advice on the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff took all practical steps to enable patients to make their own decisions. All patient notes reviewed reflected discussions held with patients and/or their relatives. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. We reviewed patient records which showed staff completed mental capacity assessments in line with local and national guidance.

Most SPCT staff had completed MCA and DoLS training in line with the trust target. While 100% of doctors were compliant with MCA and DoLS training, 91% of nurses were compliant with the training which was above the trust’s target of 90%.